Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or South Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to South Carolina only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. South Carolina (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Kool Smiles Sc-2, PC (NPI 1992018899)

Field	Value
Entity Type	Organization
Organization	Kool Smiles Sc-2, PC
Address	4400 Dorchester Rd Ste 108
City	Charleston
State	SC
ZIP	29405
Taxonomy	General Practice Dentistry
NPI Enumerated	July 20, 2010

Payer Source	Total Paid
Medicaid	$28.5M
Medicare	$0

Key Findings

KOOL SMILES SC-2, PC reports $28.5M in lifetime Medicaid revenue and has no Medicare billing on file, making its effective payer footprint overwhelmingly Medicaid. This single-payer concentration means payer-contracting dynamics, utilization reviews, and reimbursement risk are all primarily driven by Medicaid policy and fee schedules rather than Medicare benchmarks.

The provider’s top three Medicaid codes — D1120, D2392, and D1110 — together account for 25.9% of total Medicaid revenue, indicating a concentrated revenue base tied to a small set of high-volume services. Those top codes mix pediatric prophylaxis and adult cleanings with posterior composite restorations, signaling that routine preventive care and restorative dentistry are the main revenue drivers.

Procedure mix shows a strong emphasis on high-volume preventive pediatric and diagnostic services: D1120 (Prophylaxis–child), D1206 (Topical Fluoride) with 105.2K claims, D1351 (Sealant) with 50.3K claims, and D0220 (Intraoral periapical first image) with 66K claims. This pattern is consistent with a practice model oriented toward routine preventive visits, caries prevention, and frequent diagnostic imaging in a Medicaid population.

At the same time, restorative and operative work constitutes a substantial portion of revenue: D2392 (Post 2 surface resin-based composite) and D2391 (one-surface posterior composite) are among the top revenue generators, and D7240 and D7140 appear in the top-25 list with material average paid rates. The presence of both high-volume restorations and paid surgical/extraction codes suggests the provider delivers a full scope of general dental services beyond just screening and fluoride.

Across many codes the provider ranks as an outlier in the state market, frequently in the 100th-percentile for volume: examples include D1120 (ranks #3 of 473; extreme outlier), D2392 (ranks #2 of 347; extreme outlier), D1110 (ranks #2 of 591; extreme outlier), and D0150 (ranks #1 of 511; extreme outlier). These rank and percentile signals characterize KOOL SMILES SC-2, PC as a major statewide participant for core pediatric/adult preventive and common restorative codes rather than a modest local clinic.

Operational throughput is very high on several low-unit-value services, reflecting substantial visit volume: D1206 shows 105.2K claims at $17 avg paid/claim, D0120 has 70.3K claims at $24 avg paid/claim, and D0220 shows 66K claims at $13 avg paid/claim. Those large claim counts are consistent with a high-visit, high-throughput practice model that generates sizable aggregate revenue from many lower-paid encounters.

The provider’s revenue mix balances very high-volume, low-unit-price preventive codes (e.g., D1206 $17 avg paid/claim; D0220 $13 avg paid/claim) with meaningful revenue from higher-paid restorative and surgical codes (e.g., D7240 $276 avg paid/claim; D2930 $128 avg paid/claim). This diversification across low-unit preventive care and higher-unit restorative procedures reduces reliance on any single price point but keeps Medicaid as the dominant payer risk.

KOOL SMILES SC-2, PC has been enumerated since 2010-07-20 (~16 years ago), indicating a long-established presence in the South Carolina Medicaid market. Combined with its extreme-state-percentile rankings and large claim volumes, the tenure supports the view of an entrenched, high-throughput dental provider in the state Medicaid ecosystem.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

39 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1120	Prophylaxis–child	74,040	$40	$2.6M
D2392	Post 2 surface resin‑based composite	23,600	$100	$2.4M
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	43,400	$50	$2.2M
D2930	N/A	17,140	$130	$2.2M
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	105,230	$20	$1.8M
D0120	Periodic oral evaluation - established patient	70,330	$20	$1.7M
D0150	Comprehensive oral evaluation – new or established patient	40,750	$40	$1.7M
D1351	Sealant - per tooth	50,320	$30	$1.5M
D7240	N/A	5,450	$280	$1.5M
D2391	Resin‑based composite – one surface, posterior	17,130	$90	$1.5M

Showing 1–10 of 39

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other South Carolina providers billing the same CPT/HCPCS codes.

Claims Volume vs. South Carolina Distribution

Kool Smiles Sc-2, PC — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

39 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	2	130	1,060	$150	$371.1K
D7240	N/A	4	60	450	$260	$370K
D2392	Post 2 surface resin‑based composite	2	350	520	$100	$175.3K
D1120	Prophylaxis–child	3	470	600	$30	$156.7K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of…	27	120	170	$130	$125.1K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	8	290	380	$90	$125K
D3330	N/A	18	20	30	$550	$117.9K
D9230	N/A	3	210	1,150	$30	$115.5K
D2391	Resin‑based composite – one surface, posterior	3	300	270	$80	$110.5K
D1351	Sealant - per tooth	3	200	840	$30	$108.9K

Showing 1–10 of 39

Related Providers

Other providers that share a Tax Identification Number (TIN) with Kool Smiles Sc-2, PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Creston Dental-1, P.C.	SC	General Practice Dentistry	$0	$14.8M
Kool Smiles, PC	SC	General Practice Dentistry	$0	$4.3M
Kool Smiles Sc-2, PC	SC	General Practice Dentistry	$0	$4.2M
Kool Smiles, PC	SC	General Practice Dentistry	$0	$4.2M
Kool Smiles Sc-2, PC	SC	General Practice Dentistry	$0	$3M
Kool Smiles Sc-2, PC	SC	General Practice Dentistry	$0	$2.6M
Kool Smiles Sc-2, PC	SC	General Practice Dentistry	$0	$2M
David Ashley	AL	Oral and Maxillofacial Surgery (Dentist)	$0	$1.3M

Nearby Providers

Other providers in the same ZIP code as Kool Smiles Sc-2, PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Agape Hospice Of The Lowcountry LLC	SC	Community Based Hospice Care Agency	$0	$23.7M
Charleston County Government	SC	Land Ambulance	$4.1M	$7.6M
Charleston County Government	SC	Substance Abuse Rehabilitation Facility	$62.3K	$11M
Lowcountry Nursing Group LLC	SC	Nursing Care Agency	$0	$7.9M
Curana Health Of South Carolina PC	SC	Internal Medicine Physician	$0	$6.4M
Lifeguard Ambulance Service LLC	SC	Land Ambulance	$2.1M	$651.1K
Danyel Mcevoy	SC	Anatomic Pathology & Clinical Pathology Physician	$2.3M	$0
Steven Lopez Psychiatric Services	SC	Psychiatry Physician	$0	$2.2M
Center For Behavioral Health South Carolina LLC	SC	Methadone Clinic	$145.2K	$2M
Roper Saint Francis Physicians Network	SC	Clinical Medical Laboratory	$40.4K	$1.3M

Kool Smiles Sc-2, PC — Billing Profile & Reimbursement Data

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Kool Smiles Sc-2, PC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References