COVERAGE · VERMONTSHEET 46 / 51

Vermont, measured.

793 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 July 1, 2023 (view the source document). Practice costs index at 0.976 against the 1.000 national baseline.

EFFECTIVE JULY 1, 2023 · FLOORS 24 OF 25 CODES Official schedule on file
793Licensed providers
24Medicaid fee rows
0.976Geo cost index / 1.000
$33.75 to $1,296.94Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Vermont fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$39.75$42$59$91
Comprehensive exam (new patient)$97.50$71$98$152
Full-mouth X-ray series$105.75$112$156$226
Bitewing X-rays (set of 4)$51$49$68$99
Panoramic X-ray$94.50$99$137$199
Emergency
Emergency visit for pain relief$96$102$142$220
Endodontics
Root canal, front tooth$618$667$927$1,437
Root canal, molar$845.25$899$1,249$1,936
Implants
Dental implant placementNo published floor$1,441$2,001$3,102
Oral surgery
Simple tooth extraction$130.50$137$190$294
Surgical tooth extraction$216.75$232$322$499
Orthodontics
Full braces treatment, adolescent$1,296.94$4,005$5,563$7,510
Periodontics
Deep cleaning below gumline (per quadrant)$192.75$179$249$386
Ongoing gum maintenance visit$108.75$112$156$242
Preventive
Adult teeth cleaning$75.75$73$102$158
Child teeth cleaning$60.75$56$78$121
Fluoride varnish treatment$33.75$35$49$76
Protective tooth sealant$43.50$39$54$84
Restorative
Metal filling (1 surface)$101.25$109$151$234
Tooth-colored filling, front tooth$112.50$137$190$294
Tooth-colored filling, back tooth (1 surface)$125.25$148$205$318
Tooth-colored filling, back tooth (2 surfaces)$174.75$176$244$378
Ceramic crown$891.75$984$1,366$2,117
Porcelain-on-metal crown$945$808$1,122$1,739
Crown foundation buildup$213.75$211$293$454

Floor. Official Vermont Medicaid fee-for-service dental schedule, effective July 1, 2023. View the source document.

Bands. Modeled: the national median billed charge for each procedure, scaled by the Vermont geographic cost index (0.976 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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