When is D4346 used?
The D4346 dental code applies to "scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation." This procedure code is suitable for patients who have widespread gingival inflammation without periodontitis (no bone or attachment loss present). D4346 serves as an intermediate treatment between standard prophylaxis (D1110) and comprehensive periodontal scaling and root planing (D4341 or D4342). Apply D4346 when inflammation exists across the entire mouth, involving at least 30% of teeth, and the patient's condition exceeds what routine cleaning can address but doesn't require complete periodontal treatment.
D4346 Charting and Clinical Use
Accurate documentation remains essential for successful D4346 reimbursement. Dental professionals should document:
Widespread moderate or severe gingival inflammation (redness, swelling, bleeding upon probing)
Absence of attachment or bone loss (verified through radiographs and periodontal measurements)
Full-mouth presentation (minimum 30% of teeth affected)
Comprehensive clinical notes, including probe measurements, bleeding locations, and intraoral photographs when available
Typical clinical situations include patients with widespread gingivitis caused by inadequate oral hygiene, hormonal fluctuations, or systemic health issues, where inflammation is extensive but periodontitis has not developed. Always confirm that an oral evaluation (such as D0120 or D0150) is performed before executing D4346.
Billing and Insurance Considerations
Insurance companies may closely examine D4346 claims, since this is a newer code (added in 2017) and frequently misinterpreted. To enhance claim approval rates:
Include comprehensive clinical documentation and radiographs with your initial submission
Provide a written explanation describing the inflammation severity and lack of periodontitis
Confirm patient coverage and benefits for D4346 prior to treatment
Stay ready to quickly address requests for supplemental information or claim reviews
Track EOBs (Explanation of Benefits) and AR (Accounts Receivable) for rejections or reduced payments
Create a system where clinical and administrative staff work together to ensure all necessary documentation is collected and submitted. This approach minimizes processing delays and improves reimbursement success rates.
How dental practices use D4346
Case: A 35-year-old patient arrives for their routine appointment. The dental hygienist observes widespread moderate gingival inflammation (redness, swelling, and bleeding during probing) affecting over 30% of the teeth. Periodontal measurements reveal no pockets exceeding 3mm, and X-rays show no bone loss. The patient's oral evaluation (D0120) was performed during the same appointment. The clinician records all observations, captures intraoral photographs, and files a claim including detailed notes and supporting images. The insurance company initially asks for additional details, but the practice quickly provides complete documentation, resulting in D4346 claim approval.
This case demonstrates the value of detailed record-keeping, effective payer communication, and timely follow-up to secure appropriate D4346 reimbursement.
Common Questions
Can the D4346 procedure be performed on children and pediatric patients?
Yes, D4346 can be performed on pediatric patients when they meet the necessary clinical criteria: generalized moderate or severe gingival inflammation without evidence of periodontitis. Age is not a restricting factor for this procedure code, however comprehensive documentation and clinical justification are crucial for successful insurance reimbursement.
Is anesthesia necessary when performing the D4346 procedure?
Anesthesia is not typically required for D4346 procedures, since this treatment involves scaling in areas with inflammation but without deep periodontal pockets. However, if a patient experiences considerable discomfort during treatment, topical or local anesthesia may be administered based on the provider's clinical judgment.
What is the billing frequency for D4346 on the same patient?
D4346 is classified as a therapeutic procedure rather than a preventive one and should not be used routinely at every recall appointment. The billing frequency for D4346 is determined by the patient's clinical condition and specific insurance policy restrictions. Most insurance carriers require documented medical necessity for each procedure and may limit coverage to once annually or less frequently, so verification with the specific insurance payer is always recommended.