X-ray of the teeth (intraoral film)

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

HC Intraoral Occlusal Film

Payers reporting HCPCS D0240

Payer pricing summary

Low

$32

Average

$332

Median

$179

High

$1.8k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +13 other terms	288	$93	$106	$96	91%	—	$10 – $1.7k
2	Humana fee schedule · outpatient · +9 other terms	191	$90	$90	$33	37%	—	$17 – $251
3	Blue Cross Blue Shield fee schedule · outpatient · +15 other terms	190	$95	$461	$1.0k	222%	—	$19 – $5.7k
4	UnitedHealthcare fee schedule · outpatient · +16 other terms	175	$90	$115	$157	137%	—	$5 – $2.6k
5	Cigna fee schedule · outpatient · +12 other terms	103	$90	$116	$58	50%	—	$79 – $397
6	Molina fee schedule · outpatient · +9 other terms	93	$103	$126	$125	99%	—	$9 – $1.4k
7	WellCare fee schedule · outpatient · +7 other terms	76	$89	$108	$39	36%	—	$80 – $206
8	Devoted fee schedule · outpatient · +5 other terms	47	$95	$90	$6	7%	—	$81 – $98
9	Anthem facility · fee schedule · outpatient · +7 other terms	41	$120	$232	$219	94%	—	$12 – $660
10	Ambetter facility · fee schedule · outpatient · +5 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	$174	$99	57%	—	$26 – $523
13	Bcbs Tx fee schedule · outpatient · +1 other terms	23	$86	$86	$2	3%	—	$83 – $91
14	Optum fee schedule · outpatient · +6 other terms	23	$91	$134	$71	53%	—	$79 – $321
15	Clover fee schedule · outpatient · +3 other terms	21	$96	$93	$7	8%	—	$79 – $104
16	Caresource facility · fee schedule · outpatient · +3 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 · +7 other terms	14	$91	$103	$30	29%	—	$91 – $177
19	MultiPlan fee schedule · outpatient · +7 other terms	14	$146	$146	—	—	—	$146 – $146
20	Highmark fee schedule · outpatient · +3 other terms	13	$83	$82	$55	67%	—	$24 – $215
21	Bcbs Nj fee schedule · outpatient	12	$99	$209	$140	67%	—	$96 – $426
22	Tricare facility · fee schedule · outpatient · +5 other terms	12	$95	$2.2k	$2.9k	129%	—	$75 – $6.1k
23	Medical Mutual fee schedule · outpatient · +3 other terms	10	$241	$217	$74	34%	—	$76 – $366
24	Medicare other · both · +3 other terms	9	$83	$86	$6	7%	—	$83 – $101
25	Aetna Better Health facility · case rate · outpatient · +1 other terms	7	$29	$29	$0	1%	—	$28 – $29

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