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When you need to expose more tooth structure for a restoration or cosmetic improvement, dental code D4249 comes into play. This code covers a specific type of surgical crown lengthening performed by your office or a referred specialist. This article explains when D4249 applies, what documentation you need, and how to bill it correctly.
Nov 1, 2025
What is Dental Code D4249?
D4249 describes clinical crown lengthening, a surgical periodontal procedure performed to expose more tooth structure. The procedure involves removing soft tissue, bone, or both to increase the visible crown height of a tooth. You use this code when crown lengthening is necessary for restorative purposes, such as placing a crown on a tooth with subgingival decay, or for aesthetic improvements when a patient wants to reduce a "gummy" smile.
D4249 applies to procedures involving four or more contiguous teeth or bounded teeth spaces per quadrant. For isolated teeth, you would use D4249's companion codes instead.
Common Terminology
Understanding the language around crown lengthening helps you document and communicate more effectively with specialists and insurance carriers.
Clinical crown lengthening: Surgical procedure to expose more tooth structure above the gumline
Biological width: The natural space between the bone crest and the base of the sulcus, typically 2-3mm
Osseous recontouring: Reshaping of the bone during crown lengthening to establish proper biological width
Gingivectomy: Removal of gum tissue, which may be part of crown lengthening but is coded separately when performed alone
When is D4249 Used?
Clinical crown lengthening becomes necessary when insufficient tooth structure is exposed above the gumline for proper restoration or when aesthetic improvements are needed. The procedure creates adequate space for restorations while maintaining healthy biological width.
Your documentation should clearly indicate whether the procedure serves restorative or aesthetic purposes, as this affects insurance coverage.
Common Clinical Scenarios
You'll encounter several situations where D4249 is the appropriate code for the periodontal surgery you're performing.
Subgingival decay: When decay extends below the gumline and you need more tooth structure exposed to place a proper restoration
Crown margin placement: When preparing a tooth for a crown but the natural tooth structure doesn't provide enough height for adequate retention and resistance form
Fractured teeth: When a fracture line extends below the gingival margin and you need to expose sound tooth structure
Short clinical crowns: When teeth appear too short for proper restoration due to excessive gingival display or passive eruption issues
Aesthetic smile design: When patients request gummy smile correction and multiple teeth need exposure for a balanced appearance
When D4249 is NOT Appropriate
Knowing when to use a different code prevents claim denials and ensures accurate billing for the actual procedure performed.
Single tooth procedures: Use D4240 (1-3 teeth) instead for isolated crown lengthening
Gingivectomy alone: If you're only removing soft tissue without bone removal, code as D4210 or D4211
Functional crown lengthening: When performed solely to increase retention, some insurers may deny coverage
Aesthetic procedures without restorative need: Many plans exclude coverage for cosmetic-only crown lengthening
Teeth with inadequate bone support: Crown lengthening on teeth with advanced bone loss may not be advisable
Billing and Insurance Considerations
Proper documentation separates approved claims from denied ones for D4249. Insurance companies want clear evidence that the procedure serves a restorative purpose rather than purely cosmetic goals.
Your notes should explain the clinical necessity, include measurements, and document the treatment plan.
Documentation Requirements
Your clinical records must support the medical necessity of crown lengthening. Complete documentation protects you during audits and helps secure insurance approval.
Pre-operative photographs: Clinical photos showing inadequate tooth structure or excessive gingival display
Probing depths and measurements: Record gingival margin positions and the amount of tooth structure below the gumline
Treatment rationale: Detailed notes explaining why crown lengthening is necessary for the planned restoration
Periodontal charting: Current periodontal status showing bone levels and attachment
Radiographic documentation: Periapical or bitewing radiographs showing bone levels, decay extent, or fracture lines relative to the gingival margin
Insurance Coverage
Coverage for D4249 varies significantly between plans and depends heavily on whether the procedure is deemed restorative or cosmetic. Most dental insurance plans provide some coverage when crown lengthening is performed for functional restoration, but you should verify benefits before scheduling.
Medical necessity requirement: Most plans cover D4249 only when performed to facilitate a necessary restoration, not for aesthetics alone
Pre-authorization recommended: Submit clinical photos, radiographs, and detailed narratives before treatment to avoid surprises
Typical coverage range: Plans that cover periodontal surgery usually reimburse 50-80% after deductible
Frequency limitations: Some carriers limit crown lengthening to once per tooth per lifetime or every 5-10 years
Coordination with restorative codes: Document the planned restoration (crown, veneer, or filling) and submit both procedures together when possible
Common Billing Mistakes
Errors in coding D4249 can delay payment or trigger denials. Watch for these frequent issues when submitting claims.
Wrong tooth count: Using D4249 for 1-3 teeth instead of D4240, or vice versa
Missing narrative: Submitting without clinical notes explaining why crown lengthening is medically necessary
Inadequate documentation: Failing to include radiographs or photos showing the clinical situation
Billing before healing: Submitting the crown lengthening and final restoration on the same date when the restoration hasn't been completed
Incorrect quadrant coding: Billing multiple quadrants when teeth span across quadrants without proper documentation
Common Questions About D4249
How often can D4249 be billed?
You can bill D4249 once per tooth or area treated. Most insurance plans don't impose specific time limitations between procedures on different teeth, but many restrict how often crown lengthening can be performed on the same tooth. Typical restrictions include once per lifetime or once every 5-10 years per tooth. Always check the patient's specific plan, as frequency limitations vary widely between carriers.
Does insurance cover crown lengthening for cosmetic purposes?
Most dental insurance plans exclude coverage for purely cosmetic procedures, including aesthetic crown lengthening for gummy smile correction. However, if you document a restorative need in addition to the aesthetic concern, coverage may apply. For example, if crown lengthening improves aesthetics while also exposing tooth structure for proper crown margins, you have a stronger case for coverage. Submit a detailed narrative explaining both the functional and aesthetic components.
Can I bill D4249 and a crown preparation on the same day?
You should not typically bill crown preparation (D2740-D2799) on the same day as D4249. Crown lengthening requires healing time before you can accurately prepare the tooth and take final impressions. Most cases need 6-12 weeks of healing to establish stable gingival margins. Billing both codes on the same date signals to insurance that proper healing didn't occur and often triggers a denial of one or both procedures.
What's the difference between D4249 and D4240?
The primary difference is the number of teeth involved. D4240 covers crown lengthening on 1-3 contiguous teeth or bounded tooth spaces per quadrant. D4249 applies when you're treating four or more contiguous teeth or bounded spaces per quadrant. Choose your code based on the actual number of teeth requiring treatment. Don't split a procedure into multiple D4240 codes when D4249 is more appropriate.
Do I need to wait a specific time before placing the final restoration?
Yes, proper healing time is critical for successful outcomes. Gingival tissues typically take 6-8 weeks to heal and stabilize, while complete bone remodeling may take 3-6 months. Waiting allows margins to mature so you can take accurate impressions and place restorations at the correct level. Document the planned waiting period in your treatment notes. Rushing to restoration before adequate healing increases the risk of margin discrepancies and aesthetic problems.
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