COVERAGE · UTAHSHEET 45 / 51

Utah, measured.

4,002 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 0.969 against the 1.000 national baseline.

EFFECTIVE NOT STATED · FLOORS 24 OF 25 CODES Official schedule on file
4,002Licensed providers
24Medicaid fee rows
0.969Geo cost index / 1.000
$17.87 to $3,470.29Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Utah fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$24.08$42$58$90
Comprehensive exam (new patient)$35.71$70$97$150
Full-mouth X-ray series$77.62$112$155$225
Bitewing X-rays (set of 4)$35.71$49$68$99
Panoramic X-ray$63.26$98$136$197
Emergency
Emergency visit for pain relief$23.28$102$141$219
Endodontics
Root canal, front tooth$330$663$921$1,428
Root canal, molar$487$893$1,240$1,922
Implants
Dental implant placementNo published floor$1,430$1,986$3,078
Oral surgery
Simple tooth extraction$71.40$136$189$293
Surgical tooth extraction$94.71$230$320$496
Orthodontics
Full braces treatment, adolescent$3,470.29$3,977$5,523$7,456
Periodontics
Deep cleaning below gumline (per quadrant)$146.11$178$247$383
Ongoing gum maintenance visit$74.35$112$155$240
Preventive
Adult teeth cleaning$49.67$73$102$158
Child teeth cleaning$38.80$56$78$121
Fluoride varnish treatment$17.87$35$48$74
Protective tooth sealant$29.50$38$53$82
Restorative
Metal filling (1 surface)$55.88$108$150$232
Tooth-colored filling, front tooth$67.05$136$189$293
Tooth-colored filling, back tooth (1 surface)$67.06$146$203$315
Tooth-colored filling, back tooth (2 surfaces)$85.68$174$242$375
Ceramic crown$501.12$977$1,357$2,103
Porcelain-on-metal crown$501.12$802$1,114$1,727
Crown foundation buildup$85.39$210$291$451

Floor. Official Utah 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 Utah geographic cost index (0.969 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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