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Full Mouth Debridement

South Dakota 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 does Full Mouth Debridement cost?

$102

Typical physician fee. In South Dakota, October 2026.

Insurers have agreed to pay about $102 for this service. Most negotiated rates run $89.13 to $145.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $89 · 10th to 90th $44 to $105Professionalmedian $102 · 10th to 90th $52 to $372
$50$100$200facility $89professional $102

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Aetna
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$52.48
Typical High
$53.70
Medica
Setting
Facility
Modifier
None
Typical Low
$43.65
Median
$89.13
Typical High
$104.71
Medica
Setting
Professional
Modifier
None
Typical Low
$102.33
Median
$371.54
Typical High
$371.54
Midlands
Setting
Professional
Modifier
None
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
Midlands
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$125.89
Typical High
$144.54
Wellmark
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54

Where South Dakota sits

The same service costs 9.5 times more in Texas than in West Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 12th of 51

$102

TX $372WV $38.90

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.