Gingivectomy/Gingivoplasty — 4+ Teeth (Per Quad) (D4210) — National Rates

Negotiated reimbursement rates for D4210 across 50 states, sourced from CMS Transparency in Coverage data. 726 rate records.

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National Average Negotiated Rate
$383
726 rate records · 50 states
📊 Data updated monthly · Last refresh: March 2026

About D4210 — Gingivectomy/Gingivoplasty — 4+ Teeth (Per Quad)

Gingivectomy or gingivoplasty for four or more teeth per quadrant is a surgical procedure aimed at removing diseased gum tissue or reshaping the gums for aesthetic or functional purposes. Clinical indications include periodontal disease, gingival overgrowth, or preparation for restorative work. Documentation should include periodontal evaluation, treatment rationale, and post-operative care instructions. Reimbursement can vary significantly by payor and state, with some plans covering it under periodontal services while others may not. The average reimbursement for this procedure is approximately $383.

Reimbursement rates for D4210 vary significantly by state, payor, and provider network. The national average negotiated rate is $383. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.

Top Paying States for D4210

Wisconsin
$526
14 records
Kentucky
$519
10 records
New Hampshire
$519
3 records

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Full National Breakdown

Median
$367
Low
$83
High
$1,400

Highest & Lowest Reimbursement States

↑ Top 5

StateAvg Rate
Wisconsin$526
Kentucky$519
New Hampshire$519
Maine$504
Missouri$491

↓ Bottom 5

StateAvg Rate
Iowa$229
Wyoming$220
West Virginia$197
Nebraska$191
South Dakota$149

All States — D4210 Average Rates

Wisconsin
$526
Kentucky
$519
New Hampshire
$519
Maine
$504
Missouri
$491
Alaska
$480
Oregon
$471
Nevada
$464
Delaware
$435
New York
$432
Massachusetts
$430
Michigan
$424
New Jersey
$420
Georgia
$412
Washington
$411
District of Columbia
$408
Connecticut
$407
California
$406
Ohio
$404
New Mexico
$402
Maryland
$396
Louisiana
$391
Hawaii
$384
Pennsylvania
$381
Arizona
$380
Texas
$366
Colorado
$366
Mississippi
$362
South Carolina
$356
Oklahoma
$351
Florida
$333
Indiana
$332
Illinois
$320
Utah
$316
Kansas
$312
Tennessee
$308
Arkansas
$292
Virginia
$272
Minnesota
$270
Alabama
$265
Idaho
$263
Rhode Island
$262
North Carolina
$250
North Dakota
$245
Puerto Rico
$244
Iowa
$229
Wyoming
$220
West Virginia
$197
Nebraska
$191
South Dakota
$149
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State-by-State Comparison Table

StateAverageMedianMinMaxRecords
Wisconsin$526$520$512$60014
Kentucky$519$573$326$57310
New Hampshire$519$544$441$5723
Maine$504$504$489$5182
Missouri$491$485$144$67347
Alaska$480$480$375$5862
Oregon$471$516$384$5165
Nevada$464$382$379$65013
Delaware$435$430$325$5513
New York$432$505$206$55932
Massachusetts$430$429$218$57213
Michigan$424$360$308$5985
New Jersey$420$327$289$1,40035
Georgia$412$387$218$56497
Washington$411$425$320$5016
District of Columbia$408$381$246$5845
Connecticut$407$407$407$4071
California$406$409$149$59087
Ohio$404$430$149$59810
New Mexico$402$415$367$42711
Maryland$396$411$258$55012
Louisiana$391$346$346$4803
Hawaii$384$359$326$4663
Pennsylvania$381$345$258$52111
Arizona$380$367$313$47140
Texas$366$344$149$56518
Colorado$366$382$211$57310
Mississippi$362$362$360$3632
South Carolina$356$320$125$55022
Oklahoma$351$287$216$4878
Florida$333$320$208$42917
Indiana$332$360$270$3673
Illinois$320$305$149$53324
Utah$316$316$280$3532
Kansas$312$239$144$5445
Tennessee$308$326$196$49914
Arkansas$292$216$216$5335
Virginia$272$246$210$59812
Minnesota$270$208$208$1,40022
Alabama$265$266$238$2925
Idaho$263$256$149$4005
Rhode Island$262$262$262$2626
North Carolina$250$244$218$46935
North Dakota$245$245$245$2451
Puerto Rico$244$244$244$2441
Iowa$229$149$149$38613
Wyoming$220$220$220$2201
West Virginia$197$197$197$1971
Nebraska$191$191$149$2323
South Dakota$149$149$149$1491
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