Children's Hospital of Wisconsin, Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 215 procedure codes: 99213 at 2.9× median, 99212 at 4.2× median.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $104.23 per claim for 99212 (Office/outpatient visit, low complexity) — 4.2× the national median of $25.06.
Bills $88.20 per claim for 80053 (Comprehensive metabolic panel) — 12.2× the national median of $7.24.
Bills $93.73 per claim for D0120 (Periodic oral evaluation, established patient) — 3.9× the national median of $24.34.
Billing above the 90th percentile for 11 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Dentist, Pediatric Dentistry Peers
Total spending distribution among 6 providers in this specialty
This provider's total spending of $262.2M is at the 99th percentile among 6 Dentist, Pediatric Dentistry providers.
Above 99th percentile for this specialty — higher spending than 5 of 6 peers
Total Paid
$262.2M
$262,198,153
Total Claims
4.6M
Beneficiaries
3.8M
1.2 claims/patient
Avg Cost/Claim
$58
#312 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Children's Hospital of Wisconsin, Inc. is a Dentist, Pediatric Dentistry provider based in Milwaukee, WI. From the 2018–2024 period, this provider received $262.2M in Medicaid payments across 4.6M claims.
Why This Matters
This provider received $262.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 32,774 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 15% of total spending.
$38.4M
356K claims
$107.99
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$38.4M
356K claims · 14.6%
$18.3M
181K claims
$101.01
$42.48
Emergency dept visit, moderate complexity
$18.3M
181K claims · 7.0%
$14.9M
143K claims
$104.23
$25.06
Office/outpatient visit, low complexity
$14.9M
143K claims · 5.7%
$10.9M
101K claims
$108.27
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$10.9M
101K claims · 4.2%
Emergency dept visit, low complexity
$8.5M
86K claims · 3.2%
Comprehensive metabolic panel
$5.7M
65K claims · 2.2%
$5.6M
60K claims
$93.73
$24.34
Periodic oral evaluation, established patient
$5.6M
60K claims · 2.1%
$5.4M
39K claims
$138.92
$12.93
Office/outpatient visit, minimal complexity
$5.4M
39K claims · 2.1%
$4.4M
43K claims
$101.79
$69.51
Emergency dept visit, high complexity
$4.4M
43K claims · 1.7%
Therapeutic exercises, each 15 min
$4.4M
80K claims · 1.7%
$3.6M
24K claims
$154.13
$100.62
Respiratory virus detection, 3-5 targets, nucleic acid
$3.6M
24K claims · 1.4%
$3.4M
5K claims · 1.3%
$3.4M
38K claims
$89.76
$74.09
Office/outpatient visit, high complexity
$3.4M
38K claims · 1.3%
$3.3M
5K claims
$648.54
$763.43
Unlisted procedure, dentoalveolar structures
$3.3M
5K claims · 1.3%
$3.1M
4K claims
$749.76
$331.68
Tonsillectomy and adenoidectomy, under age 12
$3.1M
4K claims · 1.2%
$2.8M
65K claims
$42.74
$20.04
Therapeutic procedure, neuromuscular reeducation, per 15 minutes
$2.8M
65K claims · 1.1%
$2.8M
19K claims
$143.76
$120.85
Prefabricated stainless steel crown, primary tooth
$2.8M
19K claims · 1.1%
$2.6M
16K claims
$166.96
$99.39
Hospital observation service, per hour
$2.6M
16K claims · 1.0%
$2.6M
19K claims
$134.78
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.6M
19K claims · 1.0%
$2.4M
11K claims
$222.89
$112.83
Echocardiography, transthoracic, limited
$2.4M
11K claims · 0.9%
$2.4M
36K claims
$65.34
$39.70
COVID-19 SARS-CoV-2 amplified probe detection
$2.4M
36K claims · 0.9%
$2.0M
36K claims · 0.8%
$2.0M
10K claims
$192.67
$38.92
IV infusion, hydration, each additional hour
$2.0M
10K claims · 0.8%
$1.9M
26K claims
$73.60
$10.88
Pressurized or nonpressurized inhalation treatment
$1.9M
26K claims · 0.7%
$1.9M
2K claims
$870.74
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$1.9M
2K claims · 0.7%
Upper GI endoscopy with biopsy
$1.8M
6K claims · 0.7%
MRI brain without contrast
$1.8M
11K claims · 0.7%
$1.7M
20K claims
$84.35
$63.08
Infectious disease detection (COVID-19)
$1.7M
20K claims · 0.6%
$1.7M
34K claims
$49.27
$33.11
Therapeutic activities, each 15 min
$1.7M
34K claims · 0.6%
Prophylaxis, adult
$1.6M
51K claims · 0.6%
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