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Periodontal disease requires targeted treatment to prevent tooth loss and protect overall oral health. Understanding when and how to apply specific procedure codes helps dental practices document care accurately and bill correctly. This guide breaks down D4342, a code designed for limited periodontal scaling and root planing procedures.
Nov 1, 2025
What is Dental Code D4342?
D4342 describes periodontal scaling and root planing performed on one to three teeth per quadrant. This non-surgical procedure removes calculus, plaque, and bacterial toxins from tooth surfaces below the gumline and smooths root surfaces to promote healing and reattachment of gum tissue.
Unlike full-quadrant scaling and root planing (D4341), D4342 applies when only a few teeth in a quadrant exhibit periodontal disease. The procedure targets isolated areas of attachment loss, pocket depth, and bone loss rather than treating an entire quadrant. This focused approach addresses specific sites while avoiding unnecessary treatment of healthy teeth.
Common Terminology
The terminology surrounding D4342 helps differentiate it from similar procedures and clarifies its clinical scope.
Quadrant: One of four sections of the mouth, divided into upper right, upper left, lower right, and lower left.
Scaling and root planing: Deep cleaning that removes deposits below the gumline and smooths root surfaces to reduce inflammation and encourage tissue healing.
Periodontal pocket: Space between the tooth and gum tissue that deepens due to bone and attachment loss caused by periodontal disease.
Calculus: Hardened plaque deposits that bond to tooth surfaces and require professional removal.
Clinical attachment loss: Measurement of periodontal tissue damage, indicating the distance from the cemento-enamel junction to the base of the pocket.
When is D4342 Used?
D4342 applies when periodontal disease affects a small number of teeth within a quadrant, requiring targeted treatment rather than full-quadrant intervention. This code supports efficient care delivery by addressing only the teeth that need deep cleaning.
Common Clinical Scenarios
The following situations demonstrate appropriate use of D4342 in clinical practice.
Localized moderate periodontitis: A patient presents with 5-6mm pockets and clinical attachment loss on two molars in one quadrant while other teeth in that quadrant remain healthy.
Isolated furcation involvement: One or two multi-rooted teeth show furcation defects requiring root planing while adjacent teeth have minimal disease.
Recurrent periodontal disease: A patient with previous periodontal treatment develops new or recurring disease on one to three teeth in a quadrant.
Site-specific bone loss: Radiographs reveal vertical or horizontal bone loss affecting only a few teeth in one quadrant.
Maintenance breakdown: During a periodontal maintenance visit, clinical findings indicate that one to three teeth require additional scaling and root planing due to increased pocket depths or bleeding on probing.
When D4342 is NOT Appropriate
Understanding when D4342 does not apply prevents incorrect coding and ensures proper documentation of care.
Four or more teeth per quadrant require treatment: When disease affects four or more teeth in a quadrant, D4341 becomes the appropriate code regardless of tooth distribution.
Routine prophylaxis: Supragingival cleaning without evidence of periodontal disease, bone loss, or attachment loss requires D1110 (adult prophylaxis) instead.
Periodontal maintenance: Patients in maintenance following active periodontal therapy should be coded with D4910 unless active disease requires additional scaling and root planing.
Localized gross debridement: When heavy deposits prevent comprehensive examination, D4355 applies before any periodontal diagnosis or treatment planning.
Billing and Insurance Considerations
Proper documentation and coding practices protect both the practice and the patient when billing D4342. Insurance carriers scrutinize periodontal codes closely, making accurate records and appropriate code selection critical.
Documentation Requirements
Complete clinical documentation supports D4342 claims and demonstrates medical necessity to insurance carriers.
Comprehensive periodontal charting: Full-mouth probing depths, recession measurements, bleeding indices, and clinical attachment levels establish baseline disease status and identify teeth requiring treatment.
Detailed narrative: Clinical notes should specify which teeth received scaling and root planing, document pocket depths, note bleeding or suppuration, and describe any furcation involvement.
Radiographic documentation: Current periapical or bitewing radiographs showing bone levels, calculus presence, and bone loss patterns support medical necessity.
Treatment justification: Notes explaining why limited scaling and root planing was chosen over full-quadrant treatment clarify clinical decision-making.
Patient consent: Documentation of treatment discussion, risks, benefits, and patient agreement protects both parties.
Insurance Coverage
Coverage for D4342 varies significantly across insurance plans, requiring verification before treatment begins.
Frequency limitations: Most plans restrict periodontal scaling and root planing to once per quadrant within a 24-month period, though some allow retreatment after 12 months.
Medical necessity: Carriers require documented pocket depths typically exceeding 4mm with radiographic bone loss and bleeding on probing to approve coverage.
Age restrictions: Some plans limit coverage to adult patients or impose different reimbursement rates based on patient age.
Waiting periods: New enrollees may face waiting periods ranging from 6 to 12 months before periodontal benefits become available.
Annual maximum impact: D4342 counts toward annual maximum benefits and may consume a significant portion of available coverage depending on the number of quadrants treated.
Common Billing Mistakes
Avoiding these frequent errors reduces claim denials and maintains compliance with coding standards.
Upcoding from prophylaxis: Billing D4342 when clinical findings do not support periodontal disease diagnosis constitutes fraud and can trigger audits.
Incorrect tooth count: Including teeth that received only supragingival cleaning or failing to count all treated teeth accurately can result in underbilling or overbilling.
Same-day prophylaxis: Submitting both D1110 and D4342 on the same date of service raises red flags with carriers unless clear documentation separates healthy teeth receiving prophylaxis from diseased teeth receiving scaling and root planing.
Incomplete periodontal charting: Submitting claims without full-mouth probing and radiographic documentation invites denial.
Using D4342 for maintenance: Billing D4342 during periodontal maintenance appointments without documenting active disease progression or breakdown misrepresents the procedure performed.
Failing to specify treated teeth: Not identifying which teeth received treatment in the narrative prevents carriers from verifying appropriate code selection.
Common Questions
How often can D4342 be billed?
Most insurance plans limit periodontal scaling and root planing procedures to once per quadrant every 24 months. Some plans extend this interval to 36 months or restrict it to 12 months depending on the carrier's policies. After the initial treatment period, patients typically transition to periodontal maintenance (D4910) at three-month intervals. If disease recurs or progresses during maintenance, additional scaling and root planing may be justified with thorough documentation showing active disease. Always verify specific limitations with the patient's insurance carrier before treatment.
Can I bill D4342 and D4341 in the same mouth on the same date?
Yes, you can bill both codes when some quadrants require full-quadrant treatment (D4341) while others need limited treatment (D4342). This scenario occurs when periodontal disease severity varies across different areas of the mouth. Documentation must clearly differentiate which quadrants received full scaling and root planing and which received limited treatment. Clinical notes should explain the rationale for treating different quadrants differently based on pocket depths, bone loss, and disease distribution.
What pocket depths justify D4342?
Clinical guidelines generally require probing depths of 5mm or greater with radiographic bone loss to support periodontal scaling and root planing codes. However, pocket depth alone does not determine medical necessity. Carriers also look for bleeding on probing, clinical attachment loss, and evidence of active disease progression. Some insurance companies accept 4mm pockets with other disease indicators such as bleeding, suppuration, or documented bone loss. When documenting treatment, include multiple clinical findings rather than relying solely on pocket depth measurements.
Does D4342 include anesthesia?
D4342 includes local anesthesia when clinically necessary for patient comfort during the procedure. Practices typically do not bill separately for infiltration or block anesthesia during scaling and root planing. However, if extensive anesthesia such as nitrous oxide sedation becomes necessary, some carriers allow separate billing with appropriate documentation. Always check carrier policies regarding anesthesia billing in conjunction with periodontal procedures before submitting claims.
How do I code scaling and root planing for a single tooth?
When only one tooth requires scaling and root planing, D4342 remains the appropriate code since it covers one to three teeth per quadrant. CDT coding does not provide a separate code for single-tooth periodontal scaling and root planing. Documentation should clearly specify which tooth received treatment and why isolated treatment was clinically appropriate rather than treating additional teeth in the quadrant.
Can D4342 be billed during the same appointment as a periodic exam?
Yes, you can perform and bill for both a periodic exam (D0120) and limited scaling and root planing (D4342) during the same visit when clinical findings during the exam reveal localized periodontal disease requiring immediate treatment. However, practices must document the examination findings that led to the treatment decision. Some carriers may question same-day billing if the exam was not scheduled separately from treatment, so clear documentation explaining the clinical workflow protects the claim.
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