Periodic dental check-up exam

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT

Payers reporting HCPCS D0120

Payer pricing summary

Low

$43

Average

$251

Median

$194

High

$1.5k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +17 other terms	283	$142	$172	$127	74%	—	$11 – $931
2	Humana fee schedule · outpatient · +16 other terms	190	$131	$126	$44	35%	—	$1 – $385
3	Blue Cross Blue Shield fee schedule · outpatient · +14 other terms	183	$143	$229	$347	151%	—	$0 – $4.4k
4	UnitedHealthcare fee schedule · outpatient · +19 other terms	180	$138	$232	$332	143%	—	$8 – $3.8k
5	Cigna fee schedule · outpatient · +15 other terms	99	$138	$180	$94	52%	—	$120 – $581
6	Molina fee schedule · outpatient · +12 other terms	90	$153	$169	$69	41%	—	$1 – $361
7	WellCare fee schedule · outpatient · +9 other terms	76	$134	$161	$56	35%	—	$121 – $302
8	Ambetter facility · fee schedule · outpatient · +5 other terms	54	$244	$246	$48	20%	—	$125 – $310
9	Devoted fee schedule · outpatient · +5 other terms	47	$139	$136	$8	6%	—	$124 – $149
10	Anthem facility · case rate · outpatient · +7 other terms	36	$462	$380	$276	73%	—	$121 – $1.3k
11	Oscar fee schedule · outpatient · +4 other terms	36	$273	$259	$55	21%	—	$160 – $380
12	Kaiser fee schedule · outpatient · +4 other terms	32	$285	$247	$133	54%	—	$37 – $576
13	Optum fee schedule · outpatient · +8 other terms	24	$134	$201	$108	53%	—	$118 – $491
14	Bcbs Tx fee schedule · outpatient · +1 other terms	23	$127	$127	$4	3%	—	$121 – $133
15	Clover fee schedule · outpatient · +3 other terms	21	$141	$138	$8	6%	—	$120 – $152
16	Caresource facility · case rate · outpatient · +6 other terms	16	$763	$751	$280	37%	—	$121 – $1.3k
17	Regence facility · case rate · outpatient · +6 other terms	16	$139	$166	$76	46%	—	$119 – $411
18	Baylor Scott White Health Plan facility · fee schedule · outpatient · +1 other terms	15	$169	$168	$34	20%	—	$127 – $221
19	MultiPlan fee schedule · outpatient · +9 other terms	14	$212	$212	—	—	—	$212 – $212
20	First Health fee schedule · outpatient · +11 other terms	13	$139	$159	$48	30%	—	$139 – $271
21	Highmark fee schedule · outpatient · +6 other terms	13	$150	$145	$179	123%	—	$29 – $1.1k
22	Superior Healthplan facility · fee schedule · outpatient · +2 other terms	13	$140	$140	$0	0%	—	$140 – $141
23	Bcbs Nj fee schedule · outpatient	12	$145	$305	$205	67%	—	$141 – $623
24	Medicare other · both · +5 other terms	11	$127	$134	$12	9%	—	$126 – $160
25	Tricare fee schedule · outpatient · +9 other terms	11	$121	$124	$3	3%	—	$121 – $129

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