D5612 Medicaid reimbursement rates by state
Dental services. 22 state Medicaid programs publish a fee-for-service rate for D5612. Rates run from $40.00 in California to $211.53 in Louisiana, with a median of $80.24.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 22
- Median rate
- $80.24units vary by state
- Highest
- $211.53Louisiana
- Medicare (non-facility)
- —not on the physician fee schedule
D5612 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 |
|---|---|---|---|---|---|---|
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $211.53since 2025-04-21 | — | — | Plans must pay at least this | — | Louisiana Medicaid Dental Program Fee Sc |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $200.00since 2022-07-01 | — | — | Plans must pay at least this | — | MO HealthNet fee schedule: Dental |
| ColoradoAny qualified provider (rate does not vary by provider) · Colorado HCBS waiver for persons with developmental disabilities (DD) | $168.71since 2026-07-01 | — | — | Paid by the state, outside plans | — | HCBS-DD and SLS Waiver Dental Services f |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $139.29since 2026-01-01 | — | — | Plans must pay at least this | — | MDHHS Dental Fee Schedule database, Janu |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $133.77since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Appendix DD to OAC 5160-1-60 (ODM workbo |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $128.98since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $127.16since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $97.50since 2022-07-01 | — | — | Not classified | — | CMAP fee schedule: 10/1/2026 Adult Denta |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $89.99since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Dental r |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $85.00since 2024-07-01 | — | — | Paid by the state, outside plans | — | SCDHHS Dental Fee Schedule (Schedule upd |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $82.32since 2025-10-01 | — | — | Paid by the state, outside plans | — | NC Medicaid fee schedule 'Federally Qual |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $78.16since 2024-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $68.00since 2025-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Denta |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $67.67since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid Dental Fee Schedule |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $66.53since 2022-01-01 | — | — | Paid by the state, outside plans | — | ForwardHealth max fee schedule: Dental ( |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid dental (Maryland Healthy Smiles, fee-for-service through the dental ASO) | $63.00since 2023-08-01 | — | — | Paid by the state, outside plans | — | 2026 CDT Fee Schedule - Section 508 Comp |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $59.16since 2019-04-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $54.45since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $51.75since 2018-01-01 | — | — | Plans negotiate; applies out of network | — | HFS [[' HFS Dental Program Fee Schedule |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $44.19since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Dental General Fee Schedule (AHCA Update |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $40.69since 2025-07-01 | — | — | Paid by the state, outside plans | — | HCA Dental fee schedule (dental-20250701 |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal Dental Proposition 56 supplemental payments | $40.00since 2018-07-01 | percent of SMA | — | Paid by the state, outside plans | — | CDT Codes and SMAs for Proposition 56 Su |
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 D5612?
It depends on the state. Of the 22 states with a published fee-for-service rate, the median is $80.24. Louisiana pays the most ($211.53) and California the least ($40.00 per percent of SMA).
Which state pays the highest Medicaid rate for D5612?
Louisiana, at $211.53, effective 2025-04-21.
Do managed-care plans pay the same rate for D5612?
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.
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Track D5612 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.