COVERAGE · DISTRICT OF COLUMBIASHEET 09 / 51

District of Columbia, measured.

1,320 licensed dental providers on record, refreshed monthly from the federal registry. The Medicaid floors below come from the official state fee-for-service schedule, effective October 1, 2025 (view the source document). Practice costs index at 1.112 against the 1.000 national baseline.

EFFECTIVE OCTOBER 1, 2025 · FLOORS 25 OF 25 CODES Official schedule on file
1,320Licensed providers
25Medicaid fee rows
1.112Geo cost index / 1.000
$30.77 to $5,000Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The District of Columbia fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$33.75$48$67$104
Comprehensive exam (new patient)$73.20$80$111$172
Full-mouth X-ray series$99.17$128$178$258
Bitewing X-rays (set of 4)$40.31$56$78$113
Panoramic X-ray$74.46$112$156$226
Emergency
Emergency visit for pain relief$68$116$161$250
Endodontics
Root canal, front tooth$398$760$1,056$1,637
Root canal, molar$582$1,025$1,423$2,206
Implants
Dental implant placement$652.45$1,642$2,280$3,534
Oral surgery
Simple tooth extraction$143.47$156$217$336
Surgical tooth extraction$176.53$264$367$569
Orthodontics
Full braces treatment, adolescent$5,000$4,563$6,338$8,556
Periodontics
Deep cleaning below gumline (per quadrant)$148.53$204$284$440
Ongoing gum maintenance visit$70$128$178$276
Preventive
Adult teeth cleaning$73.20$84$117$181
Child teeth cleaning$51.88$64$89$138
Fluoride varnish treatment$30.77$40$56$87
Protective tooth sealant$44.52$44$61$95
Restorative
Metal filling (1 surface)$72$124$172$267
Tooth-colored filling, front tooth$102.85$156$217$336
Tooth-colored filling, back tooth (1 surface)$113.87$168$234$363
Tooth-colored filling, back tooth (2 surfaces)$146.92$200$278$431
Ceramic crown$689.59$1,121$1,557$2,413
Porcelain-on-metal crown$689.59$921$1,279$1,982
Crown foundation buildup$220$240$334$518

Floor. Official District of Columbia Medicaid fee-for-service dental schedule, effective October 1, 2025. View the source document.

Bands. Modeled: the national median billed charge for each procedure, scaled by the District of Columbia geographic cost index (1.112 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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