COVERAGE · MASSACHUSETTSSHEET 22 / 51

Massachusetts, measured.

13,188 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 1, 2024 (view the source document). Practice costs index at 1.064 against the 1.000 national baseline.

EFFECTIVE JUNE 1, 2024 · FLOORS 25 OF 25 CODES Official schedule on file
13,188Licensed providers
25Medicaid fee rows
1.064Geo cost index / 1.000
$24 to $1,302Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Massachusetts fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$24$46$64$99
Comprehensive exam (new patient)$41$76$106$164
Full-mouth X-ray series$76$122$170$246
Bitewing X-rays (set of 4)$36$53$74$107
Panoramic X-ray$69$107$149$216
Emergency
Emergency visit for pain relief$36$111$154$239
Endodontics
Root canal, front tooth$544$728$1,011$1,567
Root canal, molar$829$981$1,362$2,111
Implants
Dental implant placement$1,151$1,570$2,181$3,381
Oral surgery
Simple tooth extraction$77$149$207$321
Surgical tooth extraction$149$253$351$544
Orthodontics
Full braces treatment, adolescent$1,302$4,367$6,065$8,188
Periodontics
Deep cleaning below gumline (per quadrant)$134$195$271$420
Ongoing gum maintenance visit$80$122$170$264
Preventive
Adult teeth cleaning$60$81$112$174
Child teeth cleaning$55$61$85$132
Fluoride varnish treatment$28$38$53$82
Protective tooth sealant$44$42$59$91
Restorative
Metal filling (1 surface)$62$119$165$256
Tooth-colored filling, front tooth$72$149$207$321
Tooth-colored filling, back tooth (1 surface)$62$161$223$346
Tooth-colored filling, back tooth (2 surfaces)$77$192$266$412
Ceramic crown$729$1,073$1,490$2,310
Porcelain-on-metal crown$800$881$1,224$1,897
Crown foundation buildup$164$230$319$494

Floor. Official Massachusetts Medicaid fee-for-service dental schedule, effective June 1, 2024. View the source document.

Bands. Modeled: the national median billed charge for each procedure, scaled by the Massachusetts geographic cost index (1.064 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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