Billing code D5130 · Dental

D5130 Medicaid reimbursement rate by state (2026)

Dental services. Medicaid pays a median of $728.86 for D5130 across 34 states, from $40.00 in California to $1,690.40 in Missouri.

Data as of Oct 5, 202634 statesEvery rate links to its official source

Compare D5130 in all 34 states All billing codes

States publishing: 34
National median: $728.86units vary by state
Lowest: $40.00California
Highest: $1,690.40Missouri

Answer

What does Medicaid pay for D5130?

34 state Medicaid programs publish a fee-for-service rate for D5130. The national median is $728.86 (units differ between states). Missouri pays the most, $1,690.40, and California the least, $40.00 per percent of SMA, a 42.3x spread.

State ranking

D5130 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 34 states with every variant, modifier and effective date.

#	State	Medicaid rate	Unit	Per hour	Managed-care plans	% of Medicare
1	Missouri Source · since 2022-07-01	$1,690.40	—	—	Plans must pay at least this	—
2	Colorado Source · since 2026-07-01	$1,629.13	—	—	Paid by the state, outside plans	—
3	South Dakota Source · since 2026-07-01	$1,316.68	—	—	Not classified	—
···
17	Rhode Island Source · since 2024-04-01	$730.00	—	—	Paid by the state, outside plans	—
18	Nebraska Source · since 2026-07-01	$727.72	—	—	Plans negotiate; applies out of network	—
19	Hawaii Source · since 2024-03-04	$723.60	—	—	Paid by the state, outside plans	—
···
33	Kansas Source · since 1987-07-01	$250.00	—	—	Not classified	—
34	California Source · since 2018-07-01	$40.00	percent of SMA	—	Paid by the state, outside plans	—

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Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices; states with several Medicare localities show a range. Confirm rates with the payer before billing.

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FAQ

Frequently asked questions

What does Medicaid pay for D5130?

It depends on the state. Of the 34 states with a published fee-for-service rate, the median is $728.86. Missouri pays the most ($1,690.40) and California the least ($40.00 per percent of SMA).

Which state pays the highest Medicaid rate for D5130?

Missouri, at $1,690.40, effective 2022-07-01.

Do managed-care plans pay the same rate for D5130?

Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The workspace shows the rule for each state, cited to the contract or statute.

D5130 Medicaid reimbursement rate by state (2026)

What does Medicaid pay for D5130?

D5130 rate by state: highest, middle and lowest

Frequently asked questions

Related codes and states

Codes next to D5130

Most-published Dental codes

Highest-paying states