Massachusetts Medicaid Dental Coverage Guide
Massachusetts Medicaid Dental Coverage Guide: verify the Massachusetts authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
Massachusetts Medicaid Dental Coverage Guide: verify the Massachusetts authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check. Massachusetts Medicaid pays a dentist $75.00 for a patient under 21.
What this page recommends
Massachusetts Medicaid Dental Coverage Guide: verify the Massachusetts authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
- Next step: Find a Provider
What should I verify before acting?
Verify the local workflow, provider fit, pricing details, and timing directly through the canonical guide or a qualified professional before making a decision.
Related decision paths people also use
These are nearby ways people describe the same decision before they move into local comparison, pricing, or urgent next-step mode.
Massachusetts Medicaid dental reimbursement rates on this page are taken from 101 CMR 314.00: Rates for Dental Services, published by Massachusetts Executive Office of Health and Human Services, and retrieved 2026-08-26. The schedule is effective 2024-06-01. Every amount shown is what the state pays a dental provider for the procedure. It is not a price a patient pays, and self-pay and insured prices are typically far higher. Massachusetts operates a limited adult dental benefit for adults 21 and over; children's dental care is required federally under EPSDT. Verified 2026-08-26.
Massachusetts Medicaid dental reimbursement: what the program pays a dentist, not what a patient pays
| Procedure (CDT code) | Paid to the dentist for a patient under 21 | Paid to the dentist for a patient 21 and over |
|---|---|---|
| Cleaning (prophylaxis), adult (CDT D1110) | Massachusetts Medicaid pays a dentist $75.00 for a patient under 21 | $60.00 paid to the dentist for a patient 21 and over |
| Periodic oral exam (CDT D0120) | Massachusetts Medicaid pays a dentist $31.00 for a patient under 21 | $24.00 paid to the dentist for a patient 21 and over |
| Crown, porcelain/ceramic (CDT D2740) | Massachusetts Medicaid pays a dentist $853.00 for a patient under 21 | $729.00 paid to the dentist for a patient 21 and over |
| Root canal, molar tooth (CDT D3330) | Massachusetts Medicaid pays a dentist $829.00 for a patient under 21 | $829.00 paid to the dentist for a patient 21 and over |
| Extraction, erupted tooth (simple) (CDT D7140) | Massachusetts Medicaid pays a dentist $107.00 for a patient under 21 | $77.00 paid to the dentist for a patient 21 and over |
| Surgical placement of implant body (CDT D6010) | Massachusetts Medicaid pays a dentist $1,374.00 for a patient under 21 | $1,151.00 paid to the dentist for a patient 21 and over |
| Comprehensive oral exam (CDT D0150) | Massachusetts Medicaid pays a dentist $62.00 for a patient under 21 | $41.00 paid to the dentist for a patient 21 and over |
| Cleaning (prophylaxis), child (CDT D1120) | Massachusetts Medicaid pays a dentist $55.00 for a patient under 21 | $39.00 paid to the dentist for a patient 21 and over |
| Fluoride varnish (paediatric preventive) (CDT D1206) | Massachusetts Medicaid pays a dentist $28.00 for a patient under 21 | $26.00 paid to the dentist for a patient 21 and over |
| Sealant, per tooth (paediatric preventive) (CDT D1351) | Massachusetts Medicaid pays a dentist $44.00 for a patient under 21 | $30.00 paid to the dentist for a patient 21 and over |
| Amalgam filling, one surface (CDT D2140) | Massachusetts Medicaid pays a dentist $77.00 for a patient under 21 | $62.00 paid to the dentist for a patient 21 and over |
| Composite filling, one surface, posterior (CDT D2391) | Massachusetts Medicaid pays a dentist $99.00 for a patient under 21 | $62.00 paid to the dentist for a patient 21 and over |
| Crown, porcelain fused to high noble metal (CDT D2750) | Massachusetts Medicaid pays a dentist $800.00 for a patient under 21 | $686.00 paid to the dentist for a patient 21 and over |
| Crown, porcelain fused to predominantly base metal (CDT D2751) | Massachusetts Medicaid pays a dentist $727.00 for a patient under 21 | $613.00 paid to the dentist for a patient 21 and over |
| Crown, full cast predominantly base metal (CDT D2791) | Massachusetts Medicaid pays a dentist $641.00 for a patient under 21 | $538.00 paid to the dentist for a patient 21 and over |
| Root canal, anterior tooth (CDT D3310) | Massachusetts Medicaid pays a dentist $544.00 for a patient under 21 | $544.00 paid to the dentist for a patient 21 and over |
| Root canal, premolar tooth (CDT D3320) | Massachusetts Medicaid pays a dentist $639.00 for a patient under 21 | $639.00 paid to the dentist for a patient 21 and over |
| Complete denture, upper (CDT D5110) | Massachusetts Medicaid pays a dentist $858.00 for a patient under 21 | $730.00 paid to the dentist for a patient 21 and over |
| Complete denture, lower (CDT D5120) | Massachusetts Medicaid pays a dentist $852.00 for a patient under 21 | $730.00 paid to the dentist for a patient 21 and over |
| Implant-supported porcelain/ceramic crown (CDT D6058) | Massachusetts Medicaid pays a dentist $982.00 for a patient under 21 | $920.00 paid to the dentist for a patient 21 and over |
| Bridge pontic, porcelain fused to high noble metal (CDT D6240) | Massachusetts Medicaid pays a dentist $792.00 for a patient under 21 | $671.00 paid to the dentist for a patient 21 and over |
| Bridge retainer crown, porcelain fused to high noble metal (CDT D6750) | Massachusetts Medicaid pays a dentist $779.00 for a patient under 21 | $678.00 paid to the dentist for a patient 21 and over |
| Surgical extraction, erupted tooth (CDT D7210) | Massachusetts Medicaid pays a dentist $179.00 for a patient under 21 | $149.00 paid to the dentist for a patient 21 and over |
Ready to compare providers?
Use the source-backed framework above, then continue to the matching provider destination.
Verify the rule before acting
- State Medicaid and CHIP Profiles — State-specific Medicaid and CHIP program profile; reviewed 2026-08-26
- Dental Care — Federal dental benefit requirements and state-option context; reviewed 2026-08-26
- Dental Licensure by State — State dental board and licensure pathway discovery; reviewed 2026-08-26
- 101 CMR 314.00: Rates for Dental Services — Official Massachusetts Medicaid dental fee schedule: amounts the state pays a dental provider per CDT procedure. Not consumer prices.; reviewed 2026-08-26
- Massachusetts Medicaid adult dental benefit scope — Massachusetts's own statement of what dental care adult Medicaid members receive; reviewed 2026-08-26
Massachusetts publishes its Medicaid dental reimbursement rates in 101 CMR 314.00: Rates for Dental Services. Those rates are what Massachusetts Medicaid pays a dental provider for each procedure, and they are not prices a patient pays. A self-pay or insured price for the same procedure is normally much higher, so a Massachusetts reimbursement figure cannot answer what a filling or a crown would cost you. It does answer what Massachusetts Medicaid will pay a dentist who accepts it. The figures on this page were retrieved 2026-08-26.
Quick checklist
- Record the event date and the decision deadline for the Massachusetts issue.
- Select Massachusetts in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Capture the operative rule, not merely a search-result snippet.
- Use Find a Provider if interpretation or application remains uncertain.
Red flags
- A generic fifty-state chart replacing Massachusetts primary material
- No license or designation verification
- Pressure to act before written terms are supplied
Adult and child dental benefits are set differently in Massachusetts. Children's dental coverage is federally required under EPSDT, so every state must cover medically necessary dental care for eligible children. Adult dental coverage is a state option, which is why it varies so sharply. Massachusetts operates a limited adult dental benefit for adults aged 21 and over. In the state's own words: "Starting August 1, 2026, dental coverage for MassHealth members 21 and older has a yearly coverage limit of $1,750. Adults enrolled in MassHealth Standard, MassHealth CommonHealth, MassHealth Family Assistance, or MassHealth CarePlus can receive coverage for dental care up to $1,750 each benefit year." Confirm your own category before booking, because Massachusetts eligibility groups can differ. Verified 2026-08-26.
Quick checklist
- Record the event date and the decision deadline for the Massachusetts issue.
- Select Massachusetts in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Capture the operative rule, not merely a search-result snippet.
- Use Find a Provider if interpretation or application remains uncertain.
Red flags
- A Massachusetts claim with no source date
- A provider who will not identify the governing authority
- A price, deadline, or eligibility statement presented as universal
For “What should I confirm before booking Medicaid dental care in Massachusetts?,” Before relying on a Massachusetts summary, confirm the issue through Medicaid.gov’s Massachusetts profile and the current Massachusetts Medicaid dental program materials. Record the source date and verify child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. After the source check, Find a Provider routes you to the relevant local directory or service path.
Quick checklist
- Record the event date and the decision deadline for the Massachusetts issue.
- Select Massachusetts in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Capture the operative rule, not merely a search-result snippet.
- Use Find a Provider if interpretation or application remains uncertain.
Red flags
- An authority link that does not identify Massachusetts or the topic
- A summary that hides exceptions
- A provider answer that changes when you ask for documentation
For “How do prior authorization and managed-care rules affect Massachusetts dental access?,” Use Medicaid.gov’s Massachusetts profile and the current Massachusetts Medicaid dental program materials as the first verification layer for Massachusetts, then document what you checked and when. The practical review is incomplete until it addresses child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. If the rule or provider fit remains unclear, use Find a Provider for the nearest canonical next step.
Quick checklist
- Write the Massachusetts question in one sentence.
- Select Massachusetts in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Check the exception, eligibility category, or license status that applies.
- Route to the canonical provider destination with the verified facts in hand.
Red flags
- An authority link that does not identify Massachusetts or the topic
- A summary that hides exceptions
- A provider answer that changes when you ask for documentation
For “When should I use Find a Provider for Medicaid dental care in Massachusetts?,” Treat Medicaid.gov’s Massachusetts profile and the current Massachusetts Medicaid dental program materials as the source-of-record pathway for this Massachusetts question. The source review should produce a dated note covering child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. When facts or timing could change the answer, take the source record to a qualified provider.
Quick checklist
- Identify the person, service, and jurisdiction involved in Massachusetts.
- Select Massachusetts in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Separate federal rules from Massachusetts-specific rules.
- Ask the provider to explain any conflict in writing.
Red flags
- A generic fifty-state chart replacing Massachusetts primary material
- No license or designation verification
- Pressure to act before written terms are supplied
Need help applying this guide?
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- Michigan Medicaid Dental Coverage Guide
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- Massachusetts Dental Insurance Marketplace Guide
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