COVERAGE · HAWAIISHEET 12 / 51

Hawaii, measured.

2,096 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 April 1, 2026 (view the source document). Practice costs index at 1.045 against the 1.000 national baseline.

EFFECTIVE APRIL 1, 2026 · FLOORS 24 OF 25 CODES Official schedule on file
2,096Licensed providers
24Medicaid fee rows
1.045Geo cost index / 1.000
$24.66 to $5,044Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Hawaii fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$29.12$45$63$98
Comprehensive exam (new patient)$40.92$75$104$161
Full-mouth X-ray series$60.54$120$167$242
Bitewing X-rays (set of 4)$31.38$53$73$106
Panoramic X-ray$56.34$105$146$212
Emergency
Emergency visit for pain relief$59.28$109$152$236
Endodontics
Root canal, front tooth$308.76$715$993$1,539
Root canal, molar$469.20$963$1,338$2,074
Implants
Dental implant placementNo published floor$1,542$2,142$3,320
Oral surgery
Simple tooth extraction$67.60$147$204$316
Surgical tooth extraction$145.60$248$345$535
Orthodontics
Full braces treatment, adolescent$5,044$4,288$5,956$8,041
Periodontics
Deep cleaning below gumline (per quadrant)$102.77$192$266$412
Ongoing gum maintenance visit$84.87$120$167$259
Preventive
Adult teeth cleaning$43.53$79$110$170
Child teeth cleaning$29.46$60$84$130
Fluoride varnish treatment$24.66$37$52$81
Protective tooth sealant$28.25$41$57$88
Restorative
Metal filling (1 surface)$51.48$117$162$251
Tooth-colored filling, front tooth$63.60$147$204$316
Tooth-colored filling, back tooth (1 surface)$98.96$158$219$339
Tooth-colored filling, back tooth (2 surfaces)$129.89$188$261$405
Ceramic crown$543.72$1,053$1,463$2,268
Porcelain-on-metal crown$536.52$865$1,202$1,863
Crown foundation buildup$112$226$314$487

Floor. Official Hawaii Medicaid fee-for-service dental schedule, effective April 1, 2026. View the source document.

Bands. Modeled: the national median billed charge for each procedure, scaled by the Hawaii geographic cost index (1.045 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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