Custom Gum Treatment Procedure

Minnesota rates for HCPCS D4999

A gum-related treatment that doesn't match one of the standard, commonly used periodontal procedures, so your dentist provides a detailed explanation of exactly what was done. It's used for unusual situations involving the gums or supporting structures of the teeth that need an individualized approach.

Rates data updated October 2026.

How much rates vary

Facilitymedian $575 · 10th to 90th $309 to $1,660

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
BCBS Minnesota Setting Facility Modifier None Typical Low $309.03 Median $575.44 Typical High $1,659.59	Facility	None	$309.03	$575.44	$1,659.59
Medica Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $89.13	Facility	None	$89.13	$89.13	$89.13