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Consultants Corner: Periodontics

In January 2017, ADA CDT created code D4346 - scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation.

The CDT description states this procedure is for “the removal of plaque, calculus and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planning, or debridement procedures”.

D4346 is a therapeutic procedure that can be performed on the same day as an oral evaluation. It is performed to remove supra and subgingival calculus and to address swollen, red, bleeding gums that represent localized gingivitis without loss of attachment or bone loss (which is characterized in scaling and root planing). A D1110 can be performed about 2-4 weeks after the D4346 with benefits determined by plan provisions. Using this CDT code to document a time-consuming prophylaxis, often referred to as a “hard prophy” is not appropriate.

Based on the CDT descriptor, D4346 is indicated and benefited by Delta Dental of Kansas when all of these are present:

  • Exam has already been performed;
  • Patient is diagnosed with Generalized Moderate or Generalized Severe Gingivitis;
  • Generalized pocket depths 4mm or greater are present;
  • Moderate to severe bleeding on probing is present; AND
  • Radiographs show that there is less than 2mm bone loss from the Cementoenamel Junction (CEJ).

The American Dental Association has produced supporting documentation, such as the illustration below, to assist dentists in determining when the use of D4346 is appropriate. For a more in depth document, “ADA Guide to Reporting D4346”, can be downloaded by clicking on the link below.

D4346 Education Guidelines (ada.org)