D5876 Medicaid reimbursement rates by state
Dental services. 5 state Medicaid programs publish a fee-for-service rate for D5876. Rates run from $80.66 in North Carolina to $361.60 in Missouri, with a median of $166.03.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $166.03units vary by state
- Highest
- $361.60Missouri
- Medicare (non-facility)
- —not on the physician fee schedule
D5876 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 |
|---|---|---|---|---|---|---|
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $361.60since 2022-07-01 | — | — | Plans must pay at least this | — | MO HealthNet fee schedule: Dental |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $196.09since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $166.03since 2024-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $137.50since 2026-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $80.66since 2025-10-01 | — | — | Paid by the state, outside plans | — | NC Medicaid fee schedule 'General Dental |
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 D5876?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $166.03. Missouri pays the most ($361.60) and North Carolina the least ($80.66).
Which state pays the highest Medicaid rate for D5876?
Missouri, at $361.60, effective 2022-07-01.
Do managed-care plans pay the same rate for D5876?
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.