D5223 Medicaid reimbursement rates by state
Dental services. 7 state Medicaid programs publish a fee-for-service rate for D5223. Rates run from $376.35 in Illinois to $895.24 in New Mexico, with a median of $742.34.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 7
- Median rate
- $742.34units vary by state
- Highest
- $895.24New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
D5223 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $895.24since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Dental Codes fee sch |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $840.48since 2025-10-01 | — | — | Paid by the state, outside plans | — | Appendix C4 - State Dental Plan Benchmar |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $832.27since 2025-07-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $742.34since 2016-02-15 | — | — | Paid by the state, outside plans | — | DMAS procedure fee file dental.csv |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $740.00since 2023-10-01 | — | — | Paid by the state, outside plans | — | 2026 Fee Schedule - Covered Procedures R |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $645.75since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Provider Type 22 Dentist Reimbursement S |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $376.35since 2016-07-01 | — | — | Plans negotiate; applies out of network | — | HFS [[' HFS Dental Program Fee Schedule |
Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for D5223?
It depends on the state. Of the 7 states with a published fee-for-service rate, the median is $742.34. New Mexico pays the most ($895.24) and Illinois the least ($376.35).
Which state pays the highest Medicaid rate for D5223?
New Mexico, at $895.24, effective 2025-01-01.
Do managed-care plans pay the same rate for D5223?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.