How much does New York Medicaid pay for a dental cleaning?

These are the amounts New York Medicaid reimburses a clinic, not what a patient pays. A Medicaid patient usually pays $0 or a small co-pay.

How often will Medicaid pay for a root canal?

Each procedure carries its own frequency limit — some are once every six months, some once in a lifetime. The limit is listed against every procedure on this page.

434 procedures

What New York Medicaid pays for dental work

These are the amounts New York Medicaid reimburses a clinic. They are not prices. A patient on Medicaid usually pays $0 or a small co-pay.

The useful column is the last one. A frequency limit — a cleaning every six months, a root canal once in a lifetime — changes what you decide to do; the dollar figure mostly does not.

Braces

Procedure	State pays	Limits
D8010	—	Once per Lifetim · prior approval needed · age 5+
D8020	—	Once per Lifetim · prior approval needed · age 5+
D8030	—	Once per Lifetim · prior approval needed · age 5+
D8040	—	Once per Lifetim · prior approval needed · age 5+
D8070	$995.86	Once per Lifetim · prior approval needed · age 5+
D8080	$995.86	Once per Lifetim · prior approval needed · age 5+
D8090	$995.86	Once per Lifetim · prior approval needed · age 5+
D8210	By report	Twice per 1 Yea · prior approval needed · age 5+
D8220	By report	Once per Lifetim · prior approval needed · age 5+
D8660	$29.29	3 Times per 1 Yea · age 5+
D8670	$234.32	12 Times per Lifetim · prior approval needed · age 5+
D8680	$175.74	Once per Lifetim · prior approval needed · age 5+
D8695	By report	Once per Lifetim · age 5+
D8703	By report	Once per Lifetim · age 5+
D8704	By report	Once per Lifetim · age 5+
D8999	By report	age 5+

Cleanings and prevention

Procedure	State pays	Limits
Cleaning (adult)	$45.45	Once per 6 Months · age 13+
Cleaning (child)	$43.43	Once per 6 Months
D1208	$14.14	Once per 6 Months · age 6+
D1320	$10.10	No limit per No limit · age 12+
D1354	$15.15	Twice/ Four per 1 Year/ Lifetim
D1510	$117.16	Once per 1 Yea
D1516	$175.74	Once per 1 Yea
D1517	$175.74	Once per 1 Yea
D1551	$19.19	Once per 1 Yea
D1552	$19.19	Once per 1 Yea
D1553	$19.19	Once per 1 Yea
D1575	$117.16	Once per 1 Yea
D1999	By report	—
Fluoride treatment	$30.30	Once per 3 months
Sealant (one tooth)	$35.35	Once per 5 Years · prior approval needed · age 5+

Dentures

Procedure	State pays	Limits
D5211	$353.50	Once per 8 Years · prior approval needed · age 15+
D5212	$353.50	Once per 8 Years · prior approval needed · age 15+
D5213	$565.60	Once per 8 Years · prior approval needed · age 15+
D5214	$565.60	Once per 8 Years · prior approval needed · age 15+
D5225	$565.60	Once per 8 Years · prior approval needed · age 15+
D5226	$565.60	Once per 8 Years · prior approval needed · age 15+
D5410	$25.25	4 Times per 1 Yea
D5411	$25.25	4 Times per 1 Yea
D5421	$25.25	4 Times per 1 Yea
D5422	$25.25	4 Times per 1 Yea
D5511	$65.65	Twice per 1 Yea · age 18+
D5512	$65.65	Twice per 1 Yea · age 18+
D5520	$42.42	Once per 1 Yea · age 18+
D5611	$67.67	Twice per 1 Yea · age 6+
D5612	$67.67	Twice per 1 Yea · age 6+
D5621	$121.20	Once per 1 Yea · age 15+
D5622	$121.20	Once per 1 Yea · age 15+
D5630	$131.30	Twice per 1 Yea · age 6+
D5640	$60.60	Once per 1 Yea · age 6+
D5650	$65.65	Once per 1 Yea · age 6+
D5660	$103.02	Once per 1 Yea · age 6+
D5710	$171.70	Once per 5 Years · prior approval needed · age 18+
D5711	$171.70	Once per 5 Years · prior approval needed · age 18+
D5720	$175.74	Once per 5 Years · prior approval needed · age 15+
D5721	$175.74	Once per 5 Years · prior approval needed · age 15+
D5730	$126.25	Once per 1 Yea · prior approval needed · age 18+
D5731	$126.25	Once per 1 Yea · prior approval needed · age 18+
D5740	$85.85	Once per 1 Yea · prior approval needed · age 15+
D5741	$85.85	Once per 1 Yea · prior approval needed · age 15+
D5750	$171.70	Once per 2 Years · age 18+
D5751	$171.70	Once per 2 Years · age 18+
D5760	$126.25	Once per 2 Years · age 15+
D5761	$126.25	Once per 2 Years · age 15+
D5820	$175.74	Once per 1 Yea · age 6+
D5821	$175.74	Once per 1 Yea · age 6+
D5850	$25.25	Once per 5 Years · age 15+
D5851	$25.25	Once per 5 Years · age 15+
D5899	By report	—
D5911	By report	Once per 1 Yea
D5912	By report	Once per 1 Yea
D5913	By report	Once per 1 Yea
D5914	By report	Once per 1 Yea
D5915	By report	Once per 1 Yea
D5916	By report	Once per 1 Yea
D5919	By report	6 Times per 2 Months
D5922	By report	Once per 1 Yea
D5923	By report	Once per 1 Yea
D5924	By report	Once per 1 Yea
D5925	By report	Once per 1 Yea
D5926	By report	Once per 1 Yea
D5927	By report	Once per 1 Yea
D5928	By report	Once per 1 Yea
D5929	By report	Once per 1 Yea
D5931	By report	Once per 1 Yea
D5932	By report	Once per 1 Yea
D5933	By report	Once per 6 Months
D5934	By report	Once per 1 Yea
D5935	By report	Once per 1 Yea
D5936	By report	Once per 1 Yea
D5937	By report	Once per 1 Yea
D5951	By report	Once per 1 Yea
D5952	By report	Once per 1 Yea
D5953	By report	Once per 1 Yea · age 21+
D5954	By report	Once per 1 Yea
D5955	By report	Once per 1 Yea
D5958	By report	Once per 1 Yea
D5959	By report	Once per 1 Yea
D5960	By report	Once per 1 Yea
D5982	By report	Once per 1 Yea
D5983	By report	Once per 1 Yea
D5984	By report	Once per 1 Yea
D5985	By report	Once per 1 Yea
D5986	$10.10	Twice per 1 Yea
D5987	By report	Once per 1 Yea
D5988	By report	Once per 1 Yea
D5999	By report	—
Full lower denture	$565.60	Once per 8 Years · prior approval needed · age 18+
Full upper denture	$565.60	Once per 8 Years · prior approval needed · age 18+

Exams and X-rays

Procedure	State pays	Limits
Bitewing X-rays (four)	$24.24	2 Times per 1 Yea · age 6+
D0145	$30.30	Once per 6 Months
D0160	By report	3 Times per 1 Yea
D0230	$5.05	6 Times per 12 Months
D0240	$15.15	Once per 3 Years
D0250	$25.25	Twice per 1 Week
D0251	$12.12	Twice per 1 Week
D0270	$8.08	3 Times per 1 Yea · age 2+
D0272	$14.14	2 Times per 1 Yea · age 2+
D0273	$20.20	2 Times per 1 Yea · age 6+
D0310	$41.41	Twice per 1 Week
D0320	$175.74	Twice per Lifetim
D0321	By report	Twice per 1 Yea
D0330	$35.35	Once per 3 Years · age 2+
D0340	$55.55	Once per 3 Years
D0350	$12.12	Twice per 6 Months
D0364	$281.79	prior approval needed
D0365	$281.79	prior approval needed
D0366	$281.79	prior approval needed
D0367	$281.79	prior approval needed
D0368	$281.79	prior approval needed
D0470	$34.34	Once per 1 Yea · age 5+
D0474	$87.87	—
D0485	$87.87	—
D0502	By report	—
D0999	By report	—
Emergency exam for a specific problem	$14.14	Twice per 1 yea
Full exam for a new patient	$30.30	Once per Lifetim · age 3+
Full set of X-rays	$50.50	Once per 3 Years · age 12+
Routine check-up	$25.25	Once per 6 Months
Single X-ray	$8.08	3 Times per 6 Months

Extractions and oral surgery

Procedure	State pays	Limits
D7111	$35.35	Once per Lifetim
D7220	$101.00	Once per Lifetim · prior approval needed
D7230	$181.80	Once per Lifetim · prior approval needed
D7240	$303.00	Once per Lifetim · prior approval needed
D7241	By report	Once per Lifetim
D7250	$58.58	Once per Lifetim
D7260	$202.00	Once per Lifetim
D7261	$202.00	Once per Lifetim
D7270	$115.14	Once per Lifetim · age 6+
D7272	$151.50	Once per Lifetim · age 6+
D7280	$292.90	Once per Lifetim
D7283	$50.50	Once per Lifetim · age 6+
D7285	By report	Once per 1 Yea
D7286	By report	Once per 1 Yea
D7290	$146.45	Once per Lifetim · prior approval needed
D7310	$70.70	Once per Lifetim · age 6+
D7311	$50.50	Once per Lifetim · age 6+
D7320	$116.15	Once per Lifetim · age 6+
D7321	$75.75	Once per Lifetim · age 6+
D7340	$303.00	Twice per 5 Years · prior approval needed · age 18+
D7350	$404.00	Twice per 5 Years · prior approval needed · age 18+
D7410	By report	—
D7411	By report	—
D7412	By report	—
D7413	By report	—
D7414	By report	—
D7415	By report	—
D7440	By report	—
D7441	By report	—
D7450	By report	—
D7451	By report	—
D7460	By report	—
D7461	By report	—
D7465	By report	—
D7471	By report	Once per Lifetim
D7472	By report	—
D7473	By report	—
D7485	By report	Once per Lifetim
D7490	By report	—
D7510	By report	—
D7511	By report	—
D7520	By report	—
D7521	By report	—
D7530	By report	—
D7540	By report	—
D7550	By report	—
D7560	By report	—
D7610	By report	—
D7620	By report	—
D7630	By report	—
D7640	By report	—
D7650	By report	—
D7660	By report	—
D7670	By report	age 2+
D7671	By report	—
D7680	By report	—
D7710	By report	—
D7720	By report	—
D7730	By report	—
D7740	By report	—
D7750	By report	—
D7760	By report	—
D7770	By report	age 2+
D7771	By report	age 2+
D7780	By report	—
D7810	By report	—
D7820	By report	—
D7830	By report	—
D7840	By report	—
D7850	By report	Twice per Lifetim · age 12+
D7852	By report	Twice per Lifetim · age 12+
D7854	By report	Twice per Lifetim · age 12+
D7856	By report	Twice per Lifetim · age 12+
D7858	By report	Twice per Lifetim · age 12+
D7860	By report	Twice per Lifetim · age 12+
D7865	By report	Twice per Lifetim · age 12+
D7870	By report	Once per 6 Months · age 12+
D7872	By report	Twice per Lifetim · age 12+
D7873	By report	Twice per Lifetim · age 12+
D7874	By report	Twice per Lifetim · age 12+
D7875	By report	Twice per Lifetim · age 12+
D7876	By report	Twice per Lifetim · age 12+
D7877	By report	Twice per Lifetim · age 12+
D7880	By report	Once per 1 Yea
D7899	By report	—
D7910	By report	—
D7911	By report	—
D7912	By report	—
D7920	By report	—
D7940	By report	—
D7941	By report	—
D7943	By report	—
D7944	By report	—
D7945	By report	—
D7946	By report	—
D7947	By report	—
D7948	By report	—
D7949	By report	—
D7950	By report	—
D7951	$808.00	prior approval needed
D7952	$808.00	prior approval needed
D7953	$252.50	prior approval needed
D7956	$126.25	prior approval needed
D7957	$151.50	prior approval needed
D7961	By report	3 Times per Lifetim
D7962	By report	3 Times per Lifetim
D7970	By report	Twice per Lifetim · age 15+
D7971	By report	Once per 2 Years
D7972	By report	Twice per Lifetim · age 15+
D7980	By report	—
D7981	By report	—
D7982	By report	—
D7983	By report	—
D7990	By report	—
D7991	By report	Once per Lifetim
D7997	By report	—
D7998	By report	—
D7999	By report	—
Simple extraction	$50.50	Once per Lifetim
Surgical extraction	$85.85	Once per Lifetim · prior approval needed

Fillings and crowns

Procedure	State pays	Limits
Crown, porcelain fused to metal	$505.00	Once per 5 Years · prior approval needed · age 6+
D2150	$67.67	Once per 2 Years
D2160	$82.82	Once per 2 Years
D2161	$98.98	Once per 2 Years
D2331	$73.73	Once per 2 Years
D2332	$87.87	Once per 2 Years
D2335	$98.98	Once per 2 Years
D2390	$98.98	Once per 2 Years
D2392	$67.67	Once per 2 Years
D2393	$82.82	Once per 2 Years
D2394	$98.98	Once per 2 Years
D2710	$292.90	Once per 5 Years · prior approval needed
D2720	$505.00	Once per 5 Years · prior approval needed · age 6+
D2721	$505.00	Once per 5 Years · prior approval needed · age 6+
D2722	$505.00	Once per 5 Years · prior approval needed · age 6+
D2751	$505.00	Once per 5 Years · prior approval needed · age 6+
D2752	$505.00	Once per 5 Years · prior approval needed · age 6+
D2753	$505.00	Once per 5 Years · prior approval needed · age 6+
D2780	$404.00	Once per 5 Years · prior approval needed · age 6+
D2781	$404.00	Once per 5 Years · prior approval needed · age 6+
D2782	$404.00	Once per 5 Years · prior approval needed · age 6+
D2790	$505.00	Once per 5 Years · prior approval needed · age 6+
D2791	$505.00	Once per 5 Years · prior approval needed · age 6+
D2792	$505.00	Once per 5 Years · prior approval needed · age 6+
D2794	$505.00	Once per 5 Years · prior approval needed · age 6+
D2920	$30.30	Once per 2 Years
D2930	$117.16	Once per 2 Years
D2931	$117.16	Once per 5 Years · age 5+
D2932	$117.16	Once per 2 Years
D2933	$131.30	Once per 2 Years
D2934	$131.30	Once per 2 Years
D2951	$29.29	Twice per 1 Yea
D2952	$126.25	Once per 5 Years · age 6+
D2954	$126.25	Once per 5 Years · age 6+
D2955	$95.95	Once per 5 Years · age 6+
D2980	By report	Once per 5 Years · age 6+
D2999	By report	—
Porcelain crown	$505.00	Once per 5 Years · prior approval needed · age 6+
Silver filling (one surface)	$50.50	Once per 2 Years
White filling, back tooth	$50.50	Once per 2 Years
White filling, front tooth	$50.50	Once per 2 Years

Gum treatment

Procedure	State pays	Limits
D4210	By report	Once per 1 Yea
D4211	By report	Once per 1 Yea
D4245	$126.25	prior approval needed
D4249	$75.00	Once per Lifetim · prior approval needed
D4273	$303.00	prior approval needed
D4275	$404.00	prior approval needed
D4277	$404.00	prior approval needed
D4278	$303.00	prior approval needed
D4283	$202.00	prior approval needed
D4285	$303.00	prior approval needed
D4342	$30.30	Once per 2 Years · prior approval needed · age 13+
D4910	$45.45	Once per 6 Months · age 13+
D4999	By report	—
Deep cleaning (per quadrant)	$45.45	Once per 2 Years · prior approval needed · age 13+

Implants and bridges

Procedure	State pays	Limits
D6010	$1,010.00	Once per Lifetim · prior approval needed
D6013	$505.00	Once per Lifetim · prior approval needed
D6055	$404.00	Once per 8 Years · prior approval needed
D6056	$404.00	Once per 8 Years · prior approval needed
D6057	$404.00	Once per 8 Years · prior approval needed
D6058	$808.00	Once per 8 Years · prior approval needed
D6059	$808.00	Once per 8 Years · prior approval needed
D6060	$808.00	Once per 8 Years · prior approval needed
D6061	$808.00	Once per 8 Years · prior approval needed
D6062	$808.00	Once per 8 Years · prior approval needed
D6063	$808.00	Once per 8 Years · prior approval needed
D6064	$808.00	Once per 8 Years · prior approval needed
D6065	$808.00	Once per 8 Years · prior approval needed
D6066	$808.00	Once per 8 Years · prior approval needed
D6067	$808.00	Once per 8 Years · prior approval needed
D6081	By report	Once per 1 Yea
D6090	By report	Once per 1 Yea
D6091	By report	Once per 1 Yea
D6092	By report	Once per 2 Years
D6093	By report	Once per 2 Years
D6094	$808.00	Once per 8 Years · prior approval needed
D6095	By report	Once per 1 Yea
D6096	By report	Once per 1 Yea
D6100	By report	—
D6101	$252.50	Once per 2 Years · prior approval needed
D6102	$404.00	Once per 2 Years · prior approval needed
D6103	$202.00	Once per 2 Years · prior approval needed
D6104	$252.50	Once per Lifetim · prior approval needed
D6106	$126.25	prior approval needed
D6107	$151.50	prior approval needed
D6110	$1,010.00	Once per 8 Years · prior approval needed
D6111	$1,010.00	Once per 8 Years · prior approval needed
D6112	$909.00	Once per 8 Years · prior approval needed
D6113	$909.00	Once per 8 Years · prior approval needed
D6190	By report	Once per 1 Yea
D6191	$202.00	Once per 8 Years · prior approval needed
D6192	$50.50	Once per 8 Years · prior approval needed
D6193	$45.00	Once per 1 Yea
D6199	By report	—
D6210	$404.00	Once per 5 Years · prior approval needed · age 15+
D6211	$404.00	Once per 5 Years · prior approval needed · age 15+
D6212	$404.00	Once per 5 Years · prior approval needed · age 15+
D6214	$404.00	Once per 5 Years · prior approval needed · age 15+
D6240	$404.00	Once per 5 Years · prior approval needed · age 15+
D6241	$404.00	Once per 5 Years · prior approval needed · age 15+
D6242	$404.00	Once per 5 Years · prior approval needed · age 15+
D6243	$404.00	Once per 5 Years · prior approval needed · age 15+
D6245	$404.00	Once per 5 Years · prior approval needed · age 15+
D6250	$404.00	Once per 5 Years · prior approval needed · age 15+
D6251	$404.00	Once per 5 Years · prior approval needed · age 15+
D6252	$404.00	Once per 5 Years · prior approval needed · age 15+
D6545	$146.45	Once per 5 Years · prior approval needed · age 15+
D6720	$505.00	Once per 5 Years · prior approval needed · age 15+
D6721	$505.00	Once per 5 Years · prior approval needed · age 15+
D6722	$505.00	Once per 5 Years · prior approval needed · age 15+
D6740	$505.00	Once per 5 Years · prior approval needed · age 15+
D6750	$505.00	Once per 5 Years · prior approval needed · age 15+
D6751	$505.00	Once per 5 Years · prior approval needed · age 15+
D6752	$505.00	Once per 5 Years · prior approval needed · age 15+
D6753	$505.00	Once per 5 Years · prior approval needed · age 15+
D6780	$404.00	Once per 5 Years · prior approval needed · age 15+
D6781	$404.00	Once per 5 Years · prior approval needed · age 15+
D6782	$404.00	Once per 5 Years · prior approval needed · age 15+
D6783	$404.00	Once per 5 Years · prior approval needed · age 15+
D6784	$404.00	Once per 5 Years · prior approval needed · age 15+
D6790	$505.00	Once per 5 Years · prior approval needed · age 15+
D6791	$505.00	Once per 5 Years · prior approval needed · age 15+
D6792	$505.00	Once per 5 Years · prior approval needed · age 15+
D6794	$505.00	Once per 5 Years · prior approval needed · age 15+
D6930	$45.45	Once per 2 Years · age 15+
D6980	By report	Once per 5 Years · age 15+
D6999	By report	—

Root canals

Procedure	State pays	Limits
D3220	$87.87	Once per Lifetim
D3230	$151.50	Once per Lifetim · prior approval needed
D3240	$237.35	Once per Lifetim · prior approval needed
D3346	$252.50	Once per Lifetim · prior approval needed · age 6+
D3347	$303.00	Once per Lifetim · prior approval needed · age 6+
D3348	$404.00	Once per Lifetim · prior approval needed · age 6+
D3351	$82.82	Once per Lifetim · age 5+
D3352	$80.80	Once per Lifetim · age 5+
D3353	$104.03	Once per Lifetim · age 5+
D3410	$161.60	Once per Lifetim · prior approval needed · age 6+
D3421	$161.60	Once per Lifetim · prior approval needed · age 6+
D3425	$181.80	Once per Lifetim · prior approval needed · age 6+
D3426	$60.60	Once per Lifetim · prior approval needed · age 6+
D3430	$50.50	Once per Lifetim · prior approval needed · age 6+
D3999	By report	—
Root canal, front tooth	$252.50	Once per Lifetim · prior approval needed
Root canal, molar	$404.00	Once per Lifetim · prior approval needed · age 6+
Root canal, premolar	$303.00	Once per Lifetim · prior approval needed · age 6+

Sedation and other

Procedure	State pays	Limits
D9120	By report	—
D9222	$76.76	Twice per 1 Week
D9223	$76.76	Twice per 1 Week
D9224	$76.76	Twice per 1 Week
D9225	$76.76	Twice per 1 Week
D9230	$25.00	—
D9239	$76.76	Twice per 1 Week
D9243	$76.76	Twice per 1 Week
D9244	$25.00	Once per 1 Day
D9245	$25.00	Once per 1 Day
D9246	$25.00	Once per 1 Day
D9310	$30.30	Once per 6 Months
D9311	$28.46	Once per Week
D9410	By report	Once per 1 Day
D9420	By report	3 Times per 1 Week
D9430	By report	4 Times per Yea
D9440	By report	Once per 1 Day
D9610	By report	—
D9612	By report	—
D9944	By report	Once per 1 Yea
D9945	By report	Once per 1 Yea
D9946	By report	Once per 1 Yea
D9990	By report	Twice per Day
D9991	$14.14	—
D9995	—	—
D9996	—	—
D9997	$29.29	—
D9999	By report	—
Emergency pain relief	By report	Twice per 1 Yea

Where to go

Affordable dental clinics in New York — community health centres, dental schools and public health clinics selected for an affordable-care pathway. Fees and eligibility vary by location.

New York Medicaid rates, 2025. Procedure names here are our own plain-language wording. Rates are revised by state rule change without notice — confirm with the clinic before relying on them.