Free Soft Tissue Graft (First Tooth) (D4277) — National Rates

Negotiated reimbursement rates for D4277 across 48 states, sourced from CMS Transparency in Coverage data. 753 rate records.

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National Average Negotiated Rate
$713
753 rate records · 48 states
📊 Data updated monthly · Last refresh: March 2026

About D4277 — Free Soft Tissue Graft (First Tooth)

D4277 refers to the procedure of a free soft tissue graft for the first tooth. This surgical intervention is commonly indicated for patients requiring periodontal treatment, particularly in cases of gingival recession or to enhance the width of keratinized tissue. Documentation for billing should include detailed clinical notes, photographs, and a treatment plan outlining the necessity of the graft. Reimbursement for this procedure can vary significantly by payor and state, with average costs around $713. Some insurance plans may cover a portion of the grafting procedure, while others may classify it as cosmetic, leading to potential denials. It is essential to verify coverage with the specific payor prior to the procedure to avoid unexpected patient costs.

Reimbursement rates for D4277 vary significantly by state, payor, and provider network. The national average negotiated rate is $713. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.

Top Paying States for D4277

Maine
$1,087
11 records
New York
$1,017
23 records
New Hampshire
$987
12 records

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Full National Breakdown

Median
$689
Low
$83
High
$2,100

Highest & Lowest Reimbursement States

↑ Top 5

StateAvg Rate
Maine$1,087
New York$1,017
New Hampshire$987
District of Columbia$940
California$840

↓ Bottom 5

StateAvg Rate
Idaho$496
Kansas$473
Alabama$471
Nebraska$409
Wyoming$372

All States — D4277 Average Rates

Maine
$1,087
New York
$1,017
New Hampshire
$987
District of Columbia
$940
California
$840
New Jersey
$831
Georgia
$825
Indiana
$793
Maryland
$793
Connecticut
$778
Pennsylvania
$777
Virginia
$753
Florida
$734
Oregon
$728
Massachusetts
$721
West Virginia
$704
Delaware
$691
Alaska
$689
Wisconsin
$683
South Dakota
$682
Texas
$670
Michigan
$667
Mississippi
$661
Ohio
$659
Washington
$658
South Carolina
$646
North Carolina
$630
Nevada
$615
North Dakota
$612
Colorado
$610
Missouri
$607
Arizona
$586
Oklahoma
$584
New Mexico
$581
Rhode Island
$578
Illinois
$564
Tennessee
$552
Minnesota
$540
Kentucky
$536
Iowa
$532
Hawaii
$516
Utah
$514
Louisiana
$514
Idaho
$496
Kansas
$473
Alabama
$471
Nebraska
$409
Wyoming
$372
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State-by-State Comparison Table

StateAverageMedianMinMaxRecords
Maine$1,087$1,043$993$1,26011
New York$1,017$689$226$2,10023
New Hampshire$987$944$944$1,20012
District of Columbia$940$940$900$9802
California$840$839$226$1,37356
New Jersey$831$851$488$1,26024
Georgia$825$896$422$1,109114
Indiana$793$873$455$1,1095
Maryland$793$895$436$94422
Connecticut$778$818$687$8518
Pennsylvania$777$698$505$2,10014
Virginia$753$814$465$8958
Florida$734$764$444$85837
Oregon$728$689$638$8573
Massachusetts$721$656$443$1,10915
West Virginia$704$704$704$7041
Delaware$691$638$549$9374
Alaska$689$689$634$7442
Wisconsin$683$689$528$68935
South Dakota$682$682$682$6821
Texas$670$614$530$99414
Michigan$667$632$559$8056
Mississippi$661$614$614$7543
Ohio$659$680$512$78327
Washington$658$649$584$87810
South Carolina$646$700$390$1,04333
North Carolina$630$615$443$1,04330
Nevada$615$580$474$1,00321
North Dakota$612$617$414$9755
Colorado$610$617$443$90418
Missouri$607$563$428$90241
Arizona$586$629$320$72714
Oklahoma$584$512$433$1,0838
New Mexico$581$612$428$7033
Rhode Island$578$578$578$5781
Illinois$564$515$497$80020
Tennessee$552$585$352$75413
Minnesota$540$448$339$85028
Kentucky$536$524$486$62910
Iowa$532$532$376$6892
Hawaii$516$538$360$5996
Utah$514$512$447$5833
Louisiana$514$545$420$5454
Idaho$496$487$456$5544
Kansas$473$431$336$6175
Alabama$471$489$440$4925
Nebraska$409$410$285$5323
Wyoming$372$372$372$3721
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