BOOTHE, ANDREA
NPI: 1649583089
· WICHITA, KS 67214
· Dentist
· NPI assigned 07/14/2010
$124K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
2,497 |
$124K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
670 |
656 |
$56K |
| D0330 |
Panoramic radiographic image |
187 |
180 |
$25K |
| D1120 |
Prophylaxis - child |
177 |
171 |
$19K |
| D1110 |
Prophylaxis - adult |
124 |
120 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
158 |
150 |
$5K |
| D0274 |
Bitewings - four radiographic images |
153 |
150 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
254 |
246 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
31 |
31 |
$1K |
| D1351 |
Sealant - per tooth |
93 |
19 |
$476.13 |
| D0230 |
Intraoral - periapical each additional radiographic image |
650 |
203 |
$0.00 |