Caries Risk Assessment (Under 6) (D0422) — National Rates

Negotiated reimbursement rates for D0422 across 7 states, sourced from CMS Transparency in Coverage data. 44 rate records.

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National Average Negotiated Rate
$62
44 rate records · 7 states
📊 Data updated monthly · Last refresh: March 2026

About D0422 — Caries Risk Assessment (Under 6)

D0422 refers to a caries risk assessment for patients under the age of 6. This assessment involves evaluating a child's risk factors for developing dental caries, including dietary habits, oral hygiene practices, and family history. Clinical indications include preventive care and early intervention strategies. Documentation must include the assessment findings, risk factors identified, and any recommendations made to the caregiver. Reimbursement for this service can vary by payor, with some plans offering coverage as part of preventive care for young children. The average reimbursement for this code is approximately $62.

Reimbursement rates for D0422 vary significantly by state, payor, and provider network. The national average negotiated rate is $62. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.

Top Paying States for D0422

California
$66
2 records
New Jersey
$63
1 records
New York
$61
31 records

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Full National Breakdown

Median
$63
Low
$48
High
$100

Highest & Lowest Reimbursement States

↑ Top 5

StateAvg Rate
California$66
New Jersey$63
New York$61
Nevada$59
Pennsylvania$59

↓ Bottom 5

StateAvg Rate
New York$61
Nevada$59
Pennsylvania$59
Wisconsin$58
Texas$54

All States — D0422 Average Rates

California
$66
New Jersey
$63
New York
$61
Nevada
$59
Pennsylvania
$59
Wisconsin
$58
Texas
$54
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State-by-State Comparison Table

StateAverageMedianMinMaxRecords
California$66$66$57$742
New Jersey$63$63$63$631
New York$61$63$48$7031
Nevada$59$59$58$614
Pennsylvania$59$59$51$672
Wisconsin$58$58$58$581
Texas$54$54$54$541
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