Incisional Biopsy of Oral Tissue - Soft
Open-data reference.
About incisional biopsy of oral tissue - soft
What it is: Oral soft tissue biopsy The American Dental Association assigns this procedure CDT code D7286, which is the standardized billing code used by every Medicaid program and dental insurance carrier in the United States.
What it costs: The national private-market average is $332 based on the ADA Health Policy Institute Survey of Dental Fees (2024). State variation pushes this between $$293 (lowest cost-of-living states) and $$398 (highest). State Medicaid programs that cover incisional biopsy of oral tissue - soft for adults reimburse an average of $174 (range $124–$233 across covering states).
Why state matters: Two factors drive the spread. First, state Medicaid programs negotiate their own dental fee schedules — high-paying states pay roughly 1.5x what low-paying states pay for the identical CDT code. Second, the private market follows local cost of living, captured by the Bureau of Economic Analysis Regional Price Parities. The full state-by-state table is below.
(across covering states)
Top 10 states: Incisional Biopsy of Oral Tissue - Soft private cost vs national average
Incisional Biopsy of Oral Tissue - Soft cost by state
| State | Medicaid fee | Private estimate | Adult coverage |
|---|---|---|---|
| Alabama | Not covered | $294 | emergency |
| Alaska | $233 | $358 | extensive |
| Arizona | Not covered | $328 | emergency |
| Arkansas | Not covered | $298 | limited |
| California | $170 | $385 | extensive |
| Colorado | Not covered | $348 | limited |
| Connecticut | $190 | $371 | extensive |
| Delaware | Not covered | $340 | none |
| District of Columbia | $209 | $395 | extensive |
| Florida | Not covered | $337 | emergency |
| Georgia | Not covered | $314 | emergency |
| Hawaii | Not covered | $384 | limited |
| Idaho | Not covered | $318 | limited |
| Illinois | $124 | $339 | extensive |
| Indiana | Not covered | $308 | limited |
| Iowa | $156 | $307 | extensive |
| Kansas | Not covered | $307 | emergency |
| Kentucky | Not covered | $302 | limited |
| Louisiana | Not covered | $310 | limited |
| Maine | Not covered | $337 | limited |
| Maryland | $168 | $374 | extensive |
| Massachusetts | $184 | $375 | extensive |
| Michigan | $135 | $322 | extensive |
| Minnesota | $204 | $341 | extensive |
| Mississippi | Not covered | $293 | emergency |
| Missouri | Not covered | $310 | limited |
| Montana | Not covered | $319 | limited |
| Nebraska | Not covered | $310 | limited |
| Nevada | Not covered | $337 | limited |
| New Hampshire | $147 | $356 | extensive |
| New Jersey | $170 | $384 | extensive |
| New Mexico | Not covered | $313 | limited |
| New York | $217 | $398 | extensive |
| North Carolina | Not covered | $314 | limited |
| North Dakota | $190 | $312 | extensive |
| Ohio | Not covered | $310 | limited |
| Oklahoma | Not covered | $304 | emergency |
| Oregon | $168 | $347 | extensive |
| Pennsylvania | Not covered | $331 | limited |
| Rhode Island | $150 | $341 | extensive |
| South Carolina | Not covered | $310 | limited |
| South Dakota | Not covered | $301 | emergency |
| Tennessee | Not covered | $307 | emergency |
| Texas | Not covered | $327 | emergency |
| Utah | Not covered | $327 | limited |
| Vermont | $167 | $339 | extensive |
| Virginia | $156 | $346 | extensive |
| Washington | $174 | $372 | extensive |
| West Virginia | Not covered | $298 | limited |
| Wisconsin | Not covered | $325 | limited |
| Wyoming | Not covered | $323 | limited |
Analysis: how to think about incisional biopsy of oral tissue - soft costs
The roughly 36% spread between the lowest- and highest-cost states for incisional biopsy of oral tissue - soft comes almost entirely from cost of living, not from differences in clinical complexity. A dentist's fee for a D7286 procedure in Mississippi (BEA RPP 86.4) versus New York (BEA RPP 117.5) tracks the local rent, wages, and supply costs the practice has to cover. The ADA HPI national average we start from is the population-weighted survey value across all surveyed practices.
The Medicaid coverage column matters more than the Medicaid fee itself for most adults. In the 19 jurisdictions that do reimburse for incisional biopsy of oral tissue - soft under their adult Medicaid program, the reimbursement averages around $174 — about 52% of the average private fee. Practices that accept Medicaid are absorbing the gap, which is why "Medicaid-accepting dentist" is not always easy to find. For a state-specific look at adult dental coverage scope, see each state page.
When budgeting for this procedure: treat the private estimate as a midpoint, not a ceiling. Specialty providers (oral surgeons, prosthodontists, periodontists) typically charge 15–40% above the general dentist rate for procedures within their specialty. Get a written treatment estimate before treatment, and ask whether the figure is the procedure fee alone or whether it bundles diagnostic codes (X-rays, exams) commonly billed alongside.
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Source: ADA Health Policy Institute, Survey of Dental Fees (2024).
Source: ADA Health Policy Institute, Medicaid Reimbursement Compendium (2024).
Source: BEA Regional Price Parities, by State (most recent annual release).
Source: ADA Health Policy Institute, Survey of Dental Fees (2024) and Medicaid Reimbursement Compendium. State Medicaid rates: each state's published dental fee schedule (current 2026 Q1). Disclaimer: Costs shown are estimates derived from publicly-published averages and a state-level cost-of-living adjustment. Actual fees depend on the specific dentist, the geographic submarket, and clinical complexity. This site does not provide medical or dental advice.