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Periodontal care requires different treatment approaches based on the severity of disease and patient presentation. D4346 represents a distinct procedure designed for patients who need intervention beyond routine cleanings but may not yet require full periodontal therapy. Understanding when to use this code helps practices bill accurately and ensures patients receive appropriate care for their gingival condition.
Nov 1, 2025
What is Dental Code D4346?
D4346 refers to scaling in the presence of generalized moderate or severe gingival inflammation. This procedure addresses widespread inflammation affecting the gingival tissues without the presence of periodontal disease characterized by attachment loss or bone loss. The code applies when inflammation extends throughout the mouth rather than being isolated to specific areas.
This procedure goes beyond a prophylaxis because of the extent and severity of inflammation present. It requires more time, clinical skill, and often additional patient education to address the underlying causes of the inflammation.
Common Terminology
Billing and clinical documentation for D4346 often includes specific terms that clarify the patient's condition and justify the procedure.
Generalized gingival inflammation: Inflammation affecting 30% or more of the gingival tissues in the mouth
Gingivitis: Reversible inflammation of the gums without loss of attachment or bone
Scaling: Removal of plaque, calculus, and stains from tooth surfaces above and below the gumline
Bleeding on probing: Clinical indicator where gingival tissues bleed when gently touched with a periodontal probe
Edema: Swelling of gingival tissues due to inflammation
Erythema: Redness of gingival tissues indicating active inflammation
When is D4346 Used?
D4346 applies when patients present with widespread gingival inflammation that requires more intensive treatment than a standard prophylaxis. The inflammation must be generalized, affecting multiple areas of the mouth, and classified as moderate to severe based on clinical presentation.
This code addresses patients who need intervention to control inflammation before it progresses to periodontal disease.
Common Clinical Scenarios
Several patient presentations warrant the use of D4346 based on clinical findings and oral health status.
Patients with generalized bleeding on probing across multiple sextants or quadrants of the mouth
Individuals with significant plaque and calculus accumulation combined with widespread gingival swelling and redness
Patients who have missed regular cleanings and now present with inflammation affecting 30% or more of their gingival tissues
Adolescents or young adults with hormonally influenced gingivitis causing severe inflammation without periodontal disease
Patients with medication-induced gingival enlargement or inflammation requiring careful scaling
Individuals with systemic conditions affecting gingival health, such as uncontrolled diabetes, presenting with generalized inflammation
When D4346 is NOT Appropriate
Understanding when not to use this code prevents billing errors and ensures patients receive the correct level of care.
Patients with localized inflammation affecting less than 30% of gingival tissues should receive D1110 (adult prophylaxis)
Individuals with clinical attachment loss or radiographic bone loss require periodontal therapy codes (D4341 or D4342)
Patients presenting for routine maintenance without significant inflammation should be coded as D1110
Cases where inflammation is accompanied by pocket depths of 4mm or greater with attachment loss fall under periodontal treatment rather than D4346
Patients already in periodontal maintenance (D4910) should not be coded with D4346 even if inflammation is present
Billing and Insurance Considerations
Accurate billing for D4346 requires thorough documentation and understanding of insurance policies. Many carriers have specific requirements for covering this procedure, and practices must provide clinical justification to support the increased level of care compared to a standard prophylaxis.
Clear records protect the practice and help patients understand their treatment needs.
Documentation Requirements
Comprehensive clinical documentation establishes medical necessity and supports the use of D4346 for reimbursement.
Complete periodontal charting showing probing depths, recession, and bleeding indices across all sextants or quadrants
Clinical notes describing the extent and severity of gingival inflammation, including percentage of sites affected
Description of calculus deposits, plaque levels, and oral hygiene status
Documentation of patient education provided regarding inflammation causes and home care improvement
Treatment time records showing the additional time required beyond a standard prophylaxis
Follow-up recommendations and re-evaluation plans to assess inflammation resolution
Insurance Coverage
Insurance policies vary in their coverage of D4346, and practices should verify benefits before treatment.
Many dental plans cover D4346 once or twice annually, similar to prophylaxis frequency
Some carriers require documentation review before approving payment for D4346
Benefits may be subject to deductibles or lower reimbursement rates compared to preventive procedures
Pre-authorization may be required by certain insurance companies, particularly when billing D4346 instead of D1110
Out-of-pocket costs for patients can be higher if the procedure is classified as basic rather than preventive care
Common Billing Mistakes
Several billing errors occur when practices incorrectly apply D4346 or fail to provide adequate documentation.
Using D4346 when a standard prophylaxis (D1110) is appropriate, leading to overbilling concerns
Failing to document the generalized nature and severity of inflammation, resulting in claim denials
Alternating between D1110 and D4346 at each visit without clear clinical justification for the changes
Billing D4346 on the same day as other periodontal procedures without proper documentation of medical necessity
Not obtaining pre-authorization when required by the insurance carrier
Inadequate periodontal charting that doesn't support the presence of widespread moderate or severe inflammation
Common Questions
How often can D4346 be billed?
D4346 typically follows the same frequency limitations as prophylaxis, with most insurance plans covering the procedure once or twice per year. Practices should verify specific plan benefits, as some carriers impose waiting periods between D4346 procedures or between D4346 and other periodontal codes. Billing more frequently requires strong clinical documentation showing persistent or recurrent inflammation despite previous treatment.
Does D4346 require a full periodontal examination?
Yes, proper use of D4346 requires comprehensive periodontal evaluation including probing depths, bleeding indices, and assessment of inflammation extent. The examination must document that inflammation is generalized (affecting 30% or more of sites) and classified as moderate or severe. Without this documentation, insurance carriers may deny the claim or request records to verify medical necessity.
Can D4346 be billed for patients in periodontal maintenance?
No, patients already in periodontal maintenance should be coded with D4910 (periodontal maintenance) regardless of inflammation levels. D4346 is not appropriate for patients with a history of periodontal disease who are receiving ongoing maintenance care. If these patients experience increased inflammation, the treatment remains D4910, possibly with additional periodontal procedures as needed.
What's the difference between D4346 and D1110?
D1110 (adult prophylaxis) is appropriate for patients with healthy gingival tissues or mild, localized inflammation affecting less than 30% of sites. D4346 applies when inflammation is generalized, moderate to severe, and requires more intensive scaling and patient education. The key differentiators are the extent (generalized vs. localized) and severity (moderate to severe vs. mild) of gingival inflammation present.
Does D4346 include fluoride treatment?
No, D4346 covers only the scaling procedure in the presence of inflammation. Fluoride treatments (D1206 or D1208) are separate procedures and can be billed in addition to D4346 when clinically indicated. Practices should bill fluoride separately and document the clinical rationale for its application, especially for adult patients where it may not be a covered benefit.
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