Dental cleaning for children

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 Dental Prophylaxis Child

Payers reporting HCPCS D1120

Payer pricing summary

Low

Average

$1.2k

Median

$145

High

$22k

Payer rate distribution

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Filter by billing class

#
1	Humana fee schedule · outpatient · +12 other terms	75	$125	$139	$80	57%	—	$1 – $240
2	Aetna fee schedule · outpatient · +13 other terms	35	$79	$193	$299	155%	—	$16 – $931
3	UnitedHealthcare fee schedule · outpatient · +15 other terms	32	$184	$351	$497	142%	—	$25 – $1.2k
4	Molina facility · case rate · outpatient · +9 other terms	30	$425	$530	$473	89%	—	$74 – $1.6k
5	Blue Cross Blue Shield facility · fee schedule · outpatient · +12 other terms	23	$89	$712	$2.5k	345%	—	$31 – $22k
6	Anthem professional · fee schedule · outpatient · +6 other terms	17	$37	$56	$28	50%	—	$29 – $123
7	MultiPlan facility · percent of total billed charges · outpatientfrom % of charges · +7 other terms	16	$117	$3.1k	$8.1k	264%	—	$68 – $26.1k
8	Caresource facility · case rate · outpatient · +4 other terms	15	$934	$1.0k	$230	23%	—	$623 – $1.6k
9	Baylor Scott White Health Plan facility · percent of total billed charges · outpatientfrom % of charges	14	$32	$32	$3	8%	—	$30 – $35
10	Optum facility · case rate · outpatient · +4 other terms	13	$829	$815	$369	45%	—	$82 – $1.4k
11	Superior Healthplan facility · percent of total billed charges · outpatientfrom % of charges	13	$9	$9	$3	32%	—	$5 – $17
12	Cigna professional · fee schedule · outpatient · +11 other terms	10	$21	$22	$0	2%	—	$21 – $22
13	Clover facility · percent of total billed charges · outpatientfrom % of charges	10	$25	$25	—	—	—	$25 – $25
14	Highmark fee schedule · outpatient · +5 other terms	10	$129	$121	$272	224%	—	$44 – $1.1k
15	Medcost percent of total billed charges · bothfrom % of charges	9	$52	$52	$3	6%	—	$49 – $55
16	Tricare fee schedule · both · +4 other terms	9	$78	$78	—	—	—	$78 – $78
17	Medicaid fee schedule · outpatient · +4 other terms	8	$152	$153	$3	2%	—	$152 – $162
18	Aetna Better Health facility · case rate · outpatient · +3 other terms	7	$103	$103	$1	1%	—	$99 – $103
19	Amerihealth Caritas facility · case rate · outpatient · +4 other terms	7	$95	$96	$3	3%	—	$95 – $103
20	Medica fee schedule · outpatient · +3 other terms	5	$39	$31	$6	19%	—	$25 – $39
21	Kaiser fee schedule · outpatient · +3 other terms	4	$271	$261	$128	49%	—	$152 – $523
22	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$25	$25	—	—	—	$25 – $25
23	Phcs facility · percent of total billed charges · outpatientfrom % of charges · +3 other terms	3	$99	$7.4k	$10.4k	140%	—	$99 – $22.1k
24	Wellmark facility · case rate · outpatient · +2 other terms	3	$328	$288	$91	32%	—	$134 – $362
25	Excellus fee schedule · outpatient · +4 other terms	2	$89	$89	$12	14%	—	$55 – $93

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