1
Payer networks with rates on file
19
Unique CDT codes with contracted rates
Contracted Rates by Network
Source: CMS Transparency in Coverage MRF data. First 3 codes per network shown. Full rate table available with Pro access.
Aetna
19 codes on file
| CDT Code | Procedure | Contracted Rate |
|---|---|---|
D0120 |
Periodic Oral Evaluation | $19.00 |
D0140 |
Limited Oral Evaluation | $32.00 |
D0150 |
Comprehensive Oral Eval | $33.00 |
D0160 |
D0160 | $0,000 |
D0170 |
D0170 | $0,000 |
D0180 |
D0180 | $0,000 |
D0210 |
Full Mouth X-rays | $0,000 |
D0220 |
D0220 | $0,000 |
D0230 |
D0230 | $0,000 |
D0240 |
D0240 | $0,000 |
D0270 |
D0270 | $0,000 |
D0273 |
D0273 | $0,000 |
D0274 |
Bitewing X-rays (4 images) | $0,000 |
D0277 |
D0277 | $0,000 |
D0330 |
Panoramic X-ray | $0,000 |
D0340 |
D0340 | $0,000 |
D0350 |
D0350 | $0,000 |
D0364 |
D0364 | $0,000 |
D0365 |
D0365 | $0,000 |
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Rate data sourced from machine-readable files (MRFs) as required under the CMS Transparency in Coverage final rule (45 CFR §147.211). Reflects contracted rates as reported by the payer. DSO affiliation detected via NPPES organization name matching. PayorMap is not affiliated with any insurer, DSO, or dental provider.
Data Coverage
CMS MRF · Updated April 2026
Aetna
✓ On file
Highmark
No data
UnitedHealthcare
No data
Cigna, Delta Dental, Humana, and MetLife coming soon.