West Virginia Medicaid Dental Coverage Guide
West Virginia Medicaid Dental Coverage Guide: verify the West Virginia authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check.
West Virginia Medicaid Dental Coverage Guide: verify the West Virginia authority path, document the current rule or credential, compare written provider terms, and continue through Find a Provider only after the evidence check. West Virginia Medicaid pays a dentist $64.54.
What this page recommends
West Virginia Medicaid Dental Coverage Guide: verify the West 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.
West Virginia Medicaid dental reimbursement rates on this page are taken from West Virginia Medicaid Dental Fee Schedule, published by West Virginia Bureau for Medical Services, and retrieved 2026-08-26. The schedule is effective 2026-04-01. 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. West Virginia operates a limited adult dental benefit for adults 21 and over; children's dental care is required federally under EPSDT. Verified 2026-08-26.
West Virginia Medicaid dental reimbursement: what the program pays a dentist, not what a patient pays
| Procedure (CDT code) | What West Virginia Medicaid pays the dentist | Rate basis |
|---|---|---|
| Cleaning (prophylaxis), adult (CDT D1110) | West Virginia Medicaid pays a dentist $64.54 | State reimbursement, effective 2026-04-01 |
| Periodic oral exam (CDT D0120) | West Virginia Medicaid pays a dentist $29.33 | State reimbursement, effective 2026-04-01 |
| Crown, porcelain/ceramic (CDT D2740) | West Virginia Medicaid pays a dentist $745.09 | State reimbursement, effective 2026-04-01 |
| Root canal, molar tooth (CDT D3330) | West Virginia Medicaid pays a dentist $739.22 | State reimbursement, effective 2026-04-01 |
| Extraction, erupted tooth (simple) (CDT D7140) | West Virginia Medicaid pays a dentist $93.87 | State reimbursement, effective 2026-04-01 |
| Comprehensive oral exam (CDT D0150) | West Virginia Medicaid pays a dentist $41.07 | State reimbursement, effective 2026-04-01 |
| Cleaning (prophylaxis), child (CDT D1120) | West Virginia Medicaid pays a dentist $46.93 | State reimbursement, effective 2026-04-01 |
| Fluoride varnish (paediatric preventive) (CDT D1206) | West Virginia Medicaid pays a dentist $23.47 | State reimbursement, effective 2026-04-01 |
| Sealant, per tooth (paediatric preventive) (CDT D1351) | West Virginia Medicaid pays a dentist $35.20 | State reimbursement, effective 2026-04-01 |
| Amalgam filling, one surface (CDT D2140) | West Virginia Medicaid pays a dentist $85.66 | State reimbursement, effective 2026-04-01 |
| Composite filling, one surface, posterior (CDT D2391) | West Virginia Medicaid pays a dentist $109.12 | State reimbursement, effective 2026-04-01 |
| Crown, porcelain fused to high noble metal (CDT D2750) | West Virginia Medicaid pays a dentist $745.09 | State reimbursement, effective 2026-04-01 |
| Crown, porcelain fused to predominantly base metal (CDT D2751) | West Virginia Medicaid pays a dentist $745.09 | State reimbursement, effective 2026-04-01 |
| Crown, full cast predominantly base metal (CDT D2791) | West Virginia Medicaid pays a dentist $739.22 | State reimbursement, effective 2026-04-01 |
| Root canal, anterior tooth (CDT D3310) | West Virginia Medicaid pays a dentist $475.21 | State reimbursement, effective 2026-04-01 |
| Root canal, premolar tooth (CDT D3320) | West Virginia Medicaid pays a dentist $585.51 | State reimbursement, effective 2026-04-01 |
| Complete denture, upper (CDT D5110) | West Virginia Medicaid pays a dentist $634.69 | State reimbursement, effective 2026-04-01 |
| Complete denture, lower (CDT D5120) | West Virginia Medicaid pays a dentist $634.69 | State reimbursement, effective 2026-04-01 |
| Surgical extraction, erupted tooth (CDT D7210) | West Virginia Medicaid pays a dentist $152.54 | State reimbursement, effective 2026-04-01 |
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
- West Virginia Medicaid Dental Fee Schedule — Official West Virginia Medicaid dental fee schedule: amounts the state pays a dental provider per CDT procedure. Not consumer prices.; reviewed 2026-08-26
- West Virginia Medicaid adult dental benefit scope — West Virginia's own statement of what dental care adult Medicaid members receive; reviewed 2026-08-26
West Virginia publishes its Medicaid dental reimbursement rates in West Virginia Medicaid Dental Fee Schedule. Those rates are what West 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 West Virginia reimbursement figure cannot answer what a filling or a crown would cost you. It does answer what West Virginia Medicaid will pay a dentist who accepts it. The figures on this page were retrieved 2026-08-26.
Quick checklist
- Name the exact West Virginia decision and the date that could change it.
- Select West Virginia 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 West Virginia claim with no source date
- A provider who will not identify the governing authority
- A price, deadline, or eligibility statement presented as universal
Adult and child dental benefits are set differently in West 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. West Virginia operates a limited adult dental benefit for adults aged 21 and over. In the state's own words: "Eligible members can receive emergent and preventive/restorative care. Only services outlined in Chapter 505 Appendix C apply to the expanded adult dental benefit and are subject to the $1000 maximum and require to be prior authorized. Any amount over the $1,000 Medicaid Cap is the member's responsibility." Confirm your own category before booking, because West Virginia eligibility groups can differ. Verified 2026-08-26.
Quick checklist
- Record the event date and the decision deadline for the West Virginia issue.
- Select West 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 West 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 West Virginia?,” In West Virginia, verify the rule or credential through Medicaid.gov’s West Virginia profile and the current West Virginia 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
- Write the West Virginia question in one sentence.
- Select West 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 generic fifty-state chart replacing West Virginia 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 West Virginia dental access?,” For West Virginia, begin with Medicaid.gov’s West Virginia profile and the current West Virginia 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 West Virginia decision and the date that could change it.
- Select West Virginia 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 West Virginia 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 West Virginia?,” For West Virginia, begin with Medicaid.gov’s West Virginia profile and the current West Virginia 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
- Record the event date and the decision deadline for the West Virginia issue.
- Select West 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 West Virginia requirements
- A recommendation based only on advertising position
Need help applying this guide?
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