Average Medicaid Dental Cleaning & Exam Payments in Pomona, CA: $49.69
Avg. Paid
$49.69
Range
$0.00 – $72.10
Total Claims
313,121
Providers
46
Typical Payment Range
Typical Medicaid Dental Cleaning & Exam payments fall between $25.53 and $40.26 per claim (median: $32.14). The top 10% of payments exceed $55.10.
Based on per-provider averages across all Medicaid claims in this category.
Routine dental cleaning (prophylaxis) and oral examination. Includes scaling, polishing, and assessment of oral health.
Understanding these costs
The amounts shown are Medicaid reimbursement rates — what state Medicaid programs paid providers per claim. Medicaid typically pays well below private insurance rates and out-of-pocket prices. Use this data to compare relative costs between providers, not as a price estimate for privately insured or self-pay patients.
Providers Offering Dental Cleaning & Exam in Pomona, CA
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Larissa Gushansky, Dds Inc.
887 E 2Nd St Ste D |
$0.00 | 12 | 12 |
|
Xiangxiang Jiang
54 Carriage Way |
$54.17 | 12 | 12 |
|
Cohen Sedgh, Manavi & Pakravan Dental Corporation
763 Rio Rancho Road Suite120 |
$0.00 | 73 | 57 |
|
Wael Sameer Victor
763 Rio Rancho Rd Ste 120 |
$63.99 | 102 | 102 |
|
Minh T Nguyen
1151 E Holt Ave Ste R |
$55.30 | 211 | 211 |
|
Sandy Charito Gramajo Cifuentes
510 E 3Rd St Apt 411 |
$70.93 | 309 | 309 |
|
Ha Nhi Tran
667 N Indian Hill Blvd |
$43.19 | 336 | 335 |
|
Moller Awad
309 E 2Nd St |
$47.32 | 392 | 391 |
|
Van Kim Nguyen
1182 E Holt Ave |
$56.33 | 416 | 416 |
|
Shailesh Manharlal Butala
744 E Holt Ave |
$63.56 | 437 | 437 |
|
Bella C. Manchandia
551 E Holt Ave |
$25.07 | 467 | 459 |
|
Anthony D Nguyen
1290 N Garey Ave |
$45.43 | 666 | 660 |
|
Dilshad Abtin
180 E Mission Blvd |
$54.13 | 666 | 665 |
|
Darmawan Pribadi
1051 South Garey Avenue |
$50.72 | 780 | 778 |
|
Armen Mardirosian
180 E Mission Blvd Suite A |
$48.77 | 842 | 841 |
|
Laura De Lopez
1320 N Garey Ave |
$54.87 | 909 | 908 |
|
Abrahim Mustafa D.D.S.,Inc.
2280 S Garey Ave |
$0.00 | 1,035 | 1,019 |
|
Hyun-Joo Kang
1887 Wright St |
$0.00 | 1,125 | 1,125 |
|
Kent Hung
520 E Foothill Blvd Ste B |
$60.39 | 1,280 | 1,261 |
|
Homa Badihan
3292 N Garey Ave |
$52.51 | 1,476 | 1,467 |
|
Nhu Quynh Chau
1182 E Holt Ave |
$63.30 | 1,505 | 1,497 |
|
Steve Siwoo Lee
850 Indian Hill Blvd |
$43.02 | 1,772 | 1,764 |
|
Noor Kassem
2071 Rancho Valley Dr Ste 140 |
$54.50 | 2,207 | 2,191 |
|
Ublester Gomez
12 Rancho Camino Dr |
$55.09 | 3,492 | 3,474 |
|
Hernando Suarez Ayora
2280 S Garey Ave |
$37.67 | 4,247 | 4,227 |
|
Pravinchandra K Makadia
826 E Mission Blvd |
$58.40 | 4,542 | 4,533 |
|
Bhavin Chatrabhuj Changela
2407 Valley Blvd |
$55.12 | 4,861 | 4,841 |
|
Andre Widodo
2112 S Garey Ave Ste A |
$55.22 | 5,114 | 5,088 |
|
Rita Lui
175 W La Verne Ave |
$35.87 | 5,145 | 4,899 |
|
Jeffrey Lee
2112 S Garey Ave Ste A |
$45.31 | 5,333 | 5,286 |
|
Elizabeth A Andrews
795 East Second Street |
$72.10 | 6,652 | 6,624 |
|
Yvonne Shu Rodriguez
1640 Indian Hill Blvd |
$55.79 | 6,799 | 6,780 |
|
Jing Chen
430 W Holt Ave Ste E |
$63.83 | 8,762 | 8,713 |
|
Mai Thi Nguyen-Tu
1922 S Garey Ave |
$49.03 | 8,786 | 8,648 |
|
John Jongcheol Park
819 E Mission Blvd |
$60.78 | 9,170 | 9,139 |
|
Evelyn Pham
1151 E Holt Ave |
$56.33 | 10,079 | 10,020 |
|
Kim-Phung Thi Ha
756 E Holt Ave |
$49.75 | 10,133 | 10,066 |
|
Manar Jamal
2005 W Holt Ave |
$54.22 | 13,579 | 13,509 |
|
Steven William Friedrichsen
795 E Second Street |
$51.32 | 14,948 | 14,831 |
|
Abrahim Abdul Mustafa
2280 S Garey Ave |
$48.82 | 15,929 | 15,846 |
|
David A Choi
920 N Garey Ave |
$57.35 | 21,443 | 21,339 |
|
James Bell
1555 S Garey Ave |
$47.71 | 24,226 | 23,846 |
|
Sheila Therese Aquino Amisola
1021 E Holt Ave |
$41.34 | 24,418 | 24,279 |
|
Hesham Mahmoud Hassan
408 W Grove St |
$43.70 | 26,318 | 26,182 |
|
Ki Hun Sung
819 E Mission Blvd |
$40.82 | 26,946 | 26,822 |
|
Estelle Hwei-Wan Liou
1524 N Orange Grove Ave |
$50.64 | 35,169 | 34,938 |
What to Expect: Dental Cleaning & Exam
A dental cleaning typically takes 30-60 minutes. A dental hygienist removes plaque and tartar from your teeth using specialized tools, then polishes your teeth. The dentist performs an oral exam to check for cavities, gum disease, and other conditions. X-rays may be taken. Most people need cleanings every 6 months.
Cost Components
National average Medicaid payment per billing code. Individual rates vary by provider and state.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation | $28.00 | 136,235,319 | 64,580 |
| D1120 | Child prophylaxis cleaning | $33.46 | 108,321,764 | 53,285 |
| D1110 | Adult prophylaxis cleaning | $43.53 | 58,293,656 | 54,558 |
| D0150 | Comprehensive oral evaluation | $37.52 | 46,846,802 | 53,166 |
| D0140 | Limited oral evaluation | $30.78 | 25,779,640 | 37,203 |
| D0145 | Oral eval patient <3 yrs | $77.14 | 5,590,205 | 11,270 |
| D0160 | Detailed oral evaluation | $41.80 | 694,698 | 945 |
| D0180 | Comprehensive perio evaluation | $25.65 | 198,480 | 674 |
| D0170 | Re-evaluation limited problem | $25.76 | 164,602 | 581 |
These are national Medicaid averages for each billing code. Actual amounts vary by state, provider, and complexity.
Frequently Asked Questions
How much does a Dental Cleaning & Exam cost in Pomona, CA?
Based on public Medicaid payment data, the average Medicaid reimbursement for Dental Cleaning & Exam in Pomona, CA is $49.69 per claim, based on 313,121 claims from 46 providers. Typical payments fall between $25.53 and $40.26. Note: Medicaid rates are typically much lower than private insurance or self-pay prices.
How many providers offer Dental Cleaning & Exam in Pomona, CA?
There are 46 Medicaid providers offering Dental Cleaning & Exam related services in Pomona, CA according to public payment data.
What is the price range for Dental Cleaning & Exam in Pomona, CA?
Medicaid reimbursement for Dental Cleaning & Exam in Pomona, CA ranges from $0.00 to $72.10 per claim, with an average of $49.69. Private insurance and self-pay costs are typically higher than these Medicaid rates.
Dental Cleaning & Exam in Other Cities
Brooklyn, NY
Avg $29.76
5,899,905 claims · 889 providers
Chicago, IL
Avg $29.66
4,929,791 claims · 823 providers
Los Angeles, CA
Avg $49.60
3,990,780 claims · 877 providers
Houston, TX
Avg $39.95
3,744,881 claims · 918 providers
Bronx, NY
Avg $31.12
3,317,284 claims · 478 providers
New York, NY
Avg $30.52
3,240,448 claims · 723 providers
Phoenix, AZ
Avg $11.18
2,295,389 claims · 350 providers
San Antonio, TX
Avg $40.74
2,116,599 claims · 429 providers
Other Procedures in Pomona, CA
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Avg $3.21
4,565,012 claims
Office Visit
Avg $29.82
1,091,740 claims
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Avg $1.47
848,645 claims
Physical Therapy
Avg $34.06
464,973 claims
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Avg $64.29
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Emergency Room Visit
Avg $72.32
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X-Ray
Avg $10.26
271,954 claims
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Avg $4.70
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