Dental sealant repair per 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

SEALANT REPAIR PER TOOTH

Payers reporting HCPCS D1353

Payer pricing summary

Low

$17

Average

$4.3k

Median

$241

High

$41.7k

Payer rate distribution

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#
1	Molina facility · case rate · outpatient · +5 other terms	29	$667	$525	$529	101%	—	$28 – $1.6k
2	Aetna fee schedule · outpatient · +6 other terms	20	$13	$35	$32	91%	—	$11 – $140
3	UnitedHealthcare facility · case rate · outpatient · +8 other terms	20	$958	$9.0k	$14.6k	161%	—	$32 – $35k
4	Anthem facility · case rate · outpatient · +5 other terms	15	$952	$1.0k	$244	23%	—	$648 – $1.6k
5	Caresource facility · case rate · outpatient · +1 other terms	15	$970	$1.0k	$239	23%	—	$648 – $1.6k
6	Blue Cross Blue Shield facility · fee schedule · outpatient · +6 other terms	14	$70	$876	$4.1k	473%	—	$36 – $22k
7	Optum facility · case rate · outpatient · +1 other terms	13	$862	$839	$400	48%	—	$31 – $1.5k
8	Highmark fee schedule · outpatient · +1 other terms	11	$34	$35	$7	20%	—	$34 – $107
9	Cigna professional · fee schedule · outpatient · +4 other terms	10	$17	$16	$1	8%	—	$14 – $17
10	Humana facility · case rate · outpatient · +2 other terms	8	$32	$34	$2	5%	—	$32 – $36
11	Aetna Better Health facility · case rate · outpatient	7	$39	$39	$0	1%	—	$37 – $39
12	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$36	$36	$1	3%	—	$36 – $39
13	Tricare facility · fee schedule · outpatient · +1 other terms	5	$50k	$50k	—	—	—	$50k – $50k
14	MultiPlan professional · percent of total billed charges · outpatientfrom % of charges · +2 other terms	4	$68	$68	—	—	—	$68 – $68
15	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$19	$19	—	—	—	$19 – $19
16	Medica fee schedule · outpatient · +2 other terms	3	$30	$30	—	—	—	$30 – $30
17	Wellmark facility · case rate · outpatient	3	$123	$108	$34	32%	—	$50 – $136
18	Medicaid facility · case rate · outpatient	2	$32	$32	—	—	—	$32 – $32
19	Bcbs Id professional · fee schedule · outpatient	1	$61	$61	—	—	—	$61 – $61
20	Bcbs Mn fee schedule · outpatient	1	$71	$71	—	—	—	$71 – $71
21	Bcbs Nv fee schedule · outpatient	1	$17	$17	—	—	—	$17 – $17
22	Bcbs Vt professional · fee schedule · outpatient	1	$17	$17	—	—	—	$17 – $17
23	Excellus facility · fee schedule · outpatient	1	$22k	$22k	—	—	—	$22k – $22k
24	First Health facility · other · outpatient · +2 other terms	1	$35k	$35k	—	—	—	$35k – $35k
25	Medicare facility · fee schedule · outpatient	1	$22k	$22k	—	—	—	$22k – $22k

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