Texas Medicaid Dental Coverage Guide
Texas Medicaid Dental Coverage Guide: verify the Texas authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
Texas Medicaid Dental Coverage Guide: verify the Texas authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check. Texas Medicaid pays a dentist $57.87. Texas Medicaid pays a dentist $30.42.
What this page recommends
Texas Medicaid Dental Coverage Guide: verify the Texas 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.
Texas Medicaid dental reimbursement rates on this page are taken from Texas Medicaid Static Fee Schedule - Dental, published by Texas Health and Human Services Commission (via Texas Medicaid & Healthcare Partnership), and retrieved 2026-08-26. Static fee schedule generated 7/29/2026; each row carries its own 'Fee Effect' date, defined by the file as 'The effective date of service for which the fee is payable'. 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. Texas operates an emergency-only adult dental benefit for adults 21 and over; children's dental care is required federally under EPSDT. Verified 2026-08-26.
Texas Medicaid dental reimbursement: what the program pays a dentist, not what a patient pays
| Procedure (CDT code) | What Texas Medicaid pays the dentist | Rate basis |
|---|---|---|
| Cleaning (prophylaxis), adult (CDT D1110) | Texas Medicaid pays a dentist $57.87 | State reimbursement, see the schedule for per-code effective dates |
| Periodic oral exam (CDT D0120) | Texas Medicaid pays a dentist $30.42 | State reimbursement, see the schedule for per-code effective dates |
| Crown, porcelain/ceramic (CDT D2740) | Texas Medicaid pays a dentist $252.25 | State reimbursement, see the schedule for per-code effective dates |
| Root canal, molar tooth (CDT D3330) | Texas Medicaid pays a dentist $628.99 | State reimbursement, see the schedule for per-code effective dates |
| Extraction, erupted tooth (simple) (CDT D7140) | Texas Medicaid pays a dentist $67.55 | State reimbursement, see the schedule for per-code effective dates |
| Comprehensive oral exam (CDT D0150) | Texas Medicaid pays a dentist $43.50 | State reimbursement, see the schedule for per-code effective dates |
| Cleaning (prophylaxis), child (CDT D1120) | Texas Medicaid pays a dentist $38.75 | State reimbursement, see the schedule for per-code effective dates |
| Fluoride varnish (paediatric preventive) (CDT D1206) | Texas Medicaid pays a dentist $21.04 | State reimbursement, see the schedule for per-code effective dates |
| Sealant, per tooth (paediatric preventive) (CDT D1351) | Texas Medicaid pays a dentist $29.78 | State reimbursement, see the schedule for per-code effective dates |
| Amalgam filling, one surface (CDT D2140) | Texas Medicaid pays a dentist $66.22 | State reimbursement, see the schedule for per-code effective dates |
| Composite filling, one surface, posterior (CDT D2391) | Texas Medicaid pays a dentist $84.72 | State reimbursement, see the schedule for per-code effective dates |
| Crown, porcelain fused to high noble metal (CDT D2750) | Texas Medicaid pays a dentist $532.00 | State reimbursement, see the schedule for per-code effective dates |
| Crown, porcelain fused to predominantly base metal (CDT D2751) | Texas Medicaid pays a dentist $532.00 | State reimbursement, see the schedule for per-code effective dates |
| Crown, full cast predominantly base metal (CDT D2791) | Texas Medicaid pays a dentist $252.25 | State reimbursement, see the schedule for per-code effective dates |
| Root canal, anterior tooth (CDT D3310) | Texas Medicaid pays a dentist $358.68 | State reimbursement, see the schedule for per-code effective dates |
| Root canal, premolar tooth (CDT D3320) | Texas Medicaid pays a dentist $415.62 | State reimbursement, see the schedule for per-code effective dates |
| Complete denture, upper (CDT D5110) | Texas Medicaid pays a dentist $358.31 | State reimbursement, see the schedule for per-code effective dates |
| Complete denture, lower (CDT D5120) | Texas Medicaid pays a dentist $358.31 | State reimbursement, see the schedule for per-code effective dates |
| Bridge pontic, porcelain fused to high noble metal (CDT D6240) | Texas Medicaid pays a dentist $252.25 | State reimbursement, see the schedule for per-code effective dates |
| Bridge retainer crown, porcelain fused to high noble metal (CDT D6750) | Texas Medicaid pays a dentist $252.25 | State reimbursement, see the schedule for per-code effective dates |
| Surgical extraction, erupted tooth (CDT D7210) | Texas Medicaid pays a dentist $103.58 | State reimbursement, see the schedule for per-code effective dates |
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
- Texas Medicaid Static Fee Schedule - Dental — Official Texas Medicaid dental fee schedule: amounts the state pays a dental provider per CDT procedure. Not consumer prices.; reviewed 2026-08-26
- Texas Medicaid adult dental benefit scope — Texas's own statement of what dental care adult Medicaid members receive; reviewed 2026-08-26
Texas publishes its Medicaid dental reimbursement rates in Texas Medicaid Static Fee Schedule - Dental. Those rates are what Texas 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 Texas reimbursement figure cannot answer what a filling or a crown would cost you. It does answer what Texas Medicaid will pay a dentist who accepts it. The figures on this page were retrieved 2026-08-26.
Quick checklist
- Write the Texas question in one sentence.
- Select Texas 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 stale screenshot used as the only evidence
- No distinction between federal and Texas requirements
- A recommendation based only on advertising position
Adult and child dental benefits are set differently in Texas. 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. Texas operates an emergency-only adult dental benefit for adults aged 21 and over. In the state's own words: "Limited dental services are available for clients who are 21 years of age and older (not residing in an ICF-IID facility) whose dental diagnosis is secondary to and causally related to a life-threatening medical condition." Confirm your own category before booking, because Texas eligibility groups can differ. Verified 2026-08-26.
Quick checklist
- Identify the person, service, and jurisdiction involved in Texas.
- Select Texas in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Separate federal rules from Texas-specific rules.
- Ask the provider to explain any conflict in writing.
Red flags
- A stale screenshot used as the only evidence
- No distinction between federal and Texas requirements
- A recommendation based only on advertising position
For “What should I confirm before booking Medicaid dental care in Texas?,” Before relying on a Texas summary, confirm the issue through Medicaid.gov’s Texas profile and the current Texas 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
- Write the Texas question in one sentence.
- Select Texas 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 Texas claim with no source date
- A provider who will not identify the governing authority
- A price, deadline, or eligibility statement presented as universal
For “How do prior authorization and managed-care rules affect Texas dental access?,” Treat Medicaid.gov’s Texas profile and the current Texas Medicaid dental program materials as the source-of-record pathway for this Texas 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
- Write the Texas question in one sentence.
- Select Texas 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 Texas 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 Texas?,” The controlling verification path for Texas runs through Medicaid.gov’s Texas profile and the current Texas Medicaid dental program materials; screenshots and blog charts are secondary. Use the source to separate general guidance from child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. Use Find a Provider only after the authority check so the next conversation starts with the right questions.
Quick checklist
- Name the exact Texas decision and the date that could change it.
- Select Texas 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
- An authority link that does not identify Texas or the topic
- A summary that hides exceptions
- A provider answer that changes when you ask for documentation
Need help applying this guide?
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