Aims To explore the current landscape of NHS primary dental care services for fee-exempt adult patients and observe attendance, band claiming and geographical patterns.Materials and methods Data were analysed from FP17 claims submitted to NHS Business Services Authority from 2006-2019.Results Fee-exempt adult patients in 2018-2019 account for 23.7% of all adult claims in NHS primary dental care . This percentage has decreased year-on-year since 2011-2012 from 31.5% . In 2018-2019, there were significantly fewer band 1 claims for fee-exempt adult patients (36.0 %) compared to their fee-paying counterparts (58.3 %). Treatment needs appear to be higher for fee-exempt adult patients since more band 2 and 3 treatment claims were completed (49.0 %) compared to fee-payers (30.8 %). Band 3 claims were three times higher for fee-exempt adult patients.Discussion Adults with fee exemptions must be able to access timely oral health services since they appear to have higher treatment needs than fee-payers . The areas with the highest proportion of fee-exempt adult patients reflect relative levels of deprivation across regions in England . Barriers to access must be reduced to fully engage all groups of patients and improve oral health.Conclusion Oral health inequalities appear to exist between fee-paying and fee-exempt adult patients . The post-pandemic world will offer a unique opportunity to reassess NHS dental services.