Virginia Medicaid Dental Coverage Guide
Virginia Medicaid Dental Coverage Guide: verify the Virginia authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
Virginia Medicaid Dental Coverage Guide: verify the Virginia authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check. Virginia Medicaid pays a dentist $63.19. Virginia Medicaid pays a dentist $26.99.
What this page recommends
Virginia Medicaid Dental Coverage Guide: verify the Virginia 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.
Virginia Medicaid dental reimbursement rates on this page are taken from Cardinal Care Smiles Schedule of Allowable Fees, published by Virginia Department of Medical Assistance Services, and retrieved 2026-08-26. The schedule is effective 2024-07-01. 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. Virginia operates a comprehensive adult dental benefit for adults 21 and over; children's dental care is required federally under EPSDT. Verified 2026-08-26.
Virginia Medicaid dental reimbursement: what the program pays a dentist, not what a patient pays
| Procedure (CDT code) | What Virginia Medicaid pays the dentist | Rate basis |
|---|---|---|
| Cleaning (prophylaxis), adult (CDT D1110) | Virginia Medicaid pays a dentist $63.19 | State reimbursement, effective 2024-07-01 |
| Periodic oral exam (CDT D0120) | Virginia Medicaid pays a dentist $26.99 | State reimbursement, effective 2024-07-01 |
| Crown, porcelain/ceramic (CDT D2740) | Virginia Medicaid pays a dentist $669.50 | State reimbursement, effective 2024-07-01 |
| Root canal, molar tooth (CDT D3330) | Virginia Medicaid pays a dentist $909.18 | State reimbursement, effective 2024-07-01 |
| Extraction, erupted tooth (simple) (CDT D7140) | Virginia Medicaid pays a dentist $92.39 | State reimbursement, effective 2024-07-01 |
| Comprehensive oral exam (CDT D0150) | Virginia Medicaid pays a dentist $41.92 | State reimbursement, effective 2024-07-01 |
| Cleaning (prophylaxis), child (CDT D1120) | Virginia Medicaid pays a dentist $44.89 | State reimbursement, effective 2024-07-01 |
| Fluoride varnish (paediatric preventive) (CDT D1206) | Virginia Medicaid pays a dentist $27.84 | State reimbursement, effective 2024-07-01 |
| Sealant, per tooth (paediatric preventive) (CDT D1351) | Virginia Medicaid pays a dentist $43.22 | State reimbursement, effective 2024-07-01 |
| Amalgam filling, one surface (CDT D2140) | Virginia Medicaid pays a dentist $79.51 | State reimbursement, effective 2024-07-01 |
| Composite filling, one surface, posterior (CDT D2391) | Virginia Medicaid pays a dentist $99.46 | State reimbursement, effective 2024-07-01 |
| Crown, porcelain fused to high noble metal (CDT D2750) | Virginia Medicaid pays a dentist $669.50 | State reimbursement, effective 2024-07-01 |
| Crown, porcelain fused to predominantly base metal (CDT D2751) | Virginia Medicaid pays a dentist $669.50 | State reimbursement, effective 2024-07-01 |
| Crown, full cast predominantly base metal (CDT D2791) | Virginia Medicaid pays a dentist $669.50 | State reimbursement, effective 2024-07-01 |
| Root canal, anterior tooth (CDT D3310) | Virginia Medicaid pays a dentist $502.13 | State reimbursement, effective 2024-07-01 |
| Root canal, premolar tooth (CDT D3320) | Virginia Medicaid pays a dentist $575.77 | State reimbursement, effective 2024-07-01 |
| Complete denture, upper (CDT D5110) | Virginia Medicaid pays a dentist $903.63 | State reimbursement, effective 2024-07-01 |
| Complete denture, lower (CDT D5120) | Virginia Medicaid pays a dentist $903.63 | State reimbursement, effective 2024-07-01 |
| Bridge pontic, porcelain fused to high noble metal (CDT D6240) | Virginia Medicaid pays a dentist $669.50 | State reimbursement, effective 2024-07-01 |
| Bridge retainer crown, porcelain fused to high noble metal (CDT D6750) | Virginia Medicaid pays a dentist $669.50 | State reimbursement, effective 2024-07-01 |
| Surgical extraction, erupted tooth (CDT D7210) | Virginia Medicaid pays a dentist $171.39 | State reimbursement, effective 2024-07-01 |
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
- Cardinal Care Smiles Schedule of Allowable Fees — Official Virginia Medicaid dental fee schedule: amounts the state pays a dental provider per CDT procedure. Not consumer prices.; reviewed 2026-08-26
- Virginia Medicaid adult dental benefit scope — Virginia's own statement of what dental care adult Medicaid members receive; reviewed 2026-08-26
Virginia publishes its Medicaid dental reimbursement rates in Cardinal Care Smiles Schedule of Allowable Fees. Those rates are what Virginia 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 Virginia reimbursement figure cannot answer what a filling or a crown would cost you. It does answer what Virginia 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 Virginia issue.
- Select Virginia 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 stale screenshot used as the only evidence
- No distinction between federal and Virginia requirements
- A recommendation based only on advertising position
Adult and child dental benefits are set differently in Virginia. 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. Virginia operates a comprehensive adult dental benefit for adults aged 21 and over. In the state's own words: "Virginia's Medicaid Cardinal Care Smiles program offers comprehensive dental services to children, through age 20, adults and pregnant members." Confirm your own category before booking, because Virginia eligibility groups can differ. Verified 2026-08-26.
Quick checklist
- Record the event date and the decision deadline for the Virginia issue.
- Select Virginia 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 Virginia or the topic
- A summary that hides exceptions
- A provider answer that changes when you ask for documentation
For “What should I confirm before booking Medicaid dental care in Virginia?,” Treat Medicaid.gov’s Virginia profile and the current Virginia Medicaid dental program materials as the source-of-record pathway for this Virginia 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 Virginia question in one sentence.
- Select Virginia 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 Virginia requirements
- A recommendation based only on advertising position
For “How do prior authorization and managed-care rules affect Virginia dental access?,” The defensible starting point in Virginia is Medicaid.gov’s Virginia profile and the current Virginia 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 Virginia.
- Select Virginia in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Separate federal rules from Virginia-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 Virginia requirements
- A recommendation based only on advertising position
For “When should I use Find a Provider for Medicaid dental care in Virginia?,” A current Virginia answer starts at Medicaid.gov’s Virginia profile and the current Virginia Medicaid dental program materials and then narrows to the exact facts, date, and service involved. Your written comparison should cover child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. The final action is a provider search informed by the source record, not an unsourced recommendation.
Quick checklist
- Identify the person, service, and jurisdiction involved in Virginia.
- Select Virginia in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Separate federal rules from Virginia-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 Virginia requirements
- A recommendation based only on advertising position
Need help applying this guide?
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- Washington Medicaid Dental Coverage Guide
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