Washington Medicaid Dental Coverage Guide
Washington Medicaid Dental Coverage Guide: verify the Washington authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
Washington Medicaid Dental Coverage Guide: verify the Washington authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check. Washington Medicaid pays a dentist $42.19 for a patient under 21.
What this page recommends
Washington Medicaid Dental Coverage Guide: verify the Washington 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.
Washington Medicaid dental reimbursement rates on this page are taken from Apple Health (Medicaid) Dental Program Fee Schedule, published by Washington State Health Care Authority, and retrieved 2026-08-26. The schedule is effective 2026-07-01. 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. Washington operates a limited adult dental benefit for adults 21 and over; children's dental care is required federally under EPSDT. Verified 2026-08-26.
Washington 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) | Washington Medicaid pays a dentist $42.19 for a patient under 21 | $51.57 paid to the dentist for a patient 21 and over |
| Periodic oral exam (CDT D0120) | Washington Medicaid pays a dentist $27.07 for a patient under 21 | $30.36 paid to the dentist for a patient 21 and over |
| Crown, porcelain/ceramic (CDT D2740) | Washington Medicaid pays a dentist $560.97 for a patient under 21 | No rate listed for this age group |
| Root canal, molar tooth (CDT D3330) | Washington Medicaid pays a dentist $543.11 for a patient under 21 | No rate listed for this age group |
| Extraction, erupted tooth (simple) (CDT D7140) | Washington Medicaid pays a dentist $57.65 for a patient under 21 | $45.73 paid to the dentist for a patient 21 and over |
| Comprehensive oral exam (CDT D0150) | Washington Medicaid pays a dentist $39.03 for a patient under 21 | $37.26 paid to the dentist for a patient 21 and over |
| Cleaning (prophylaxis), child (CDT D1120) | Washington Medicaid pays a dentist $32.17 for a patient under 21 | No rate listed for this age group |
| Fluoride varnish (paediatric preventive) (CDT D1206) | Washington Medicaid pays a dentist $19.50 for a patient under 21 | $19.50 paid to the dentist for a patient 21 and over |
| Sealant, per tooth (paediatric preventive) (CDT D1351) | Washington Medicaid pays a dentist $30.93 for a patient under 21 | No rate listed for this age group |
| Amalgam filling, one surface (CDT D2140) | Washington Medicaid pays a dentist $59.97 for a patient under 21 | $49.74 paid to the dentist for a patient 21 and over |
| Composite filling, one surface, posterior (CDT D2391) | Washington Medicaid pays a dentist $59.97 for a patient under 21 | $49.74 paid to the dentist for a patient 21 and over |
| Crown, porcelain fused to high noble metal (CDT D2750) | Washington Medicaid pays a dentist $560.97 for a patient under 21 | No rate listed for this age group |
| Crown, porcelain fused to predominantly base metal (CDT D2751) | Washington Medicaid pays a dentist $560.97 for a patient under 21 | No rate listed for this age group |
| Root canal, anterior tooth (CDT D3310) | Washington Medicaid pays a dentist $395.69 for a patient under 21 | $351.94 paid to the dentist for a patient 21 and over |
| Root canal, premolar tooth (CDT D3320) | Washington Medicaid pays a dentist $446.12 for a patient under 21 | No rate listed for this age group |
| Complete denture, upper (CDT D5110) | Washington Medicaid pays a dentist $470.07 for a patient under 21 | $585.34 paid to the dentist for a patient 21 and over |
| Complete denture, lower (CDT D5120) | Washington Medicaid pays a dentist $470.07 for a patient under 21 | $585.34 paid to the dentist for a patient 21 and over |
| Surgical extraction, erupted tooth (CDT D7210) | Washington Medicaid pays a dentist $89.05 for a patient under 21 | $89.70 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
- Apple Health (Medicaid) Dental Program Fee Schedule — Official Washington Medicaid dental fee schedule: amounts the state pays a dental provider per CDT procedure. Not consumer prices.; reviewed 2026-08-26
- Washington Medicaid adult dental benefit scope — Washington's own statement of what dental care adult Medicaid members receive; reviewed 2026-08-26
Washington publishes its Medicaid dental reimbursement rates in Apple Health (Medicaid) Dental Program Fee Schedule. Those rates are what Washington 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 Washington reimbursement figure cannot answer what a filling or a crown would cost you. It does answer what Washington 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 Washington issue.
- Select Washington 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 Washington or the topic
- A summary that hides exceptions
- A provider answer that changes when you ask for documentation
Adult and child dental benefits are set differently in Washington. 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. Washington operates a limited adult dental benefit for adults aged 21 and over. In the state's own words: "Dental services for adults (21 years of age and older) are covered directly by Apple Health using your ProviderOne services card. Dental services not covered for adults include, but are not limited to: Bridges; Porcelain crowns; Orthodontics (braces); Dental implants; Root canals (premolars and molars)." Confirm your own category before booking, because Washington eligibility groups can differ. Verified 2026-08-26.
Quick checklist
- Write the Washington question in one sentence.
- Select Washington 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 Washington 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 Washington?,” For Washington, begin with Medicaid.gov’s Washington profile and the current Washington 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 Washington question in one sentence.
- Select Washington 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 generic fifty-state chart replacing Washington 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 Washington dental access?,” In Washington, verify the rule or credential through Medicaid.gov’s Washington profile and the current Washington Medicaid dental program materials before comparing providers or acting. A provider-facing checklist should test child EPSDT obligations, optional adult coverage, covered service categories, prior authorization, managed-care network rules, and current state contacts. The provider CTA is the next step, not a substitute for verifying the governing source.
Quick checklist
- Identify the person, service, and jurisdiction involved in Washington.
- Select Washington in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Separate federal rules from Washington-specific rules.
- Ask the provider to explain any conflict in writing.
Red flags
- An authority link that does not identify Washington 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 Washington?,” Before relying on a Washington summary, confirm the issue through Medicaid.gov’s Washington profile and the current Washington 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
- Identify the person, service, and jurisdiction involved in Washington.
- Select Washington in Medicaid.gov’s state profiles, then confirm adult and child dental benefits in the state program documents.
- Separate federal rules from Washington-specific rules.
- Ask the provider to explain any conflict in writing.
Red flags
- A generic fifty-state chart replacing Washington primary material
- No license or designation verification
- Pressure to act before written terms are supplied
Need help applying this guide?
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