# What does DentaQuest allow on a Medicaid plan?

> On DentaQuest's government plans, across the practices Kaylie serves, the median allowed amount in the twelve months to 10 September 2026 was $29.40 for a periodic exam (D0120), $63.80 for an adult cleaning (D1110) and $143.40 for a surgical extraction (D7210). Each median pools five to seven independent practices across six to eight separate state contracts.

_Updated 2026-09-10. Canonical: https://www.kaylie.ai/blog/what-does-dentaquest-allow-on-a-medicaid-plan_

Across the practices Kaylie serves, DentaQuest's government plans allowed a median of
$29.40 for a periodic exam (D0120), $63.80 for an adult cleaning (D1110), $107.82 for a
one-surface posterior composite (D2391) and $143.40 for a surgical extraction (D7210) in the
twelve months to 10 September 2026. These are the only Medicaid allowed amounts on this site
that clear the publication bar of five independent practices, and they come with a caveat
that is bigger than the numbers: each one pools six to eight separate state contracts, so it
is a description of what this payer paid, not a fee schedule anyone can be held to. The
middle half of the range is the useful part of the table below, not the median.

## What we measured

| Code | Procedure | 25th pct | Median | 75th pct | Full range | Distinct prices | Lines | Practices | Offices | States |
|---|---|---|---|---|---|---|---|---|---|---|
| D0120 | Periodic exam | $29.40 | $29.40 | $31.90 | $18.40–$51.42 | 21 | 462 | 7 | 23 | 8 |
| D0150 | Comprehensive exam | $30.00 | $34.64 | $51.57 | $17.00–$83.63 | 16 | 255 | 5 | 21 | 6 |
| D0210 | Full-mouth series | $58.00 | $86.54 | $88.31 | $12.10–$131.35 | 23 | 115 | 5 | 20 | 6 |
| D0274 | Four bitewings | $19.94 | $27.26 | $31.90 | $2.25–$61.36 | 27 | 238 | 6 | 18 | 7 |
| D1110 | Adult prophylaxis | $54.52 | $63.80 | $80.74 | $30.00–$159.00 | 23 | 280 | 7 | 19 | 8 |
| D2391 | Posterior composite — 1 surface | $57.75 | $107.82 | $110.02 | $30.57–$146.47 | 16 | 183 | 5 | 10 | 6 |
| D2392 | Posterior composite — 2 surfaces | $56.82 | $84.00 | $137.78 | $52.00–$204.91 | 16 | 241 | 6 | 12 | 7 |
| D4341 | Scaling and root planing per quadrant | $63.80 | $220.70 | $225.20 | $34.50–$226.30 | 11 | 61 | 5 | 10 | 6 |
| D7140 | Simple extraction | $53.55 | $106.89 | $109.07 | $45.00–$144.00 | 11 | 298 | 5 | 14 | 6 |
| D7210 | Surgical extraction | $118.80 | $143.40 | $144.00 | $67.32–$242.32 | 19 | 414 | 7 | 24 | 8 |

Adjudicated claim lines carrying a stated allowed amount above zero, date of service 1 September
2025 to 9 September 2026, measured 10 September 2026. Denied lines are excluded: a denial
records no allowance. Across all twenty codes examined, this payer produced 3,619 priced
lines from 8 practices and 39 offices in 9 states — Arizona, Colorado, Illinois, Missouri,
New Jersey, New York, South Carolina, Texas and Wisconsin. Nineteen of the twenty codes
appeared, eleven cleared the five-practice bar and ten are printed above: the eight codes
left out were each backed by fewer than five practices, and the eleventh is withheld for the
reason below.

One row is deliberately missing. A porcelain crown (D2740) cleared the practice count
on 90 lines, and its median is withheld because it sits far enough above the rest of this
book to suggest those lines were priced as a percentage of the practice's own submitted fee
rather than off a fee schedule. That has not been established either way, so the figure is
not published. A number we cannot explain is not evidence.

## Is that really the payer's allowance?

Yes, and it was checked rather than assumed. An allowed amount that has quietly been copied
from the fee the office billed is the standing hazard in this kind of measurement, because
it turns the practice's own price list into what looks like a carrier rate. Across 36
payer-and-code combinations checked, only 4 contained
even a single line where the allowed amount equalled the submitted fee. Median submitted fee
ran two to six times median allowed, and median allowed tracked median paid. The allowance
in the table is the payer's number.

One limitation on its provenance. Of the 78,194 Medicaid lines in this window, 72,101 came
from payer portals and 6,093 from uploaded explanation-of-benefits documents. Not one
arrived as an X12 835 electronic remittance. So the allowance is whatever the portal page or
the document stated — which is what the office sees too, and is not the same thing as the
payer's own electronic remittance file.

## Why the median is the least useful column

Look at D0274. Four bitewings drew 27 distinct allowed amounts between $2.25 and $61.36. That
spread is not one contract behaving erratically; it is mostly seven different state contracts
averaged into one row. Look at D2392 against D2391: the two-surface composite allows a lower
median than the one-surface composite, which no single fee schedule would ever do. Both
readings say the same thing. This payer administers separate state programmes under one
brand, and a median across them describes a population of contracts, not a price.

D0120 is the exception that proves the point in reverse: its 25th percentile and its median
are the same $29.40, so at least a quarter of these exams were allowed at exactly that
number and half at that number or less.
Where the quartiles collapse onto each other, you are probably looking at a real schedule
fee for the states carrying most of the volume. Where they spread — D4341 runs from a $63.80
25th percentile to a $220.70 median — you are looking at several schedules stacked.

## What to do

- **Use your own state's published Medicaid schedule to set expectations**, and use this
  table only to sanity-check that what you are being allowed is in the same world as what
  other practices are allowed.
- **Compare against the quartiles, not the median.** An allowance inside the middle half is
  unremarkable. One below the 25th percentile on a code with tight quartiles is worth a look.
- **Post the allowed amount from the remittance, not from a schedule you keep locally.** On
  these plans the stated allowance arrived on a portal page or a document, and that is the
  number the payment reconciles against.
- **Keep the state contract, not the brand, as the unit you record.** "DentaQuest" is nine
  contracts in this measurement alone, and they do not price alike.

Numbers last refreshed September 2026.