Hawaii Medicaid Dental Fee Schedule
What Hawaii Medicaid pays dentists for common procedures. Hawaii ranks #32 of 51 states and DC by our common-procedure basket (below the national median).
Key Medicaid dental rates
What Hawaii Medicaid pays per procedure
A fixed basket of the procedures patients and dentists search for most. Rates are the representative amount across Hawaii's published schedules.
| Code | Procedure | Medicaid rate |
|---|---|---|
| D0120 | Periodic oral exam | $29.85 |
| D1110 | Adult cleaning | $45.84 |
| D1120 | Child cleaningPediatric | $31.15 |
| D2391 | 1-surface composite filling | $104.58 |
| D2930 | Stainless steel crown (primary tooth)Pediatric | $130.59 |
| D7140 | Simple extraction | $73.02 |
Schedule covers 169 CDT procedure codes (2026 rates). “Not covered” means the procedure is not listed in the published fee schedule.
Hawaii Medicaid dental schedules
Hawaii publishes 10 distinct dental fee schedules. Each covers a different population or provider tier.
162 codes
162 codes
160 codes
160 codes
158 codes
158 codes
158 codes
158 codes
154 codes
154 codes
Common questions
What does Hawaii Medicaid pay for a dental cleaning?
Hawaii Medicaid pays $45.84 for an adult cleaning (D1110) and $31.15 for a child cleaning (D1120).
What does Hawaii Medicaid pay for adult dental?
Hawaii's Medicaid fee schedule lists rates for adult dental procedures, including an adult cleaning at $45.84 and a 1-surface filling at $104.58. A listed rate is what Medicaid pays when a service is reimbursed, not a statement of adult eligibility; confirm current coverage with the state program.
What is the Hawaii Medicaid rate for a dental crown?
Hawaii Medicaid pays $130.59 for a stainless steel crown on a primary tooth (D2930), the standard crown billed under pediatric Medicaid dental.
How does Hawaii Medicaid dental reimbursement compare to other states?
On a fixed basket of common procedures (exam, adult and child cleaning, filling, crown, extraction), Hawaii ranks #32 of 51 jurisdictions, below the national median for dental Medicaid reimbursement.
When was the Hawaii Medicaid dental fee schedule last updated?
The Hawaii Medicaid dental rates on this page reflect the 2026 published fee schedule. ProviderSignal refreshes state Medicaid schedules on the cadence each program publishes, typically quarterly or annually.
Methodology
Rates are pulled from Hawaii’s published Medicaid dental fee schedule, a public record. The national rank uses a fixed basket of six common procedures (periodic exam, adult and child cleaning, 1-surface filling, stainless steel crown, simple extraction) so every state is compared on the same procedures rather than on a raw average that code mix would distort. Where a state publishes separate adult and pediatric schedules, both are shown. These are fee-for-service schedule amounts (what Medicaid pays when a service is reimbursed), not a coverage or eligibility guarantee, and they do not reflect Medicaid managed-care plan rates. Confirm current rates and eligibility with the state Medicaid program.