R. GARY HENSLEY, DMD, PA I

$236K

Total Medicaid Paid

5,722

Total Claims

5,054

Beneficiaries

22

Codes Billed

2018-01

First Month

2018-09

Last Month

Authorized Official	HARRIS, CRYSTAL (OFFICE MANAGER)
NPI Enumeration Date	02/05/2008

Provider	City	State	Total Paid
MICHAEL J. A. MAGNOTTA DDS, PLLC	MORGANTON	NC	$363K
R. GARY HENSLEY D.M.D. PA I	MORGANTON	NC	$295K

Year	Claims	Total Paid
2018	5,722	$236K

Code	Description	Claims	Beneficiaries	Total Paid
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	458	255	$45K
D0140	Limited oral evaluation - problem focused	699	665	$23K
D2391	Resin-based composite - one surface, posterior, primary or permanent	264	161	$20K
D3330	Endodontic therapy, molar tooth (excluding final restoration)	43	39	$16K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	132	94	$15K
D0120	Periodic oral evaluation - established patient	637	628	$15K
D1110	Prophylaxis - adult	410	405	$14K
D0330	Panoramic radiographic image	233	223	$12K
D1120	Prophylaxis - child	416	409	$10K
D1208	Topical application of fluoride, excluding varnish	607	603	$9K
D0220	Intraoral - periapical first radiographic image	672	626	$9K
D0150	Comprehensive oral evaluation - new or established patient	231	226	$9K
D7140	Extraction, erupted tooth or exposed root	146	79	$9K
D2335		65	32	$7K
D3310		25	15	$7K
D0274	Bitewings - four radiographic images	232	227	$6K
D0272	Bitewings - two radiographic images	189	187	$3K
D0210	Intraoral - complete series of radiographic images	29	28	$2K
D0230	Intraoral - periapical each additional radiographic image	172	98	$2K
D2332		17	12	$2K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	33	30	$1K
D4355		12	12	$768.48

Medicaid Provider Spending