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Periodic Oral Evaluation

Indiana rates for HCPCS D0120

A routine check-up exam for a patient who has already been seen by the dental practice, usually done at recall visits every so often. The dentist checks for new cavities, gum changes, and overall oral health, and compares findings to prior visits. It is shorter than a full first-time evaluation since the patient's history is already on file.

Rates data updated October 2026.

How much does Periodic Oral Evaluation cost?

$22.91

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $22.91 for this service. The price depends on where it is billed: about $22.91 from a physician practice, and about $550 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$22.91$16.22 to $22.91
FacilityA hospital or hospital-owned outpatient department$550$39.81 to $955

How much rates vary

Facilitymedian $550 · 10th to 90th $17 to $2,089Professionalmedian $23 · 10th to 90th $12 to $26
$20$50$100$200$500$1K$2Kfacility $550professional $23

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$12.30
Median
$12.30
Typical High
$17.38
Aetna
Setting
Professional
Modifier
None
Typical Low
$12.30
Median
$12.30
Typical High
$17.38
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$22.91
Median
$407.38
Typical High
$549.54
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$22.91
Median
$22.91
Typical High
$28.84
Cigna
Setting
Professional
Modifier
None
Typical Low
$12.88
Median
$15.49
Typical High
$15.49
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$912.01
Median
$954.99
Typical High
$2,187.76
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$16.22
Median
$22.39
Typical High
$37.15
United
Setting
Professional
Modifier
None
Typical Low
$19.95
Median
$28.84
Typical High
$36.31

Where Indiana sits

The same service costs 4.9 times more in Minnesota than in West Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Indiana· 27th of 51

$22.91

MN $54.95WV $11.22

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.