D5630 Medicaid reimbursement rates by state
Dental services. 34 state Medicaid programs publish a fee-for-service rate for D5630 at the physician psychologist level. Rates run from $40.00 in California to $251.49 in Colorado, with a median of $111.89.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 34
- Median rate
- $111.89units vary by state
- Highest
- $251.49Colorado
- Medicare (non-facility)
- —not on the physician fee schedule
D5630 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 |
|---|---|---|---|---|---|---|
| ColoradoAny qualified provider (rate does not vary by provider) · Colorado HCBS waiver for persons with developmental disabilities (DD) | $251.49since 2026-07-01 | — | — | Paid by the state, outside plans | — | HCBS-DD and SLS Waiver Dental Services f |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $240.80since 2022-07-01 | — | — | Plans must pay at least this | — | MO HealthNet fee schedule: Dental |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $201.38since 2025-04-21 | — | — | Plans must pay at least this | — | Louisiana Medicaid Dental Program Fee Sc |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $192.00since 2023-07-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - HCPCS (i |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $176.71since 2026-01-01 | — | — | Plans must pay at least this | — | MDHHS Dental Fee Schedule database, Janu |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $159.62since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $157.91since 2025-10-01 | — | — | Paid by the state, outside plans | — | NC Medicaid fee schedule 'Federally Qual |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $148.51since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $148.48since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Appendix DD to OAC 5160-1-60 (ODM workbo |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $147.47since 2019-07-01 | — | — | Plans must pay at least this | — | Utah Medicaid Coverage and Reimbursement |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $146.22since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $140.14since 2016-09-01 | — | — | Not classified | — | CMAP fee schedule: 10/1/2026 Pediatric D |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $131.30since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid Dental Fee Schedule |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $129.15since 2024-01-01 | — | — | Plans must pay at least this | — | Provider Type 20 Physician, MD., Osteopa |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $115.48since 2010-10-01 | — | — | Paid by the state, outside plans | — | DMAS procedure fee file dental.csv |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $114.57since 2025-07-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $112.81since 2024-01-01 | — | — | Plans must pay at least this | — | SoonerCare Dental Fee Schedule |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $110.96since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Dental Codes fee sch |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $94.13since 2000-08-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $93.41since 2024-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $89.95since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Dental r |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $87.12since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $82.68since 2022-01-01 | — | — | Paid by the state, outside plans | — | ForwardHealth max fee schedule: Dental ( |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $78.29since 2023-10-01 | — | — | Paid by the state, outside plans | — | 2026 Fee Schedule - Covered Procedures R |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $71.50since 2015-07-01 | — | — | Plans negotiate; applies out of network | — | HFS [[' HFS Dental Program Fee Schedule |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $69.23since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | BMS 2026 Dental Fee Schedule Effective 4 |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $64.90since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Dental fee schedule (2023Den |
| 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 |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $59.40since 2007-10-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $57.76since 2025-07-01 | — | — | Paid by the state, outside plans | — | HCA Dental fee schedule (dental-20250701 |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $56.25since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Dental General Fee Schedule (AHCA Update |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $51.86since 2013-07-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #14 CLINIC (C |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $47.78since 2025-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Denta |
| 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 D5630?
It depends on the state. Of the 34 states with a published fee-for-service rate, the median is $111.89. Colorado pays the most ($251.49) and California the least ($40.00 per percent of SMA).
Which state pays the highest Medicaid rate for D5630?
Colorado, at $251.49, effective 2026-07-01.
Do managed-care plans pay the same rate for D5630?
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 D5630 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.