Gingivectomy/Gingivoplasty (Restorative, Per Tooth) (D4212) — National Rates

Negotiated reimbursement rates for D4212 across 47 states, sourced from CMS Transparency in Coverage data. 426 rate records.

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National Average Negotiated Rate
$156
426 rate records · 47 states
📊 Data updated monthly · Last refresh: March 2026

About D4212 — Gingivectomy/Gingivoplasty (Restorative, Per Tooth)

D4212 refers to a gingivectomy or gingivoplasty procedure performed on a per tooth basis. This surgical procedure involves the removal or reshaping of gum tissue to improve aesthetics or facilitate restorative work. Clinical indications for this procedure include the presence of excessive gingival tissue, periodontal disease, or the need for crown lengthening. Proper documentation is essential, including pre-operative and post-operative photographs, periodontal charting, and a detailed treatment plan. Billing notes should reflect the specific tooth treated and any related procedures. Reimbursement for D4212 can vary significantly by payor and state, with average payments around $156. Some insurance plans may have limitations on coverage based on medical necessity or frequency of treatment, so verifying benefits prior to treatment is advisable.

Reimbursement rates for D4212 vary significantly by state, payor, and provider network. The national average negotiated rate is $156. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.

Top Paying States for D4212

Maine
$346
3 records
Delaware
$243
2 records
New York
$232
13 records

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Full National Breakdown

Median
$142
Low
$25
High
$630

Highest & Lowest Reimbursement States

↑ Top 5

StateAvg Rate
Maine$346
Delaware$243
New York$232
Alaska$232
New Jersey$223

↓ Bottom 5

StateAvg Rate
Mississippi$76
Nebraska$74
Alabama$71
Kansas$64
Iowa$63

All States — D4212 Average Rates

Maine
$346
Delaware
$243
New York
$232
Alaska
$232
New Jersey
$223
Connecticut
$214
Wisconsin
$209
New Mexico
$206
California
$204
Indiana
$190
Ohio
$190
Pennsylvania
$180
Colorado
$180
Arizona
$180
Maryland
$179
Michigan
$176
North Dakota
$162
Puerto Rico
$160
New Hampshire
$158
North Carolina
$150
Florida
$145
District of Columbia
$145
Illinois
$145
West Virginia
$142
Georgia
$136
Idaho
$134
Virginia
$133
Rhode Island
$130
Massachusetts
$126
Arkansas
$120
Texas
$120
South Carolina
$120
Missouri
$116
Washington
$110
Wyoming
$109
Minnesota
$107
Kentucky
$100
Utah
$94
Louisiana
$88
Tennessee
$85
Hawaii
$84
Nevada
$79
Mississippi
$76
Nebraska
$74
Alabama
$71
Kansas
$64
Iowa
$63
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State-by-State Comparison Table

StateAverageMedianMinMaxRecords
Maine$346$364$291$3823
Delaware$243$243$213$2732
New York$232$130$88$63013
Alaska$232$232$232$2321
New Jersey$223$241$58$30615
Connecticut$214$240$105$2496
Wisconsin$209$210$203$2108
New Mexico$206$211$192$2114
California$204$191$58$34864
Indiana$190$164$128$3034
Ohio$190$158$60$27816
Pennsylvania$180$208$72$24314
Colorado$180$184$125$2427
Arizona$180$180$171$1882
Maryland$179$181$145$22417
Michigan$176$169$169$2157
North Dakota$162$121$58$3063
Puerto Rico$160$160$160$1601
New Hampshire$158$158$124$1922
North Carolina$150$152$58$2496
Florida$145$138$58$30660
District of Columbia$145$145$145$1451
Illinois$145$154$42$2294
West Virginia$142$142$106$1772
Georgia$136$125$60$19915
Idaho$134$134$134$1342
Virginia$133$129$113$20111
Rhode Island$130$130$130$1308
Massachusetts$126$130$92$1537
Arkansas$120$120$120$1201
Texas$120$105$100$24311
South Carolina$120$100$25$24014
Missouri$116$119$82$1318
Washington$110$115$96$1347
Wyoming$109$109$109$1091
Minnesota$107$115$53$1444
Kentucky$100$100$100$1001
Utah$94$94$94$942
Louisiana$88$88$88$8818
Tennessee$85$100$60$10012
Hawaii$84$84$84$842
Nevada$79$70$62$10511
Mississippi$76$76$65$882
Nebraska$74$74$74$742
Alabama$71$72$65$806
Kansas$64$64$64$641
Iowa$63$42$42$1185
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