The Same Filling Pays $33 in Minnesota and $250 in Delaware

D2391 is one of the most common codes in dentistry: a one-surface, tooth-colored filling on a back tooth. The procedure is the same everywhere. The code is the same everywhere. What Medicaid pays for it is not. Minnesota reimburses about $33 for a D2391. Delaware reimburses about $250. That is a 7.7x gap for identical work, and it is not an outlier pair; it is the shape of the whole system.

Across the 51 published state fee schedules, the median Medicaid rate for that filling is about $84. The five most generous schedules (Delaware ~$250, Missouri ~$170, Wisconsin ~$160, Alaska ~$142, South Dakota ~$137) pay three to seven times what the five lowest do (Minnesota ~$33, Illinois ~$36, California ~$39, Florida ~$46, Nevada ~$50).

The gaps ignore geography entirely. Minnesota's $33 sits directly across the state line from Wisconsin's $160. In metro St. Louis, the Mississippi River is the difference between Illinois paying $36 and Missouri paying $170 for the same tooth. A dentist can nearly quintuple a Medicaid reimbursement by moving one bridge east or west.

Why a federal program pays 51 different prices

Medicaid is federally funded in part, but every state runs its own program and sets its own fee schedule. Federal law mandates that children receive comprehensive dental coverage everywhere (the EPSDT benefit), but it says nothing about what a state must pay for that care, and adult dental is not mandated at all; it is an optional benefit each legislature funds on its own. There is no federal floor under a single dental rate. The result is 51 schedules that reflect 51 budget fights, some updated annually, some untouched for a decade.

Why the number matters beyond the invoice

Reimbursement is the quiet variable behind most Medicaid dental access debates. A schedule that pays $33 for a filling asks a practice to treat Medicaid patients at or below cost, and participation tends to follow. The states at the top of the list are not necessarily richer; several of the highest payers (South Dakota, Alaska, North Dakota) are rural states using rates to keep any dental access at all. For an office manager, the schedule decides whether Medicaid patients are a viable part of the book. For a rep, it shapes what a practice in that state can afford to buy. Same chair, same resin, very different economics.

Look up your own state

Every number above comes from the states' published fee schedules, which we collect and normalize across all 50 states and DC. You can see every state ranked on a common-procedure basket, open your state's page for its full schedule and adult-vs-pediatric breakdown (here is Minnesota and Delaware), or compare all 51 jurisdictions on this exact filling. Each state page can email you the common-procedure schedule as a CSV, and will alert you when the published rates change, because they do change, quietly, and the practices that notice first bill correctly first.

Methodology: rates queried from the ProviderSignal reimbursement database on July 3, 2026. Per-state figure = median published rate for CDT D2391 across the state's fee schedules and localities, after excluding zero and implausible values. All 51 jurisdictions publish a payable D2391 rate. These are fee-for-service schedule amounts, not Medicaid managed-care plan rates, and rates shift as states publish updates.