R. GARY HENSLEY D.M.D. PA I

$295K

Total Medicaid Paid

5,560

Total Claims

4,662

Beneficiaries

21

Codes Billed

2018-01

First Month

2018-09

Last Month

Authorized Official	HARRIS, CRYSTAL (OFFICE MANAGER)
NPI Enumeration Date	10/25/2006

Provider	City	State	Total Paid
MICHAEL J. A. MAGNOTTA DDS, PLLC	MORGANTON	NC	$363K
R. GARY HENSLEY, DMD, PA I	MARION	NC	$236K

Year	Claims	Total Paid
2018	5,560	$295K

Code	Description	Claims	Beneficiaries	Total Paid
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	386	189	$39K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	322	214	$31K
D2335		215	111	$24K
D2391	Resin-based composite - one surface, posterior, primary or permanent	307	197	$22K
D1110	Prophylaxis - adult	630	625	$22K
D0140	Limited oral evaluation - problem focused	655	619	$22K
D0210	Intraoral - complete series of radiographic images	280	275	$18K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	142	106	$17K
D2332		184	119	$17K
D0330	Panoramic radiographic image	235	231	$12K
D2394		74	58	$11K
D0120	Periodic oral evaluation - established patient	462	462	$11K
D0150	Comprehensive oral evaluation - new or established patient	252	249	$10K
D2330		127	91	$8K
D0274	Bitewings - four radiographic images	245	243	$7K
D4355		109	109	$7K
D0220	Intraoral - periapical first radiographic image	357	342	$5K
D2331		58	42	$4K
D1208	Topical application of fluoride, excluding varnish	242	240	$4K
D0230	Intraoral - periapical each additional radiographic image	261	123	$3K
D1120	Prophylaxis - child	17	17	$413.92

Medicaid Provider Spending