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Custom Gum Treatment Procedure

Ohio 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

Professionalmedian $50 · 10th to 90th $40 to $60
$1$2$5$10$20$50professional $50

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
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$1.00
Median
$1.00
Typical High
$1.00
Molina
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$50.12
Typical High
$60.26