COVERAGE · INDIANASHEET 15 / 51

Indiana, measured.

6,909 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 June 9, 2026 (view the source document). Practice costs index at 0.947 against the 1.000 national baseline.

EFFECTIVE JUNE 9, 2026 · FLOORS 20 OF 25 CODES Official schedule on file
6,909Licensed providers
20Medicaid fee rows
0.947Geo cost index / 1.000
$26.48 to $3,875.59Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Indiana fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$29.40$41$57$88
Comprehensive exam (new patient)$51.44$68$95$147
Full-mouth X-ray series$74.81$109$152$220
Bitewing X-rays (set of 4)$36.76$48$66$96
Panoramic X-ray$64.28$96$133$193
Emergency
Emergency visit for pain reliefNo published floor$99$137$212
Endodontics
Root canal, front tooth$517.30$648$900$1,395
Root canal, molar$719.77$873$1,212$1,879
Implants
Dental implant placementNo published floor$1,398$1,941$3,009
Oral surgery
Simple tooth extraction$137.15$133$185$287
Surgical tooth extraction$200.86$225$313$485
Orthodontics
Full braces treatment, adolescent$3,875.59$3,887$5,398$7,287
Periodontics
Deep cleaning below gumline (per quadrant)$192.65$174$241$374
Ongoing gum maintenance visit$102.03$109$152$236
Preventive
Adult teeth cleaning$62.05$71$99$153
Child teeth cleaning$46.34$55$76$118
Fluoride varnish treatment$26.48$34$47$73
Protective tooth sealant$32.62$37$52$81
Restorative
Metal filling (1 surface)$63.47$106$147$228
Tooth-colored filling, front tooth$76.06$133$185$287
Tooth-colored filling, back tooth (1 surface)$82.45$143$199$308
Tooth-colored filling, back tooth (2 surfaces)$104.53$171$237$367
Ceramic crownNo published floor$955$1,326$2,055
Porcelain-on-metal crownNo published floor$784$1,089$1,688
Crown foundation buildupNo published floor$204$284$440

Floor. Official Indiana Medicaid fee-for-service dental schedule, effective June 9, 2026. View the source document.

Bands. Modeled: the national median billed charge for each procedure, scaled by the Indiana geographic cost index (0.947 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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