COVERAGE · CALIFORNIASHEET 05 / 51

California, measured.

58,313 licensed dental providers on record, refreshed monthly from the federal registry. The Medicaid floors below come from the official state fee-for-service schedule, published without a stated effective date; figures reflect the current edition (view the source document). Practice costs index at 1.082 against the 1.000 national baseline.

EFFECTIVE NOT STATED · FLOORS 22 OF 25 CODES Official schedule on file
58,313Licensed providers
22Medicaid fee rows
1.082Geo cost index / 1.000
$6 to $750Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The California fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$15$47$65$101
Comprehensive exam (new patient)$25$78$108$167
Full-mouth X-ray series$40$125$173$251
Bitewing X-rays (set of 4)$18$55$76$110
Panoramic X-ray$25$109$151$219
Emergency
Emergency visit for pain relief$45$113$157$243
Endodontics
Root canal, front tooth$216$740$1,028$1,593
Root canal, molar$331$997$1,385$2,147
Implants
Dental implant placementNo published floor$1,597$2,218$3,438
Oral surgery
Simple tooth extraction$41$152$211$327
Surgical tooth extraction$85$257$357$553
Orthodontics
Full braces treatment, adolescent$750$4,440$6,167$8,325
Periodontics
Deep cleaning below gumline (per quadrant)$50$199$276$428
Ongoing gum maintenance visit$55$125$173$268
Preventive
Adult teeth cleaning$40$82$114$177
Child teeth cleaning$30$63$87$135
Fluoride varnish treatment$6$39$54$84
Protective tooth sealant$22$43$60$93
Restorative
Metal filling (1 surface)$39$121$168$260
Tooth-colored filling, front tooth$57.21$152$211$327
Tooth-colored filling, back tooth (1 surface)$39$163$227$352
Tooth-colored filling, back tooth (2 surfaces)$48$194$270$418
Ceramic crown$340$1,091$1,515$2,348
Porcelain-on-metal crownNo published floor$896$1,244$1,928
Crown foundation buildupNo published floor$234$325$504

Floor. Official California Medicaid fee-for-service dental schedule, current edition, no stated effective date. View the source document.

Bands. Modeled: the national median billed charge for each procedure, scaled by the California geographic cost index (1.082 against a 1.000 national baseline), with the insurer-typical amount modeled at roughly 72 percent of area billed charges. Estimates, not quotes.

HOW TO READ IT

Reading this table

The Medicaid floor is the exact fee on the state schedule: the lowest rate a practice accepts for that procedure, and the anchor of the revenue spectrum. Insurer typical models what a commercial plan tends to allow, about 72 percent of area billed charges. Private-pay p50 and p90 are modeled billed-charge bands: the national median scaled by the state cost index, and the top of the usual range. Where a practice actually lands depends on its payer mix. The floor is owned data; the bands are estimates.

CROSS REFERENCE
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