4346/D4346 Code for Dental Scaling - 
How To Successfully Use It

There is a new procedure code that every general dentist office needs to know about. This new CDT code was created by the Code Maintenance Committee (CMC) to be consistent with the widely accepted "Code for what you do"philosophy. It went into effect on January 1, 2017.

Prior to this 4346 code, dentists were performing dental treatment that had no code. For reimbursement purposes, they were either overcoding to 4341/4342 Scaling & Root Planing (resulting in many denied claims), or undercoding to 1110 Prophy. Both are inappropriate because they are not codes that accurately describe the service actually rendered.

Summary

Use this code when all of these are present:

• Exam has already been performed;
• Patient is diagnosed with Generalized Moderate Gingivitis 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 no bone loss.

Do NOT use this code in any of these scenarios:

• Patient is diagnosed with any classification of periodontitis (vs. gingivitis);
• Patient is diagnosed with Localized Gingivitis (vs. generalized);
• Patient is diagnosed with Slight Gingivitis (vs. moderate or severe);
• Bleeding on probing is localized (vs. generalized);
• Attachment loss is present;
• Radiographs show bone loss;
• There is too much plaque and calculus for an exam to be done.

Include in the insurance claim submission:

• Complete periodontal charting, showing pocket depths;
• Narrative (or copy of patient notes) stating the diagnosis;
• Narrative describing bleeding on probing status if not included on perio chart;
• Narrative stating when last prophy was done, if longer than 12 months;
• Narrative describing other contributing factors such as plaque deposits, calculus deposits, description of gingiva appearance, pain, malodor;
• Intraoral photographs if they help illustrate the gingival condition.

Example case

Here is an example of one possible scenario for this situation:

• 19-year-old patient comes into the dental office for a cleaning. He hasn't been in for two years. Exam reveals heavy plaque and calculus due to very poor oral hygiene. Perio charting shows 4mm, 5mm, and even 6mm pockets around many teeth. Gingiva has generalized bleeding during probing. Interproximal papillae appear swollen, with loss of stippling on the attached gingiva. Intraoral x-rays show many areas of supra- and subgingival calculus. The bone levels appear normal; no bone loss is noted. Since there appears to be no loss of gingival attachment, the pockets are due to coronal migration of the gingival margin (pseudopockets) rather than due to apical migration of the gingival attachment. A diagnosis of Generalized Plaque-Induced Gingivitis is made by the dentist.

So far, so good. But what is the recommended treatment? Most dentists and hygienists intuitively know what he needs...clean him up, and get his oral hygiene back on track. It will most likely take a significantly longer appointment than a regular prophy. More instrumentation will be required. Possibly two appointments. Possibly with local anesthetic. More time spent with oral hygiene instruction. But how do you code for this? Prior to the new D4346 code, the choices were...

• D1110 Prophylaxis
  • This isn't appropriate because it is primarily a Preventive procedure. That's why it is in the D1000-D1999 Preventive series in the CDT codes. This patient has nothing to prevent. He has been diagnosed with active disease. He needs active treatment. He is past the prevention phase.
  • If this code were chosen, it would be an inappropriate "undercoding", and would not be "coding for what you do".
• D4341 or D4342 Scaling and Root Planing
  • The key concept here is ROOT PLANING. When the gingival attachment is in a normal position, there are no roots to plane. In the periodontal disease Periodontitis, the gingival attachment has migrated down the root, so there are roots to plane. But, in the periodontal disease Gingivitis, the gingival attachment is still in the normal position, so there are no roots to plane. If no roots are planed, then scaling AND ROOT PLANING has not been done.
  • If this code were chosen, it would be an inappropriate "overcoding", and would not be "coding for what you do".
  • If a D4341 claim was submitted for this case, it has a high likelihood of being denied because there is no radiographic bone loss to document that there is loss of attachment, and hence no roots to plane, and hence D4341 was not performed.
• D4355 Full Mouth Debridement
  • This code is applicable only when there is so much stuff on the teeth that the dentist can't even do the exam. In this example case, an exam was possible, and a diagnosis was made, so this code would not be applicable.
• D4999 Unspecified Periodontal Procedure, By Report
  • This code can be used for any periodontal procedure that is not adequately described by other existing codes. It requires a narrative description of the actual service performed.
  • Most insurance plans generally do not pay for Dx999 By Report procedures.

Now, the new D4346 code fills this gap. It finally allows the dental office to code for what was actually done.

Another example case for D4346

• Patient who has been coming in for years for regular exams and cleanings, and has been periodontally healthy. This time, however, they report a change in their medical history. Nine months ago she had a stroke, and could not take care of her dental needs. She is late returning for her recommended preventive care. Now her gums bleed easily, and she has many deeper pockets. Her x-ray findings show more subgingival calculus accumulated than usual. Even though it is subgingival, it is limited to the clinical crowns and not the root surfaces. No bone loss is evident when compared to prior x-rays. She is no longer periodontally healthy. Since her inflammation is limited to gingiva, and not the gingival attachment or bone, she is diagnosed with Generalized Gingivitis. She doesn't need scaling & root planing since there is no apparent bone loss, and hence no roots to plane. She needs more than a routine preventive prophy.

D4346 details

• Procedure code:
  • D4346
• Category:
  • D4000-D4999 Periodontics
• Nomenclature:
  • "Scaling in presence of generalized moderate or severe gingival inflammation - full mouth, after oral evaluation."
• Descriptor:
  • "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 planing, or debridement procedures."
• Effective date:
  • This new code went into effect on January 1, 2017. It may be used for procedures performed after that date, although it usually takes a while for insurance companies to integrate new procedure codes into their processing systems and customer contracts.
• Generalized moderate to severe gingival inflammation:
  • The ADA suggests that "generalized" it would apply when 30% or more of the patient's teeth at one or more sites are involved, which is analogous to the AAP definition of generalized chronic periodontitis.
  • Loe & Silness Gingival Index can be a guideline for defining "moderate to severe inflammation".
    • Moderate inflammation - redness, edema, glazing; bleeding on probing.
    • Severe inflammation - marked redness and edema, ulceration; tendency toward spontaneous bleeding.
• This is a therapeutic procedure, to treat a diagnosed disease.
  • There has been some disagreement on this subtle point. Some argue that "...generalized moderate or severe gingival inflammation" is a clinical finding, but not a disease, therefore this code does not belong in the D4xxx Periodontics category. Others argue that the very definition of gingivitis is gingival inflammation, so of course this code describes actual disease treatment..
• It is based on clinical conditions found during exam, not on complexity of treatment required.
• It is appropriate for patients who do not have periodontitis, i.e. attachment loss.
• It is performed after a periodic or comprehensive exam.
• It can be performed on same date of service as the exam.
• It is a full mouth procedure, not a per quadrant procedure.
  • There has been discussion about how this seems inappropriate. This might be readdressed in future CMC meetings.
• It can be used for any age patient, and in any dentition stage.
• "...in conjunction with..." means on the same date of service. Prophylaxis, scaling and root planing, or debridement procedures may be performed at a future date, after D4346, as long as the codes thereafter are used appropriately.
• D4910 Periodontal Maintenance is not appropriate after a D4346 Scaling.
• There are no stated limitations on how frequently or how often this procedure can be used.
  • Insurance companies, however, will usually set their own benefit limitations.
• Consider this procedure code when the patient's periodontium is not healthy, and the periodontal disease diagnosis is limited to soft tissue (gingivitis) and is generalized, but has not progressed to the advanced disease stage with bone loss (periodontitis).

Submitting D4346 on insurance claims

• The claim should contain documentation that clearly shows necessity for the procedure (vs. D1110 prophy).
• Include a current full mouth perio chart as an attachment with the claim.
• Since D4346 is a treatment based on a diagnosis, the claim should include the periodontal diagnosis in a narrative or on the accompanying perio charting.
• Include information about bleeding on probing. This can be accomplished via obvious graphics on the perio chart, or in a separate concise narrative.
• Other pertinent clinical findings to document might include date of last prophy; plaque deposits; calculus deposits; description of gingiva appearance, contour, consistency; bleeding tendency; pain; malodor.
• Also include etiologic factors identified that are contributing to the generalized gingivitis diagnosis such as overhangs, orthodontic apparatus, open contacts, improper pontic designs, overcontoured restorations, crowded teeth, rotations, tipping, food impactions, mouth breathing, smoking, pregnancy, hormonal disturbances, oral hormonal therapy, handicaps, disabilities, medical conditions.
• Although diagnostic images are not required to be submitted with D4346, they can be beneficial.
  • Photographs can provide good documentation of clinical findings. They can show localized vs. generalized inflammation.
  • Radiographs can document the lack of bone loss, and support a diagnosis of gingival disease (vs. periodontitis), although a gingivitis diagnosis is made primarily from non-radiographic clinical findings.

Insurance coverage of D4346

• It appears that most insurance companies are linking reimbursement level to contracted prophy code, such as D4346 = 1.2 x D1110 fee. This will likely be reexamined as they accumulate more data, and as they hear feedback from customers and dental providers.
  • A disturbing early observation is that most reimbursements are being set unreasonably low. For example, Delta in Washington State sent a notice to their providers stating they will reimburse D4346 at the same fee as a prophy. A D4346 will obviously require more time than a regular prophy. Having the fees the same demonstrates how far insurance companies have strayed from the realities of treating dental patients.
  • If providers want D4346 reimbursement to be at a higher, more reasonable level that reflects the increased complexity compared to a regular prophy, then the dental insurance companies must hear the complaints. Write letters to those who are in insurance company positions to effect policy change. Encourage colleagues to do the same. Encourage patients to complain to their employer who is responsible for selecting their plan every year so that they can complain to the insurance company (this one is the most effective -- remember, the insurance company's customer is the employer, not the dentists!).
• Ultimately, it is the patient's benefit plan contract (the details of which were selected and purchased by their employer) that determines benefits. Since this is a new code, there is likely to be significant variation in benefits among different insurance payors, and different employee plans. It will take time for the insurance companies to accumulate actuarial data applicable to this code, and then fine tune their coverage, limitations, or exclusions.
• For now, a predetermination is the safest way to determine estimated benefits.
• Examples of 4346 processing policies:
  • Delta Dental of Kansas
  • Delta Dental of Wisconsin

Implementing the new code

• It is important for ALL dental office personnel to be familiar with CDT coding. It should be the clinical staff that determines the code to be billed, not the front office staff. In particular, it should be the dentist who makes the determination. This is because dental offices should be using the code that most accurately describes the procedure actually performed (as documented in patient record)...NOT the code that is most likely to be paid by insurance.
  • Every office needs to have a copy of the ADA's CDT manual. There is useful information about many of the codes that is not contained in practice management software.
  • Legally, the treating dentist is ultimately responsible for information submitted on an insurance claim. If proper codes are not used, it can have serious consequences for the treating dentist. This is true even if the dentist is an associate, and their employer/boss/owner is telling them to do something questionable.
  • Submitting insurance claims with procedure codes that aren't the most accurate codes describing the procedures actually done (and documented in patient chart) is getting into the dangerous area of insurance fraud. Don't go there.
• Have a staff meeting, and discuss the intricacies with this new code so everyone understands it.
  • Decide how clinical staff needs to modify the patient record keeping protocol to document necessity for this procedure for each patient who needs it.
  • Decide how the office needs to modify your insurance claims submission protocol so that D4346 claims include adequate supporting documentation (periodontal charting, narratives, diagnosis).
  • Decide how everyone will explain to a patient why they need this service rather than a regular prophy.
• Follow up on claims submitted with the new D4346. If there are denials, determine whether it is due to plan limitations (nothing dental office can do to change this) or due to missing information or inadequate documentation sent with the claim (resubmit claims with new information, then change future claims submission protocol).

Important periodontal concepts that everyone should know

There is a significant lack of understanding of some key clinical periodontal concepts by dentists, hygienists, insurance companies, dental consultants, and dental advisors. But it is critical to be familiar with these concepts in order to properly utilize the periodontal codes, especially the new D4346 code. If you read through these concepts and find any of them unfamiliar, then try to increase your knowledge until they become second nature. Only then will you be able to understand a proper periodontal disease diagnosis, and the corresponding treatment (and code).

1. Deepening pocket depths have multiple causes:

• A pocket depth is a measurement from the gingival margin to the base of the pocket.
• A pocket can deepen by:
  1. Migration of gingival margin in a coronal direction; or
  2. Migration of the gingival attachment in an apical direction.

2. There is a significant difference between Pseudopocket...

• Pocket develops because of gingival enlargement.
  • Causes of gingival enlargement can be plaque-induced inflammation, gingival hyperplasia, edema, drug-induced, or hormones (pregnancy gingivitis).
• No loss of supporting periodontal tissues.
• No loss of connective tissue attachment.
• No apical migration of junctional epithelium.
  • Gingival margin migrates coronally.
• Base of pocket is coronal to alveolar bone crest (suprabony; supracrestal; supraalveolar).

... and True Periodontal Pocket:

• Pocket develops because of migration of connective tissue attachment along the root.
• Actual loss of supporting periodontal tissues.
• Actual loss of connective tissue attachment.
• Apical migration of junctional epithelium.
• Base of pocket can be coronal to alveolar bone crest (horizontal bone loss), or apical to alveolar bone crest (infrabony; subcrestal; intraalveolar; angular bone loss).

3. Loss of Attachment features:

• Loss of attachment is damage to the structures that support the tooth.
• Most commonly caused by periodontitis.
• Junctional epithelium relocates to the tooth root.
• Gingival fibers and periodontal ligament fibers are destroyed.
• Results in loss of alveolar bone support from around the tooth.

4. Clinical Attachment Level (CAL):

• CAL does not stand for "calibrated attachment level" or "clinical attachment loss".
• The greater the loss of clinical attachment, the larger the CAL measurement.
• Loss of clinical attachment level is associated with true periodontal pockets, but not necessarily with pseudopockets.
• There are three possible scenarios, and calculating CAL is different for each.
  1. Gingival margin is right at CEJ:
     • CAL = pocket depth
  2. Tooth has recession, and gingival margin is below/apical to the CEJ:
     • CAL = (pocket depth) PLUS (gingival margin level from CEJ)
  3. Gingival margin is above/coronal to CEJ:
     • CAL = (pocket depth) MINUS (gingival margin level)
• CAL is frequently measured and charted incorrectly. For dental practice management software to automatically calculate CAL correctly, then dental personnel must properly enter pocket depths AND gingival margin level, including using + and - correctly.
• There is a great illustration of CAL calculation here (PDF file).

5. AAP has definitions we should understand:

• Pseudopocket: A deepening of the gingival crevice resulting primarily from an increase in bulk of the gingiva without apical migration of the junctional epithelium or appreciable destruction of the underlying tissue.
• Periodontal Pocket: A pathologic fissure between a tooth and the crevicular epithelium, and limited at its apex by the junctional epithelium. It is an abnormal apical extension of the gingival crevice caused by migration of the junctional epithelium along the root as the periodontal ligament is detached by a disease process.
• Suprabony Pocket: A periodontal pocket with a base coronal to the alveolar bone.
• Infrabony Pocket: A periodontal pocket that extends into an intrabony periodontal defect.

6. Periodontal disease isn't a diagnosis:

• "Periodontal disease" is NOT a diagnosis in itself. It is a classification. There are many diseases and conditions that fall under the classification of periodontal disease.
  • Periodontitis is just one of the numerous periodontal diseases.
  • Gingivitis is another one of the numerous periodontal diseases.
• Perio Case Type is NOT a diagnosis. It is a classification that was created many years ago by insurance companies, not by dentists. It is not the classification system recommended by the AAP. If it is used on insurance claims, an actual periodontal disease diagnosis should still be documented in the patient record, and on the claim.
• See "Classification System for Periodontal Diseases and Conditions" for further understanding.

7. Calculus location is meaningful:

• Many people assume that subgingival calculus means scaling and root planing is in order. This is not always true.
• Subgingival calculus can still be limited to the anatomic crown, i.e. the enamel portion of the tooth, particularly when there has been no loss of attachment.
• When calculus is on the anatomic crown of the tooth, it is removed by scaling, regardless of whether it is supragingival or subgingival, and regardless of whether it is sparse or heavy.
• Only when the calculus is on the actual root, i.e. cementum or dentin, is it removed via root planing.
• No attachment loss = no roots exposed = no calculus on the roots = no root planing possible.
• Calculus on the root = attachment loss has occurred = root planing is performed to remove the calculus.

8. Generalized moderate to severe gingival inflammation:

• The D4346 descriptor contains this wording.
• The ADA suggests that it would apply when 30% or more of the patient's teeth at one or more sites are involved, which is analogous to the AAP definition of generalized chronic periodontitis.

It is important to understand what Scaling and Root Planing is...and isn't

• D4341 or D4342 is for scaling AND ROOT PLANING. The key here is "root". For root planing, by definition you need roots available to instruments. A healthy mouth has roots covered by periodontal attachment apparatus. For roots to be present to plane, they must be exposed in the sulcus, i.e. there must have been some loss of the clinical attachment.
• If no roots exposed via loss of attachment = no roots to plane = root planing is not being done = D4341/D4342 is not being done and isn't appropriate code to use.
• A pocket depth over 3mm does not necessarily equate to loss of clinical attachment level. Pockets can be deeper in gingivitis cases (pseudopockets) but no loss of clinical attachment, therefore no roots to plane.
• Bleeding does not necessarily equate to loss of clinical attachment level. Bleeding can be present in gingivitis cases but no loss of clinical attachment and therefore no roots to plane.
• Subgingival calculus does not necessarily equate to SRP need. There can be subgingival calculus but it can still be on the enamel. That is not root; that does not require root planing. Subgingival calculus on the root, however, does require root planing.
• The AAP website has a page on "Non-surgical periodontal treatment". In their SRP description it includes "...to smooth the tooth root". In other words, if no root is present, SRP is not being done. No root = no SRP.

History of the D4346 code

• In 2014, three individuals submitted separate CDT Code Action Requests to the ADA's Code Maintenance Committee for consideration at the next annual meeting in 2015. At the meeting, there was significant disagreement among CDC members during the discussion of these new code proposals. The Committee decided to table the vote and create an Ad-hoc Working Group to study the issues and present their conclusions in one year, at the 2016 CMC meeting.
• The Ad-hoc Working Group held many meetings and had productive discussions. They agreed that there was a coding gap, and created a recommendation.
• At the 2016 meeting, the Ad-Hoc Working Group presented their findings, and recommended creation of a new code to describe a procedure that was already widely being performed. The committee voted to add the new 4346 procedure code to the CDT, effective January 1, 2017.
• Numerous concerns about the new code have been expressed.
  • It will be misunderstood if the basic underlying periodontal concepts are not well understood by dentists, hygienists, office staff, insurance companies, dental consultants and advisors.
  • It will be confused with the old "difficult prophy" procedure code which has been deleted.
  • It will create increased payout liabilities for insurance companies.
  • It will be misused or abused on dental insurance claims.
• However, all of these concerns were overridden by the CMC because they understood that there was indeed a gap in the code, and a new code was needed in order to fulfill the "Code for what you do" principle.
• The ADA gathered input from various experts and interested parties, and produced educational materials to help everyone understand and properly use the new code (see Further Reference section below).

Code comparisons (as of CDT 2017)

• D1110 Prophylaxis - adult
  • Descriptor: "Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors."
  • This code is primarily a preventive procedure.
  • The ADA states that it is also applicable for patients with localized gingivitis to prevent further progression of disease.
• D4341 and D4342 Periodontal Scaling and Root Planing
  • Descriptor: "This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designed for the removal of cementum and dentin that is rough, and/or permeated by calculus or contaminated with toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used as a definitive treatment in some stages of periodontal disease and/or as a part of pre-surgical procedures in others."
  • This is a therapeutic procedure, to treat a diagnosed disease; specifically those periodontal diseases that have resulted in attachment loss, such as periodontitis.
  • It involves instrumentation of exposed root surface.
  • It is performed after a periodic or comprehensive exam.
• D4346 Scaling in presence of generalized moderate or severe gingival inflammation - full mouth, after oral evaluation
  • Descriptor: "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 planing, or debridement procedures."
  • This is a therapeutic procedure, to treat a diagnosed disease.
  • It is based on a diagnosis rather than intensity of treatment required.
  • Appropriate for patients who do not have periodontitis, i.e. attachment loss.
  • It is performed after a periodic or comprehensive exam.
  • "...in conjunction with..." means on the same date of service. Prophylaxis, scaling and root planing, or debridement procedures may be performed at a future date, after D4346, as long as the codes thereafter are used appropriately.
  • Code went into effect on January 1, 2017.
• D4355 Full Mouth Debridement to Enable Comprehensive Evaluation and Diagnosis
  • Descriptor: "The gross removal of plaque and calculus that interfere with the ability of the dentist to perform a comprehensive oral evaluation. This preliminary procedure does not preclude the need for additional procedures."
  • Appropriate when periodontal probing and charting may be difficult or impossible due to gross plaque and calculus.
  • Exam occurs after debridement, since by definition it is not possible to do the exam before the debridement.
• D4910 Periodontal Maintenance
  • Descriptor: "This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered."
  • It is performed after active periodontal therapy, such as scaling and root planing, gingival flap surgery, or osseous surgery.
  • It is not appropriate to use D4910 after a D4346. D4346 involves gingival tissues, not periodontal tissues. When a D4346 is performed, periodontal therapy has not been performed, so D4910 is not appropriate following a D4346.

Difficult prophy

• In years past, there was an actual "difficult prophy" code (CDT 4345). It was deleted quite a few years ago, but many people still remember the code, and use the "difficult prophy" phrase in discussions. This is adding confusion to discussions of the necessity and proper use of the new D4346 code.
• The difficult prophy code was not based on a diagnosis of disease. The new D4346 is based on a diagnosis of disease.
• The difficult prophy code was described as prophylactic, not therapeutic, in nature. The new D4346 is therapeutic, not prophylactic.

Implants

• There is a separate code, D6081, for "scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surfaces, without flap."
• This code can be appropriate to use at the same time as a D4346 if clinical findings warrant it.
• The descriptor for this code states that it is not performed in conjunction with D1110 prophy or D4910 perio maintenance.

ADA's Code Maintenance Committee

Who makes the CDT Codes? The committee has input from numerous stakeholders. As of 2017, the 21-member CMCconsists of:

• Five representatives from the American Dental Association, one of whom will serve as chair.
• One representative from each of the nine recognized dental specialty organizations.
  • American Academy of Oral and Maxillofacial Pathology
  • American Academy of Oral and Maxillofacial Radiology
  • American Academy of Pediatric Dentistry
  • American Academy of Periodontology
  • American Association of Endodontists
  • American Association of Oral and Maxillofacial Surgeons
  • American Association of Orthodontists
  • American Association of Public Health Dentistry
  • American College of Prosthodontics
• One representative from the Academy of General Dentistry
• One representative from each of the following third-party payer organizations
  • America's Health Insurance
  • Plans Blue Cross and Blue Shield Association
  • Centers for Medicare and Medicaid Services
  • Delta Dental Plans Association
  • National Association of Dental Plans
• One representative from the American Dental Education Association

Anyone can request a CDT code addition, revision, or deletion. Every year, requests are submitted from dentists, hygienists, educators, and organizations. If you are interested in suggesting changes to the CDT Code, go to the ADA's "Request a Change to the Code" page for instructions. Every submission is reviewed, and the ADA encourages involvement from all areas of dentistry. Personally, I think it is important for practicing dentists to be a part of this process.

Further reference

• ADA free publication "Guide to Reporting D4346" (pdf) 
  • Contains excellent usage information for dentists, hygienists, and staff.
  • Updated versions will be posted by ADA at www.ada.org/en/publications/cdt/coding-guidance.
• ADA webinar "The D4346 Scaling Procedure" (see list under Webinars section).
  • Approximately 1 hour in length.
• ADA "CDT 2017" book. Every office should have a copy of the Dental Procedure Codes book.
  • Updated and published annually.
• Charles Blair "Coding With Confidence" book.
  • Great reference; sample available; considered the bible of dental coding.
  • Updated and published annually.
• 1-hour on-demand CE (free, by Acteon Learning) "A New Periodontal Code Is Here! Now What?"
• DrBicuspid.com "The new gingival inflammation code: Part 1, Opportunity or Chaos?" by Patti DiGangi RDH 
• Classification System for Periodontal Diseases and Conditions
• List of possible inclusions when performing a Periodontal Assessment and Treatment Plan.
• ADA News article, March 15 2016, "Code Maintenance Committee approves new scaling code".
• American Academy of Periodontology (AAP) "Glossary of Periodontal Terms" (pdf) 
• American Academy of Periodontology (AAP) "Parameters of Care" (pdf) 
• General tips for better dental insurance claims success: Tips For Successful Dental Insurance Claim Submission.

Last Updated: 10 January 2020

 

Published: 04 July 2018

Written by Jacob Hodara