COVERAGE · MAINESHEET 20 / 51

Maine, measured.

1,664 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 January 1, 2025 (view the source document). Practice costs index at 0.965 against the 1.000 national baseline.

EFFECTIVE JANUARY 1, 2025 · FLOORS 24 OF 25 CODES Official schedule on file
1,664Licensed providers
24Medicaid fee rows
0.965Geo cost index / 1.000
$26.58 to $3,172.63Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Maine fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$34.70$42$58$90
Comprehensive exam (new patient)$66.47$69$96$149
Full-mouth X-ray series$99.47$111$154$223
Bitewing X-rays (set of 4)$48$49$68$99
Panoramic X-ray$90.10$97$135$196
Emergency
Emergency visit for pain relief$72.12$101$140$217
Endodontics
Root canal, front tooth$626.25$660$917$1,421
Root canal, molar$995.07$889$1,235$1,914
Implants
Dental implant placementNo published floor$1,424$1,978$3,066
Oral surgery
Simple tooth extraction$119.50$135$188$291
Surgical tooth extraction$146.22$229$318$493
Orthodontics
Full braces treatment, adolescent$3,172.63$3,960$5,500$7,425
Periodontics
Deep cleaning below gumline (per quadrant)$165.80$177$246$381
Ongoing gum maintenance visit$105.17$111$154$239
Preventive
Adult teeth cleaning$71.34$73$101$157
Child teeth cleaning$54.65$55$77$119
Fluoride varnish treatment$26.58$35$48$74
Protective tooth sealant$33.23$38$53$82
Restorative
Metal filling (1 surface)$84.74$108$150$232
Tooth-colored filling, front tooth$84.74$135$188$291
Tooth-colored filling, back tooth (1 surface)$111.66$146$203$315
Tooth-colored filling, back tooth (2 surfaces)$134.26$174$241$374
Ceramic crown$616.19$973$1,351$2,094
Porcelain-on-metal crown$691.24$799$1,110$1,720
Crown foundation buildup$137.37$209$290$450

Floor. Official Maine Medicaid fee-for-service dental schedule, effective January 1, 2025. View the source document.

Bands. Modeled: the national median billed charge for each procedure, scaled by the Maine geographic cost index (0.965 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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