When is D4910 used?
The D4910 dental code applies to periodontal maintenance treatments that follow completed active periodontal therapy, including scaling and root planing or periodontal surgical procedures. This code differs from standard cleaning procedures and is specifically intended for patients who have documented periodontal disease history requiring continuous care to preserve gum and bone health. Apply D4910 only after finishing comprehensive periodontal treatment, with patient records clearly showing this treatment history. Using D4910 for patients without prior active periodontal therapy may result in claim rejections and regulatory concerns.
D4910 Charting and Clinical Use
Proper documentation is essential for D4910 billing. Patient records must contain:
Comprehensive periodontal charting (pocket depths, bleeding indicators, gum recession)
Record of completed periodontal treatment (such as scaling and root planing or surgical intervention)
Treatment notes detailing maintenance procedures, including subgingival and supragingival plaque removal, targeted scaling, and tooth polishing
Continuous evaluation of periodontal condition and patient education on oral care
Common clinical applications for D4910 involve patients scheduled for follow-up visits every 3–4 months following initial treatment to track periodontal health and prevent disease progression. When patients achieve healthy periodontal status and no longer require intensive maintenance, evaluate whether a prophylaxis code would be more suitable.
Billing and Insurance Considerations
Insurance companies examine D4910 claims carefully. To enhance claim approval rates and minimize accounts receivable delays, implement these strategies:
Confirm coverage and frequency restrictions: Review patient benefits for periodontal maintenance coverage and permitted treatment intervals prior to appointment scheduling.
Include supporting records: Provide periodontal charts, treatment records, and clinical documentation with claims. Most insurers require evidence of previous therapy.
Follow proper sequence: Confirm D4910 is not submitted before completing active periodontal treatment codes (such as D4341, D4342).
Contest rejected claims: When claims are denied, examine the explanation of benefits, compile additional evidence, and file a comprehensive appeal with patient periodontal background and clinical justification.
Clear patient communication regarding insurance benefits and potential personal expenses is vital for efficient billing and payment collection.
How dental practices use D4910
Take a patient who finished scaling and root planing six months prior. During their maintenance appointment, you conduct a thorough periodontal assessment, eliminate subgingival buildup, and review proper oral hygiene techniques. Patient documentation includes periodontal background, current pocket measurements, and maintenance treatment details. You file a D4910 claim with treatment records and prior therapy dates included. The insurance provider accepts the claim based on demonstrated medical necessity and complete documentation.
Following these procedures and keeping detailed records helps dental practices optimize reimbursement and maintain compliance when using the D4910 dental code.
Common Questions
Is it appropriate to alternate D4910 with routine prophylaxis (D1110) for patients who have periodontal disease history?
No, alternating D4910 with D1110 (prophylaxis) is not recommended for patients with documented periodontal disease history who need ongoing maintenance care. After a patient receives a periodontal disease diagnosis and completes active treatment, all future maintenance appointments should be coded as D4910. Using alternating codes may lead to claim denials and doesn't follow proper clinical protocols or insurance requirements.
How do D4910 and D4346 dental codes differ from each other?
D4910 applies to periodontal maintenance after completing active periodontal treatment, while D4346 is for scaling when there's widespread moderate to severe gingival inflammation without loss of attachment. D4346 suits patients with gingivitis but no periodontitis, whereas D4910 is designated for patients with periodontitis history requiring continuous maintenance care.
What is the typical billing frequency for D4910 with insurance providers?
D4910 can generally be billed every three to four months, based on individual patient risk factors and clinical requirements. Insurance plans may impose their own frequency restrictions, so it's essential to confirm each patient's coverage details prior to scheduling and billing periodontal maintenance appointments.