COVERAGE · NEBRASKASHEET 28 / 51

Nebraska, measured.

2,410 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, 2026 (view the source document). Practice costs index at 0.940 against the 1.000 national baseline.

EFFECTIVE JANUARY 1, 2026 · FLOORS 23 OF 25 CODES Official schedule on file
2,410Licensed providers
23Medicaid fee rows
0.940Geo cost index / 1.000
$25.72 to $459.90Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Nebraska fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$29.77$40$56$87
Comprehensive exam (new patient)$29.77$68$94$146
Full-mouth X-ray series$60.89$108$150$218
Bitewing X-rays (set of 4)$25.72$48$66$96
Panoramic X-ray$48.69$95$132$191
Emergency
Emergency visit for pain relief$31.12$98$136$211
Endodontics
Root canal, front tooth$328.70$643$893$1,384
Root canal, molar$451.78$866$1,203$1,865
Implants
Dental implant placementNo published floor$1,387$1,927$2,987
Oral surgery
Simple tooth extraction$89.27$132$183$284
Surgical tooth extraction$125.81$223$310$480
Orthodontics
Full braces treatment, adolescentNo published floor$3,858$5,358$7,233
Periodontics
Deep cleaning below gumline (per quadrant)$135.26$173$240$372
Ongoing gum maintenance visit$39.23$108$150$232
Preventive
Adult teeth cleaning$44.64$71$99$153
Child teeth cleaning$35.17$54$75$116
Fluoride varnish treatment$27.06$34$47$73
Protective tooth sealant$33.82$37$52$81
Restorative
Metal filling (1 surface)$67.64$105$146$226
Tooth-colored filling, front tooth$78.46$132$183$284
Tooth-colored filling, back tooth (1 surface)$79.81$142$197$305
Tooth-colored filling, back tooth (2 surfaces)$101.45$169$235$364
Ceramic crown$459.90$948$1,316$2,040
Porcelain-on-metal crown$459.90$778$1,081$1,676
Crown foundation buildup$98.75$203$282$437

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

Bands. Modeled: the national median billed charge for each procedure, scaled by the Nebraska geographic cost index (0.940 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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