Analysis of Medicaid Reimbursement Rates for Pediatric Dentistry

Objectives: To identify state Medicaid reimbursement rates of common pediatric dental procedures and to compare those rates with the American Dental Association (ADA) Survey of Dental Fees.
Methods: This project was carried out by collecting the current Medicaid fee schedules from all 50 states and comparing the average Medicaid rate (AMR) for common pediatric procedures to the 2013 ADA Survey of Dental Fees. The procedures utilized included recall exam, child prophy, sealant, one surface amalgam, one surface composite, pulpotomy, stainless steel crown, extraction, space-maintainer, and nitrous oxide.
Results: Almost every state Medicaid covered all the studied procedures with the exception of nitrous oxide not being covered by Kentucky, Michigan, Missouri, New York, and Ohio. For recall exam, the ADA reported the average cost as $72.92+20.6 while AMR was $34.22+13.7 (Range: $14.00-$79.80). For child prophy, the ADA average was $63.08+14.1 while AMR was $32.81+10.1 (Range: $18.34-$64.95). For dental sealant, the ADA average was $49.31+11.15 while AMR was $27.15+7.4 (Range: $15.12-$50.40). For one surface amalgam, the ADA average was $137.29+32.43 while AMR was $57.18+20.6 (Range: $28.00-$131.04). For one surface composite, the ADA average was $148.77+35.36 while AMR was $64.74+23.7 (Range: $25.62-$148.68). For pulpotomy, the ADA average was $168.75+54 while AMR was $75.24+27.0 (Range: $26.00-$181.60). For stainless steel crown, the ADA average was $249.10+63.47 while AMR was $121.73+40.2 ($73.12-241.08). For extraction, the ADA Survey average was $156.39+42.82 while AMR was $66.75+25.4 (Range: $50.35-$160). For space-maintainer, the ADA Survey average was $290.44+62 while AMR was $137.20+40.9 (Range: $70.60-$283.92). For nitrous oxide (D9230), the ADA average was $52.77+28.05 while AMR was $31.67+14.8 (Range: $6.43-$70.56).
Conclusions: Medicaid reimbursement rates can vary greatly by state. The implications of this disparity may provide insight into low provider participation and lack of access to dental care for low-income children.