Periodontal Procedures Coding Flashcards

Which CDT code added in recent CDT editions describes scaling in the presence of generalized moderate or severe gingival inflammation — full mouth?

Answer: D4346

D4346 was introduced to capture scaling performed when generalized moderate or severe gingival inflammation is present but the patient does not meet criteria for SRP (no bone loss).

What documentation is typically required by insurers when submitting a claim for periodontal scaling and root planing (D4341/D4342)?

Answer: Periodontal probing depths, radiographic evidence of bone loss, and a description of clinical findings

Claims for SRP require supporting documentation including periodontal charting with probing depths, radiographs demonstrating bone loss, and narrative clinical findings to establish medical necessity.

A patient completed full mouth scaling and root planing six months ago and returns for a supportive care visit. Which code should be reported?

Answer: D4910

Once a patient has undergone active periodontal therapy, all subsequent supportive cleaning appointments are reported as D4910 (periodontal maintenance), not D1110.

What is the most common insurance-allowed frequency for periodontal maintenance (D4910) per year?

Answer: Every 3 to 4 months (three to four times per year)

Most dental insurance plans allow D4910 up to three or four times per year (every 3–4 months), reflecting the clinical recommendation for supportive periodontal therapy intervals.

What information must typically be included when submitting a claim for osseous surgery (D4260)?

Answer: Quadrant, tooth numbers, radiographic evidence of bone loss, and periodontal probing documentation

Insurance claims for osseous surgery require the quadrant treated, specific tooth numbers, radiographic evidence of osseous defects, and periodontal probing records to support medical necessity.

Which CDT code is used to report a pedicle soft tissue graft procedure?

Answer: D4270

D4270 describes a pedicle soft tissue graft, where the donor tissue remains partially attached (rotated or advanced), unlike a free graft which is completely detached.

When a dental coder must report a procedure not adequately described by any existing CDT code for a periodontal service, which code is used?

Answer: D4999

D4999 is the unspecified periodontal procedure code used when no existing CDT code accurately describes the service rendered, and it typically requires a written narrative.