New York Medicaid Dental Coverage Guide
New York Medicaid Dental Coverage Guide: verify the New York authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
New York Medicaid Dental Coverage Guide: verify the New York authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check. New York Medicaid pays a dentist $45.45.
What this page recommends
New York Medicaid Dental Coverage Guide: verify the New York authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
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New York Medicaid dental reimbursement rates on this page are taken from New York State Medicaid Dental Fee Schedule, published by New York State Department of Health (eMedNY), and retrieved 2026-08-26. The schedule is effective 2026-01-01. 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. New York operates a comprehensive adult dental benefit for adults 21 and over; children's dental care is required federally under EPSDT. Verified 2026-08-26.
New York Medicaid dental reimbursement: what the program pays a dentist, not what a patient pays
| Procedure (CDT code) | What New York Medicaid pays the dentist | Rate basis |
|---|---|---|
| Cleaning (prophylaxis), adult (CDT D1110) | New York Medicaid pays a dentist $45.45 | State reimbursement, effective 2026-01-01 |
| Periodic oral exam (CDT D0120) | New York Medicaid pays a dentist $25.25 | State reimbursement, effective 2026-01-01 |
| Crown, porcelain/ceramic (CDT D2740) | New York Medicaid pays a dentist $505.00 | State reimbursement, effective 2026-01-01 |
| Root canal, molar tooth (CDT D3330) | New York Medicaid pays a dentist $404.00 | State reimbursement, effective 2026-01-01 |
| Extraction, erupted tooth (simple) (CDT D7140) | New York Medicaid pays a dentist $50.50 | State reimbursement, effective 2026-01-01 |
| Surgical placement of implant body (CDT D6010) | New York Medicaid pays a dentist $1,010.00 | State reimbursement, effective 2026-01-01 |
| Comprehensive oral exam (CDT D0150) | New York Medicaid pays a dentist $30.30 | State reimbursement, effective 2026-01-01 |
| Cleaning (prophylaxis), child (CDT D1120) | New York Medicaid pays a dentist $43.43 | State reimbursement, effective 2026-01-01 |
| Fluoride varnish (paediatric preventive) (CDT D1206) | New York Medicaid pays a dentist $30.30 | State reimbursement, effective 2026-01-01 |
| Sealant, per tooth (paediatric preventive) (CDT D1351) | New York Medicaid pays a dentist $35.35 | State reimbursement, effective 2026-01-01 |
| Amalgam filling, one surface (CDT D2140) | New York Medicaid pays a dentist $50.50 | State reimbursement, effective 2026-01-01 |
| Composite filling, one surface, posterior (CDT D2391) | New York Medicaid pays a dentist $50.50 | State reimbursement, effective 2026-01-01 |
| Crown, porcelain fused to high noble metal (CDT D2750) | New York Medicaid pays a dentist $505.00 | State reimbursement, effective 2026-01-01 |
| Crown, porcelain fused to predominantly base metal (CDT D2751) | New York Medicaid pays a dentist $505.00 | State reimbursement, effective 2026-01-01 |
| Crown, full cast predominantly base metal (CDT D2791) | New York Medicaid pays a dentist $505.00 | State reimbursement, effective 2026-01-01 |
| Root canal, anterior tooth (CDT D3310) | New York Medicaid pays a dentist $252.50 | State reimbursement, effective 2026-01-01 |
| Root canal, premolar tooth (CDT D3320) | New York Medicaid pays a dentist $303.00 | State reimbursement, effective 2026-01-01 |
| Complete denture, upper (CDT D5110) | New York Medicaid pays a dentist $565.60 | State reimbursement, effective 2026-01-01 |
| Complete denture, lower (CDT D5120) | New York Medicaid pays a dentist $565.60 | State reimbursement, effective 2026-01-01 |
| Implant-supported porcelain/ceramic crown (CDT D6058) | New York Medicaid pays a dentist $808.00 | State reimbursement, effective 2026-01-01 |
| Bridge pontic, porcelain fused to high noble metal (CDT D6240) | New York Medicaid pays a dentist $404.00 | State reimbursement, effective 2026-01-01 |
| Bridge retainer crown, porcelain fused to high noble metal (CDT D6750) | New York Medicaid pays a dentist $505.00 | State reimbursement, effective 2026-01-01 |
| Surgical extraction, erupted tooth (CDT D7210) | New York Medicaid pays a dentist $85.85 | State reimbursement, effective 2026-01-01 |
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
- New York State Medicaid Dental Fee Schedule — Official New York Medicaid dental fee schedule: amounts the state pays a dental provider per CDT procedure. Not consumer prices.; reviewed 2026-08-26
- New York Medicaid adult dental benefit scope — New York's own statement of what dental care adult Medicaid members receive; reviewed 2026-08-26
New York publishes its Medicaid dental reimbursement rates in New York State Medicaid Dental Fee Schedule. Those rates are what New York 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 New York reimbursement figure cannot answer what a filling or a crown would cost you. It does answer what New York Medicaid will pay a dentist who accepts it. The figures on this page were retrieved 2026-08-26.
Quick checklist
- Name the exact New York decision and the date that could change it.
- Select New York in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Save the source URL, page title, and review date in your notes.
- Compare provider scope and written terms before using Find a Provider.
Red flags
- A generic fifty-state chart replacing New York primary material
- No license or designation verification
- Pressure to act before written terms are supplied
Adult and child dental benefits are set differently in New York. 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. New York operates a comprehensive adult dental benefit for adults aged 21 and over. In the state's own words: "The schedule is published as a single Medicaid dental fee schedule covering adults and children, with per-procedure age limits stated in the schedule's own Min Age and Max Age columns." Confirm your own category before booking, because New York eligibility groups can differ. Verified 2026-08-26.
Quick checklist
- Name the exact New York decision and the date that could change it.
- Select New York in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Save the source URL, page title, and review date in your notes.
- Compare provider scope and written terms before using Find a Provider.
Red flags
- A generic fifty-state chart replacing New York primary material
- No license or designation verification
- Pressure to act before written terms are supplied
For “What should I confirm before booking Medicaid dental care in New York?,” The defensible starting point in New York is Medicaid.gov’s New York profile and the current New York Medicaid dental program materials, not an undated national summary. Then confirm child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. Do not rely on the summary alone; verify first, then use Find a Provider.
Quick checklist
- Identify the person, service, and jurisdiction involved in New York.
- Select New York in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Separate federal rules from New York-specific rules.
- Ask the provider to explain any conflict in writing.
Red flags
- A generic fifty-state chart replacing New York primary material
- No license or designation verification
- Pressure to act before written terms are supplied
For “How do prior authorization and managed-care rules affect New York dental access?,” For New York, begin with Medicaid.gov’s New York profile and the current New York Medicaid dental program materials; it is the correct authority path for this page’s decision. Do not advance until the evidence file covers child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. Find a Provider routes to the canonical destination for current local options and verification.
Quick checklist
- Name the exact New York decision and the date that could change it.
- Select New York in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Save the source URL, page title, and review date in your notes.
- Compare provider scope and written terms before using Find a Provider.
Red flags
- A New York claim with no source date
- A provider who will not identify the governing authority
- A price, deadline, or eligibility statement presented as universal
For “When should I use Find a Provider for Medicaid dental care in New York?,” For New York, begin with Medicaid.gov’s New York profile and the current New York Medicaid dental program materials; it is the correct authority path for this page’s decision. Do not advance until the evidence file covers child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. Find a Provider routes to the canonical destination for current local options and verification.
Quick checklist
- Write the New York question in one sentence.
- Select New York 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
- A New York claim with no source date
- A provider who will not identify the governing authority
- A price, deadline, or eligibility statement presented as universal
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