Pennsylvania Medicaid Dental Fee Schedule
What Pennsylvania Medicaid pays dentists for common procedures. Pennsylvania ranks #47 of 51 states and DC by our common-procedure basket (bottom quartile).
Key Medicaid dental rates
What Pennsylvania Medicaid pays per procedure
A fixed basket of the procedures patients and dentists search for most. Rates are the representative amount across Pennsylvania's published schedule.
| Code | Procedure | Medicaid rate |
|---|---|---|
| D0120 | Periodic oral exam | $20.00 |
| D1110 | Adult cleaning | $36.00 |
| D1120 | Child cleaningPediatric | $30.00 |
| D2391 | 1-surface composite filling | $50.00 |
| D2930 | Stainless steel crown (primary tooth)Pediatric | $99.00 |
| D7140 | Simple extraction | $65.00 |
Schedule covers 166 CDT procedure codes (2025 rates). “Not covered” means the procedure is not listed in the published fee schedule.
Common questions
What does Pennsylvania Medicaid pay for a dental cleaning?
Pennsylvania Medicaid pays $36.00 for an adult cleaning (D1110) and $30.00 for a child cleaning (D1120).
What does Pennsylvania Medicaid pay for adult dental?
Pennsylvania's Medicaid fee schedule lists rates for adult dental procedures, including an adult cleaning at $36.00 and a 1-surface filling at $50.00. 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 Pennsylvania Medicaid rate for a dental crown?
Pennsylvania Medicaid pays $99.00 for a stainless steel crown on a primary tooth (D2930), the standard crown billed under pediatric Medicaid dental.
How does Pennsylvania Medicaid dental reimbursement compare to other states?
On a fixed basket of common procedures (exam, adult and child cleaning, filling, crown, extraction), Pennsylvania ranks #47 of 51 jurisdictions, bottom quartile for dental Medicaid reimbursement.
When was the Pennsylvania Medicaid dental fee schedule last updated?
The Pennsylvania Medicaid dental rates on this page reflect the 2025 published fee schedule. ProviderSignal refreshes state Medicaid schedules on the cadence each program publishes, typically quarterly or annually.
Methodology
Rates are pulled from Pennsylvania’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.