The purpose of scaling—frequently referred to as deep-cleaning—is to remove plaque and tartar from the surface down to the bottom of each tooth gum pocket. Root planing is a part of that process, helping smooth the root and helping the gums reattach to the tooth in hopes of shrinking the pocket depth. This is something that is not easily accomplished by a regular dental cleaning (prophylaxis).
There are two specific codes used for submissions to dental insurance plans:
D4341: Scaling and root planing four or more teeth, per quad
D434: Scaling and root planing one to three teeth, per quad
To determine whether your patient has dental plan coverage and if he or she is eligible for benefits, follow these steps:
- The doctor determines whether treatment is necessary.
- Check the patient's dental plan eligibility and history.
- Ensure the documentation you have is sufficient for claim submission.
- Complete two quadrants per visit.
- Patient requires periodontal maintenance (D4910) 90 days later.
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If your patient fails to meet the criteria, or if you fail to provide supporting information when submitting the claim, you can be sure the dental plan will deny the claim for payment.
When considering submission to the patient’s insurance plan, you need to be sure you submit documentation. This includes periodontal charting (within six months); a clear indication of periodontal classification; and whether any presence of calculus, bleeding on probing, or bone loss is present. A full set of x-rays (preferably a full-mouth series) should be included.
Reasons insurance companies may deny include:
- Pocket depths are not greater than 4 mm
- You fail to provide supporting documentation
- Annual maximum has been absorbed (PPO)
- Exceeded plan limitation period. Most plans usually cover once every 24 months.
Editor's note: Originally posted in 2016; content reviewed and updated in Dec. 2022