{
 "about": {
  "title": "Dental Cliff 2027 — analysis results",
  "generated": "2026-09-28",
  "command": "node analysis/run.cjs (run from the repository root)",
  "provenance": "data/sources.json lists every raw file with its URL, download date and SHA-256.",
  "attribution": "Source: California Health and Human Services Open Data Portal — 'Dental Utilization By Provider' (CY2018–CY2024) and 'Profile of Enrolled Medi-Cal Dental Fee-for-Service (FFS) Providers and Safety Net Clinics (SNCs)' (October 2025). Modified data: repeated rows were counted once, hidden cells were replaced by an assumed value, and files were joined and summarised by this project. These are not official figures of the State of California or DHCS.",
  "hiddenCellValue": 5,
  "hiddenCellNote": "The public files hide any count from 1 to 10. The main analysis counts each hidden cell as 5 (near the middle of 1–10); hiddenCellSensitivity repeats the key numbers with 1 and 10.",
  "simulation": {
   "seed": 2027,
   "draws": 2000,
   "note": "Seeded random numbers: re-running gives identical results."
  },
  "privacy": "No dentist is named, ranked or identified anywhere in the outputs. laDistribution holds anonymous counts only, sorted, with no identifiers."
 },
 "glossary": {
  "patientCount": "Medi-Cal members with at least one dental visit with a dentist in the year (the state's 'ADV USER CNT'), summed over delivery systems (FFS, GMC, PHP, HPSM) and provider types. A person who saw two dentists is counted by both, so totals are patient counts, not unique patients.",
  "adult": "Age 21 and over ('AGE 21+'). Child means age 0–20.",
  "laEnrolledDentist": "An NPI with at least one rendering listing in Los Angeles County in the October 2025 enrolled-provider profile ('Dental Rendering Provider information' or 'Rendering Provider at Safety Net Clinic'), excluding registered dental hygienists.",
  "renderingNpi": "The National Provider Identifier of the dentist (or other clinician) who performed the service. Counts cover all of that NPI's offices, inside or outside LA.",
  "hiddenCell": "Hidden cells (counts of 1–10 the state suppresses) are counted as 5.",
  "repeatedRows": "Some cells appear two or three times in a file, identical except for the spelling of the provider's name. Each cell is counted once."
 },
 "la": {
  "year": 2024,
  "enrolledDentists": {
   "value": 4730,
   "definition": "LA enrolled dentists (see glossary), October 2025 profile."
  },
  "excludedHygienists": {
   "value": 35,
   "definition": "LA rendering NPIs dropped because their specialty is a registered dental hygienist (RDHAP/RDH)."
  },
  "adultPatientCounts": {
   "value": 1508927,
   "definition": "Sum of CY2024 adult patient counts of the 4,730 LA dentists, counting all of each dentist's Medi-Cal patients wherever they were seen (the files have no office or county; see alsoListedInAnotherCounty). This is the base for every LA share ('LA adult patient counts'). Hidden cells (counts of 1–10 the state suppresses) are counted as 5."
  },
  "childPatientCounts": {
   "value": 1851738,
   "definition": "Sum of CY2024 child patient counts of the 4,730 LA dentists, counting all of each dentist's Medi-Cal patients wherever they were seen. Hidden cells (counts of 1–10 the state suppresses) are counted as 5."
  },
  "noPatients": {
   "n": 225,
   "pct": 4.8,
   "definition": "LA dentists with no Medi-Cal dental patients of any age in CY2024 (no row in the CY2024 file). pct = share of all LA dentists."
  },
  "childrenOnly": {
   "n": 386,
   "pct": 8.2,
   "definition": "LA dentists with child patients but no adult patients in CY2024."
  },
  "noAdults": {
   "n": 611,
   "pct": 12.9,
   "definition": "LA dentists with no adult Medi-Cal patients in CY2024 (noPatients + childrenOnly)."
  },
  "adults1to10": {
   "n": 610,
   "pct": 12.9,
   "definition": "LA dentists whose adult count is 1–10 after counting hidden cells as 5 (in practice: only hidden adult cells)."
  },
  "adults11to99": {
   "n": 813,
   "pct": 17.2,
   "definition": "LA dentists with 11–99 adult patient counts in CY2024."
  },
  "adults100plus": {
   "n": 2696,
   "pct": 57,
   "definition": "LA dentists with 100 or more adult patient counts in CY2024."
  },
  "twoPlusPractices": {
   "n": 2130,
   "pct": 45,
   "definition": "LA dentists listed under two or more billing providers (practices) in LA County. Why per-office numbers are impossible: the utilization counts are per dentist, not per office."
  },
  "twoPlusAddresses": {
   "n": 2197,
   "pct": 46.4,
   "definition": "LA dentists listed at two or more distinct LA street addresses (address line 1 + ZIP)."
  },
  "alsoListedInAnotherCounty": {
   "n": 1907,
   "pct": 40.3,
   "shareOfAdultPatientCounts": 47.7,
   "shareOfChildPatientCounts": 59.6,
   "amongBusiest10PctAdult": 234,
   "definition": "LA dentists that also have a rendering listing in another California county (n; pct = share of LA dentists). Part of their patient counts may come from offices outside LA, and the files cannot say how much. shareOfAdultPatientCounts / shareOfChildPatientCounts = their share (%) of the LA adult / child patient counts; amongBusiest10PctAdult = how many of the busiest 10% of LA dentists by adult count they are. So 'LA patient counts' means the patient counts of dentists listed in LA, not patients seen in LA."
  }
 },
 "coverage": {
  "definition": "Who the study group leaves out. The October 2025 profile lists Medi-Cal Dental fee-for-service (FFS) providers and safety net clinics (SNCs); its CHHS description says it 'does not include Dental Managed Care providers' (see externalContext). The utilization files include every delivery system. The files carry no county, so the gap can only be measured statewide.",
  "profileRenderingNpis": {
   "value": 14381,
   "definition": "NPIs with at least one rendering listing ('Dental Rendering Provider information' or 'Rendering Provider at Safety Net Clinic') in any county of the October 2025 profile, hygienists included."
  },
  "notInProfile2024": {
   "npis": 1590,
   "adult": 404705,
   "child": 307173,
   "adultShare": 10.2,
   "childShare": 6.8,
   "definition": "NPIs in the CY2024 utilization file with no rendering listing anywhere in the October 2025 profile: npis = how many; adult / child = their patient counts; adultShare / childShare = % of statewide CY2024 adult / child patient counts. They may be dental-managed-care-only providers, clinic clinicians not listed individually, or providers who left between 2024 and October 2025; the files cannot tell which, or how many practice in LA. Hidden cells (counts of 1–10 the state suppresses) are counted as 5."
  },
  "notInProfile2024ByProviderType": {
   "definition": "The same NPIs split by the provider type of their CY2024 cells ('RENDERING' or 'RENDERING SNC' = rendered at a safety net clinic). An NPI with both kinds of cells appears in both rows, so npis do not add up to the total; patient counts do.",
   "rows": [
    {
     "providerType": "RENDERING",
     "npis": 446,
     "adult": 41894,
     "child": 53195,
     "adultShare": 1.1,
     "childShare": 1.2
    },
    {
     "providerType": "RENDERING SNC",
     "npis": 1252,
     "adult": 362811,
     "child": 253978,
     "adultShare": 9.2,
     "childShare": 5.6
    }
   ]
  },
  "notInProfile2024ByDeliverySystem": {
   "definition": "The same NPIs split by delivery system of their CY2024 cells (FFS = fee-for-service; GMC = Sacramento Geographic Managed Care; PHP = prepaid health plans, LA dental managed care; HPSM = Health Plan of San Mateo). An NPI can appear in several rows.",
   "rows": [
    {
     "deliverySystem": "FFS",
     "npis": 1428,
     "adult": 378293,
     "child": 288110,
     "adultShare": 9.6,
     "childShare": 6.3
    },
    {
     "deliverySystem": "GMC",
     "npis": 94,
     "adult": 13788,
     "child": 13525,
     "adultShare": 0.3,
     "childShare": 0.3
    },
    {
     "deliverySystem": "HPSM",
     "npis": 167,
     "adult": 7014,
     "child": 3706,
     "adultShare": 0.2,
     "childShare": 0.1
    },
    {
     "deliverySystem": "PHP",
     "npis": 124,
     "adult": 5610,
     "child": 1832,
     "adultShare": 0.1,
     "childShare": 0
    }
   ]
  },
  "statewide2024ByProviderType": {
   "definition": "All CY2024 cells by provider type: npis, patient counts and share (%) of statewide adult / child patient counts.",
   "rows": [
    {
     "providerType": "RENDERING",
     "npis": 10009,
     "adult": 2927126,
     "child": 3774166,
     "adultShare": 74,
     "childShare": 83.1
    },
    {
     "providerType": "RENDERING SNC",
     "npis": 2671,
     "adult": 1029137,
     "child": 770074,
     "adultShare": 26,
     "childShare": 16.9
    }
   ]
  },
  "statewide2024ByDeliverySystem": {
   "definition": "All CY2024 cells by delivery system: npis, patient counts and share (%) of statewide adult / child patient counts.",
   "rows": [
    {
     "deliverySystem": "FFS",
     "npis": 11678,
     "adult": 3676506,
     "child": 4285272,
     "adultShare": 92.9,
     "childShare": 94.3
    },
    {
     "deliverySystem": "GMC",
     "npis": 553,
     "adult": 130965,
     "child": 168319,
     "adultShare": 3.3,
     "childShare": 3.7
    },
    {
     "deliverySystem": "HPSM",
     "npis": 582,
     "adult": 37174,
     "child": 35803,
     "adultShare": 0.9,
     "childShare": 0.8
    },
    {
     "deliverySystem": "PHP",
     "npis": 1549,
     "adult": 111618,
     "child": 54846,
     "adultShare": 2.8,
     "childShare": 1.2
    }
   ]
  },
  "laSafetyNetClinicListed": {
   "n": 169,
   "pct": 3.6,
   "shareOfAdultPatientCounts": 7.4,
   "shareOfChildPatientCounts": 3.8,
   "amongBusiest10PctAdult": 59,
   "definition": "LA enrolled dentists with a 'Rendering Provider at Safety Net Clinic' listing in LA County (n; pct = share of LA dentists), and their share (%) of LA adult / child patient counts. Compare statewide2024ByProviderType: clinic-rendered care is a much larger share of statewide patient counts than SNC-listed dentists hold in the LA group, so clinic care is under-represented in the LA group."
  }
 },
 "concentration": {
  "top10Dentists": {
   "value": 473,
   "definition": "10% of LA dentists, rounded: the busiest dentists by CY2024 adult (or child) patient count."
  },
  "top10AdultShare": {
   "value": 43.7,
   "definition": "Share (%) of all LA adult patient counts held by the busiest 10% of LA dentists (ranked by adult count). The base is all LA dentists, including those with no adult patients."
  },
  "top10ChildShare": {
   "value": 63.9,
   "definition": "Share (%) of all LA child patient counts held by the busiest 10% of LA dentists (ranked by child count)."
  },
  "dentistsHoldingHalfOfAdult": {
   "n": 595,
   "pct": 12.6,
   "definition": "Fewest LA dentists (busiest first) whose adult patient counts add up to at least half of the LA total; pct = share of all LA dentists."
  },
  "dentistsHoldingHalfOfChild": {
   "n": 283,
   "pct": 6,
   "definition": "Fewest LA dentists (busiest first by child count) whose child patient counts add up to at least half of the LA child total; pct = share of all LA dentists."
  },
  "withoutVeryLargeNpis": {
   "cap": 5000,
   "adult": {
    "npisAboveCap": 5,
    "theirShareOfPatientCounts": 2.4,
    "top10Share": 42.6,
    "dentistsHoldingHalf": {
     "n": 616,
     "pct": 13
    }
   },
   "child": {
    "npisAboveCap": 30,
    "theirShareOfPatientCounts": 11.3,
    "top10Share": 60.9,
    "dentistsHoldingHalf": {
     "n": 318,
     "pct": 6.8
    }
   },
   "definition": "Robustness check. Some single rendering NPIs carry more patients than one clinician could plausibly see in a year (the largest LA counts are 8,304 adults and 11,622 children), probably team or program billing under one number. Here the NPIs with more than 5,000 patient counts in an age group are removed from that age group and the numbers recomputed on the rest: npisAboveCap = how many were removed; theirShareOfPatientCounts = their share (%) of the LA total; top10Share = share (%) held by the busiest 10% of the remaining dentists; dentistsHoldingHalf = fewest remaining dentists holding half of the remaining counts (pct of the remaining dentists). The cap is a judgment call, not a rule from the data."
  },
  "curve": {
   "definition": "Element p-1 = share (%) of LA patient counts held by the busiest p% of LA dentists, p = 1..100 (adult and child ranked separately).",
   "adult": [
    10.3,
    16.2,
    21,
    25.1,
    28.9,
    32.2,
    35.3,
    38.3,
    41.1,
    43.7,
    46.2,
    48.7,
    51,
    53.2,
    55.3,
    57.3,
    59.2,
    61.1,
    62.9,
    64.7,
    66.3,
    67.9,
    69.5,
    70.9,
    72.4,
    73.7,
    75,
    76.3,
    77.5,
    78.7,
    79.8,
    80.9,
    81.9,
    82.9,
    83.9,
    84.8,
    85.7,
    86.5,
    87.4,
    88.2,
    88.9,
    89.7,
    90.3,
    91,
    91.7,
    92.3,
    92.8,
    93.4,
    93.9,
    94.4,
    94.8,
    95.3,
    95.7,
    96.1,
    96.5,
    96.8,
    97.2,
    97.5,
    97.7,
    98,
    98.2,
    98.5,
    98.7,
    98.8,
    99,
    99.2,
    99.3,
    99.4,
    99.5,
    99.6,
    99.6,
    99.7,
    99.7,
    99.8,
    99.8,
    99.8,
    99.8,
    99.9,
    99.9,
    99.9,
    99.9,
    99.9,
    99.9,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100
   ],
   "child": [
    15.4,
    25.2,
    33,
    39.5,
    45.3,
    50.2,
    54.3,
    57.9,
    61.1,
    63.9,
    66.3,
    68.4,
    70.3,
    72,
    73.7,
    75.1,
    76.5,
    77.7,
    78.9,
    80.1,
    81.1,
    82.1,
    83,
    83.9,
    84.7,
    85.5,
    86.2,
    86.9,
    87.6,
    88.2,
    88.8,
    89.4,
    90,
    90.5,
    91,
    91.5,
    92,
    92.4,
    92.9,
    93.3,
    93.6,
    94,
    94.4,
    94.7,
    95,
    95.3,
    95.6,
    95.9,
    96.1,
    96.4,
    96.6,
    96.8,
    97.1,
    97.3,
    97.4,
    97.6,
    97.8,
    98,
    98.1,
    98.3,
    98.4,
    98.5,
    98.6,
    98.8,
    98.9,
    99,
    99.1,
    99.2,
    99.2,
    99.3,
    99.4,
    99.5,
    99.5,
    99.6,
    99.6,
    99.7,
    99.7,
    99.8,
    99.8,
    99.8,
    99.9,
    99.9,
    99.9,
    99.9,
    99.9,
    99.9,
    99.9,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100,
    100
   ]
  }
 },
 "exit49": {
  "surveyFraction": {
   "value": 49,
   "definition": "The California Dental Association's survey figure: 49% of responding Medi-Cal dentists said they would leave the program if the proposed rate cuts take effect (see externalContext). Used here as a scenario, not a forecast."
  },
  "dentistsLeaving": {
   "value": 2318,
   "definition": "49% of the 4,730 LA dentists, rounded."
  },
  "quietestFirst": {
   "value": 5.2,
   "definition": "Lower bound: share (%) of LA adult patient counts whose dentist leaves if the 49% who leave are the quietest (fewest adult patients first). Includes the dentists with no adult patients."
  },
  "busiestFirst": {
   "value": 93.9,
   "definition": "Upper bound: the same share if the busiest 49% leave."
  },
  "random": {
   "expected": 49,
   "median": 48.9,
   "lo95": 46.7,
   "hi95": 51.1,
   "definition": "If the 49% who leave were picked at random: the expected share is 49% of patient counts; median and 95% interval from the simulation with equal weights."
  },
  "historyBased": {
   "median": 34.2,
   "lo95": 31.8,
   "hi95": 36.8,
   "definition": "Central estimate (the main model version): share (%) of LA adult patient counts whose dentist leaves if 49% of LA dentists leave AND exits follow the statewide 2019→2024 pattern by adult volume (exitsByVolume). median = median over the simulated draws. lo95–hi95 = a 95% simulation interval (2.5th–97.5th percentile of the draws): it covers chance only (the luck of the draw and resampling of the 2019 history), not the choice of model. How much the answer depends on the model is in acrossModels.",
   "method": [
    "Each draw resamples the 9,877 NPIs of the 2019 statewide cohort with replacement (a bootstrap) and recomputes the exit rate of each tenth of that cohort by 2019 adult volume. The 2019 cohort is the complete population, not a sample; the bootstrap treats it as one draw of what exit rates could have been, which is a modelling choice.",
    "Each LA dentist with adult patients is placed in the tenth of LA dentists (ranked by 2024 adult count) that matches, and gets that tenth's historical exit rate as its weight. Dentists with identical counts are treated alike: a group that straddles two tenths gets the blended rate.",
    "LA dentists with only child patients get the exit rate of 2019 NPIs that had only child patients. LA dentists with no patients at all get the rate of the quietest tenth.",
    "Then 2,318 LA dentists are drawn without replacement, each draw proportional to weight (a raffle where tickets = historical exit rate), and the share of LA adult patient counts they held is recorded.",
    "Repeated 2,000 times with seed 2027; the median is the central estimate and the 2.5th–97.5th percentiles form the 95% simulation interval."
   ],
   "assumptions": [
    "Exactly 49% of LA's enrolled dentists leave (the CDA survey figure, taken as a scenario). Nothing here says whether that will happen.",
    "Who leaves follows the 2019→2024 statewide pattern by volume: quieter dentists stopped more often. Those exits had many causes (retirement, moves, COVID-19, business changes), not a payment cut; a cut could hit busy practices differently.",
    "The pattern is statewide because the utilization files have no county; LA may differ.",
    "Exit propensity depends on adult volume only. Child volume also predicts who left (see exitsByVolume.byAdultAndChild: among 2019 NPIs with hidden adult counts, those with few children left far more often than those with 100+ children), so the main version treats busy pediatric practices with few adults like the quietest adult dentists. The adultAndChildVolume check matches on both and gives a higher answer.",
    "The raffle is one way to stretch a 29.7% five-year exit pattern to exactly 49%. It does not preserve the historical gradient: it flattens it. In the simulation LA's quietest tenth leaves 2.24 times as often as its busiest tenth (68.6% vs 30.6%), against 3.2 times in history. Scaling rules that keep more of the gradient (proportional, power) give lower answers; see modelGrid.",
    "A dentist's rank in 2024 LA volume stands in for their 2019 statewide rank.",
    "Enrolled LA dentists with no patients at all have no historical counterpart in the files (the files list only dentists with patients); they are given the quietest tenth's rate. Alternatives are in modelChecks.",
    "A patient whose dentist leaves is counted as 'losing their dentist'; the model does not know whether another dentist would absorb them.",
    "Hidden cells (counts of 1–10 the state suppresses) are counted as 5."
   ],
   "gradient": {
    "quietestTenthLeaving": 68.6,
    "busiestTenthLeaving": 30.6,
    "ratio": 2.24,
    "historicalRatio": 3.2,
    "definition": "Average share (%) of LA's quietest and busiest tenth of dentists with adult patients (ranked by 2024 adult count) that leaves across the main draws, their ratio, and the same ratio in the 2019→2024 history (exitsByVolume.quietestToBusiestDecileRatio). A lower simulated ratio means the raffle has flattened the historical gradient."
   },
   "whoLeaves": {
    "definition": "For each LA group: number of dentists, the group's share (%) of LA adult patient counts, and the average share (%) of the group that leaves across the history-based draws.",
    "rows": [
     {
      "group": "No patients at all",
      "dentists": 225,
      "shareOfAdultPatientCounts": 0,
      "averageShareLeaving": 69
     },
     {
      "group": "Children only",
      "dentists": 386,
      "shareOfAdultPatientCounts": 0,
      "averageShareLeaving": 65.3
     },
     {
      "group": "Adults 1–10 (hidden)",
      "dentists": 610,
      "shareOfAdultPatientCounts": 0.2,
      "averageShareLeaving": 68.5
     },
     {
      "group": "Adults 11–24",
      "dentists": 216,
      "shareOfAdultPatientCounts": 0.2,
      "averageShareLeaving": 67.1
     },
     {
      "group": "Adults 25–49",
      "dentists": 205,
      "shareOfAdultPatientCounts": 0.5,
      "averageShareLeaving": 58.4
     },
     {
      "group": "Adults 50–99",
      "dentists": 392,
      "shareOfAdultPatientCounts": 1.9,
      "averageShareLeaving": 55.3
     },
     {
      "group": "Adults 100–249",
      "dentists": 807,
      "shareOfAdultPatientCounts": 9,
      "averageShareLeaving": 45.9
     },
     {
      "group": "Adults 250–499",
      "dentists": 849,
      "shareOfAdultPatientCounts": 20.2,
      "averageShareLeaving": 36.8
     },
     {
      "group": "Adults 500–999",
      "dentists": 735,
      "shareOfAdultPatientCounts": 34.3,
      "averageShareLeaving": 32
     },
     {
      "group": "Adults 1,000+",
      "dentists": 305,
      "shareOfAdultPatientCounts": 33.6,
      "averageShareLeaving": 30.6
     }
    ]
   },
   "dentistsLeavingPerDraw": 2318
  },
  "acrossModels": {
   "low": 29,
   "high": 37.7,
   "versions": 15,
   "definition": "The lowest and highest median across the 15 versions of the history-based model tried: the 12 rows of modelGrid (three ways to match history to LA dentists × four ways to turn five-year exit rates into '49% leave') plus the three other checks in modelChecks (exit = no adult patients; dentists with no patients leave first; they get the children-only rate). It is the spread across the versions tried, not a probability interval, and it does not cover whether a pay cut would change who leaves. The main (reference) version is the raffle because it removes exactly 49%, as the scenario states; that does not make it more likely to be right."
  },
  "modelGrid": {
   "definition": "The history-based estimate under every combination of matching (rank in adult volume; absolute adult volume; absolute adult volume × child volume) and scaling rule (raffle; odds; proportional, capped at 100%; power). Median and 95% simulation interval (chance only) of each. isMain marks the headline version. Same seed and number of draws.",
   "rows": [
    {
     "matching": "Rank in adult volume (tenths)",
     "scaling": "Raffle: exactly 49% drawn, tickets = historical exit rate",
     "weighting": "decile",
     "method": "raffle",
     "median": 34.2,
     "lo95": 31.8,
     "hi95": 36.8,
     "isMain": true
    },
    {
     "matching": "Rank in adult volume (tenths)",
     "scaling": "Odds: historical odds × one common factor; independent exits",
     "weighting": "decile",
     "method": "odds",
     "median": 33.5,
     "lo95": 30.8,
     "hi95": 36.2,
     "isMain": false
    },
    {
     "matching": "Rank in adult volume (tenths)",
     "scaling": "Proportional: historical rate × one common factor, capped at 100%; independent exits",
     "weighting": "decile",
     "method": "proportional",
     "median": 29,
     "lo95": 26.4,
     "hi95": 31.7,
     "isMain": false
    },
    {
     "matching": "Rank in adult volume (tenths)",
     "scaling": "Power: 1 − (1 − rate)^factor, the historical process run for longer; independent exits",
     "weighting": "decile",
     "method": "power",
     "median": 31.5,
     "lo95": 28.9,
     "hi95": 34.3,
     "isMain": false
    },
    {
     "matching": "Absolute adult volume (tiers)",
     "scaling": "Raffle: exactly 49% drawn, tickets = historical exit rate",
     "weighting": "tier",
     "method": "raffle",
     "median": 35.4,
     "lo95": 32.7,
     "hi95": 38.4,
     "isMain": false
    },
    {
     "matching": "Absolute adult volume (tiers)",
     "scaling": "Odds: historical odds × one common factor; independent exits",
     "weighting": "tier",
     "method": "odds",
     "median": 35.2,
     "lo95": 32,
     "hi95": 38.2,
     "isMain": false
    },
    {
     "matching": "Absolute adult volume (tiers)",
     "scaling": "Proportional: historical rate × one common factor, capped at 100%; independent exits",
     "weighting": "tier",
     "method": "proportional",
     "median": 29.9,
     "lo95": 26.8,
     "hi95": 33.1,
     "isMain": false
    },
    {
     "matching": "Absolute adult volume (tiers)",
     "scaling": "Power: 1 − (1 − rate)^factor, the historical process run for longer; independent exits",
     "weighting": "tier",
     "method": "power",
     "median": 33,
     "lo95": 30,
     "hi95": 36.2,
     "isMain": false
    },
    {
     "matching": "Absolute adult volume × child volume",
     "scaling": "Raffle: exactly 49% drawn, tickets = historical exit rate",
     "weighting": "adultAndChild",
     "method": "raffle",
     "median": 37.7,
     "lo95": 34.8,
     "hi95": 40.5,
     "isMain": false
    },
    {
     "matching": "Absolute adult volume × child volume",
     "scaling": "Odds: historical odds × one common factor; independent exits",
     "weighting": "adultAndChild",
     "method": "odds",
     "median": 37.5,
     "lo95": 34.3,
     "hi95": 40.7,
     "isMain": false
    },
    {
     "matching": "Absolute adult volume × child volume",
     "scaling": "Proportional: historical rate × one common factor, capped at 100%; independent exits",
     "weighting": "adultAndChild",
     "method": "proportional",
     "median": 33.4,
     "lo95": 30,
     "hi95": 36.8,
     "isMain": false
    },
    {
     "matching": "Absolute adult volume × child volume",
     "scaling": "Power: 1 − (1 − rate)^factor, the historical process run for longer; independent exits",
     "weighting": "adultAndChild",
     "method": "power",
     "median": 35.7,
     "lo95": 32.3,
     "hi95": 39,
     "isMain": false
    }
   ]
  },
  "modelChecks": {
   "definition": "The history-based estimate re-run with one assumption changed at a time. Median and 95% simulation interval (chance only). Same seed and number of draws.",
   "rows": [
    {
     "name": "main",
     "description": "As above: deciles of 2019 adult volume, exit = no users of any age in 2024, raffle, history resampled.",
     "median": 34.2,
     "lo95": 31.8,
     "hi95": 36.8
    },
    {
     "name": "exitMeansNoAdults",
     "description": "Exit defined as 'no adult users in 2024' instead of 'no users of any age'.",
     "median": 33.6,
     "lo95": 31.3,
     "hi95": 36
    },
    {
     "name": "fixedVolumeTiers",
     "description": "History matched by absolute volume (tiers 1–10, 11–24 … 1,000+) instead of by rank (deciles).",
     "median": 35.4,
     "lo95": 32.7,
     "hi95": 38.4
    },
    {
     "name": "adultAndChildVolume",
     "description": "History matched on adult AND child volume (adult tier × child band 0–10 / 11–99 / 100+), so busy pediatric practices get the exit rate of busy pediatric practices, not of the quietest adult tenth. LA dentists with no patients get the rate of 2019 NPIs with no published count at all.",
     "median": 37.7,
     "lo95": 34.8,
     "hi95": 40.5
    },
    {
     "name": "noPatientDentistsLeaveFirst",
     "description": "The LA dentists with no patients at all are assumed to be the first to leave.",
     "median": 32.9,
     "lo95": 30.5,
     "hi95": 35.3
    },
    {
     "name": "noPatientDentistsLikeChildOnly",
     "description": "The LA dentists with no patients at all get the exit rate of 2019's children-only dentists.",
     "median": 34.3,
     "lo95": 32,
     "hi95": 36.9
    },
    {
     "name": "oddsScaling",
     "description": "Instead of the raffle, each dentist leaves independently; historical odds scaled by one common factor so 49% leave on average.",
     "median": 33.5,
     "lo95": 30.8,
     "hi95": 36.2
    },
    {
     "name": "proportionalScaling",
     "description": "Each dentist leaves independently with the historical five-year rate times one common factor (capped at 100%) so 49% leave on average. Keeps the historical ratio between quiet and busy dentists until the cap.",
     "median": 29,
     "lo95": 26.4,
     "hi95": 31.7
    },
    {
     "name": "powerScaling",
     "description": "Each dentist leaves independently with probability 1 − (1 − historical rate)^factor, i.e. the historical exit process run for longer, so 49% leave on average.",
     "median": 31.5,
     "lo95": 28.9,
     "hi95": 34.3
    },
    {
     "name": "historyFixed",
     "description": "History not resampled: only the luck of which dentists are drawn varies (shows how much of the interval comes from that).",
     "median": 34.2,
     "lo95": 32.2,
     "hi95": 36.4
    }
   ]
  }
 },
 "exitsByVolume": {
  "cohort": {
   "value": 9877,
   "definition": "Statewide rendering NPIs in the CY2019 file with any adult users (all delivery systems)."
  },
  "exitDefinition": "Exit = the NPI has no Medi-Cal dental users of any age in CY2024 (it is absent from the CY2024 file). This includes retirement, moving away, and stopping Medi-Cal; the files cannot tell these apart.",
  "exited": {
   "value": 2932,
   "definition": "Cohort members that exited."
  },
  "overallExitRate": {
   "value": 29.7,
   "definition": "Exited ÷ cohort, %."
  },
  "quietestToBusiestDecileRatio": {
   "value": 3.2,
   "definition": "Exit rate of the quietest tenth ÷ exit rate of the busiest tenth."
  },
  "deciles": {
   "definition": "Cohort sorted by 2019 adult patient count and cut into ten equal tenths (decile 1 = quietest). Dentists with identical counts are treated alike (a tie group straddling a boundary is shared between the two tenths), so 'dentists' can be fractional. exitRate = % of the tenth that exited. adultPatientCounts2019 = lowest and highest 2019 adult count in the tenth (hidden cells appear as the stand-in value); label = the same range in words.",
   "rows": [
    {
     "decile": 1,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 5,
      "max": 5
     },
     "label": "1–10 (hidden)",
     "exitRate": 52.6
    },
    {
     "decile": 2,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 5,
      "max": 12
     },
     "label": "up to 12",
     "exitRate": 50.3
    },
    {
     "decile": 3,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 12,
      "max": 39
     },
     "label": "12–39",
     "exitRate": 39.1
    },
    {
     "decile": 4,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 39,
      "max": 83
     },
     "label": "39–83",
     "exitRate": 33
    },
    {
     "decile": 5,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 83,
      "max": 139
     },
     "label": "83–139",
     "exitRate": 27
    },
    {
     "decile": 6,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 139,
      "max": 209
     },
     "label": "139–209",
     "exitRate": 22.3
    },
    {
     "decile": 7,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 209,
      "max": 296
     },
     "label": "209–296",
     "exitRate": 19.9
    },
    {
     "decile": 8,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 296,
      "max": 422
     },
     "label": "296–422",
     "exitRate": 20.2
    },
    {
     "decile": 9,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 422,
      "max": 648
     },
     "label": "422–648",
     "exitRate": 16
    },
    {
     "decile": 10,
     "dentists": 987.7,
     "adultPatientCounts2019": {
      "min": 648,
      "max": 74200
     },
     "label": "648–74,200",
     "exitRate": 16.5
    }
   ]
  },
  "tiers": {
   "definition": "The same cohort grouped by fixed 2019 adult patient-count ranges. exitRate = exited ÷ dentists, %.",
   "rows": [
    {
     "tier": "1–10 (hidden)",
     "dentists": 1905,
     "exited": 982,
     "exitRate": 51.5
    },
    {
     "tier": "11–24",
     "dentists": 620,
     "exited": 267,
     "exitRate": 43.1
    },
    {
     "tier": "25–49",
     "dentists": 691,
     "exited": 247,
     "exitRate": 35.7
    },
    {
     "tier": "50–99",
     "dentists": 1031,
     "exited": 308,
     "exitRate": 29.9
    },
    {
     "tier": "100–249",
     "dentists": 2194,
     "exited": 533,
     "exitRate": 24.3
    },
    {
     "tier": "250–499",
     "dentists": 1856,
     "exited": 340,
     "exitRate": 18.3
    },
    {
     "tier": "500–999",
     "dentists": 1208,
     "exited": 187,
     "exitRate": 15.5
    },
    {
     "tier": "1,000+",
     "dentists": 372,
     "exited": 68,
     "exitRate": 18.3
    }
   ]
  },
  "childOnly2019": {
   "dentists": 1237,
   "exited": 589,
   "exitRate": 47.6,
   "definition": "Statewide NPIs in the CY2019 file with child users but no adult users; exitRate = % with no users of any age in CY2024. Used for LA's children-only dentists."
  },
  "byAdultAndChild": {
   "definition": "The whole 2019 statewide file (NPIs with adult users plus children-only NPIs) grouped by 2019 adult volume (No adults, then the tiers) × 2019 child volume (0–10, 11–99, 100+; 0 and hidden 1–10 share a band because some cells would be tiny). exitRate = % with no users of any age in CY2024. Used by the adultAndChildVolume model version.",
   "rows": [
    {
     "adults": "No adults",
     "children": "0–10 children",
     "dentists": 442,
     "exited": 339,
     "exitRate": 76.7
    },
    {
     "adults": "No adults",
     "children": "11–99 children",
     "dentists": 255,
     "exited": 106,
     "exitRate": 41.6
    },
    {
     "adults": "No adults",
     "children": "100+ children",
     "dentists": 540,
     "exited": 144,
     "exitRate": 26.7
    },
    {
     "adults": "1–10 (hidden)",
     "children": "0–10 children",
     "dentists": 1171,
     "exited": 823,
     "exitRate": 70.3
    },
    {
     "adults": "1–10 (hidden)",
     "children": "11–99 children",
     "dentists": 176,
     "exited": 63,
     "exitRate": 35.8
    },
    {
     "adults": "1–10 (hidden)",
     "children": "100+ children",
     "dentists": 558,
     "exited": 96,
     "exitRate": 17.2
    },
    {
     "adults": "11–24",
     "children": "0–10 children",
     "dentists": 262,
     "exited": 138,
     "exitRate": 52.7
    },
    {
     "adults": "11–24",
     "children": "11–99 children",
     "dentists": 208,
     "exited": 102,
     "exitRate": 49
    },
    {
     "adults": "11–24",
     "children": "100+ children",
     "dentists": 150,
     "exited": 27,
     "exitRate": 18
    },
    {
     "adults": "25–49",
     "children": "0–10 children",
     "dentists": 170,
     "exited": 75,
     "exitRate": 44.1
    },
    {
     "adults": "25–49",
     "children": "11–99 children",
     "dentists": 372,
     "exited": 147,
     "exitRate": 39.5
    },
    {
     "adults": "25–49",
     "children": "100+ children",
     "dentists": 149,
     "exited": 25,
     "exitRate": 16.8
    },
    {
     "adults": "50–99",
     "children": "0–10 children",
     "dentists": 120,
     "exited": 38,
     "exitRate": 31.7
    },
    {
     "adults": "50–99",
     "children": "11–99 children",
     "dentists": 680,
     "exited": 205,
     "exitRate": 30.1
    },
    {
     "adults": "50–99",
     "children": "100+ children",
     "dentists": 231,
     "exited": 65,
     "exitRate": 28.1
    },
    {
     "adults": "100–249",
     "children": "0–10 children",
     "dentists": 86,
     "exited": 33,
     "exitRate": 38.4
    },
    {
     "adults": "100–249",
     "children": "11–99 children",
     "dentists": 858,
     "exited": 213,
     "exitRate": 24.8
    },
    {
     "adults": "100–249",
     "children": "100+ children",
     "dentists": 1250,
     "exited": 287,
     "exitRate": 23
    },
    {
     "adults": "250–499",
     "children": "0–10 children",
     "dentists": 33,
     "exited": 9,
     "exitRate": 27.3
    },
    {
     "adults": "250–499",
     "children": "11–99 children",
     "dentists": 267,
     "exited": 58,
     "exitRate": 21.7
    },
    {
     "adults": "250–499",
     "children": "100+ children",
     "dentists": 1556,
     "exited": 273,
     "exitRate": 17.5
    },
    {
     "adults": "500–999",
     "children": "0–10 children",
     "dentists": 27,
     "exited": 5,
     "exitRate": 18.5
    },
    {
     "adults": "500–999",
     "children": "11–99 children",
     "dentists": 63,
     "exited": 11,
     "exitRate": 17.5
    },
    {
     "adults": "500–999",
     "children": "100+ children",
     "dentists": 1118,
     "exited": 171,
     "exitRate": 15.3
    },
    {
     "adults": "1,000+",
     "children": "0–10 children",
     "dentists": 41,
     "exited": 11,
     "exitRate": 26.8
    },
    {
     "adults": "1,000+",
     "children": "11–99 children",
     "dentists": 12,
     "exited": 1,
     "exitRate": 8.3
    },
    {
     "adults": "1,000+",
     "children": "100+ children",
     "dentists": 319,
     "exited": 56,
     "exitRate": 17.6
    }
   ]
  },
  "hiddenAdultsByChildBand": {
   "definition": "2019 NPIs whose adult count was hidden (1–10), split by 2019 child volume: exit rate by 2024. Shows that child volume predicts exits among dentists with the same (tiny) adult volume.",
   "rows": [
    {
     "children": "0–10 children",
     "dentists": 1171,
     "exited": 823,
     "exitRate": 70.3
    },
    {
     "children": "11–99 children",
     "dentists": 176,
     "exited": 63,
     "exitRate": 35.8
    },
    {
     "children": "100+ children",
     "dentists": 558,
     "exited": 96,
     "exitRate": 17.2
    }
   ]
  },
  "noPublishedCount2019": {
   "dentists": 1613,
   "exited": 1162,
   "exitRate": 72,
   "definition": "2019 NPIs with no published count at all (adults 0 or hidden, children 0 or hidden) and their exit rate by 2024. Used for LA's no-patient dentists in the adultAndChildVolume version."
  },
  "alternativeExitDefinition": {
   "definition": "Same tables with exit = no ADULT users in CY2024 (a dentist who kept only children counts as exited).",
   "overallExitRate": 32,
   "deciles": [
    {
     "decile": 1,
     "exitRate": 59.9
    },
    {
     "decile": 2,
     "exitRate": 56.8
    },
    {
     "decile": 3,
     "exitRate": 41.8
    },
    {
     "decile": 4,
     "exitRate": 35.5
    },
    {
     "decile": 5,
     "exitRate": 27.7
    },
    {
     "decile": 6,
     "exitRate": 23.1
    },
    {
     "decile": 7,
     "exitRate": 20.5
    },
    {
     "decile": 8,
     "exitRate": 20.8
    },
    {
     "decile": 9,
     "exitRate": 17.1
    },
    {
     "decile": 10,
     "exitRate": 16.9
    }
   ],
   "tiers": [
    {
     "tier": "1–10 (hidden)",
     "exitRate": 58.6
    },
    {
     "tier": "11–24",
     "exitRate": 46.5
    },
    {
     "tier": "25–49",
     "exitRate": 37.6
    },
    {
     "tier": "50–99",
     "exitRate": 32
    },
    {
     "tier": "100–249",
     "exitRate": 24.9
    },
    {
     "tier": "250–499",
     "exitRate": 18.9
    },
    {
     "tier": "500–999",
     "exitRate": 16.6
    },
    {
     "tier": "1,000+",
     "exitRate": 18.3
    }
   ]
  }
 },
 "attrition": {
  "definition": "Statewide rendering NPIs with 100+ users in CY2019 (adults and children counted separately), and their users in CY2024. Percentages of the 2019 cohort; 'none' includes NPIs absent from the CY2024 file.",
  "adult": {
   "base": 5630,
   "noneIn2024": 20.7,
   "oneTo10": 3.1,
   "elevenTo99": 6.6,
   "still100plus": 69.6
  },
  "child": {
   "base": 5871,
   "noneIn2024": 20.5,
   "oneTo10": 2.8,
   "elevenTo99": 14.1,
   "still100plus": 62.7
  }
 },
 "statewide": {
  "definition": "Sums over all rendering NPIs in each year's file (all counties, all delivery systems). Patient counts, not unique patients.",
  "adult2019": 2685486,
  "adult2024": 3956263,
  "child2019": 4238965,
  "child2024": 4544240,
  "npis2019": 11114,
  "npis2024": 11954,
  "adultChangePct": 47.3
 },
 "trend": {
  "definition": "Statewide, one row per calendar year, all rendering NPIs in that year's file.",
  "columns": {
   "renderingNpis": "Rendering NPIs with any Medi-Cal dental users that year (every NPI in the file has at least one).",
   "npisWithAdultUsers": "Of those, NPIs with any adult users.",
   "npisWithChildUsers": "Of those, NPIs with any child users.",
   "adultPatientCounts": "Sum of adult patient counts.",
   "childPatientCounts": "Sum of child patient counts.",
   "top10AdultShare": "Share (%) of adult patient counts held by the busiest 10% of ALL rendering NPIs in the file (the same base as the LA figure).",
   "top10ChildShare": "Same for children.",
   "top10AdultShareAmongAdultProviders": "Share (%) held by the busiest 10% of NPIs with any adult users (a stricter base).",
   "top10ChildShareAmongChildProviders": "Same for children.",
   "top10AdultShareWithoutLargestNpi": "top10AdultShare recomputed without the single largest NPI of that year (a check that one very large NPI — tens of thousands of users a year, far more than one dentist could see, so probably clinic-level — is not driving the trend).",
   "top10ChildShareWithoutLargestNpi": "Same for children.",
   "npisAboveCapAdult": "NPIs with more than 5,000 adult patient counts that year (the same plausibility cap as concentration.withoutVeryLargeNpis): more than one clinician could plausibly see, so probably team, clinic or program billing under one number.",
   "npisAboveCapAdultShare": "Their share (%) of that year's adult patient counts.",
   "largestAdultNpi": "The largest adult patient count of any single NPI that year.",
   "top10AdultShareWithoutVeryLargeNpis": "top10AdultShare recomputed with every NPI above 5,000 adult patient counts removed (base: all remaining NPIs in the file, as for top10AdultShare). A check that the trend is not driven by a few very large billing numbers.",
   "top10AdultShareAmongAdultProvidersWithoutVeryLargeNpis": "The same with the stricter base: remaining NPIs with any adult users.",
   "npisAboveCapChild": "NPIs with more than 5,000 child patient counts that year.",
   "npisAboveCapChildShare": "Their share (%) of that year's child patient counts.",
   "top10ChildShareWithoutVeryLargeNpis": "top10ChildShare recomputed with every NPI above 5,000 child patient counts removed.",
   "safetyNetClinicAdultShare": "Share (%) of that year's adult patient counts in cells with provider type 'RENDERING SNC' (care rendered at a safety net clinic). A shift here can reflect billing or reporting changes as well as care.",
   "safetyNetClinicChildShare": "Same for children.",
   "hiddenCellShare": "Share (%) of cells in the file that are hidden (1–10).",
   "repeatedRowsRemoved": "Rows dropped because the same cell was listed more than once.",
   "cellsByDeliverySystem": "Cells per delivery system (FFS = fee-for-service; GMC = Sacramento Geographic Managed Care; PHP = prepaid health plans (LA dental managed care); HPSM = Health Plan of San Mateo, present from CY2022)."
  },
  "rows": [
   {
    "year": 2018,
    "renderingNpis": 10849,
    "npisWithAdultUsers": 9595,
    "npisWithChildUsers": 9959,
    "adultPatientCounts": 2580083,
    "childPatientCounts": 4154794,
    "top10AdultShare": 48.1,
    "top10ChildShare": 56,
    "top10AdultShareAmongAdultProviders": 45,
    "top10ChildShareAmongChildProviders": 53.9,
    "top10AdultShareWithoutLargestNpi": 47.1,
    "top10ChildShareWithoutLargestNpi": 55.8,
    "npisAboveCapAdult": 9,
    "npisAboveCapAdultShare": 4.9,
    "largestAdultNpi": 50263,
    "top10AdultShareWithoutVeryLargeNpis": 45.7,
    "top10AdultShareAmongAdultProvidersWithoutVeryLargeNpis": 42.4,
    "npisAboveCapChild": 59,
    "npisAboveCapChildShare": 10.4,
    "top10ChildShareWithoutVeryLargeNpis": 52.2,
    "safetyNetClinicAdultShare": 27.9,
    "safetyNetClinicChildShare": 18.7,
    "hiddenCellShare": 24.2,
    "repeatedRowsRemoved": 527,
    "cellsByDeliverySystem": {
     "FFS": 19423,
     "PHP": 3332,
     "GMC": 1018
    }
   },
   {
    "year": 2019,
    "renderingNpis": 11114,
    "npisWithAdultUsers": 9877,
    "npisWithChildUsers": 10324,
    "adultPatientCounts": 2685486,
    "childPatientCounts": 4238965,
    "top10AdultShare": 47.4,
    "top10ChildShare": 56.4,
    "top10AdultShareAmongAdultProviders": 44.5,
    "top10ChildShareAmongChildProviders": 54.6,
    "top10AdultShareWithoutLargestNpi": 45.9,
    "top10ChildShareWithoutLargestNpi": 56.1,
    "npisAboveCapAdult": 8,
    "npisAboveCapAdultShare": 5.5,
    "largestAdultNpi": 74200,
    "top10AdultShareWithoutVeryLargeNpis": 44.6,
    "top10AdultShareAmongAdultProvidersWithoutVeryLargeNpis": 41.5,
    "npisAboveCapChild": 57,
    "npisAboveCapChildShare": 10.3,
    "top10ChildShareWithoutVeryLargeNpis": 52.6,
    "safetyNetClinicAdultShare": 28.3,
    "safetyNetClinicChildShare": 19.2,
    "hiddenCellShare": 23.4,
    "repeatedRowsRemoved": 532,
    "cellsByDeliverySystem": {
     "FFS": 20247,
     "PHP": 3271,
     "GMC": 988
    }
   },
   {
    "year": 2020,
    "renderingNpis": 11339,
    "npisWithAdultUsers": 9913,
    "npisWithChildUsers": 10450,
    "adultPatientCounts": 2189200,
    "childPatientCounts": 3222485,
    "top10AdultShare": 47.6,
    "top10ChildShare": 58.7,
    "top10AdultShareAmongAdultProviders": 44.3,
    "top10ChildShareAmongChildProviders": 56.7,
    "top10AdultShareWithoutLargestNpi": 46.2,
    "top10ChildShareWithoutLargestNpi": 58.4,
    "npisAboveCapAdult": 7,
    "npisAboveCapAdultShare": 5.6,
    "largestAdultNpi": 59611,
    "top10AdultShareWithoutVeryLargeNpis": 44.7,
    "top10AdultShareAmongAdultProvidersWithoutVeryLargeNpis": 41.1,
    "npisAboveCapChild": 32,
    "npisAboveCapChildShare": 7.4,
    "top10ChildShareWithoutVeryLargeNpis": 56,
    "safetyNetClinicAdultShare": 26.4,
    "safetyNetClinicChildShare": 17.5,
    "hiddenCellShare": 25,
    "repeatedRowsRemoved": 615,
    "cellsByDeliverySystem": {
     "FFS": 20044,
     "PHP": 3355,
     "GMC": 1150
    }
   },
   {
    "year": 2021,
    "renderingNpis": 11389,
    "npisWithAdultUsers": 10104,
    "npisWithChildUsers": 10442,
    "adultPatientCounts": 2710911,
    "childPatientCounts": 3911456,
    "top10AdultShare": 43.7,
    "top10ChildShare": 58.1,
    "top10AdultShareAmongAdultProviders": 40.7,
    "top10ChildShareAmongChildProviders": 56,
    "top10AdultShareWithoutLargestNpi": 43.6,
    "top10ChildShareWithoutLargestNpi": 58,
    "npisAboveCapAdult": 6,
    "npisAboveCapAdultShare": 1.4,
    "largestAdultNpi": 7712,
    "top10AdultShareWithoutVeryLargeNpis": 43,
    "top10AdultShareAmongAdultProvidersWithoutVeryLargeNpis": 40,
    "npisAboveCapChild": 48,
    "npisAboveCapChildShare": 8,
    "top10ChildShareWithoutVeryLargeNpis": 55.5,
    "safetyNetClinicAdultShare": 21,
    "safetyNetClinicChildShare": 16,
    "hiddenCellShare": 24.3,
    "repeatedRowsRemoved": 601,
    "cellsByDeliverySystem": {
     "FFS": 20203,
     "PHP": 3482,
     "GMC": 1236
    }
   },
   {
    "year": 2022,
    "renderingNpis": 11052,
    "npisWithAdultUsers": 9909,
    "npisWithChildUsers": 10319,
    "adultPatientCounts": 2990917,
    "childPatientCounts": 4144463,
    "top10AdultShare": 41.8,
    "top10ChildShare": 57.7,
    "top10AdultShareAmongAdultProviders": 39.1,
    "top10ChildShareAmongChildProviders": 56,
    "top10AdultShareWithoutLargestNpi": 41.6,
    "top10ChildShareWithoutLargestNpi": 57.6,
    "npisAboveCapAdult": 7,
    "npisAboveCapAdultShare": 1.8,
    "largestAdultNpi": 10813,
    "top10AdultShareWithoutVeryLargeNpis": 40.9,
    "top10AdultShareAmongAdultProvidersWithoutVeryLargeNpis": 38.1,
    "npisAboveCapChild": 63,
    "npisAboveCapChildShare": 10,
    "top10ChildShareWithoutVeryLargeNpis": 54.3,
    "safetyNetClinicAdultShare": 22.7,
    "safetyNetClinicChildShare": 15.8,
    "hiddenCellShare": 21.7,
    "repeatedRowsRemoved": 379,
    "cellsByDeliverySystem": {
     "FFS": 20272,
     "GMC": 954,
     "HPSM": 813,
     "PHP": 2660
    }
   },
   {
    "year": 2023,
    "renderingNpis": 11441,
    "npisWithAdultUsers": 10246,
    "npisWithChildUsers": 10682,
    "adultPatientCounts": 3379840,
    "childPatientCounts": 4388101,
    "top10AdultShare": 42.1,
    "top10ChildShare": 58.7,
    "top10AdultShareAmongAdultProviders": 39.4,
    "top10ChildShareAmongChildProviders": 57,
    "top10AdultShareWithoutLargestNpi": 41.8,
    "top10ChildShareWithoutLargestNpi": 58.6,
    "npisAboveCapAdult": 11,
    "npisAboveCapAdultShare": 2.7,
    "largestAdultNpi": 16213,
    "top10AdultShareWithoutVeryLargeNpis": 40.7,
    "top10AdultShareAmongAdultProvidersWithoutVeryLargeNpis": 37.9,
    "npisAboveCapChild": 62,
    "npisAboveCapChildShare": 10.1,
    "top10ChildShareWithoutVeryLargeNpis": 55.4,
    "safetyNetClinicAdultShare": 23.8,
    "safetyNetClinicChildShare": 16.4,
    "hiddenCellShare": 21.2,
    "repeatedRowsRemoved": 360,
    "cellsByDeliverySystem": {
     "FFS": 20924,
     "GMC": 1019,
     "PHP": 2804,
     "HPSM": 848
    }
   },
   {
    "year": 2024,
    "renderingNpis": 11954,
    "npisWithAdultUsers": 10768,
    "npisWithChildUsers": 11188,
    "adultPatientCounts": 3956263,
    "childPatientCounts": 4544240,
    "top10AdultShare": 42.7,
    "top10ChildShare": 59.9,
    "top10AdultShareAmongAdultProviders": 40.1,
    "top10ChildShareAmongChildProviders": 58.3,
    "top10AdultShareWithoutLargestNpi": 42.3,
    "top10ChildShareWithoutLargestNpi": 59.7,
    "npisAboveCapAdult": 14,
    "npisAboveCapAdultShare": 3.1,
    "largestAdultNpi": 29430,
    "top10AdultShareWithoutVeryLargeNpis": 41.2,
    "top10AdultShareAmongAdultProvidersWithoutVeryLargeNpis": 38.5,
    "npisAboveCapChild": 71,
    "npisAboveCapChildShare": 11.1,
    "top10ChildShareWithoutVeryLargeNpis": 56.3,
    "safetyNetClinicAdultShare": 26,
    "safetyNetClinicChildShare": 16.9,
    "hiddenCellShare": 20.2,
    "repeatedRowsRemoved": 350,
    "cellsByDeliverySystem": {
     "FFS": 22097,
     "GMC": 909,
     "PHP": 2643,
     "HPSM": 869
    }
   }
  ],
  "change": {
   "top10AdultShare2018to2024": -5.4,
   "top10ChildShare2018to2024": 3.9,
   "top10AdultShareWithoutVeryLargeNpis2018to2024": -4.5,
   "top10AdultShare2020to2021": -3.9,
   "top10AdultShareWithoutVeryLargeNpis2020to2021": -1.7,
   "definition": "Percentage-point change in the top-10% share from CY2018 to CY2024 (and, for the adult share, from CY2020 to CY2021, the year of the largest one-year drop, when the very large NPIs' share and the safety-net-clinic share also fell)."
  }
 },
 "hiddenCellSensitivity": {
  "definition": "Key numbers recomputed with every hidden cell counted as 1, 5 (main) and 10. ByYear arrays run CY2018..CY2024.",
  "rows": [
   {
    "hiddenCellValue": 1,
    "laAdultPatientCounts": 1505043,
    "noAdultsPct": 12.9,
    "adults100plusPct": 57,
    "top10AdultShare": 43.8,
    "top10ChildShare": 64,
    "dentistsHoldingHalfOfAdult": 593,
    "quietestFirst": 5,
    "busiestFirst": 94.1,
    "historyMedian": 34.1,
    "historyLo95": 31.7,
    "historyHi95": 36.6,
    "attritionAdultNoneIn2024": 20.7,
    "statewideAdult2019": 2673366,
    "statewideAdult2024": 3945003,
    "top10AdultShareByYear": [
     48.3,
     47.6,
     47.9,
     43.9,
     41.9,
     42.2,
     42.8
    ],
    "top10ChildShareByYear": [
     56.1,
     56.5,
     58.9,
     58.3,
     57.8,
     58.8,
     60
    ]
   },
   {
    "hiddenCellValue": 5,
    "laAdultPatientCounts": 1508927,
    "noAdultsPct": 12.9,
    "adults100plusPct": 57,
    "top10AdultShare": 43.7,
    "top10ChildShare": 63.9,
    "dentistsHoldingHalfOfAdult": 595,
    "quietestFirst": 5.2,
    "busiestFirst": 93.9,
    "historyMedian": 34.2,
    "historyLo95": 31.8,
    "historyHi95": 36.8,
    "attritionAdultNoneIn2024": 20.7,
    "statewideAdult2019": 2685486,
    "statewideAdult2024": 3956263,
    "top10AdultShareByYear": [
     48.1,
     47.4,
     47.6,
     43.7,
     41.8,
     42.1,
     42.7
    ],
    "top10ChildShareByYear": [
     56,
     56.4,
     58.7,
     58.1,
     57.7,
     58.7,
     59.9
    ]
   },
   {
    "hiddenCellValue": 10,
    "laAdultPatientCounts": 1513782,
    "noAdultsPct": 12.9,
    "adults100plusPct": 57.1,
    "top10AdultShare": 43.6,
    "top10ChildShare": 63.7,
    "dentistsHoldingHalfOfAdult": 598,
    "quietestFirst": 5.4,
    "busiestFirst": 93.7,
    "historyMedian": 34.3,
    "historyLo95": 31.9,
    "historyHi95": 36.9,
    "attritionAdultNoneIn2024": 20.7,
    "statewideAdult2019": 2700636,
    "statewideAdult2024": 3970338,
    "top10AdultShareByYear": [
     47.9,
     47.2,
     47.3,
     43.5,
     41.6,
     42,
     42.6
    ],
    "top10ChildShareByYear": [
     55.9,
     56.2,
     58.4,
     58,
     57.5,
     58.6,
     59.8
    ]
   }
  ]
 },
 "dataQuality": {
  "repeatedRows": {
   "definition": "Per file: rows that repeat a cell already seen (same NPI, delivery system, provider type and age group). In every case the user count is identical; only the provider-name spelling (and sometimes the service count) differs.",
   "rows": [
    {
     "year": 2018,
     "rows": 24300,
     "repeatedRows": 527,
     "repeatsWithDifferentUserCount": 0
    },
    {
     "year": 2019,
     "rows": 25038,
     "repeatedRows": 532,
     "repeatsWithDifferentUserCount": 0
    },
    {
     "year": 2020,
     "rows": 25164,
     "repeatedRows": 615,
     "repeatsWithDifferentUserCount": 0
    },
    {
     "year": 2021,
     "rows": 25522,
     "repeatedRows": 601,
     "repeatsWithDifferentUserCount": 0
    },
    {
     "year": 2022,
     "rows": 25078,
     "repeatedRows": 379,
     "repeatsWithDifferentUserCount": 0
    },
    {
     "year": 2023,
     "rows": 25955,
     "repeatedRows": 360,
     "repeatsWithDifferentUserCount": 0
    },
    {
     "year": 2024,
     "rows": 26868,
     "repeatedRows": 350,
     "repeatsWithDifferentUserCount": 0
    }
   ]
  },
  "firstPassComparison": {
   "definition": "BRIEF.md's numbers came from first-pass scripts that summed repeated rows. reportedInBrief = the number in BRIEF.md; firstPassMethodRecomputed = this pipeline with repeated rows summed (should match); corrected = this pipeline with each cell counted once (the number to use).",
   "rows": [
    {
     "finding": "laDentists",
     "reportedInBrief": 4730,
     "firstPassMethodRecomputed": 4730,
     "corrected": 4730,
     "changed": false
    },
    {
     "finding": "noPatientsPct",
     "reportedInBrief": 4.8,
     "firstPassMethodRecomputed": 4.8,
     "corrected": 4.8,
     "changed": false
    },
    {
     "finding": "childrenOnlyPct",
     "reportedInBrief": 8.2,
     "firstPassMethodRecomputed": 8.2,
     "corrected": 8.2,
     "changed": false
    },
    {
     "finding": "noAdultsPct",
     "reportedInBrief": 12.9,
     "firstPassMethodRecomputed": 12.9,
     "corrected": 12.9,
     "changed": false
    },
    {
     "finding": "adults100plusPct",
     "reportedInBrief": 57.1,
     "firstPassMethodRecomputed": 57.1,
     "corrected": 57,
     "changed": true
    },
    {
     "finding": "top10AdultShare",
     "reportedInBrief": 44.2,
     "firstPassMethodRecomputed": 44.2,
     "corrected": 43.7,
     "changed": true
    },
    {
     "finding": "top10ChildShare",
     "reportedInBrief": 63.8,
     "firstPassMethodRecomputed": 63.8,
     "corrected": 63.9,
     "changed": true
    },
    {
     "finding": "dentistsHoldingHalf",
     "reportedInBrief": 587,
     "firstPassMethodRecomputed": 587,
     "corrected": 595,
     "changed": true
    },
    {
     "finding": "dentistsHoldingHalfPct",
     "reportedInBrief": 12.4,
     "firstPassMethodRecomputed": 12.4,
     "corrected": 12.6,
     "changed": true
    },
    {
     "finding": "quietestFirst",
     "reportedInBrief": 5.1,
     "firstPassMethodRecomputed": 5.1,
     "corrected": 5.2,
     "changed": true
    },
    {
     "finding": "busiestFirst",
     "reportedInBrief": 94,
     "firstPassMethodRecomputed": 94,
     "corrected": 93.9,
     "changed": true
    },
    {
     "finding": "attritionBase",
     "reportedInBrief": 5657,
     "firstPassMethodRecomputed": 5657,
     "corrected": 5630,
     "changed": true
    },
    {
     "finding": "attritionNone",
     "reportedInBrief": 20.9,
     "firstPassMethodRecomputed": 20.9,
     "corrected": 20.7,
     "changed": true
    },
    {
     "finding": "attritionStill100",
     "reportedInBrief": 69.6,
     "firstPassMethodRecomputed": 69.6,
     "corrected": 69.6,
     "changed": false
    },
    {
     "finding": "statewideAdult2019",
     "reportedInBrief": 2816007,
     "firstPassMethodRecomputed": 2816007,
     "corrected": 2685486,
     "changed": true
    },
    {
     "finding": "statewideAdult2024",
     "reportedInBrief": 4007808,
     "firstPassMethodRecomputed": 4007808,
     "corrected": 3956263,
     "changed": true
    }
   ]
  }
 },
 "externalContext": {
  "definition": "Facts from outside the data files, recorded here so every number on the site traces to this file. 'checked' says what this project verified itself.",
  "rows": [
   {
    "fact": "California Dental Association (CDA) survey, late November to early December 2025: 1,527 responses, 990 of them from dentists currently enrolled in Medi-Cal. CDA reports that '49% of Medi-Cal dentists would leave the program if the proposed cuts to provider rates take effect this year' and that 30% would see fewer Medi-Cal patients. The survey was run while the cuts were due in July 2026, before the June 2026 budget delayed them to July 2027.",
    "value": 49,
    "responses": 1527,
    "enrolledMediCalRespondents": 990,
    "fewerPatientsPct": 30,
    "source": "CDA newsroom, 'Poll: Nearly half of Medi-Cal dentists said they would disenroll if Medi-Cal rate cuts take effect; 1 in 3 said they would see fewer Medi-Cal members', January 22, 2026. https://www.cda.org/newsroom/access-to-care/poll-nearly-half-of-medi-cal-dentists-said-they-would-disenroll-if-medi-cal-rate-cuts-take-effect-1-in-3-said-they-would-see-fewer-medi-cal-members/",
    "checked": "Wording, date and counts read in the CDA article on 2026-09-28. The article describes no sampling method or response rate: it is a self-reported intention among people who chose to answer. An earlier summary ('a survey of 1,500+ Medi-Cal dentists') was imprecise: 1,527 is all responses, of which 990 came from enrolled Medi-Cal dentists."
   },
   {
    "fact": "The June 2026 state budget delayed about $1 billion in proposed Medi-Cal dental cuts, which would end the higher reimbursement rates established after Proposition 56 (the tobacco tax measure California voters approved in 2016), to July 1, 2027. The date could move again.",
    "value": "2027-07-01",
    "amountUsd": 1000000000,
    "source": "CDA newsroom, 'Medi-Cal Dental funding protected for another year in new state budget', June 29, 2026 (https://www.cda.org/newsroom/medi-cal-denti-cal/medi-cal-dental-funding-protected-for-another-year-in-new-state-budget/).",
    "checked": "Read in the CDA article on 2026-09-28 ('the $1B in proposed cuts are now delayed until July 1, 2027'; Proposition 56 described as the 2016 tobacco tax measure). The CalMatters/LAist article of the same day does not mention the $1 billion or Proposition 56; it supports only the delay of benefits for undocumented enrollees (next row). Not confirmed against DHCS or budget-bill text (DHCS pages blocked automated access)."
   },
   {
    "fact": "W&I Code §14043.62(a): the department shall deactivate a provider's number when the provider 'has not submitted a claim for reimbursement from the Medi-Cal program for one year' (after due diligence to contact the provider).",
    "value": 12,
    "source": "California Welfare and Institutions Code §14043.62, https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=14043.62",
    "checked": "Statute text read on leginfo.legislature.ca.gov on 2026-09-28 (as amended by Stats. 2007, Ch. 188). How consistently DHCS applies it is not known to this project."
   },
   {
    "fact": "Nasseh K, Fosse C, Vujicic M. Dentists Who Participate in Medicaid: Who They Are, Where They Locate, How They Practice. Medical Care Research and Review 2023;80(2):245–252. doi:10.1177/10775587221108751 (PMID 35838345, PMC10009318). National 2017 data on general and pediatric dentists: 'The majority of dentists in our sample (67%) had zero Medicaid patients and about 18% had more than 100 Medicaid patients' (Medicaid/CHIP child patients).",
    "value": null,
    "source": "Europe PMC full text of PMC10009318; PubMed record 35838345",
    "checked": "Title, authors, journal, pages, DOI and the 67% / ~18% sentence verified in the full text on 2026-09-28. It shows participation is highly uneven nationally; it is not an LA or California dentist-level analysis and reports no top-10% shares."
   },
   {
    "fact": "Roughly 2.3 million immigrants (adults including undocumented people, deferred-action recipients and many green-card holders) are set to lose non-emergency Medi-Cal dental benefits on July 1, 2027, after a one-year delay; only dental emergencies would be covered.",
    "value": "2027-07-01",
    "people": 2300000,
    "source": "Public Health Watch (S. Arredondo), 'California Delayed Medi-Cal Dental Cuts for Immigrants, But Worry and Confusion Persist', September 15, 2026 (https://publichealthwatch.org/2026/09/15/california-medical-immigrants-dental-immigrants-uninisured/); the delay to July 2027 is also reported by CalMatters/LAist, June 29, 2026.",
    "checked": "Read on 2026-09-28. The 2.3 million figure is news reporting, not a DHCS document; not confirmed against DHCS. This project does not model this coverage change (the files carry no immigration status)."
   },
   {
    "fact": "The CHHS description of the 'Profile of Enrolled Medi-Cal Dental FFS Providers and SNCs' (October 2025): 'This dataset does not include Dental Managed Care providers.'",
    "value": null,
    "source": "CHHS Open Data Portal API, package_show?id=profile-of-enrolled-medi-cal-dental-fee-for-service-ffs-providers-and-safety-net-clinics-sncs (dataset notes).",
    "checked": "Read in the API response on 2026-09-28. See coverage for what this leaves out."
   },
   {
    "fact": "California State Auditor, Report 2013-125 (December 2014), 'California Department of Health Care Services: Weaknesses in Its Medi-Cal Dental Program Limit Children's Access to Dental Care'. It counted active Medi-Cal dental providers (at least one procedure for a child beneficiary in the year) and county provider-to-child-beneficiary ratios for 2009–2013 (statewide 1:807 in 2013) and found some counties without active providers or providers accepting new patients.",
    "value": null,
    "year": 2014,
    "reportNumber": "2013-125",
    "source": "https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf",
    "checked": "Report PDF read on 2026-09-28 (cover, letter of 11 December 2014, summary and Chapter 1). It concerns children and counties; it does not measure how concentrated care is among dentists."
   },
   {
    "fact": "Nasseh, Fosse & Vujicic (2023) excluded dentists from seven states and the District of Columbia (Arkansas, DC, Indiana, Nebraska, Nevada, Pennsylvania, South Dakota, West Virginia) because of missing provider NPIs in the 2017 T-MSIS data, so their figures describe a national sample, not every state.",
    "value": null,
    "statesExcluded": 7,
    "source": "PMC full text of PMC10009318 (NCBI E-utilities efetch, db=pmc), Methods.",
    "checked": "Sentence read in the full text on 2026-09-28."
   },
   {
    "fact": "The June 2026 budget also delayed, to July 2027, the end of Medi-Cal benefits (including dental) for undocumented enrollees.",
    "value": "2027-07",
    "source": "Yu YS, 'Newsom's parting gift: A budget that delays California's deep cuts to 2027', CalMatters, as published by LAist, June 29, 2026 (https://laist.com/news/politics/newsoms-parting-gift-a-budget-that-delays-californias-deep-cuts-to-2027).",
    "checked": "Read on 2026-09-28. This article does not mention the $1 billion or Proposition 56."
   }
  ]
 },
 "caveats": [
  "Counts are per rendering dentist across all their offices; 'LA dentists' are defined by the October 2025 listing, while their counts include any offices outside LA. 'LA patient counts' therefore means the Medi-Cal patient counts of dentists listed in LA, wherever the patients were seen: the 47.7% of adult and 59.6% of child counts held by LA dentists also listed in another county may partly come from outside LA (la.alsoListedInAnotherCounty).",
  "A rendering NPI can carry team or program volume: 30 LA NPIs have more than 5,000 child patient counts (11.3% of LA child counts) and 5 have more than 5,000 adult counts, more than one clinician could plausibly see. 'The busiest 10% of dentists' therefore partly means the busiest billing numbers; concentration.withoutVeryLargeNpis repeats the shares without them.",
  "Patient counts, not patients: someone who saw two dentists is counted twice.",
  "Hidden cells (1–10) are counted as 5; see hiddenCellSensitivity for 1 and 10.",
  "The enrolled list is from October 2025 and the utilization is from calendar 2024. How many dentists joined or left in between is not known: the listing's enrollment-date field is blank for many LA dentists and cannot identify recent enrollees, so some of the dentists with no 2024 patients may be new.",
  "Claims data lag roughly a year; CY2024 is the newest year published.",
  "Utilization shows who was seen, not who is accepting new patients.",
  "The statewide trend and exit pattern use every rendering NPI in the files, which may include some hygienists and clinic-level NPIs; the files carry no specialty or county.",
  "Delivery-system coverage changes over time (for example, Health Plan of San Mateo rows appear from CY2022), which can move statewide totals.",
  "This is a desk analysis of public files: no patients or dentists were interviewed.",
  "The LA group is dentists listed in the Medi-Cal Dental FFS provider profile, which excludes dental-managed-care-only providers. Statewide, 1,590 NPIs with CY2024 patients have no rendering listing in the profile; they hold 10.2% of adult and 6.8% of child patient counts, mostly care rendered at safety net clinics (coverage)."
 ],
 "laDistribution": {
  "definition": "Anonymous CY2024 patient counts for each of the 4,730 LA dentists, sorted high to low, no identifiers (for the site's charts and simulator). Hidden cells (counts of 1–10 the state suppresses) are counted as 5.",
  "adult": [
   8304,
   8193,
   7753,
   6516,
   6155,
   4557,
   4192,
   4166,
   4073,
   3981,
   3848,
   3800,
   3520,
   3384,
   3115,
   3080,
   3049,
   2984,
   2927,
   2881,
   2837,
   2828,
   2682,
   2677,
   2677,
   2568,
   2553,
   2530,
   2500,
   2492,
   2487,
   2482,
   2457,
   2448,
   2356,
   2344,
   2330,
   2310,
   2307,
   2300,
   2286,
   2245,
   2229,
   2215,
   2164,
   2151,
   2134,
   2131,
   2122,
   2111,
   2107,
   2082,
   2077,
   2070,
   2035,
   2020,
   2015,
   2003,
   2000,
   1986,
   1973,
   1968,
   1963,
   1932,
   1925,
   1897,
   1872,
   1838,
   1820,
   1802,
   1793,
   1790,
   1787,
   1782,
   1780,
   1776,
   1771,
   1769,
   1745,
   1742,
   1740,
   1740,
   1740,
   1735,
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   2616,
   2611,
   2600,
   2596,
   2593,
   2575,
   2574,
   2568,
   2567,
   2556,
   2539,
   2527,
   2522,
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   2503,
   2495,
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   2327,
   2320,
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   2300,
   2297,
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   2281,
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   2278,
   2277,
   2272,
   2267,
   2266,
   2256,
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   2232,
   2198,
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   2168,
   2162,
   2138,
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   2116,
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   2104,
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   2097,
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   2090,
   2090,
   2066,
   2061,
   2056,
   2048,
   2044,
   2042,
   2037,
   2028,
   2024,
   2017,
   2010,
   2007,
   1991,
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   1984,
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   1944,
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   1018,
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   1007,
   1001,
   1000,
   998,
   997,
   993,
   993,
   992,
   990,
   984,
   983,
   981,
   978,
   977,
   974,
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   961,
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