Massachusetts Medicaid Dental Services Fee Schedule 2026

MassHealth, the Massachusetts Medicaid program, pays for dental care services using a fixed fee schedule. The schedule lists CDT procedure codes, descriptions, and applicable adult and EPSDT payment amounts. Some procedures have fixed fees, while others are reimbursed through Individual Consideration (I.C.). These rates are established by the Massachusetts Executive Office of Health and Human Services (EOHHS).

Important to Know: dental procedures are reported with CDT codes (Current Dental Terminology, D-codes published by the American Dental Association), not with CPT codes. CPT codes appear only when an oral surgeon bills a medical-style service under the physician fee regulations.

Massachusetts Medicaid Dental Services Reimbursement Rates in 2026

The MassHealth Dental services reimbursement rates are divided in certain categories, as shown below.

Note: These rates give dental practices a reference point for checking their payments. If your reimbursements consistently fall short of what your practice is eligible to receive, consider speaking with an experienced Massachusetts medical billing company to find out where the difference is coming from.

➜ Category 1: Diagnostic Services

Clinical Oral Evaluations (D0120–D0191)

These codes cover routine dental examinations, problem-focused evaluations, comprehensive assessments, and patient screenings. Payment varies by examination type, with separate adult and EPSDT rates for most services.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D0120	Periodic oral evaluation – established patient	$24	$31
D0140	Limited oral evaluation – problem focused	$43	$49
D0145	Oral evaluation, patient under three years of age, with counseling of primary caregiver	I.C.	$27
D0150	Comprehensive oral evaluation – new or established patient	$41	$62
D0160	Detailed and extensive oral evaluation – problem focused, by report	$64	$77
D0170	Re-evaluation – limited, problem focused (not postoperative visit)	$39	$45
D0180	Comprehensive periodontal evaluation – new or established patient	$37	$58
D0190	Screening of patient	$20	$29
D0191	Assessment of patient	$20	$29

Dental Radiographs and Imaging (D0210–D0350)

This category includes intraoral and extraoral X-rays, bitewing images, panoramic imaging, and cephalometric studies. The listed fees depend on the type and number of images, while certain advanced imaging procedures require individual consideration (I.C).

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D0210	Intraoral – complete series of radiographic images	$76	$94
D0220	Intraoral – periapical, first radiographic image	$15	$21
D0230	Intraoral – periapical, each additional radiographic image	$13	$17
D0240	Intraoral – occlusal radiographic image	$21	$26
D0250	Extra-oral 2D projection radiographic image (stationary source and detector)	$23	$28
D0270	Bitewing – single radiographic image	$14	$17
D0272	Bitewings – two radiographic images	$25	$32
D0273	Bitewings – three radiographic images	$27	$35
D0274	Bitewings – four radiographic images	$36	$46
D0277	Vertical bitewings – 7 to 8 radiographic images	$47	$55
D0310	Sialography	$45	$48
D0320	Temporomandibular joint arthrogram, including injection	$230	$321
D0321	Other temporomandibular joint radiographic image, by report	$96	$114
D0330	Panoramic radiographic image	$69	$94
D0340	2D cephalometric radiographic image – acquisition, measurement and analysis	$74	$85
D0350	2D oral/facial photographic image, intra-orally or extra-orally	$39	$47

Diagnostic Tests and Oral Pathology (D0460–D0480)

These procedures include pulp vitality testing, diagnostic casts, and tissue or cytological examinations. The table lists fixed fees for the selected diagnostic services, while several other laboratory and pathology codes are reimbursed through individual consideration.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D0460	Pulp vitality tests	$31	$37
D0470	Diagnostic casts	$62	$72
D0472	Accession of tissue, gross examination, preparation and written report	$72	$87
D0480	Accession of exfoliative cytologic smears, microscopic examination and written report	$54	$65

➜ Category 2: Preventive Services

Cleanings, Fluoride, Sealants and Caries Arrest (D1110–D1354)

Preventive services include professional cleanings, fluoride applications, oral hygiene instructions, dental sealants, and caries-arresting treatments.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D1110	Prophylaxis – adult	$60	$75
D1120	Prophylaxis – child	$39	$55
D1206	Topical application of fluoride varnish	$26	$28
D1208	Topical application of fluoride – excluding varnish	$29	$31
D1330	Oral hygiene instructions	$15	$21
D1351	Sealant – per tooth	$30	$44
D1354	Application of caries arresting medicament – per tooth	$15	$15

Space Maintainers (D1510–D1527)

Space maintainer fees cover fixed and removable appliances used to preserve space for developing permanent teeth. The payment amount varies according to the appliance design, arch, and whether it is unilateral or bilateral.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D1510	Space maintainer – fixed, unilateral – per quadrant	$191	$229
D1516	Space maintainer – fixed, bilateral, maxillary	$306	$345
D1517	Space maintainer – fixed, bilateral, mandibular	$306	$345
D1520	Space maintainer – removable, unilateral – per quadrant	$230	$244
D1526	Space maintainer – removable, bilateral, maxillary	$345	$368
D1527	Space maintainer – removable, bilateral, mandibular	$345	$368

➜ Category 3: Restorative Services

Amalgam and Composite Fillings (D2140–D2394)

Restorative filling fees depend on the material used, the tooth location, and the number of surfaces restored. The schedule includes both amalgam and resin-based composite procedures, with different adult and EPSDT payment amounts.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D2140	Amalgam – one surface, primary or permanent	$62	$77
D2150	Amalgam – two surfaces, primary or permanent	$77	$95
D2160	Amalgam – three surfaces, primary or permanent	$92	$110
D2161	Amalgam – four or more surfaces, primary or permanent	$116	$137
D2330	Resin-based composite – one surface, anterior	$72	$98
D2331	Resin-based composite – two surfaces, anterior	$92	$118
D2332	Resin-based composite – three surfaces, anterior	$116	$147
D2335	Resin-based composite – four or more surfaces or involving incisal angle (anterior)	$146	$188
D2390	Resin-based composite crown, anterior	$106	$133
D2391	Resin-based composite – one surface, posterior	$62	$99
D2392	Resin-based composite – two surfaces, posterior	$77	$123
D2393	Resin-based composite – three surfaces, posterior	$92	$133
D2394	Resin-based composite – four or more surfaces, posterior	$116	$182

Inlays and Onlays (D2530–D2664)

This table covers indirect restorations made from metallic, porcelain, ceramic, and resin-based composite materials. Fees vary according to the restoration material and the number of tooth surfaces involved.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D2530	Inlay – metallic – three or more surfaces	$307	$367
D2542	Onlay – metallic – two surfaces	$499	$596
D2543	Onlay – metallic – three surfaces	$690	$788
D2544	Onlay – metallic – four or more surfaces	$715	$800
D2620	Inlay – porcelain/ceramic – two surfaces	$422	$504
D2630	Inlay – porcelain/ceramic – three or more surfaces	$640	$744
D2642	Onlay – porcelain/ceramic – two surfaces	$675	$722
D2643	Onlay – porcelain/ceramic – three surfaces	$651	$768
D2644	Onlay – porcelain/ceramic – four or more surfaces	$660	$788
D2662	Onlay – resin-based composite – two surfaces	$613	$656
D2663	Onlay – resin-based composite – three surfaces	$612	$727
D2664	Onlay – resin-based composite – four or more surfaces	$612	$731

Single Crowns (D2710–D2799)

Single-crown reimbursement depends primarily on the restorative material and crown design. The schedule includes resin, porcelain, ceramic, and metal-based crowns, with separate amounts for different material classifications.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D2710	Crown – resin-based composite (indirect)	$230	$244
D2720	Crown – resin with high noble metal	$633	$757
D2721	Crown – resin with predominantly base metal	$460	$550
D2722	Crown – resin with noble metal	$521	$558
D2740	Crown – porcelain/ceramic	$729	$853
D2750	Crown – porcelain fused to high noble metal	$686	$800
D2751	Crown – porcelain fused to predominantly base metal	$613	$727
D2752	Crown – porcelain fused to noble metal	$633	$735
D2780	Crown – 3/4 cast high noble metal	$705	$841
D2783	Crown – 3/4 porcelain/ceramic	$682	$812
D2790	Crown – full cast high noble metal	$690	$808
D2791	Crown – full cast predominantly base metal	$538	$641
D2792	Crown – full cast noble metal	$651	$748
D2799	Interim crown – further treatment or completion of diagnosis necessary prior to final impression	$191	$228

Prefabricated Crowns, Buildups, Posts, Veneers and Restorative Repairs (D2910–D2980)

These procedures cover supporting restorative treatments, including prefabricated crowns, core buildups, post placement, veneers, and crown repairs. The listed fees reflect the specific restoration or repair performed, including differences between primary and permanent teeth.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D2910	Re-cement or re-bond inlay, onlay or partial coverage restoration	$57	$69
D2920	Re-cement or re-bond crown	$57	$68
D2930	Prefabricated stainless steel crown – primary tooth	$153	$205
D2931	Prefabricated stainless steel crown – permanent tooth	$171	$199
D2932	Prefabricated resin crown	$211	$224
D2933	Prefabricated stainless steel crown with resin window	$153	$184
D2934	Prefabricated esthetic coated stainless steel crown – primary tooth	$153	$184
D2940	Placement of interim direct restoration (formerly protective restoration)	$61	$72
D2950	Core buildup, including any pins when required	$164	$197
D2951	Pin retention – per tooth, in addition to restoration	$27	$31
D2952	Post and core in addition to crown, indirectly fabricated	$233	$276
D2954	Prefabricated post and core in addition to crown	$191	$229
D2960	Labial veneer (resin laminate) – direct	$307	$420
D2961	Labial veneer (resin laminate) – indirect	$422	$504
D2962	Labial veneer (porcelain laminate) – laboratory	$574	$688
D2980	Crown repair necessitated by restorative material failure	$115	$137

➜ Category 4: Endodontic Services

Root Canal Therapy, Pulp Treatment and Retreatment (D3110–D3950)

This category includes pulp capping, pulpotomy, root canal treatment, endodontic retreatment, and related procedures. Payment varies by tooth type and treatment complexity, and the listed root canal fees exclude the final restoration.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D3110	Pulp cap – direct (excluding final restoration)	$34	$40
D3120	Pulp cap – indirect (excluding final restoration)	$34	$40
D3220	Therapeutic pulpotomy (excluding final restoration)	$88	$106
D3221	Pulpal debridement, primary and permanent teeth	$115	$123
D3310	Endodontic therapy, anterior tooth (excluding final restoration)	$544	$544
D3320	Endodontic therapy, premolar tooth (excluding final restoration)	$639	$639
D3330	Endodontic therapy, molar tooth (excluding final restoration)	$829	$829
D3332	Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth	$191	$205
D3333	Internal root repair of perforation defects	$230	$274
D3346	Retreatment of previous root canal therapy – anterior	$456	$545
D3347	Retreatment of previous root canal therapy – premolar	$538	$641
D3348	Retreatment of previous root canal therapy – molar	$613	$789
D3351	Apexification/recalcification – initial visit	$122	$146
D3920	Hemisection (including any root removal), not including root canal therapy	$211	$243
D3950	Canal preparation and fitting of preformed dowel or post	$69	$111

Endodontic Surgery (D3410–D3460)

Surgical endodontic procedures include apicoectomies, retrograde fillings, root amputations, and endodontic implant placement. Fees vary according to the surgical procedure, tooth location, and number of roots treated.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D3410	Apicoectomy – anterior	$407	$471
D3421	Apicoectomy – premolar (first root)	$460	$550
D3425	Apicoectomy – molar (first root)	$598	$639
D3426	Apicoectomy (each additional root)	$230	$264
D3430	Retrograde filling – per root	$77	$91
D3450	Root amputation – per root	$288	$343
D3460	Endodontic endosseous implant	$462	$744

➜ Category 5: Periodontal Services

Non-Surgical Periodontal Care and Maintenance (D4341–D4920)

These services address periodontal disease through scaling and root planing, gingival inflammation treatment, full-mouth debridement, and ongoing periodontal maintenance. Payment is determined by the procedure performed and, where applicable, the number of teeth or treatment units involved.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D4341	Periodontal scaling and root planing – four or more teeth per quadrant	$134	$160
D4342	Periodontal scaling and root planing – one to three teeth per quadrant	$90	$107
D4346	Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation	$60	$75
D4355	Full mouth debridement to enable comprehensive periodontal evaluation and diagnosis on a subsequent visit	$77	$93
D4381	Localized delivery of antimicrobial agents via controlled release vehicle, per tooth	$88	$121
D4910	Periodontal maintenance	$80	$111
D4920	Unscheduled dressing change (by someone other than treating dentist)	$67	$76

Periodontal Surgery and Grafting (D4210–D4274)

This table covers surgical treatments involving gum tissue, periodontal flaps, bone replacement grafts, and guided tissue regeneration.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D4210	Gingivectomy or gingivoplasty – four or more contiguous teeth per quadrant	$307	$343
D4211	Gingivectomy or gingivoplasty – one to three contiguous teeth per quadrant	$111	$133
D4240	Gingival flap procedure, including root planing – four or more teeth per quadrant	$449	$606
D4249	Clinical crown lengthening – hard tissue	$460	$550
D4260	Osseous surgery – four or more contiguous teeth per quadrant	$795	$1,101
D4261	Osseous surgery – one to three contiguous teeth per quadrant	$708	$759
D4263	Bone replacement graft – retained natural tooth – first site in quadrant	$253	$351
D4264	Bone replacement graft – retained natural tooth – each additional site in quadrant	$188	$202
D4266	Guided tissue regeneration, natural teeth – resorbable barrier, per site	$307	$359
D4267	Guided tissue regeneration, natural teeth – non-resorbable barrier, per site	$307	$328
D4270	Pedicle soft tissue graft procedure	$604	$800
D4273	Autogenous connective tissue graft procedure – first tooth, implant or edentulous position	$651	$779
D4274	Mesial/distal wedge procedure, single tooth	$326	$384

➜ Category 6: Removable Prosthodontics

Complete, Partial and Interim Dentures (D5110–D5821)

Denture reimbursement covers complete, partial, immediate, and interim appliances for both the maxillary and mandibular arches. Payment varies by denture type, materials, and construction, with certain flexible-base and immediate partial denture procedures subject to individual consideration.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D5110	Complete denture – maxillary	$730	$858
D5120	Complete denture – mandibular	$730	$852
D5130	Immediate denture – maxillary	$767	$935
D5140	Immediate denture – mandibular	$766	$934
D5211	Maxillary partial denture – resin base (including clasping materials, rests and teeth)	$556	$650
D5212	Mandibular partial denture – resin base (including clasping materials, rests and teeth)	$595	$691
D5213	Maxillary partial denture – cast metal framework with resin denture bases	$1,097	$974
D5214	Mandibular partial denture – cast metal framework with resin denture bases	$1,134	$986
D5225	Maxillary partial denture – flexible base	I.C.	$974
D5226	Mandibular partial denture – flexible base	I.C.	$986
D5810	Interim complete denture (maxillary)	$145	$193
D5811	Interim complete denture (mandibular)	$145	$193
D5820	Interim partial denture, maxillary	$268	$321
D5821	Interim partial denture, mandibular	$295	$316

Denture Adjustments, Repairs, Rebases, Relines and Conditioning (D5410–D5862)

These procedures cover maintenance and restoration of existing complete and partial dentures. The fees vary according to the type of adjustment, repair, rebase, reline, or tissue-conditioning service provided.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D5410	Adjust complete denture – maxillary	$42	$49
D5411	Adjust complete denture – mandibular	$42	$49
D5421	Adjust partial denture – maxillary	$53	$56
D5422	Adjust partial denture – mandibular	$39	$45
D5511	Repair broken complete denture base, mandibular	$85	$109
D5512	Repair broken complete denture base, maxillary	$85	$109
D5520	Replace missing or broken teeth – complete denture – per tooth	$77	$89
D5611	Repair broken resin partial denture base, mandibular	$77	$93
D5612	Repair broken resin partial denture base, maxillary	$77	$93
D5621	Repair broken cast partial denture base, mandibular	$104	$121
D5622	Repair broken cast partial denture base, maxillary	$104	$121
D5630	Repair or replace broken retentive/clasping materials – per tooth	$99	$107
D5640	Replace missing or broken teeth – partial denture – per tooth	$77	$91
D5650	Add tooth to existing partial denture – per tooth	$92	$110
D5660	Add clasp to existing partial denture – per tooth	$98	$125
D5710	Rebase complete maxillary denture	$253	$301
D5711	Rebase complete mandibular denture	$201	$257
D5720	Rebase maxillary partial denture	$230	$274
D5721	Rebase mandibular partial denture	$284	$323
D5730	Reline complete maxillary denture (direct)	$158	$188
D5731	Reline complete mandibular denture (direct)	$173	$184
D5740	Reline maxillary partial denture (direct)	$142	$169
D5741	Reline mandibular partial denture (direct)	$134	$160
D5750	Reline complete maxillary denture (indirect)	$214	$255
D5751	Reline complete mandibular denture (indirect)	$215	$256
D5760	Reline maxillary partial denture (indirect)	$211	$252
D5761	Reline mandibular partial denture (indirect)	$211	$252
D5850	Tissue conditioning, maxillary	$72	$86
D5851	Tissue conditioning, mandibular	$65	$77
D5862	Precision attachment, by report	$230	$254

➜ Category 7: Implant Services

Implant Placement, Abutments and Implant-Supported Crowns (D6010–D6080)

Implant services include surgical implant placement, abutment connections, implant-supported crowns, and implant maintenance. The schedule provides fixed fees for the listed procedures, while several other implant-related services are reimbursed through individual consideration.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D6010	Surgical placement of implant body: endosteal implant	$1,151	$1,374
D6040	Surgical placement: eposteal implant	$1,534	$1,632
D6050	Surgical placement: transosteal implant	$134	$162
D6055	Connecting bar – implant supported or abutment supported	$230	$274
D6056	Prefabricated abutment – includes modification and placement	$278	$331
D6057	Custom fabricated abutment – includes placement	$402	$480
D6058	Abutment supported porcelain/ceramic crown	$920	$982
D6059	Abutment supported porcelain fused to metal crown (high noble metal)	$756	$894
D6060	Abutment supported porcelain fused to metal crown (predominantly base metal)	$729	$778
D6061	Abutment supported porcelain fused to metal crown (noble metal)	$758	$812
D6062	Abutment supported cast metal crown (high noble metal)	$767	$894
D6064	Abutment supported cast metal crown (noble metal)	$920	$1,091
D6065	Implant supported porcelain/ceramic crown	$920	$1,015
D6066	Implant supported crown – porcelain fused to high noble alloys	$878	$1,049
D6067	Implant supported crown – high noble alloys	$996	$1,067
D6080	Implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments (full arch fixed hybrid prosthesis)	$96	$115

➜ Category 8: Fixed Prosthodontics

Bridge Pontics, Retainer Crowns and Fixed Prosthesis Services (D6210–D6980)

Fixed prosthodontic services include bridge pontics, retainer crowns, precision attachments, and bridge repairs. Fees vary by restorative material and component type, with bridge components generally priced separately for each unit.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D6210	Pontic – cast high noble metal	$651	$748
D6211	Pontic – cast predominantly base metal	$584	$667
D6212	Pontic – cast noble metal	$632	$676
D6240	Pontic – porcelain fused to high noble metal	$671	$792
D6241	Pontic – porcelain fused to predominantly base metal	$606	$691
D6242	Pontic – porcelain fused to noble metal	$613	$731
D6250	Pontic – resin with high noble metal	$703	$807
D6251	Pontic – resin with predominantly base metal	$517	$575
D6252	Pontic – resin with noble metal	$555	$691
D6545	Retainer – cast metal for resin bonded fixed prosthesis	$268	$320
D6720	Retainer crown – resin with high noble metal	$527	$671
D6721	Retainer crown – resin with predominantly base metal	$536	$610
D6722	Retainer crown – resin with noble metal	$207	$246
D6750	Retainer crown – porcelain fused to high noble metal	$678	$779
D6751	Retainer crown – porcelain fused to predominantly base metal	$610	$691
D6752	Retainer crown – porcelain fused to noble metal	$613	$731
D6780	Retainer crown – 3/4 cast high noble metal	$517	$617
D6790	Retainer crown – full cast high noble metal	$703	$897
D6791	Retainer crown – full cast predominantly base metal	$556	$661
D6792	Retainer crown – full cast noble metal	$589	$701
D6930	Recement bridge	$72	$87
D6940	Stress breaker	$153	$204
D6950	Precision attachment	$166	$220
D6980	Fixed partial denture repair necessitated by restorative material failure	$134	$155

➜ Category 9: Oral and Maxillofacial Surgery

Extractions and Surgical Tooth Removal (D7111–D7250)

This table covers routine extractions and more complex surgical tooth removals, including impacted teeth and residual roots. Payment depends on the extraction technique, degree of impaction, and additional surgical work required.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D7111	Extraction, coronal remnants – primary tooth	$75	$80
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	$77	$107
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	$149	$179
D7220	Removal of impacted tooth – soft tissue	$191	$223
D7230	Removal of impacted tooth – partially bony	$249	$286
D7240	Removal of impacted tooth – completely bony	$295	$378
D7241	Removal of impacted tooth – completely bony, with unusual surgical complications	$326	$427
D7250	Surgical removal of residual tooth roots (cutting procedure)	$144	$173

Other Oral Surgery: Biopsies, Alveoloplasty, Lesions, Soft Tissue and Salivary Procedures (D7260–D7983)

These codes cover a range of oral surgical procedures, including biopsies, alveoloplasty, lesion removal, soft-tissue surgery, and salivary gland treatments. The listed fees vary according to the procedure performed, anatomical site, and complexity of treatment.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D7260	Oroantral fistula closure	$339	$398
D7270	Tooth reimplantation and/or stabilization of accidentally avulsed or displaced tooth	$106	$145
D7272	Tooth transplantation	$161	$218
D7280	Exposure of an unerupted tooth	$380	$452
D7283	Placement of device to facilitate eruption of impacted tooth	$73	$84
D7285	Incisional biopsy of oral tissue – hard (bone, tooth)	$122	$146
D7286	Incisional biopsy of oral tissue – soft	$164	$197
D7290	Surgical repositioning of teeth	$79	$109
D7291	Transseptal fiberotomy/supra crestal fiberotomy, by report	$137	$165
D7310	Alveoloplasty in conjunction with extractions – four or more teeth per quadrant	$142	$163
D7311	Alveoloplasty in conjunction with extractions – one to three teeth per quadrant	$128	$146
D7320	Alveoloplasty not in conjunction with extractions – four or more teeth per quadrant	$187	$202
D7321	Alveoloplasty not in conjunction with extractions – one to three teeth per quadrant	$149	$162
D7340	Vestibuloplasty – ridge extension (second epithelialization)	$747	$796
D7350	Vestibuloplasty – ridge extension (including soft tissue grafts and muscle reattachments)	$943	$1,236
D7410	Excision of benign lesion up to 1.25 cm	$115	$124
D7411	Excision of benign lesion greater than 1.25 cm	$208	$254
D7440	Excision of malignant tumor – lesion diameter up to 1.25 cm	$188	$256
D7441	Excision of malignant tumor – lesion diameter greater than 1.25 cm	$249	$339
D7450	Removal of benign odontogenic cyst or tumor – up to 1.25 cm	$248	$252
D7451	Removal of benign odontogenic cyst or tumor – greater than 1.25 cm	$288	$343
D7460	Removal of benign nonodontogenic cyst or tumor – up to 1.25 cm	$121	$142
D7461	Removal of benign nonodontogenic cyst or tumor – greater than 1.25 cm	$143	$194
D7471	Removal of lateral exostosis (maxilla or mandible)	$143	$194
D7510	Incision and drainage of abscess – intraoral soft tissue	$96	$115
D7520	Incision and drainage of abscess – extraoral soft tissue	$80	$86
D7530	Removal of foreign body from mucosa, skin or subcutaneous alveolar tissue	$210	$224
D7540	Removal of reaction-producing foreign bodies, musculoskeletal system	$464	$544
D7560	Maxillary sinusotomy for removal of tooth fragment or foreign body	$267	$364
D7910	Suture of recent small wounds up to 5 cm	$31	$42
D7911	Complicated suture – up to 5 cm	$106	$129
D7912	Complicated suture – greater than 5 cm	$106	$145
D7961	Buccal/labial frenectomy (frenulectomy)	$107	$353
D7962	Lingual frenectomy (frenulectomy)	$107	$353
D7963	Frenuloplasty	$416	$480
D7970	Excision of hyperplastic tissue – per arch	$246	$334
D7971	Excision of pericoronal gingiva	$79	$109
D7980	Surgical sialolithotomy	$106	$145
D7981	Excision of salivary gland, by report	$649	$850
D7982	Sialodochoplasty	$282	$387
D7983	Closure of salivary fistula	$517	$705

Fracture Treatment, TMJ and Jaw Surgery (D7610–D7950)

This category includes surgical and nonsurgical fracture reductions, jaw reconstruction procedures, temporomandibular joint treatments, and bone grafting. Payment varies considerably according to the anatomical area, surgical approach, and complexity of the procedure.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D7610	Maxilla – open reduction (teeth immobilized, if present)	$1,250	$1,704
D7620	Maxilla – closed reduction (teeth immobilized, if present)	$419	$569
D7630	Mandible – open reduction (teeth immobilized, if present)	$1,045	$1,425
D7640	Mandible – closed reduction (teeth immobilized, if present)	$624	$850
D7650	Malar and/or zygomatic arch – open reduction	$833	$1,135
D7660	Malar and/or zygomatic arch – closed reduction	$207	$282
D7670	Alveolus – closed reduction, may include stabilization of teeth	$296	$387
D7710	Maxilla – open reduction	$1,250	$1,704
D7730	Mandible – open reduction	$1,045	$1,425
D7740	Mandible – closed reduction	$624	$846
D7750	Malar and/or zygomatic arch – open reduction	$833	$1,135
D7760	Malar and/or zygomatic arch – closed reduction	$207	$282
D7770	Alveolus – open reduction stabilization of teeth	$312	$380
D7780	Facial bones – complicated reduction with fixation and multiple surgical approaches	$115	$137
D7810	Open reduction of dislocation	$521	$711
D7820	Closed reduction of dislocation	$80	$109
D7840	Condylectomy	$833	$1,135
D7870	Arthrocentesis	$106	$145
D7880	Occlusal orthotic device, by report	$345	$367
D7943	Osteotomy – mandibular rami with bone graft; includes obtaining the graft	$2,501	$3,409
D7944	Osteotomy – segmented or subapical	$1,015	$1,384
D7945	Osteotomy – body of mandible	$2,084	$2,843
D7950	Osseous, osteoperiosteal or cartilage graft of the mandible or maxilla – autogenous or nonautogenous, by report	$833	$1,135

➜ Category 10: Orthodontic Services

Orthodontic Treatment, Appliances and Retention (D8010–D8704)

Orthodontic fees cover limited and comprehensive treatment, removable appliances, periodic treatment visits, and retention services. Limited orthodontic treatment has different adult and EPSDT payment arrangements, while other services carry procedure-specific rates

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D8010	Limited orthodontic treatment of the primary dentition	I.C.	$250
D8020	Limited orthodontic treatment of the transitional dentition	I.C.	$250
D8030	Limited orthodontic treatment of the adolescent dentition	I.C.	$250
D8040	Limited orthodontic treatment of the adult dentition	I.C.	$250
D8080	Comprehensive orthodontic treatment of the adolescent dentition	$1,227	$1,302
D8210	Removable appliance therapy	$85	$95
D8660	Pre-orthodontic treatment examination to monitor growth and development	$24	$31
D8670	Periodic orthodontic treatment visit (as part of contract)	$215	$288
D8680	Orthodontic retention (removal of appliances, construction and placement of retainer)	$85	$102
D8690	Orthodontic treatment (alternative billing to a contract fee)	$122	$136
D8703	Replacement of lost or broken retainer – maxillary	$85	$95
D8704	Replacement of lost or broken retainer – mandibular	$85	$95

➜ Category 11: Adjunctive General Services

Anesthesia, Sedation and Palliative Care (D9110–D9243)

These services include dental pain relief, local anesthesia, nitrous oxide, moderate sedation, and deep sedation or general anesthesia. Sedation fees are structured around initial and subsequent time increments, while palliative care and other anesthesia services have their own payment amounts.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D9110	Palliative treatment of dental pain – per visit	$36	$75
D9210	Local anesthesia not in conjunction with operative or surgical procedures	$11	$15
D9222	Administration of deep sedation/general anesthesia – First 15 minute increment, or any portion thereof	$90	$109
D9223	Administration of deep sedation/general anesthesia – Each subsequent 15 minute increment, or any portion thereof	$90	$109
D9230	Administration of nitrous oxide	$15	$22
D9239	Administration of moderate sedation – intravenous – First 15 minute increment, or any portion thereof	$78	$101
D9243	Administration of moderate sedation – intravenous – Each subsequent 15 minute increment, or any portion thereof	$78	$101

Consultations, Special Visits and Behavior Management (D9310–D9930)

This category covers consultations, facility visits, observation appointments, case presentations, behavior management, and postsurgical complication treatment. Reimbursement depends on the type and circumstances of the additional dental service rather than a conventional restorative procedure.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D9310	Consultation – diagnostic service provided by dentist or physician other than requesting dentist or physician	$54	$63
D9410	House/extended care facility call, once per facility per day	$39	$36
D9420	Hospital or ambulatory surgical center call	$34	$48
D9430	Office visit for observation (during regularly scheduled hours) – no other services performed	$18	$26
D9440	Office visit – after regularly scheduled hours	$23	$30
D9450	Case presentation, subsequent to detailed and extensive treatment planning	$31	$31
D9920	Behavior management, by report	$86	$86
D9930	Treatment of complications (postsurgical) – unusual circumstances, by report	$30	$66

Drugs, Desensitizing, Mouthguards and Occlusal Services (D9610–D9952)

These procedures include therapeutic drug administration, medicaments, desensitizing treatments, athletic mouthguards, occlusal guards, and bite adjustments. Payment varies by the service or appliance provided, with certain occlusal guard procedures reimbursed through individual consideration.

CDT Code	Description	Adult Rate (21+)	EPSDT Rate (under 21)
D9610	Therapeutic parenteral drug, single administration	$29	$40
D9630	Drugs or medicaments dispensed in the office for home use	$8	$10
D9910	Application of desensitizing medicament	$21	$22
D9941	Fabrication of athletic mouthguard	$61	$85
D9944	Occlusal guard – hard appliance, full arch	I.C.	$308
D9945	Occlusal guard – soft appliance, full arch	I.C.	$308
D9946	Occlusal guard – hard appliance, partial arch	I.C.	$308
D9950	Occlusion analysis – mounted case	$32	$45
D9951	Occlusal adjustment – limited	$32	$45
D9952	Occlusal adjustment – complete	$149	$179

Who Can Provide Dental Services and How Payments Are Determined By MassHealth

➜ Eligible Dental Providers

MassHealth dental services may be provided by the following eligible providers and facilities:

• Registered dentists who meet MassHealth participation requirements.
• Authorized government, nonprofit, and charitable dental clinics.
• Title V dental clinics.
• Teaching dental clinics.
• Certified public health dental hygienists working in authorized public health settings.
• Community health centers, hospital-licensed health centers, and hospital outpatient departments, where applicable under MassHealth requirements.

➜ Rates by Member Age (Not by Provider License)

The MassHealth dental fee schedule organizes reimbursement rates according to the member’s age rather than the provider’s license type.

• Adult rates: Apply to members aged 21 and older.
• EPSDT rates: Apply to eligible members under age 21.
• The same fee schedule applies to eligible dentists, clinics, and certified public health dental hygienists.
• Rates are not divided into separate fee columns based on provider size or license type.

What Impacts MassHealth Dental Rates

1). State law and the efficiency, economy and quality standard

EOHHS sets rates under M.G.L. c. 118E, sections 13C and 13D, and every rate update must be justified against those requirements.

2). Cost adjustment factors tied to inflation

The 2024 increases were calculated from a Massachusetts-specific consumer price index forecast. Adjustments can be prospective, based on a forecast, or retrospective, which catches up for earlier cost growth.

3). Budget and fiscal impact

Every proposal comes with an estimated annual cost. The 2024 changes cost about $9.9 million a year, and the 2027 proposal about $233,000.

4). Federal approval

Proposals are subject to federal approval, because they change the state’s Medicaid payment methods.

5). Member age

Whether a member is under 21 (EPSDT) or 21 and older decides which column pays, and in rare cases the order flips, as with cast metal partial dentures.

6). Provider charge level

If a provider’s usual fee is lower than the scheduled amount, the lower amount is paid.

7). Individual consideration

For I.C. codes, MassHealth looks at time required, skill needed, severity or complexity of the condition and the practices of other third-party payers.

8). Coverage policy and frequency limits

Dental Manual rules, prior authorization, frequency limits and the new $1,750 annual maximum decide what is covered, even though they do not change the dollar rate per code.

9). New codes

The annual CDT update adds codes that start at I.C. until EOHHS sets a rate.