Average Medicaid Dental Cleaning & Exam Payments
Typical Medicaid Dental Cleaning & Exam reimbursement across 8,581 cities
Avg. Medicaid Paid
$34.13
Price Range
$0.00 – $576.79
Total Claims
361.6M
Cities
8581
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.
About This Procedure
Routine dental cleaning (prophylaxis) and oral examination. Includes scaling, polishing, and assessment of oral health.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Bay City, MI | $55.56 | $21.31 – $117.95 | 70,040 | 28 |
| Tamarac, FL | $23.97 | $11.51 – $52.63 | 70,034 | 13 |
| Cheraw, SC | $32.34 | $31.98 – $34.21 | 70,025 | 5 |
| Columbus, GA | $26.31 | $6.75 – $58.33 | 69,676 | 15 |
| Streetsboro, OH | $24.32 | $18.10 – $40.41 | 69,541 | 9 |
| Ithaca, NY | $40.00 | $10.09 – $61.95 | 69,490 | 12 |
| Wethersfield, CT | $31.71 | $24.59 – $39.55 | 69,489 | 12 |
| San Mateo, CA | $45.05 | $24.91 – $76.51 | 69,467 | 27 |
| Burlington, VT | $36.85 | $0.00 – $104.43 | 69,421 | 26 |
| Sunnyvale, CA | $43.49 | $0.00 – $82.98 | 69,399 | 21 |
| Rainsville, AL | $25.02 | $24.84 – $26.80 | 69,380 | 3 |
| Hilo, HI | $44.66 | $31.50 – $179.15 | 69,313 | 15 |
| Victoria, TX | $42.40 | $25.13 – $120.21 | 69,284 | 10 |
| Grand Blanc, MI | $37.46 | $23.67 – $61.88 | 69,272 | 25 |
| Morehead, KY | $37.14 | $17.14 – $48.64 | 69,259 | 12 |
| Bluffton, SC | $33.38 | $27.00 – $39.55 | 69,238 | 10 |
| Naranjito, PR | $20.78 | $14.97 – $26.26 | 69,059 | 12 |
| Matthews, NC | $30.17 | $0.00 – $39.91 | 69,038 | 23 |
| Egg Harbor Township, NJ | $27.77 | $24.88 – $43.60 | 69,016 | 8 |
| Joplin, MO | $36.59 | $18.01 – $109.92 | 68,929 | 18 |
| Springfield, VA | $27.69 | $0.00 – $49.79 | 68,886 | 26 |
| Flowood, MS | $25.64 | $1.29 – $37.41 | 68,852 | 14 |
| Corona Del Mar, CA | $48.45 | $31.40 – $65.19 | 68,815 | 4 |
| Brooklyn, OH | $26.26 | $22.32 – $26.56 | 68,719 | 2 |
| Temple City, CA | $52.86 | $33.85 – $86.25 | 68,697 | 18 |
| New Lexington, OH | $23.26 | $0.00 – $26.63 | 68,686 | 8 |
| Ironton, OH | $22.17 | $0.03 – $31.00 | 68,641 | 10 |
| Fort Wayne, IN | $34.95 | $13.83 – $73.91 | 68,537 | 60 |
| Mandeville, LA | $34.91 | $19.54 – $41.40 | 68,514 | 12 |
| Saluda, SC | $33.01 | $31.92 – $33.92 | 68,458 | 5 |
| Georgetown, TX | $29.54 | $0.00 – $48.61 | 68,309 | 25 |
| Park Falls, WI | $34.54 | $16.81 – $45.56 | 68,305 | 7 |
| Garden City, KS | $33.68 | $18.66 – $151.07 | 68,155 | 14 |
| Jacksonville, AR | $32.61 | $27.94 – $32.93 | 68,080 | 8 |
| Stafford, VA | $22.29 | $0.00 – $57.36 | 68,076 | 19 |
| Chillicothe, OH | $23.41 | $0.00 – $55.16 | 67,922 | 19 |
| Burkesville, KY | $32.87 | $27.80 – $36.27 | 67,918 | 7 |
| Irmo, SC | $32.67 | $29.61 – $33.87 | 67,798 | 6 |
| Hermitage, TN | $34.26 | $22.14 – $93.00 | 67,780 | 17 |
| Shelby Township, MI | $35.79 | $22.09 – $52.21 | 67,646 | 27 |
| Gainesville, GA | $28.71 | $15.15 – $53.94 | 67,567 | 9 |
| Huber Heights, OH | $25.30 | $8.25 – $41.09 | 67,394 | 7 |
| Smithfield, NC | $30.35 | $0.00 – $38.79 | 67,373 | 21 |
| Stockbridge, GA | $26.23 | $23.20 – $42.38 | 67,294 | 7 |
| Keizer, OR | $27.97 | $0.00 – $35.33 | 67,241 | 10 |
| Lumberton, NC | $31.72 | $22.84 – $40.73 | 67,239 | 38 |
| Hendersonville, TN | $28.30 | $0.00 – $60.13 | 67,214 | 24 |
| Columbia, MO | $35.07 | $14.01 – $143.37 | 67,196 | 31 |
| Bonney Lake, WA | $29.73 | $0.00 – $42.23 | 67,070 | 7 |
| East Lansing, MI | $32.21 | $19.16 – $64.04 | 67,021 | 23 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| 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 averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.