Florida Medicaid Dental General Fee Schedule 2026
Wyatt Buttler
The 2026 Florida Medicaid dental fee schedule has established new reimbursement standards for general dental services covered under the program. For dental practices treating Medicaid-enrolled patients, that means confirming updated CDT code rates, frequency limits, and which services apply to children versus adults before claims go out the door.
Florida's Medicaid dental benefit is managed through the statewide dental managed care program, meaning most claims are actually adjudicated by a dental plan such as DentaQuest or MCNA Dental rather than paid directly by AHCA, though the state fee schedule still sets the baseline.
Here's a breakdown of the general dental fee schedule structure for 2026, along with the coverage differences that trip up practices billing both pediatric and adult patients.
Children vs. Adult Dental Coverage Under Florida Medicaid
Florida Medicaid provides comprehensive dental coverage for enrollees under age 21 through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, including preventive, diagnostic, restorative, and, when medically necessary, orthodontic and oral surgery services.
Adult dental coverage is more limited. Historically, Florida Medicaid covered dental services for adults age 21 and older largely on an emergency and pain-relief basis. Expanded adult dental benefits have been added over recent years, so practices should verify current adult coverage rules rather than assuming the older emergency-only model still applies to every service.
2026 General Dental Fee Schedule (Selected CDT Codes)
| CDT Code | Description of Service | Frequency Limit |
|---|---|---|
| D0120 | Periodic oral evaluation | 2 per benefit year |
| D0150 | Comprehensive oral evaluation, new or established patient | 1 per provider, per patient |
| D0272 | Bitewing radiographs, two films | 1 per benefit year (children) |
| D1120 | Prophylaxis (cleaning), child | 2 per benefit year |
| D1206 | Topical fluoride varnish | 2 per benefit year (children) |
| D2391 | Resin-based composite restoration, one surface, posterior | Per tooth, per surface, subject to replacement limits |
| D7140 | Extraction, erupted tooth or exposed root | Per tooth |
Frequency Limits and Medical Necessity
Preventive services such as cleanings, exams, and fluoride treatments carry strict frequency limits, typically twice per benefit year for pediatric patients. Billing a service before the frequency limit resets results in an automatic denial, even when the clinical need appears reasonable.
Restorative and surgical procedures, such as fillings and extractions, are generally not subject to a flat frequency cap but do require documentation supporting medical necessity, particularly for adult patients where coverage is narrower than pediatric coverage.
Common Billing Mistake
Submitting an adult claim using pediatric frequency assumptions, or billing a preventive service before the benefit-year reset, are two of the most common reasons Florida Medicaid dental claims come back denied. Verify the patient's age-based benefit category and last service date before submitting.
Billing Through the Statewide Dental Managed Care Plans
Most Florida Medicaid enrollees receive dental benefits through a statewide managed dental plan rather than traditional fee-for-service Medicaid. That means claims are submitted to the enrollee's specific dental plan, using that plan's payer ID and, in some cases, the plan's own prior authorization rules layered on top of the state fee schedule.
Before treatment, confirm which dental plan the patient is enrolled in and check that plan's specific provider manual for authorization requirements, since requirements can differ between plans even though the underlying state fee schedule sets the baseline maximum rates.
Tips for Clean Dental Claims in 2026
- Confirm which statewide dental plan the patient is enrolled in before billing
- Verify the patient's age-based benefit category (under 21 vs. adult)
- Track frequency limits on preventive services per benefit year
- Document medical necessity clearly for adult restorative and surgical claims
- Check current CDT code rates against the plan's fee schedule, not last year's figures
- Confirm prior authorization requirements for procedures beyond routine preventive care
Has the Dental Fee Schedule Changed for 2026?
AHCA reviews and republishes Florida Medicaid's dental fee schedule on a recurring basis. CDT codes and frequency limits tend to remain structurally similar year over year, but reimbursement rates and covered service lists can shift.
Before finalizing your 2026 dental fee tables, pull the current dental fee schedule directly from AHCA and cross-check it against the specific managed dental plan's published rates.
Frequently Asked Questions
Does Florida Medicaid cover dental care for adults?
Adult dental coverage is more limited than pediatric coverage and has expanded over recent years. Confirm current adult coverage rules for the specific service before assuming it falls under an emergency-only model.
Who actually pays Florida Medicaid dental claims?
Most claims are adjudicated by the enrollee's statewide managed dental plan (such as DentaQuest or MCNA Dental) rather than paid directly by AHCA, though the state fee schedule sets the underlying baseline rates.
How often can a preventive cleaning be billed?
Preventive services such as prophylaxis (cleanings) are typically limited to twice per benefit year for pediatric patients. Billing before the frequency limit resets results in a denial.
Disclaimer: This blog is for informational purposes only and does not constitute billing or legal advice. Florida Medicaid dental fee schedules and coverage policies are updated periodically. Always verify current codes, rates, and rules against the official AHCA fee schedule and the applicable dental plan before billing.
Tags: Dental, Fee Schedule, Florida, Medicaid
