COVERAGE · WISCONSINSHEET 50 / 51

Wisconsin, measured.

6,546 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 June 1, 2026 (view the source document). Practice costs index at 0.953 against the 1.000 national baseline.

EFFECTIVE JUNE 1, 2026 · FLOORS 22 OF 25 CODES Official schedule on file
6,546Licensed providers
22Medicaid fee rows
0.953Geo cost index / 1.000
$18.05 to $1,516.37Floor range
FEE SPECTRUM25 BENCHMARK CDT CODES

The Wisconsin fee table

ProcedureMedicaid floorInsurer typicalPrivate-pay p50Private-pay p90
Diagnostic
Routine checkup (existing patient)$18.40$41$57$88
Comprehensive exam (new patient)$27.93$68$95$147
Full-mouth X-ray series$60.80$109$152$220
Bitewing X-rays (set of 4)$23.90$48$67$97
Panoramic X-ray$53.34$96$133$193
Emergency
Emergency visit for pain relief$33.82$99$138$214
Endodontics
Root canal, front tooth$276.49$652$905$1,403
Root canal, molar$436.44$878$1,220$1,891
Implants
Dental implant placementNo published floor$1,407$1,954$3,029
Oral surgery
Simple tooth extraction$55.66$134$186$288
Surgical tooth extraction$120.96$226$314$487
Orthodontics
Full braces treatment, adolescent$1,516.37$3,911$5,432$7,333
Periodontics
Deep cleaning below gumline (per quadrant)$107.69$175$243$377
Ongoing gum maintenance visit$61.43$109$152$236
Preventive
Adult teeth cleaning$37.69$72$100$155
Child teeth cleaning$30.55$55$76$118
Fluoride varnish treatment$18.05$35$48$74
Protective tooth sealant$23.10$37$52$81
Restorative
Metal filling (1 surface)$46.06$107$148$229
Tooth-colored filling, front tooth$54.50$134$186$288
Tooth-colored filling, back tooth (1 surface)$57.83$144$200$310
Tooth-colored filling, back tooth (2 surfaces)$74.44$171$238$369
Ceramic crown$421.60$960$1,334$2,068
Porcelain-on-metal crownNo published floor$789$1,096$1,699
Crown foundation buildupNo published floor$206$286$443

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

Bands. Modeled: the national median billed charge for each procedure, scaled by the Wisconsin geographic cost index (0.953 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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