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When is D4212 used?
The D4212 dental code applies to gingivectomy or gingivoplasty procedures performed to provide access for restorative treatment, charged per individual tooth. This code is appropriate when excessive gingival tissue prevents proper placement or completion of restorations like crowns or fillings. It should not be applied for aesthetic gum contouring or periodontal disease treatment—these situations require alternative CDT codes, including D4240 for bone surgery or D4210 for comprehensive gingivectomy procedures.
Apply D4212 exclusively when gum tissue removal or reshaping is essential to access the treatment area for restorative procedures, and the work is confined to the specific tooth requiring restoration. Correct code usage ensures regulatory compliance and optimizes payment outcomes.
D4212 Charting and Clinical Use
Thorough documentation is essential for effective claims processing. When applying D4212, dental practices should document:
Comprehensive clinical records explaining the necessity of gingival removal for restorative access.
Before and after photographs demonstrating tissue obstruction and post-procedure results.
X-rays or intraoral documentation supporting the access requirement.
Exact tooth identification and the intended restorative treatment (such as crown or composite restoration).
Typical clinical applications include accessing subgingival decay, establishing crown margins, or restoring broken teeth where gum tissue blocks the treatment area.
Billing and Insurance Considerations
Insurance companies carefully evaluate D4212 submissions, making strategic billing approaches crucial:
Prior approval: File pre-treatment requests with supporting materials to confirm coverage and prevent claim rejections.
Claim processing: Include clinical documentation, photographs, and restorative procedure codes with your submission. Clearly demonstrate that gingivectomy/gingivoplasty was required for restorative access.
Benefits review: When claims are denied, examine the explanation for denial reasons and prepare comprehensive appeal documentation with additional supporting materials.
Code coordination: Submit D4212 alongside the relevant restorative procedure code (such as crown or filling) to establish medical necessity.
Maintaining organized records and monitoring outstanding claims ensures prompt payment and reduces processing delays.
How dental practices use D4212
A patient needs crown treatment on tooth #14. During preparation, the dentist observes excessive gingival tissue covering the margin area, which would compromise crown placement. After recording the clinical necessity, the dentist completes a targeted gingivectomy on tooth #14, eliminates the interfering tissue, and finishes the crown preparation. The team documents the procedure with photographs and detailed chart notes. During billing, they process D4212 for the gingivectomy along with the crown procedure code, including all supporting materials. The insurance provider approves both treatments, resulting in complete claim payment.
This case demonstrates the value of complete documentation and accurate coding when incorporating D4212 into dental practice billing systems.
Common Questions
Is it possible to bill D4212 for multiple teeth during one appointment?
Yes, D4212 is billed on a per-tooth basis. When the procedure is performed on several teeth in the same visit, you should report the code for each individual tooth treated, making sure your documentation clearly indicates the medical necessity for treatment at each specific site.
Do most dental insurance plans have waiting periods or frequency restrictions for D4212?
Most dental insurance plans typically establish frequency restrictions or waiting periods for surgical procedures such as D4212. It's essential to check the patient's individual plan coverage prior to treatment to prevent unexpected claim denials or additional patient expenses.
Are dental hygienists authorized to perform D4212 procedures, or is a dentist required?
D4212 procedures generally require the expertise and clinical decision-making of a licensed dentist, since they involve surgical modification of gingival tissues to support restorative procedures. The majority of state dental licensing boards limit this type of procedure to dentists and do not permit dental hygienists to perform it.