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Full Mouth Debridement

Wisconsin 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 July 2026.

Facilitymedian $60 · 10th–90th $43$1260%10%10th90th$60Professionalmedian $59 · 10th–90th $46$1380%10%10th90th$59$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$42.66
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$52.48
Typical High
$70.79
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$89.13
Typical High
$177.83
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$58.88
Typical High
$109.65
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Medica
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$60.26
Typical High
$125.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$60.26
Typical High
$70.79
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$58.88
Typical High
$109.65
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Quartz
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$125.89
Typical High
$186.21
Quartz
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$891.25
Quartz
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$371.54
Typical High
$371.54
Security Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$144.54