Adult dental cleaning (prophylaxis)

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

PROPHYLAXIS - ADULT

Payers reporting HCPCS D1110

Payer pricing summary

Low

$56

Average

$286

Median

$184

High

$1.7k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +15 other terms	278	$143	$172	$126	74%	—	$24 – $931
2	Humana fee schedule · outpatient · +13 other terms	189	$139	$158	$74	47%	—	$39 – $385
3	Blue Cross Blue Shield fee schedule · outpatient · +15 other terms	179	$143	$244	$356	146%	—	$0 – $4.4k
4	UnitedHealthcare fee schedule · outpatient · +16 other terms	172	$138	$244	$336	138%	—	$16 – $3.8k
5	Cigna fee schedule · outpatient · +12 other terms	98	$138	$178	$92	52%	—	$120 – $581
6	Molina fee schedule · outpatient · +8 other terms	88	$155	$173	$66	38%	—	$37 – $361
7	WellCare fee schedule · outpatient · +7 other terms	75	$133	$161	$56	35%	—	$121 – $302
8	Ambetter facility · fee schedule · outpatient · +4 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	Kaiser case rate · both · +7 other terms	41	$269	$243	$138	57%	—	$102 – $488
11	Anthem facility · case rate · outpatient · +8 other terms	36	$462	$412	$335	81%	—	$121 – $1.6k
12	Oscar fee schedule · outpatient · +4 other terms	36	$273	$259	$55	21%	—	$160 – $380
13	Bcbs Tx fee schedule · outpatient · +1 other terms	23	$127	$127	$4	3%	—	$121 – $133
14	Optum fee schedule · outpatient · +8 other terms	23	$139	$205	$108	53%	—	$121 – $491
15	Clover fee schedule · outpatient · +3 other terms	21	$141	$138	$8	6%	—	$120 – $152
16	Caresource facility · case rate · outpatient · +5 other terms	16	$922	$904	$346	38%	—	$121 – $1.6k
17	Regence facility · case rate · outpatient · +4 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	First Health fee schedule · outpatient · +8 other terms	14	$139	$145	$58	40%	—	$42 – $271
20	MultiPlan fee schedule · outpatient · +8 other terms	14	$212	$212	—	—	—	$212 – $212
21	Superior Healthplan facility · fee schedule · outpatient · +2 other terms	13	$140	$140	$0	0%	—	$140 – $141
22	Bcbs Nj fee schedule · outpatient	12	$145	$305	$205	67%	—	$141 – $623
23	Highmark fee schedule · outpatient · +6 other terms	12	$159	$156	$174	112%	—	$57 – $1.1k
24	Tricare fee schedule · outpatient · +7 other terms	11	$121	$124	$3	3%	—	$121 – $129
25	Medical Mutual fee schedule · outpatient · +4 other terms	10	$353	$323	$110	34%	—	$116 – $559

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