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Custom Gum Treatment Procedure

Montana 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 July 2026.

How much rates vary

Professionalmedian $79 · 10th to 90th $79 to $85
professional $79

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11