Dental PPO Reimbursement Rates in Maryland (2026)

Maryland publishes what it will pay you to examine and clean an adult's mouth: $31.81 for a periodic oral evaluation and $67.12 for an adult prophylaxis, or $98.93 for the visit, per the Maryland Healthy Smiles Dental Program fee schedule effective August 1, 2023 and revised November 27, 2024. Your worst PPO contract pays something you have almost certainly never calculated on a per-hour basis, and that asymmetry is where Maryland owners are losing money in 2026.

Here is our position, and plenty of owners will argue with it: the negotiated fee schedule is not the number worth fighting over. The number worth fighting over is what one hour of your chair time collects under each individual plan, and by that measure most Maryland general practices are carrying at least one contract that pays the owner less per clinical hour than the average Maryland dentist earns as somebody else's employee. Fee schedules are a symptom. Chair time is the asset. Owners who reorganize around the second number tend to fix the first one by accident.

Maryland Publishes Its Floor, and That Floor Is Useful

Maryland raised Medicaid dental reimbursement for certain services by 9.4% for dates of service beginning July 1, 2022, a State Plan Amendment CMS approved on April 7, 2023, alongside an adult dental expansion. That matters for two reasons that have nothing to do with whether you take Medicaid.

First, it gives you the only published, government-set, Maryland-specific dental price list in existence. Commercial PPO schedules are contractual and confidential. Medicaid's is a PDF. When you sit down to evaluate a carrier's offer, you now have a hard floor to measure against, and the distance between that floor and your lowest PPO tier is the single most honest description of what that plan actually is.

Second, the state moved. It raised rates 9.4% and widened adult eligibility. Ask yourself when your oldest PPO agreement last moved 9.4% in your favor. If the answer is "it hasn't," you are in a market where the public payer has repriced and the private payers have not, which is close to the inverse of how most owners assume the world works.

Use the floor as a diagnostic, not a target. If a commercial PPO is paying you within roughly 10% to 15% of the Healthy Smiles allowable on your bread-and-butter hygiene and diagnostic codes, you are not running a private practice with an insurance contract. You are running a public program with private-sector overhead, front desk labor, credit card fees and a full-time person chasing claims.

No Carrier Will Show You the Maryland Market

There is no published table of Maryland PPO reimbursement rates, and there never will be, because the confidentiality is the product. Carriers price each office against what that office has already agreed to accept, and against whatever leased-network arrangement sits underneath the contract you signed nine years ago. Two practices four miles apart in Towson can be paid materially different amounts for D2740 under the same plan name.

What we can say, in the aggregate, is that average PPO contracted discounts run 30% to 40% off gross usual, customary and reasonable fees industry-wide, citing the ADA's 2023 Survey of Dental Fees. That is a national band, not a Maryland number, and you should treat it exactly that way: as a sanity check on your own reports, not as evidence about your own contracts. If your write-off percentage on a given plan sits well outside that band, something in your fee schedule or your coding is worth a hard look.

Which brings us to the part most owners handle badly.

The Mistake: Ranking Plans by Write-Off Percentage

The specific error, and we see it most often in one-doctor and two-doctor practices where the office manager pulls the adjustment report and the owner approves the conclusion, is ranking PPOs by write-off percentage and dropping whichever one shows the biggest adjustment. It feels rigorous. It is not. Write-off percentage measures the size of your discount against a fee you set yourself. Raise your UCR fees 8% tomorrow and every plan's write-off percentage gets worse while your collections improve.

Our view: write-off percentage is the wrong metric, and we wouldn't walk into a renegotiation carrying a report built on it. The right metric is Collections per Provider Hour: net collections from a payer divided by the provider chair hours that produced them, computed separately for each plan. It answers the only question that matters when you have finite chairs and finite days, which is what an hour of clinical time earns under this contract versus that one.

The two metrics routinely disagree. A plan with a 34% write-off and a heavy restorative mix can out-earn a plan with a 22% write-off that sends you nothing but recall and radiographs. Ranking by discount tells you to keep the second one.

Plan D Collects $212 an Hour. Plan A Collects $318.

Take a single-owner Maryland general practice, two hygiene chairs, four PPO contracts, and run the two plans at the ends of the range.

• Plan A: 1,120 visits a year, $286,000 in net collections, 900 provider chair hours across doctor and hygiene.
• Plan D: 760 visits a year, $148,500 in net collections, 700 provider chair hours.

Plan A's Collections per Provider Hour is $317.78. Plan D's is $212.14. The gap is $105.64 an hour. Applied across the 700 hours Plan D consumes, that gap is worth $73,948 a year in collections on identical clinical time.

Now push it one step further, because this is the number that should change how you sleep. Assume 62% overhead, and use your own figure if you have one, because that assumption drives everything that follows. Plan D leaves $80.61 per provider hour after overhead. The Bureau of Labor Statistics puts Maryland's 2,970 general dentists at an annual mean wage of $234,670, or $112.82 an hour, as of May 2023. So Plan D pays the owner of the building roughly $32 an hour less than the average Maryland dentist earns working for somebody else.

That is the line worth texting to your partner tonight: on your worst contract, you are paying yourself less per hour to own the practice than you would earn as an associate down the road.

Plan D Needs 69% Retention to Justify Staying

Knowing Plan D is your weakest hour does not tell you to drop it. Empty chairs collect nothing at all, and that is the trap owners fall into after reading an article like this one. Run the Break-Even Retention Test before you send a termination letter.

Plan D's net collections per visit are $195.39. Out of network, with the same procedure mix at full fee and a 3% allowance for bad debt, call net collections per visit $284. Break-even retention is $195.39 divided by $284, which is 68.8%. In visit terms, you need to keep about 523 of those 760 annual visits for collections to stay flat.

So here is our call, and it is conditional on one thing you can measure this week. If your hygiene columns are running at 92% or better and you are booking new patients more than two weeks out, we'd drop Plan D. You are not risking $148,500; you are risking the portion of it you fail to keep, and you are freeing 700 hours that your own data says are worth over $100 more each. If your schedule has open chair time, we wouldn't touch it. Dropping a plan you cannot refill converts $212 an hour into $0 an hour, and no renegotiation upside covers that.

In the middle case, with 85% hygiene use and a thin new-patient flow, renegotiate and set a trigger: no increase by the second cycle and you leave. Write the trigger down with a date. Contracts that never get a deadline never get repriced.

A Frozen 2019 Fee Schedule Is Erosion, Not Drift

Use Drift vs. Erosion on your reimbursement trend, because owners consistently misclassify this one. Drift is small, steady, recoverable, and you manage it operationally: a lab bill creeping up 3%, a supply category running hot for a quarter. Erosion is structural and compounding, and it requires renegotiation, repricing or exit.

A PPO schedule that has not moved since 2019 while wages, lab fees and rent all have is erosion, full stop. Every year the same allowable buys you less of everything required to produce it, and no amount of scheduling discipline reverses it. Treating that as drift, as something you can outrun with better block scheduling and a tighter recall script, is the expensive mistake in this category. It is also the most common one, because the monthly numbers never look alarming. Erosion never announces itself; it just quietly reprices your career.

The industry has noticed. More than half of dentists nationally named insurance-related issues, including low reimbursement and delayed or denied claims, as a top concern heading into 2026, according to an ADA Health Policy Institute poll reported by ADA News. The same piece notes that 37 dental insurance reform laws passed across 18 states in 2025, many of them targeting practices like downcoding and bundling. That is the tell: the fight has moved from headline rates to how carriers adjudicate what they already agreed to pay. A contract at a fair allowable that downcodes your posterior composites to amalgam allowables and bundles your buildups is not a fair contract, and your write-off report will not flag it. Only a claim-by-claim read of your explanations of benefits will.

What We're Watching in Annapolis

Three things would change the analysis above. First, whether Maryland joins the states legislating on downcoding and bundling, because adjudication reform would raise the effective value of contracts you already hold without a single renegotiation. Second, whether the state moves Healthy Smiles rates again, since another increase keeps pulling the published floor up toward the weakest commercial tiers and makes the comparison sharper. Third, whether the carriers in this market start differentiating rates by network tier in a way that rewards practices willing to drop out of the leased networks underneath their agreements. If that happens, the exit math gets better fast, and plans we would keep today become plans we would leave.

Do This Before Friday

Pull twelve months of net collections by plan, then pull the provider hours behind them, and compute Collections per Provider Hour for every contract you hold. Rank them, then check the bottom one against the $98.93 Maryland Medicaid hygiene visit and against your own hygiene use rate. Run the Break-Even Retention Test on that bottom plan and write the number on a sticky note, because that single percentage decides whether you negotiate or walk. Then request a fee schedule review in writing, with a date, for every contract more than three years old.

If you want to see how your own per-hour numbers and PPO exit math compare against other practices before you send that letter, run your own numbers through our free PPO-exit calculator. It takes the plan-level collections and hours you just pulled and returns the break-even retention rate you need to hold. Better to find out on a spreadsheet than in next spring's schedule.