D5630 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for D5630, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 24 of the 42 states list more than one rate for D5630, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 42 states, 1 publish D5630 per unit and 1 per percent of sma, and 40 schedules print no unit at all (a flat amount per service).
• Per hour. D5630 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for D5630, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for D5630 run from $40.00 in California to $308.91 in Delaware. The two publish it in different units (no unit printed versus percent of SMA), so part of that gap is the unit rather than the price. Half the states pay more than the median of $115.03 and half pay less. The usual reasons for a spread like this in dental rates:

• Federal rules require dental coverage for children through EPSDT, while adult dental benefits are optional and range from emergency-only to comprehensive.
• Many states run dental through a dental benefit administrator, and fee updates are often infrequent compared with medical schedules.
• Some states publish separate child and adult fees for the same procedure, or pay specialists more than general dentists.

Timing matters too. 11 states set the current rate for D5630 in 2026 or later, while 11 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For D5630, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 10 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 11 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 10 states, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 11 states is not classified yet.

• Plans negotiate; the published rate applies out of network (11 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Paid by the state, outside the plans (10 states). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
• Plans must pay at least the published rate (10 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Delaware managed care.

D5630 is a CDT dental code in the dental line, billed mostly by general dentists, pediatric dentists, oral surgeons and dental clinics. CDT codes are maintained by the American Dental Association. Each is paid once per procedure, with the tooth number and surfaces on the claim, and many states publish separate child and adult amounts.

Dental codes (CDT, maintained by the American Dental Association) are paid once per procedure, with the tooth number and surfaces on the claim. Frequency limits, such as how often an exam or cleaning is covered, decide whether a service is paid at all, regardless of the fee.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.