Forest fire frequency, extent, and severity have rapidly increased in recent decades across the western United States (US) due to climate change and suppression-oriented wildfire management. Fuels reduction treatments are an increasingly popular management tool, as evidenced by California’s plan to treat one million acres annually by 2050. However, the aggregate efficacy of fuels treatments in dry forests at regional and multi-decadal scales is unknown. We develop a novel fuels treatment module within a coupled dynamic vegetation and fire model to study the effects of dead biomass removal from forests in the Sierra Nevada region of California. We ask how annual areal treatment extent, stand-level treatment intensiveness, and spatial treatment placement alter fire severity and live carbon loss. We find that a ~30% reduction in stand-replacing fire was achieved under our baseline treatment scenario of 1000 km2 year-1 after a 100-year treatment period. Prioritizing the most fuel-heavy stands based on precise fuel distributions yielded cumulative reductions in pyrogenic stand-replacement of up to 50%. Both removing constraints on treatment location due to remoteness, topography, and management jurisdiction and prioritizing the most fuel-heavy stands yielded the highest stand-replacement rate reduction of ~90%. Even treatments that succeeded in lowering aggregate fire severity often took multiple decades to yield measurable effects, and avoided live carbon loss remained negligible across scenarios. Our results suggest that strategically placed fuels treatments are a promising tool for controlling forest fire severity at regional, multi-decadal scales, but may be less effective for mitigating live carbon losses.