Methodology & Data Sources

Overview

Every cost figure on PlainDentalCost is derived from one of three public datasets, with a transparent formula linking the source data to what appears on the page. This page documents each source, the formulas, the limitations of the approach, and how often we refresh.

Data sources

1. ADA Health Policy Institute - Medicaid Reimbursement Compendium (2024)

Per-state Medicaid dollar figures on this site are modeled estimates, not a live transcription of every state agency fee schedule. We take the ADA HPI Medicaid Reimbursement Compendium national average for each CDT code and scale it by a state multiplier derived from the same HPI cross-state comparison (see Formulas). Upstream, states do publish fee schedules; those schedules inform the HPI compendium, but this portal does not claim a current per-state schedule ingest. When a state tier does not cover a CDT code under adult Medicaid, our table shows "Not covered" rather than zero or a placeholder.

2. ADA Health Policy Institute - Survey of Dental Fees (2024)

The American Dental Association's Health Policy Institute conducts a periodic national survey of practicing dentists' fees, with results published as the Survey of Dental Fees. The survey captures the 50th percentile (median) and other percentile values for each major CDT code across the respondent universe. We use the median (population-weighted national average) figures from the most recent published edition (2024) as the national private-market baseline. Source: ADA Health Policy Institute.

3. How state fee schedules relate (and what we do not claim)

Each state Medicaid agency publishes a dental fee schedule listing reimbursement rates paid to dentists for CDT codes under that state's adult program (when covered). Those schedules are the authoritative source for a live benefit decision. This portal's modeled estimates are useful for comparison and research context only, confirm benefits, limits, prior authorization, and provider payment with the state program before arranging care.

4. MACPAC - Medicaid Coverage of Dental Benefits for Adults

The Medicaid and CHIP Payment and Access Commission (MACPAC) publishes a periodic compendium that categorizes each state's adult Medicaid dental coverage scope into four tiers: extensive (comprehensive), limited (typically preventive plus basic restorative, often subject to an annual dollar cap), emergency only (extractions for acute pain), and none (no adult dental benefit). The coverage tier shown on each PlainDentalCost state page reflects this categorization, a recorded database snapshot, not a live eligibility determination. Source: MACPAC.

5. U.S. Bureau of Economic Analysis - Regional Price Parities, by State

BEA publishes annual Regional Price Parities (RPPs) at the state level. RPPs measure differences in the price levels of goods and services across states relative to the overall national level (US average = 100). We use the most recent annual release as the cost-of-living adjustment factor for state-level private-market estimates. Source: BEA Regional Price Parities.

Corpus placement (#N of M)

Procedure and state pages show where each entity sits in PlainDentalCost's ADA HPI-derived corpus. Ranks are computed from the live SQLite tables with no hand-picked lists:

• Procedures - dual signals: national private-market average (highest = #1) and count of jurisdictions with a modeled adult Medicaid estimate (most covered = #1). Private cost and Medicaid coverage breadth can diverge.
• States - dual signals: average private-market estimate across tracked CDT codes (highest = #1) and total procedures with a modeled Medicaid estimate (most covered = #1). Coverage-breadth #1 is not uncovered-basket #1: a limited-tier state can outrank a none-tier state on dollars because the join prices uncovered codes at that state's private level.

These ranks are inventory and cost-level placement signals, not clinical quality grades or live benefit determinations.

Modeled uncovered-basket exposure

State pages carry one figure that is not a restatement of a published table. A private-market estimate here is the national ADA HPI average scaled by the state's BEA Regional Price Parity, so any reader with those two tables can reproduce it. The exposure figure is the join between coverage and price: the procedures a state's adult Medicaid program does not cover, priced at that state's own cost level.

• Uncovered basket - the tracked CDT codes with no adult-Medicaid estimate for that state.
• Exposure - the sum of this site's modeled private-market estimates for those codes.
• Rank - every jurisdiction ordered by that sum, #1 being the most exposed. Competition rank for coverage breadth (most covered CDT codes) is computed in application code, not SQL RANK(), and tied counts share a rank.

Two limits travel with the number. Coverage is recorded at MACPAC's program-tier level, so states sharing a benefit tier share a covered-procedure set in this dataset, and the figure moves between them only through the price level; and the dollar side is modeled, not billed, so it describes the scope of what a program leaves to the patient rather than any individual bill. Nobody needs every procedure in the basket - the figure is a comparison of how much a program leaves uncovered, not a prediction of what one person will spend.

Formulas

State private-market estimate

For each procedure-and-state combination:

state_private_estimate(d_code, state) =
    national_private_avg(d_code)  /* ADA HPI 2024 */
  × state_rpp(state) / 100         /* BEA Regional Price Parity */

Worked example for a porcelain crown (CDT D2740) in Mississippi: national average = $1,338, Mississippi RPP = 86.4 ÷ 100 = 0.864, state estimate = $1,338 × 0.864 ≈ $1,156. Same procedure in New York: national average = $1,338, New York RPP = 117.5 ÷ 100 = 1.175, state estimate = $1,338 × 1.175 ≈ $1,572.

State Medicaid estimate (modeled)

For states that cover the procedure under their adult Medicaid program (per MACPAC categorization):

state_medicaid_fee(d_code, state) =
    national_medicaid_avg(d_code)  /* ADA HPI Medicaid Compendium 2024 */
  × state_medicaid_multiplier(state)

The state-level Medicaid multiplier is derived from the ADA HPI cross-state Medicaid comparison: states that publish complete dental fee schedules and report a representative basket of CDT codes are mapped to a single state-level multiplier (e.g., Arkansas = 0.73, New York = 1.51) that captures their position relative to the national-average reimbursement curve. For "limited" coverage states, the multiplier is applied only to procedures the state covers (typically diagnostic, preventive, basic restorative, simple extractions, palliative care, and nitrous-oxide sedation); other categories show "Not covered". These values are estimates for comparison, not the amount any specific state will pay on a claim.

National averages

On the per-procedure pages, "National average" figures are computed at runtime as the simple mean across all 51 jurisdictions (50 states + DC) - for the private-market estimate, all 51 are included; for Medicaid reimbursement, only jurisdictions that cover the procedure for adults are included. Min/max columns show the extremes within the same denominator.

Limitations

Be aware of these constraints when using PlainDentalCost cost figures:

• State-level RPP, not metro-level. Within a state, urban downtowns typically run 10-25% above the state RPP and rural areas 10-15% below. Our private estimates are the state midpoint, not the price you will see at any specific dentist.
• Specialty premium not modeled. Specialists (oral surgeons, prosthodontists, periodontists, endodontists, orthodontists) often charge more than a general dentist for procedures within their specialty. The ADA HPI national figures are general-dentist averages; specialty work prices higher in practice.
• Insurance discounts not modeled. Privately-insured patients generally pay an in-network negotiated rate that is materially below the "private estimate" shown here. Out-of-network and uninsured patients face the full rate.
• Coverage is a snapshot. State Medicaid programs add and remove adult dental benefits from time to time. We track major changes (e.g., Maryland 2023 expansion, NH April 2025 restoration) but small policy adjustments may lag our update cycle by a few months.
• The cost methodology aggregates all complexity levels. The ADA HPI national averages are means across the full distribution of clinical presentations for each CDT code; an unusually complex case will price higher, a routine case lower.
• Not all 50 states publish CSV/Excel fee schedules. A small number of states publish only PDF schedules with limited line-item detail; for these, our state-level Medicaid multiplier is the best available estimate but cannot be cross-checked at every CDT code. State pages note where this applies.

What we do NOT include

• The CDT manual itself. CDT (Current Dental Terminology) is a copyrighted code set of the American Dental Association. We reference CDT code numbers and provide brief plain-language descriptions of what each code covers, which is a fair use; we do not republish the official CDT manual or its full clinical descriptions.
• Individual dentist fees or directories. PlainDentalCost does not list specific clinics or dentists, does not rank named providers, and does not publish individual fee transparency data. For provider-level pricing, see your state's hospital and dental price-transparency disclosures and any negotiated-rate files published under federal price transparency rules.
• Pediatric dentistry coverage details. All Medicaid programs are required to cover pediatric dental services through EPSDT. PlainDentalCost focuses on the highly-variable adult coverage scope; pediatric coverage is comprehensive everywhere by federal mandate.
• Dental insurance plan comparisons. PlainDentalCost prices procedures, not plans. For plan comparisons, see your state's healthcare exchange or your employer's benefits portal.

Update schedule

• State Medicaid coverage tier: a recorded source snapshot, not a continuously monitored benefits determination. Confirm current coverage with the state program.
• ADA HPI national averages: refreshed only after a verified source release is incorporated into a new database snapshot.
• BEA RPPs: refreshed only after a verified release is incorporated into a new database snapshot.
• State Medicaid fee schedules: values remain a snapshot until their source material is revalidated and a new database snapshot is deployed.

Disclaimer

PlainDentalCost is a data portal that organizes dental procedure cost information from public sources. The cost figures on this site are estimates, not quotes. Actual fees you pay will depend on the specific dentist you choose, the geographic submarket within your state, the clinical complexity of your case, your insurance status, and the negotiated rate (if any) between your insurance carrier and your provider. Always request a written treatment estimate from your dentist before treatment. PlainDentalCost does not provide medical, dental, financial, legal, or insurance advice.