The problem? Many dental teams either do not use this code or, when they do, they face denials due to documentation issues or payor misunderstandings. If you want to get reimbursed for D4346, your documentation needs to be crystal clear, and your team needs to know when and how to bill it correctly.
Whether you are a dentist, billing coordinator, or office manager, understanding the nuances of D4346 can help you provide better care and protect your revenue.
What Is D4346 and When Should It Be Used?
Per the ADA, D4346 is “scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation.”
It is meant for cases where:
- There is generalized (not localized) inflammation. Generalized inflammation is defined as 30% or more of the teeth having bleeding points.
- The patient does not have bone loss
- Periodontal therapy is not indicated
- A full-mouth scaling is necessary to remove plaque, calculus, and irritants
This code typically applies to patients who have gone a long time without a cleaning, are returning after a lapse in care, or present with gingivitis that has progressed beyond the scope of a standard prophylaxis. D4346 is not a “difficult prophy,” or a prophylaxis that takes longer than normal. It is a clinically defined disease process that must meet certain criteria for diagnosis.
Key Differences Between D4346 and Other Codes
One of the biggest challenges with D4346 is distinguishing it from similar codes. Here is a quick breakdown:
- D1110: Prophylaxis is most often used for healthy patients or those with mild or localized gingivitis.
- D4341/D4342: Scaling and root planing for periodontitis (requires radiographic evidence of bone loss in addition to active inflammation).
- D4346: Scaling for generalized gingival inflammation without bone loss (bleeding on 30% or more of teeth is present).
Prophylaxis is preventive and supportive in nature, while D4346 and SRP are therapeutic, meaning they are treating a disease (gingivitis or periodontitis). Payors are often quick to deny D4346 if documentation looks too similar to D1110 or if the clinical notes do not justify the presence of generalized inflammation.
Documentation Tips: What Payors Need to See
To reduce the risk of denials, your clinical documentation should clearly support the medical necessity for D4346. Make sure to include:
- A full periodontal charting
- Bleeding on probing (BOP) scores and inflammation notes
- Pocket depths (generally 4mm or less)
- Clear evidence that there is no bone loss or clinical attachment loss
- Notes on plaque, calculus, and generalized inflammation across multiple quadrants, demonstrating and discussing an active disease process
- Radiographs that show intact bone support
- Intraoral photographs showing red, swollen, inflamed, and bleeding gum tissue
It is not enough to simply state that the patient has gingivitis. Payors want to see clinical proof that the condition meets the criteria for D4346.
Insurance Coverage Challenges
One of the most frustrating aspects of D4346 is that not all payors cover it, even when documented properly. Some carriers still do not recognize the code, while others deny it due to a lack of understanding or system limitations.
To reduce surprises:
- Verify coverage with each patient’s plan before treatment
- Document both medical necessity and informed consent
- Consider submitting a narrative and chart notes with the claim
- Be ready to appeal denials with supporting documentation if needed
When in Doubt, Submit a Pre-Authorization
Because D4346 falls into a gray area for many carriers, it is often helpful to submit a pre-authorization, especially for patients with inconsistent histories or borderline clinical findings. While pre-auths are not a guarantee of payment, they can help clarify coverage and give patients a better understanding of potential out-of-pocket costs.
The Opportunity with D4346
Many offices underutilize D4346 simply out of fear of denial. But when used correctly, this code:
- Improves clinical care by recognizing and treating advanced gingivitis
- Creates a billing path for patients who do not yet qualify for SRP but require a more involved treatment than prophylaxis alone
- Helps prevent the progression to full periodontal disease
- Adds revenue that might otherwise go uncollected
With accurate charting,a well-trained team , and payor-specific knowledge, you can confidently code and bill D4346 – and get paid for it.
Make D4346 Work for Your Practice
D4346 is not a loophole. It is a valid, clinically appropriate procedure when used for the right patients. But it requires a clear clinical picture, proper documentation, and a solid billing strategy.
If your team is unsure when to use D4346, struggling with denials, or tired of guesswork around documentation, you are not alone.
Schedule a free consultation with eAssist to find out how our expert billing team can help your practice reduce denials, strengthen documentation, and get paid faster for the care you provide.
Let us handle the billing, so you can focus on patient care.
Disclaimer: Insurance administration and dental billing recommendations presented here represent the opinions of the author or our staff and are for informational purposes only. You are responsible for your own use of the CDT Codes, insurance administration, and dental billing. For the latest CDT codes and official interpretations, contact the American Dental Association or visit ADA.org.
