Initial intraoral X-ray of one tooth

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

INTRAORAL PERIAPICAL FIRST

Payers reporting HCPCS D0220

Payer pricing summary

Low

$22

Average

$309

Median

$160

High

$2.8k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +15 other terms	281	$93	$98	$57	58%	—	$5 – $619
2	Blue Cross Blue Shield fee schedule · outpatient · +15 other terms	184	$94	$171	$346	202%	—	$0 – $4.4k
3	Humana fee schedule · outpatient · +14 other terms	184	$88	$82	$29	36%	—	$10 – $251
4	UnitedHealthcare fee schedule · outpatient · +16 other terms	170	$89	$112	$159	142%	—	$4 – $2.6k
5	Cigna fee schedule · outpatient · +11 other terms	102	$90	$117	$58	50%	—	$79 – $397
6	Molina fee schedule · outpatient · +11 other terms	86	$109	$114	$50	44%	—	$5 – $253
7	WellCare fee schedule · outpatient · +8 other terms	70	$90	$110	$40	36%	—	$80 – $206
8	Anthem facility · fee schedule · outpatient · +7 other terms	43	$115	$193	$216	112%	—	$4 – $660
9	Devoted fee schedule · outpatient · +5 other terms	41	$95	$89	$6	7%	—	$81 – $98
10	Ambetter facility · fee schedule · outpatient · +6 other terms	40	$152	$156	$32	21%	—	$94 – $212
11	Oscar fee schedule · outpatient · +5 other terms	39	$181	$169	$37	22%	—	$103 – $248
12	Kaiser fee schedule · outpatient · +6 other terms	31	$187	$172	$101	59%	—	$16 – $523
13	Optum fee schedule · outpatient · +6 other terms	23	$91	$134	$71	53%	—	$79 – $321
14	Clover fee schedule · outpatient · +3 other terms	21	$96	$93	$7	8%	—	$79 – $104
15	Bcbs Tx fee schedule · outpatient · +1 other terms	17	$86	$86	$3	3%	—	$83 – $91
16	Caresource facility · fee schedule · outpatient · +5 other terms	17	$133	$125	$35	28%	—	$89 – $173
17	Regence facility · case rate · outpatient · +4 other terms	16	$91	$110	$53	48%	—	$82 – $283
18	First Health fee schedule · outpatient · +8 other terms	15	$91	$91	$43	47%	—	$5 – $177
19	MultiPlan fee schedule · outpatient · +9 other terms	14	$146	$146	—	—	—	$146 – $146
20	Highmark fee schedule · outpatient · +6 other terms	13	$80	$79	$57	72%	—	$17 – $215
21	Tricare facility · fee schedule · outpatient · +9 other terms	13	$88	$2.1k	$2.8k	135%	—	$82 – $6.1k
22	Bcbs Nj fee schedule · outpatient	12	$99	$209	$140	67%	—	$96 – $426
23	Medical Mutual fee schedule · outpatient · +4 other terms	10	$241	$217	$74	34%	—	$76 – $366
24	Medicare other · both · +3 other terms	9	$83	$86	$6	7%	—	$83 – $101
25	Medicaid fee schedule · outpatient · +2 other terms	8	$55	$55	$1	2%	—	$55 – $58

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