COVERAGE · RHODE ISLANDSHEET 40 / 51

Rhode Island, measured.

1,176 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 1.020 against the 1.000 national baseline.

EFFECTIVE NOT STATED · FLOORS 24 OF 25 CODES Official schedule on file
1,176Licensed providers
24Medicaid fee rows
1.020Geo cost index / 1.000
$18 to $2,000Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Rhode Island fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$21$44$61$95
Comprehensive exam (new patient)$40$73$102$158
Full-mouth X-ray series$74$117$163$236
Bitewing X-rays (set of 4)$35$51$71$103
Panoramic X-ray$67$103$143$207
Emergency
Emergency visit for pain relief$40$107$148$229
Endodontics
Root canal, front tooth$480$698$969$1,502
Root canal, molar$300$940$1,306$2,024
Implants
Dental implant placementNo published floor$1,506$2,091$3,241
Oral surgery
Simple tooth extraction$75$143$199$308
Surgical tooth extraction$149$243$337$522
Orthodontics
Full braces treatment, adolescent$2,000$4,186$5,814$7,849
Periodontics
Deep cleaning below gumline (per quadrant)$134$187$260$403
Ongoing gum maintenance visit$27$117$163$253
Preventive
Adult teeth cleaning$53$77$107$166
Child teeth cleaning$22$59$82$127
Fluoride varnish treatment$26$37$51$79
Protective tooth sealant$18$40$56$87
Restorative
Metal filling (1 surface)$62$114$158$245
Tooth-colored filling, front tooth$72$143$199$308
Tooth-colored filling, back tooth (1 surface)$62$154$214$332
Tooth-colored filling, back tooth (2 surfaces)$77$184$255$395
Ceramic crown$550$1,028$1,428$2,213
Porcelain-on-metal crown$550$845$1,173$1,818
Crown foundation buildup$164$220$306$474

Floor. Official Rhode Island 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 Rhode Island geographic cost index (1.020 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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