COVERAGE · MONTANASHEET 27 / 51

Montana, measured.

1,282 licensed dental providers on record, refreshed monthly from the federal registry. The Medicaid floors below come from the official state fee-for-service schedule, published without a stated effective date; figures reflect the current edition (view the source document). Practice costs index at 1.000 against the 1.000 national baseline.

EFFECTIVE NOT STATED · FLOORS 24 OF 25 CODES Official schedule on file
1,282Licensed providers
24Medicaid fee rows
1.000Geo cost index / 1.000
$23.71 to $3,596.32Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Montana fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$27.66$43$60$93
Comprehensive exam (new patient)$39.52$72$100$155
Full-mouth X-ray series$79.04$115$160$232
Bitewing X-rays (set of 4)$39.52$50$70$102
Panoramic X-ray$63.23$101$140$203
Emergency
Emergency visit for pain relief$79.04$104$145$225
Endodontics
Root canal, front tooth$403.10$684$950$1,472
Root canal, molar$553.28$922$1,280$1,984
Implants
Dental implant placementNo published floor$1,476$2,050$3,178
Oral surgery
Simple tooth extraction$86.94$140$195$302
Surgical tooth extraction$158.08$238$330$512
Orthodontics
Full braces treatment, adolescent$3,596.32$4,104$5,700$7,695
Periodontics
Deep cleaning below gumline (per quadrant)$197.60$184$255$395
Ongoing gum maintenance visit$79.04$115$160$248
Preventive
Adult teeth cleaning$59.28$76$105$163
Child teeth cleaning$39.52$58$80$124
Fluoride varnish treatment$23.71$36$50$78
Protective tooth sealant$31.62$40$55$85
Restorative
Metal filling (1 surface)$79.04$112$155$240
Tooth-colored filling, front tooth$79.04$140$195$302
Tooth-colored filling, back tooth (1 surface)$79.04$151$210$326
Tooth-colored filling, back tooth (2 surfaces)$158.08$180$250$388
Ceramic crown$790.40$1,008$1,400$2,170
Porcelain-on-metal crown$869.44$828$1,150$1,782
Crown foundation buildup$158.08$216$300$465

Floor. Official Montana Medicaid fee-for-service dental schedule, current edition, no stated effective date. View the source document.

Bands. Modeled: the national median billed charge for each procedure, scaled by the Montana geographic cost index (1.000 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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