D0120 Dental Code: Periodic oral exam Cost in 2026

What D0120 means on your bill

D0120 is the code for a periodic oral exam: the routine check-up a dentist performs on a patient already on file, distinct from the more thorough exam given to someone new to the practice. Most offices schedule it twice a year, alongside a cleaning (D1110) and bitewing X-rays, so the codes usually appear together on one claim. A patient returning after a long gap, or with an unresolved issue from before, may instead get a different, more comprehensive exam code carrying a different fee. Because D0120 assumes an established, routine patient, using it in place of a more thorough exam code changes both the cost and how a plan classes the visit. Guide: teeth cleaning and exam cost.

D0120 cost: cash fair price vs what Medicaid paid (2026)

D0120 is one of the least expensive codes on this site, and the chart shows why prevention pays: the cash fair price runs $50–$350, typical $203, for a visit built around checking for problems rather than treating them. Medicaid paid dentists a national average of $30 per claim line across 48,171,895 claim lines in 2023-2024, a gap of 6.7x against the cash figure, small in dollars but still real. That paid amount is the program's weighted-average payment to the dentist, drawn from HHS T-MSIS, not what an enrolled patient owes. Only about 20% of active dentists billed Medicaid at all in 2023-2024, so access matters as much as the fee.

What Medicaid paid dentists for D0120, by state (2023-2024)

46 states publish a figure for D0120 below; the rest fail the data-quality gate or report too few claim lines to average reliably. The highest payment is $86 in Alaska, the lowest $6 in Idaho, a range wide relative to the size of the fee itself. The cash column beside each state is that state's independent average outside insurance, shown for comparison, not derived from the Medicaid number. A generous Medicaid payment for a routine exam in a given state does not mean that state covers adult dental care broadly; see Medicaid adult dental by state for what is actually covered. These figures are specific to the exam code alone. A periodic exam is where a state's official schedule and its paid figure sit closest: New Jersey prints $17, Wyoming $39 (unchanged since April 2023) and Ohio $34, so the Fee ÷ paid column reads close to 1 where fee-for-service dominates.

Medicaid paid: per claim line, weighted average 2023-2024, derived from HHS T-MSIS Medicaid provider spending (Real Dental Costs, DOI 10.7910/DVN/7F2BZI); states with a data-quality flag or too few lines are omitted. Official Medicaid fee: the fee-for-service rate for this code on the state's published Medicaid dental fee schedule (captured for Illinois, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, Texas, Wyoming; effective dates, source URLs and file hashes in the API file); "—" where no schedule was captured or the code is not on it. Michigan publishes $34 on its schedule but has no publishable paid row here (its Medicaid claims cannot be geolocated). Fee and paid differ by design: paid mixes managed-care encounters, reduced and bundled lines and 2023-2024 rates, while the schedule is the current fee-for-service rate. Schedule notes: Illinois: first two fee columns captured (fee_usd = first column); New Jersey: fee_usd = specialist adult column; fee_alt_usd = non-specialist adult column (child columns not captured); Ohio: first two fee columns captured (fee_usd = first column); Texas: no single effective date printed on the schedule; fee = most frequent non-zero rate across provider types; Wyoming: XLSX master schedule substituted for the ADA-indexed PDF (which carries no dental codes); effective date = latest active rate begin date. Cash: Real Dental Costs procedure API, periodic oral exam proxy = Exam, cleaning & X-rays (basis estimated). Program payments, not patient bills; not a quote.

How insurance classes D0120

Plans almost always class D0120 as preventive, reimbursed at 100% with no deductible, subject only to a frequency limit, typically twice a year. Because it is fully covered so often, a pre-treatment estimate rarely matters for D0120 itself, though it becomes useful the moment a comprehensive or problem-focused exam replaces the routine one. The annual maximum, commonly $1,000-$2,000 for the year, is set up so preventive visits like this one do not eat into the room left for restorative work later on. If an office bills a different exam code than expected, ask whether the visit was still routine. Coverage explained: dental insurance guide.

Chains, schools and where D0120 costs less

Aspen Dental publishes $80 on average for a new-patient exam with X-rays, offered as an introductory price ($29-$150), which is not the same visit as the established-patient exam priced above and often carries different terms. Dental school clinics, staffed by supervised students, typically run 30-60% below private-practice fees for routine exams; see dental school cost. Every other procedure price tracked on this site is listed at every procedure price. Cash averages for this exam range from $170 in Alabama to $260 in California.

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