Medicaid paid per claim line for dental CDT codes by U.S. state, 2018-2024 (T-MSIS × NPPES)
Description
This dataset reports what U.S. state Medicaid programs actually paid dentists for dental care, by state and CDT procedure code, from 2018 to 2024. It covers 61 dental CDT codes (D0120-D7953) across the 50 states and the District of Columbia, with the average Medicaid paid amount per claim line for each state-code pair and period. Figures are derived from the federal Transformed Medicaid Statistical Information System (T-MSIS) analytic claims files, with dental providers identified through NPPES taxonomy records. Unlike published fee schedules or allowed amounts, these values reflect amounts actually paid per claim line, making them a ground-truth benchmark for Medicaid dental reimbursement research, provider participation analysis, and comparisons with cash prices. A companion analysis and interactive tables are maintained at realdentalcosts.com. https://realdentalcosts.com/en/medicaid-dental-coverage-by-state/ https://realdentalcosts.com/en/api/ https://realdentalcosts.com/en/methodology/
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Steps to reproduce
We processed the CMS Transformed Medicaid Statistical Information System (T-MSIS) provider-spending analytic files (2018-2024), isolating dental claim lines by CDT procedure code. Dental providers were identified by crossing billing NPIs with NPPES taxonomy records for dentistry. For each state, CDT code and year, we computed the volume-weighted average Medicaid paid amount per claim line plus distribution statistics (median, p25, p75), excluding non-positive payments and low-volume cells. Column-by-column documentation is in the README file included with this dataset. Full methodology: https://realdentalcosts.com/en/methodology/