Largest Medicaid vs Private Spreads | PlainDentalCost
PlainDentalCost ranks CDT-coded dental procedures by the average difference between published private-pay cost estimates and Medicaid fees across states. The ranking surfaces procedures where Medicaid reimbursement diverges most from typical private-pay charges.
Research period:
Research question
Across the CDT-coded dental procedures tracked by PlainDentalCost, which show the largest average spread between published private-pay cost estimates and Medicaid fees, and how does that spread vary across procedure categories?
Methodology
This ranking reflects the recorded database snapshot cited below. It is not a live coverage, reimbursement, or eligibility determination.
Coverage and exclusions: the ranking excludes rows without both recorded private and Medicaid figures. State schedules and benefit rules can change after the snapshot, so confirm current coverage, limits, and authorization requirements with the state program.
Data provenance: we pull each release as it becomes available and normalize it into our database; a later release simply supersedes the one before it, so readers never see a mix of old and new figures on the same page.
Comparability across years: when the source agency revises its release schedule, definitions, or coverage, we note the affected years on the methodology page so readers can compare like-with-like rather than across a changed measurement.
Corrections are checked against the cited primary source before the database snapshot is changed.
Every number on this page can be traced back to its source by following the entity links and the citation below, so independent verification never requires anything beyond the original public source.
See the methodology page for the complete ETL pipeline, source vintage, and column lineage.
Top 10 Dental Procedures by Largest Medicaid-to-Private-Pay Cost Spread
Database snapshot: recorded cost-reference rows
The ranked top 10
Every row below reflects this 10-record database snapshot. Check the source program for current benefit decisions.
| # | Procedure | D-code | Avg private-Medicaid spread ($) | Avg private-pay estimate ($) | Avg Medicaid fee ($) |
|---|---|---|---|---|---|
| 1 | Surgical Placement of Implant Body | D6010 | 1,199.327 | 2,475.776 | 1,276.449 |
| 2 | Maxillary Partial Denture - Cast Metal Framework | D5213 | 1,094.598 | 2,211.188 | 1,116.591 |
| 3 | Mandibular Partial Denture - Cast Metal Framework | D5214 | 1,094.598 | 2,211.188 | 1,116.591 |
| 4 | Complete Denture - Maxillary | D5110 | 1,019.136 | 2,055.797 | 1,036.661 |
| 5 | Complete Denture - Mandibular | D5120 | 1,019.136 | 2,055.797 | 1,036.661 |
| 6 | Implant-Supported Porcelain/Ceramic Crown | D6065 | 975.994 | 1,973.901 | 997.907 |
| 7 | Retreatment of Previous Root Canal - Molar | D3348 | 926.081 | 1,691.466 | 765.385 |
| 8 | Endodontic Therapy - Molar Tooth | D3330 | 856.278 | 1,562.322 | 706.044 |
| 9 | Abutment-Supported Porcelain/Ceramic Crown | D6058 | 850.278 | 1,719.814 | 869.536 |
| 10 | Retreatment of Previous Root Canal - Anterior | D3346 | 743.335 | 1,351.284 | 607.948 |
Source: ADA HPI Medicaid Reimbursement Compendium, ADA HPI private-market baselines, BEA Regional Price Parities, and MACPAC adult dental coverage tiers. Values reflect PlainDentalCost's recorded database snapshot, not live fee schedules or benefit information.
Findings
Top entity in the ranking
The top-ranked record in this dataset is Surgical Placement of Implant Body, with a value of 1,199.327 on the Avg private-Medicaid spread ($) column. The full top-10 set is rendered in the table above. Every value derives from the underlying procedures table; no number is hardcoded into this page. When the American Dental Association Health Policy Institute publishes a revision and our ETL pipeline reingests, the ranking and the prose around it update on the next page load.
Distribution shape
The gap between the top-ranked record (1,199.327) and the 10th-ranked record (743.335) characterizes how concentrated the top of the distribution is. Where the top value is many multiples of the median value of the visible set, the population is highly concentrated, a small number of entities accumulate the bulk of the measured quantity. Where the top and bottom of the visible set are close together, the distribution is relatively flat across the top end. The full distribution beyond this top-10 cut is summarized in the aggregate context section below and explored in the linked entity profiles.
Aggregate context
Across all tracked procedures, the snapshot's summary figures put this top-10 ranking in context: the number of qualifying records, the total recorded count, and the average per-record value. The methodology page explains which rows are included and why records without an estimate are excluded. These summaries and the ranking use the same documented snapshot.
Source provenance
This ranking uses the ADA HPI Medicaid Reimbursement Compendium, ADA HPI private-market baselines, BEA Regional Price Parities, and MACPAC adult dental coverage tiers. State-dollar figures are modeled estimates rather than live fee schedules, so the displayed spread is not a quote, payment guarantee, or current benefit determination. The methodology page documents the source links, snapshot date, and how the figures are prepared.
Why this ranking matters
Rankings like this one let a reader scan a population quickly and identify outliers, concentrations, and patterns that warrant deeper investigation. The detail pages linked from each entity in the table above give the full per-entity context: time-series history where available, related metrics from adjacent tables, and links onward to the underlying source records. The methodology page explains how an entity earns inclusion in the dataset and how the ranking column is computed at the source.
What this analysis cannot tell us
Private-pay cost estimates in the PlainDentalCost database derive from publicly available regional dental fee surveys and provider-published rate sheets as of the snapshot vintage, scaled to each state using state-level regional price parity (RPP). Private-pay estimates are not actual charged or paid amounts and do not reflect insurance-negotiated rates, in-network adjustments, or member cost-sharing. Medicaid figures are modeled estimates (ADA HPI national × state multiplier) and exclude managed-care plan adjustments, withholding, or supplemental payments. The spread calculation subtracts the Medicaid fee from the private-pay estimate and is calculated only where both values are non-null for the same state-D-code row; procedures or states with one-sided data do not appear in the ranking. Spread magnitude varies systematically by procedure category, higher-acuity restorative and surgical procedures tend to show larger absolute spreads than diagnostic or preventive procedures. The spread does not measure provider profitability, payer-mix economics, or member affordability; it is an arithmetic difference between two published cost reference points. This data does not constitute fee advice, price prediction, treatment recommendation, or guidance about any individual provider, payer contract, or patient situation. Actual out-of-pocket costs depend on the provider's chosen fee, the patient's insurance plan, deductibles, copayments, and any prior-authorization or coverage limitations applicable to the procedure.
Secondary cut from the same source
Top 10 dental procedures by average private-pay cost estimate
Sources
- American Dental Association, Code on Dental Procedures and Nomenclature (CDT) - https://www.ada.org/publications/cdt
- ADA Health Policy Institute, Medicaid Reimbursement Compendium - https://www.ada.org/resources/research/health-policy-institute