The album moved roughly 121,000 total album-equivalent units in its first week, made up of 98,000 SEA units (127.82 million on-demand streams), 21,000 album sales and 2,000 TEA units. Twelve Carat Toothache was initially released as a 14-track album on June 3, with a deluxe version featuring two extra songs then dropping on June 7.
With features from Roddy Ricch, Doja Cat, Gunna, The Weeknd, The Kid LAROI and Fleet Foxes, the album serves as Post Malone’s fourth straight Top 5 album. In comparison, his last album Hollywood’s Bleeding debuted at No. 1 on the Billboard 200 in September 2019 with roughly 489,000 total album-equivalent units, spending five weeks in the top spot.