go back

Custom Gum Treatment Procedure

Texas 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 does Custom Gum Treatment Procedure cost?

$759

Typical physician fee. In Texas, October 2026.

Insurers have agreed to pay about $759 for this service. Most negotiated rates run $759 to $759.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 3 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $759 · 10th to 90th $759 to $759
$50$100$200$500professional $759

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
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Providence
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$60.26
Typical High
$79.43
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$758.58
Median
$758.58
Typical High
$758.58

Where Texas sits

The same service costs 69183.1 times more in Pennsylvania than in Colorado. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Texas· 7th of 36

$759

PA $58,884CO $0.85

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.