What Medicaid Actually Paid for Dental Care, by State and CDT Code (2018-2024): An Open Benchmark from T-MSIS
This paper presents an open, claim-level benchmark derived from 2018–2024 T-MSIS data that details actual Medicaid dental payments by state and CDT code, revealing substantial geographic variation unexplained by cost of living and providing comprehensive statistics for 61 procedures across the U.S.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the United States, the cost of a medical or dental procedure is often a mystery to the person receiving it. A patient might see a price tag on a website, hear a quote from a doctor's office, or receive a bill from an insurance company, yet these numbers rarely match what the government actually hands over to the provider. This gap exists because the price a consumer pays is a negotiation between a patient and a clinic, while the amount a government program pays is a fixed rate set by policy. For millions of Americans, Medicaid is the primary source of dental coverage, a safety net designed to ensure access to care for low-income families. However, for years, the specific amounts that state Medicaid programs actually paid dentists for specific procedures were buried in massive, difficult-to-read government databases. Without a clear view of these real payments, it has been impossible to know if the system is funding care at a level that allows dentists to stay in business or if the rates are simply too low to cover the cost of doing the work.
A new study by independent researcher Tresor Kaya cuts through this fog by mining a federal database known as T-MSIS, which tracks how Medicaid money flows across the country. The researcher focused on a seven-year window, from 2018 to 2024, to build a clear picture of what Medicaid actually paid for 61 different dental procedures in every state. Instead of looking at what dentists charge or what insurance plans allow, the study looks strictly at the final check written by the state. By matching the location of the dentist to the claim, the researcher created a detailed map of payments, revealing that the cost of the same dental work can vary wildly depending on which side of a state line a patient lives. This work does not offer medical advice or predict future prices; it simply reports the historical reality of what was paid, providing a rare, data-driven look at the financial engine behind public dental care.
The core of this research is a massive collection of claim records, where each line represents a single dental procedure performed on a single patient. The researcher filtered this data to include only the most common procedures, such as root canals on back teeth and complete upper dentures, ensuring that the numbers were based on enough cases to be reliable. The study found that for the period between 2023 and 2024, the national average payment for a molar root canal was $516.24 per claim. For a complete upper denture, the average payment was $498.53. While these national averages provide a baseline, they hide a much more complex story. When the data is broken down by state, the variation is startling. For example, in the same time period, the state of Virginia paid an average of just $231.47 for a molar root canal, while neighboring Maryland paid $667.06 for the exact same procedure. This difference is not a small fluctuation; it is a gap where one state pays less than half of what another pays for identical work.
The study also highlights that these payment differences do not simply follow the cost of living. In some cases, states with lower costs of living pay significantly more than wealthier states for the same service. For instance, New York paid $342.06 for a root canal, while New Jersey, a state with a similar economic profile, paid $502.05. The data shows that a state's generosity or stinginess is not a single, consistent trait. A state might pay well for dentures but poorly for root canals, or vice versa. In New York, the payment for a complete upper denture was only $192.16, which is drastically lower than the $502.05 paid for a root canal in the same state. This inconsistency suggests that there is no single "Medicaid price" for dental care in the country; instead, there are 51 different markets, each with its own rules and financial realities.
One of the most important findings of the paper is what it cannot tell us. The study explicitly notes that it does not include dental implants because the number of claims for that procedure was too low in most states to meet the government's privacy rules. This means the data is a floor, not a ceiling; it represents the minimum amount of participation required to be visible, but it may miss smaller states or low-volume procedures entirely. Furthermore, the numbers represent what Medicaid actually paid, not what a patient would pay out of pocket. The study points out that a self-pay price for a complete set of dentures can be nearly four times higher than what Medicaid pays for just the upper half, illustrating the vast difference between government reimbursement rates and the cash prices consumers face in the open market.
The researcher made every effort to ensure the data was accurate and traceable, using government records that are publicly available but rarely analyzed in this way. They filtered out any data that was too small to be statistically reliable, ensuring that the numbers presented are based on thousands of actual patients and hundreds of providers. The study concludes that while the national averages offer a snapshot, the true story of Medicaid dental care is written in the details of state-by-state variation. For anyone trying to understand the economics of public health, this work provides a solid foundation, showing that the price of a dental procedure is not just about the work being done, but largely about where the patient lives and which state is paying the bill.
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