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Custom Gum Treatment Procedure

Missouri 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 $89 · 10th to 90th $89 to $100Professionalmedian $112 · 10th to 90th $112 to $112
$100facility $89professional $112

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
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
Medica
Setting
Facility
Modifier
None
Typical Low
$89.13
Median
$89.13
Typical High
$100.00
Medica
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$77.62
Typical High
$77.62