Non-Autogenous Connective Tissue Graft (First Tooth) (D4275) — National Rates

Negotiated reimbursement rates for D4275 across 48 states, sourced from CMS Transparency in Coverage data. 609 rate records.

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National Average Negotiated Rate
$416
609 rate records · 48 states
📊 Data updated monthly · Last refresh: March 2026

About D4275 — Non-Autogenous Connective Tissue Graft (First Tooth)

The D4275 code is for a Non-Autogenous Connective Tissue Graft for the first tooth, which involves using donor tissue to cover exposed roots due to gingival recession. This procedure is indicated for patients who may not have sufficient tissue available from their own palate. Documentation should include clinical assessments, photographs, and a justification for using non-autogenous material. Coverage and reimbursement can vary significantly by payor, with some requiring pre-authorization and others having specific limitations on graft types. The average reimbursement for this procedure is about $416.

Reimbursement rates for D4275 vary significantly by state, payor, and provider network. The national average negotiated rate is $416. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.

Top Paying States for D4275

Washington
$634
5 records
Nevada
$614
17 records
Oregon
$592
2 records

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Full National Breakdown

Median
$389
Low
$83
High
$1,889

Highest & Lowest Reimbursement States

↑ Top 5

StateAvg Rate
Washington$634
Nevada$614
Oregon$592
Texas$546
District of Columbia$546

↓ Bottom 5

StateAvg Rate
Tennessee$266
Kentucky$262
Idaho$244
Iowa$224
South Dakota$207

All States — D4275 Average Rates

Washington
$634
Nevada
$614
Oregon
$592
Texas
$546
District of Columbia
$546
Florida
$543
New Hampshire
$524
North Dakota
$517
New York
$516
South Carolina
$509
Georgia
$483
Alabama
$483
Massachusetts
$481
Delaware
$478
Oklahoma
$476
Michigan
$470
Virginia
$436
California
$430
Maine
$424
Alaska
$406
Missouri
$406
Indiana
$398
Hawaii
$394
Arizona
$387
New Jersey
$375
West Virginia
$375
Kansas
$369
Connecticut
$368
Minnesota
$368
Pennsylvania
$346
Maryland
$345
Utah
$341
Ohio
$338
Nebraska
$325
New Mexico
$324
Colorado
$314
Mississippi
$300
Rhode Island
$295
Illinois
$284
Wisconsin
$283
Arkansas
$277
Louisiana
$273
North Carolina
$267
Tennessee
$266
Kentucky
$262
Idaho
$244
Iowa
$224
South Dakota
$207
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State-by-State Comparison Table

StateAverageMedianMinMaxRecords
Washington$634$618$618$6785
Nevada$614$564$323$1,04417
Oregon$592$592$533$6512
Texas$546$500$204$97048
District of Columbia$546$479$331$8283
Florida$543$617$243$85831
New Hampshire$524$471$243$7525
North Dakota$517$402$191$1,0734
New York$516$422$253$1,88920
South Carolina$509$416$243$1,04021
Georgia$483$413$221$72523
Alabama$483$489$452$5083
Massachusetts$481$480$227$8519
Delaware$478$478$478$4781
Oklahoma$476$553$256$6193
Michigan$470$470$440$4992
Virginia$436$431$387$50311
California$430$422$191$1,044101
Maine$424$424$424$4241
Alaska$406$406$406$4061
Missouri$406$418$207$55917
Indiana$398$392$254$5564
Hawaii$394$466$222$4666
Arizona$387$418$253$53918
New Jersey$375$309$191$80122
West Virginia$375$375$375$3752
Kansas$369$336$207$5597
Connecticut$368$385$267$4374
Minnesota$368$366$170$49415
Pennsylvania$346$326$259$4678
Maryland$345$351$241$4937
Utah$341$348$310$3653
Ohio$338$276$207$56111
Nebraska$325$224$207$8017
New Mexico$324$324$314$3354
Colorado$314$298$216$50510
Mississippi$300$300$300$3001
Rhode Island$295$295$295$2951
Illinois$284$264$207$46412
Wisconsin$283$275$255$43016
Arkansas$277$277$208$3462
Louisiana$273$216$216$5005
North Carolina$267$250$215$43826
Tennessee$266$238$204$49412
Kentucky$262$254$249$43444
Idaho$244$222$207$3478
Iowa$224$207$207$3448
South Dakota$207$207$207$2071
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