Gingival Irrigation — Per Quadrant (D4921) — National Rates

Negotiated reimbursement rates for D4921 across 25 states, sourced from CMS Transparency in Coverage data. 246 rate records.

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National Average Negotiated Rate
$40
246 rate records · 25 states
📊 Data updated monthly · Last refresh: March 2026

About D4921 — Gingival Irrigation — Per Quadrant

Gingival Irrigation — Per Quadrant involves the application of an antimicrobial solution to the gingival tissues in a specific quadrant to reduce inflammation and bacterial load. This procedure is indicated for patients with localized gingival inflammation or periodontal disease. Documentation should include the quadrant treated, the solution used, and the clinical rationale for the irrigation. Reimbursement for this service averages around $40, but it can vary by payor and state, with some plans offering limited coverage based on the patient's overall periodontal treatment plan.

Reimbursement rates for D4921 vary significantly by state, payor, and provider network. The national average negotiated rate is $40. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.

Top Paying States for D4921

Hawaii
$76
1 records
California
$69
53 records
Washington
$58
2 records

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Full National Breakdown

Median
$34
Low
$8
High
$106

Highest & Lowest Reimbursement States

↑ Top 5

StateAvg Rate
Hawaii$76
California$69
Washington$58
New York$56
Connecticut$54

↓ Bottom 5

StateAvg Rate
Alabama$19
Maryland$18
Kentucky$14
Ohio$14
Illinois$8

All States — D4921 Average Rates

Hawaii
$76
California
$69
Washington
$58
New York
$56
Connecticut
$54
Nevada
$41
Wisconsin
$40
Colorado
$40
Utah
$35
Pennsylvania
$34
Georgia
$33
North Carolina
$29
Texas
$28
Louisiana
$25
Massachusetts
$25
Virginia
$24
New Jersey
$23
Michigan
$22
Minnesota
$21
Missouri
$19
Alabama
$19
Maryland
$18
Kentucky
$14
Ohio
$14
Illinois
$8
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State-by-State Comparison Table

StateAverageMedianMinMaxRecords
Hawaii$76$76$76$761
California$69$67$32$10653
Washington$58$58$58$582
New York$56$75$12$7510
Connecticut$54$56$14$904
Nevada$41$40$37$464
Wisconsin$40$40$16$652
Colorado$40$26$19$866
Utah$35$35$35$351
Pennsylvania$34$22$18$754
Georgia$33$34$13$3460
North Carolina$29$28$25$344
Texas$28$32$22$5045
Louisiana$25$25$25$251
Massachusetts$25$25$25$251
Virginia$24$25$15$2711
New Jersey$23$23$23$231
Michigan$22$22$22$221
Minnesota$21$21$21$2112
Missouri$19$19$19$191
Alabama$19$18$18$2510
Maryland$18$18$18$192
Kentucky$14$9$9$253
Ohio$14$11$10$223
Illinois$8$8$8$81
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