Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

⚖️ Compare🖨️ Print Report

RAFAEL RIVERA, JR., DDS, PLLC

Dentist·WINSTON SALEM, NC·NPI: 1740459650Share
Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$22.2M

$22,173,699

Total Claims

590K

Beneficiaries

499K

1.2 claims/patient

Avg Cost/Claim

$38

Monthly Spending Trend

Yearly Spending

2018
$3.3M
+4%
2019
$3.4M
-19%
2020
$2.7M
+32%
2021
$3.6M
-13%
2022
$3.1M
+3%
2023
$3.2M
-12%
2024
$2.8M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 44 distinct procedure codes. The top code (D2930 (Prefabricated stainless steel crown, primary tooth)) accounts for 13% of total spending.

D2930Top 25%

Prefabricated stainless steel crown, primary tooth

$2.8M

19K claims · 12.8%

Your Cost: $145.47/claim|Median: $120.85
1.2× median
D0120Normal range

Periodic oral evaluation, established patient

$2.3M

87K claims · 10.3%

Your Cost: $26.13/claim|Median: $24.34
1.1× median
D1120Normal range

Prophylaxis, adult

$1.6M

60K claims · 7.4%

Your Cost: $27.33/claim|Median: $33.86
0.8× median
D2140Top 10%

Amalgam, one surface, primary or permanent

$1.5M

21K claims · 6.7%

Your Cost: $71.50/claim|Median: $52.77
1.4× median
D1110Normal range

Prophylaxis, adult cleaning

$1.5M

38K claims · 6.6%

Your Cost: $38.43/claim|Median: $43.38
0.9× median
D1206Normal range

Topical application of fluoride varnish

$1.3M

82K claims · 6.0%

Your Cost: $16.38/claim|Median: $18.12
0.9× median
D3220Normal range

Therapeutic pulpotomy

$1.3M

16K claims · 5.9%

Your Cost: $81.91/claim|Median: $81.27
1.0× median
D2934Top 25%

$1.1M

5,711 claims · 4.9%

Your Cost: $190.57/claim|Median: $143.67
1.3× median
D2150Top 10%

Amalgam, two surfaces, primary or permanent

$1.0M

11K claims · 4.7%

Your Cost: $94.03/claim|Median: $66.00
1.4× median
D1351Normal range

Sealant, per tooth

$905K

33K claims · 4.1%

Your Cost: $27.60/claim|Median: $26.10
1.1× median
D0220Top 25%

Intraoral periapical radiographic image, first film

$870K

58K claims · 3.9%

Your Cost: $15.11/claim|Median: $10.51
1.4× median
D7140Normal range

Extraction, erupted tooth or exposed root

$680K

11K claims · 3.1%

Your Cost: $63.93/claim|Median: $57.39
1.1× median
D0274Normal range

Bitewings, four radiographic images

$665K

24K claims · 3.0%

Your Cost: $27.47/claim|Median: $22.54
1.2× median
D0330Top 25%

Panoramic radiographic image

$650K

13K claims · 2.9%

Your Cost: $49.84/claim|Median: $37.36
1.3× median
D9243Normal range

$546K

4,002 claims · 2.5%

Your Cost: $136.38/claim|Median: $81.52
1.7× median
D0272Normal range

Bitewings, two radiographic images

$477K

26K claims · 2.1%

Your Cost: $18.35/claim|Median: $15.81
1.2× median
D7230Normal range

Extraction, impacted tooth, partial bony

$362K

2,189 claims · 1.6%

Your Cost: $165.48/claim|Median: $187.09
0.9× median
D0230Top 25%

Intraoral, periapical radiographic image, first film

$348K

29K claims · 1.6%

Your Cost: $12.05/claim|Median: $7.33
1.6× median
D0150Normal range

Comprehensive oral evaluation, new or established patient

$342K

7,816 claims · 1.5%

Your Cost: $43.74/claim|Median: $32.07
1.4× median
D1208Normal range

Topical application of fluoride, excluding varnish

$245K

16K claims · 1.1%

Your Cost: $15.72/claim|Median: $14.36
1.1× median
D7240Normal range

Extraction, impacted tooth, complete bony

$235K

1,183 claims · 1.1%

Your Cost: $198.94/claim|Median: $231.00
0.9× median
D2160Top 10%

Amalgam filling, three surfaces

$211K

1,907 claims · 1.0%

Your Cost: $110.47/claim|Median: $78.55
1.4× median
D1510Top 25%

$156K

810 claims · 0.7%

Your Cost: $192.51/claim|Median: $147.00
1.3× median
D2392Top 25%

Resin-based composite, two surfaces, posterior

$148K

1,508 claims · 0.7%

Your Cost: $98.11/claim|Median: $71.00
1.4× median
D9230Top 10%

Inhalation of nitrous oxide/analgesia, anxiolysis

$148K

3,254 claims · 0.7%

Your Cost: $45.44/claim|Median: $26.24
1.7× median
D2391Top 25%

Resin-based composite, one surface, posterior

$132K

1,696 claims · 0.6%

Your Cost: $77.89/claim|Median: $54.60
1.4× median
D0140Top 25%

Limited oral evaluation, problem focused

$128K

3,421 claims · 0.6%

Your Cost: $37.32/claim|Median: $27.07
1.4× median
D0145Normal range

Oral evaluation for patient under 3 years, counseling

$86K

3,924 claims · 0.4%

Your Cost: $21.94/claim|Median: $57.30
0.4× median
D9239Normal range

$81K

1,109 claims · 0.4%

Your Cost: $72.83/claim|Median: $73.67
1.0× median
D7111Normal range

$80K

1,577 claims · 0.4%

Your Cost: $50.75/claim|Median: $49.49
1.0× median
D3230Top 25%

$67K

484 claims · 0.3%

Your Cost: $138.88/claim|Median: $98.27
1.4× median
D9610Normal range

$39K

1,095 claims · 0.2%

Your Cost: $36.00/claim|Median: $28.44
1.3× median
D9420Normal range

$20K

170 claims · 0.1%

Your Cost: $119.46/claim|Median: $81.82
1.5× median
D2331Normal range

Resin-based composite filling, two surfaces, anterior

$13K

192 claims · 0.1%

Your Cost: $68.13/claim|Median: $73.58
0.9× median
D2330Normal range

Resin-based composite filling, one surface, anterior

$11K

176 claims · 0.1%

Your Cost: $63.11/claim|Median: $66.63
0.9× median
D2393Top 25%

Resin-based composite, three surfaces, posterior

$9K

67 claims · 0.0%

Your Cost: $133.96/claim|Median: $84.26
1.6× median
D2332Normal range

$3K

53 claims · 0.0%

Your Cost: $64.56/claim|Median: $87.21
0.7× median
D7210Normal range

Extraction, erupted tooth, surgical approach

$2K

21 claims · 0.0%

Your Cost: $98.89/claim|Median: $109.42
0.9× median
D2335Normal range

$2K

14 claims · 0.0%

Your Cost: $127.48/claim|Median: $105.06
1.2× median
D9440Top 25%

$894

14 claims · 0.0%

Your Cost: $63.85/claim|Median: $31.27
2.0× median
D0999Normal range

Unspecified diagnostic procedure, by report

$323

17 claims · 0.0%

Your Cost: $19.02/claim|Median: $101.33
0.2× median
D1354Normal range

$254

36 claims · 0.0%

Your Cost: $7.06/claim|Median: $12.52
0.6× median
D0350Normal range

$234

4,068 claims · 0.0%

Your Cost: $0.06/claim|Median: $9.73
0.0× median
D1999Normal range

$0

280 claims · 0.0%

Your Cost: $0.00/claim|Median: $11.95

Other Top Providers in North Carolina

View all →

Laboratory Corporation of America Holdings

Clinical Medical Laboratory

$1.44B

Aeroflow INC

Durable Medical Equipment & Medical Supplies

$571.7M

Abound Health, LLC

In Home Supportive Care

$324.3M

Laboratory Corporation of America Holdings

Clinical Medical Laboratory

$281.4M

Laboratory Corporation of America Holdings

Clinical Medical Laboratory

$264.3M

← All providersAll providers in North Carolina →How we detect fraud →