D5916 Medicaid reimbursement rates by state
Dental services. 6 state Medicaid programs publish a fee-for-service rate for D5916. Rates run from $40.00 in California to $4,268.42 in Oklahoma, with a median of $597.13.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 6
- Median rate
- $597.13units vary by state
- Highest
- $4,268.42Oklahoma
- Medicare (non-facility)
- —not on the physician fee schedule
D5916 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 |
|---|---|---|---|---|---|---|
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $4,268.42⚠ over 3× mediansince 2024-01-01 | — | — | Plans must pay at least this | — | SoonerCare Dental Fee Schedule |
| ColoradoAny qualified provider (rate does not vary by provider) · Colorado HCBS waiver for persons with developmental disabilities (DD) | $3,595.38⚠ over 3× mediansince 2026-07-01 | — | — | Paid by the state, outside plans | — | HCBS-DD and SLS Waiver Dental Services f |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $656.78since 1996-12-01 | — | — | Paid by the state, outside plans | — | RI Medicaid Interactive Fee For Service |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $537.47since 2025-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Denta |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $452.41since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | BMS 2026 Dental Fee Schedule Effective 4 |
| 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 marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 D5916?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $597.13. Oklahoma pays the most ($4,268.42) and California the least ($40.00 per percent of SMA).
Which state pays the highest Medicaid rate for D5916?
Oklahoma, at $4,268.42, effective 2024-01-01.
Do managed-care plans pay the same rate for D5916?
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.