Full Mouth Debridement

Hawaii rates for HCPCS D4355

Removal of heavy plaque and tartar buildup across the entire mouth when deposits are so extensive that the dentist cannot properly see the teeth and gums to complete an exam. It is a preliminary cleaning step, done before a comprehensive evaluation or treatment planning can happen, rather than a routine cleaning. A separate cleaning or gum treatment is typically still needed afterward.

Rates data updated October 2026.

How much rates vary

Professionalmedian $58 · 10th to 90th $46 to $91

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier	Facility/Professional	Modifier	Typical Low	Median	Typical High
Aetna Setting Professional Modifier None Typical Low $45.71 Median $57.54 Typical High $89.13	Professional	None	$45.71	$57.54	$89.13
Kaiser Permanente Setting Professional Modifier None Typical Low $676.08 Median $676.08 Typical High $676.08	Professional	None	$676.08	$676.08	$676.08