Let’s start by reviewing what defines an adult prophylaxis visit
According to the CDT descriptor, an adult prophylaxis consists of removal of plaque, calculus, and stains from tooth structures in the permanent and transitional dentition. It is intended to control local irritation factors.
Now let’s dissect the long description and break it down into what matters
When is it appropriate to bill D1110–Prophylaxis adult?
• If you are a general dentist (GP)
• If your patient has no signs of periodontitis or deep pockets
• If your patient is 14 years of age or older (some plans will consider age 16). Be sure to check age limitations and exclusions with the patient’s insurance carrier.
• If your patient does not require a D4355–full mouth debridement
• If your patient has not undergone any type of periodontal therapy, such as scaling and root planing, osseous surgery, or ongoing periodontal maintenance visits
• If your patient is completely endentulous and has upper and/or lower dentures. (Be sure to include a narrative explaining that your patient has dentures.)
Examinations should always be billed separately.
Now let’s review what defines a periodontal maintenance visit
According to the CDT descriptor, a periodontal maintenance visit 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 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.
Now let’s dissect this longer and even more confusing description and break it down into what matters most
When is it appropriate to bill D4910–periodontal maintenance?
• If the dentist is a periodontal specialist (periodontist)
• If your patient is currently being maintained for a history of periodontal disease
• If your patient has undergone a full mouth debridement and requires therapy to maintain healthy gums in order to slow progression of periodontal disease
• If your patient has undergone periodontal scaling and root planing within the last 24 months
• If your patient has undergone periodontal osseous surgery within the last 24 months
• If your patient has a history of periodontal gingival flap surgery
Be sure to bill periodontal examinations separately.
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