Understanding Dental Code D4210

When to Use D4210 dental code

The D4210 dental code is used to report gingivectomy or gingivoplasty procedures performed in four or more contiguous teeth or tooth bounded spaces per quadrant. This CDT code specifically applies when there is a need to remove and reshape gum tissue due to conditions such as gingival hyperplasia, deep periodontal pockets, or to facilitate restorative procedures. It is not intended for simple gingival trimming or procedures limited to fewer than four teeth—those scenarios may require a different code, such as D4211 for fewer than four teeth.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful claim approval. Clinical notes should clearly indicate the diagnosis (e.g., chronic inflammatory gingival enlargement), the specific teeth or areas treated, and the medical necessity for the procedure. Include pre-operative periodontal charting, intraoral photographs, and radiographs when applicable. For instance, if the gingivectomy is performed to improve access for restorative work or to address persistent pocketing after scaling and root planing, this rationale must be clearly stated in the patient record. Always ensure the documentation supports the use of D4210 rather than a more limited procedure code.

Insurance Billing Tips

When billing D4210, start by verifying the patient’s dental benefits to confirm coverage for periodontal surgical procedures. Many plans require evidence of prior non-surgical therapy, such as scaling and root planing, and may request supporting documentation like periodontal charting and radiographs. Submit a detailed narrative with your claim, outlining the diagnosis, previous treatments, and the reason surgical intervention is necessary. If the claim is denied, review the Explanation of Benefits (EOB) for the denial reason and prepare a thorough appeal, including any additional clinical notes or documentation requested by the payer. Timely follow-up on Accounts Receivable (AR) is critical to ensure prompt reimbursement.

Example Case for D4210

A 52-year-old patient presents with generalized gingival overgrowth affecting the upper right quadrant, involving teeth #2 through #5. Previous scaling and root planing failed to resolve the condition. The periodontist documents persistent 6-7mm pockets and difficulty maintaining oral hygiene. After obtaining pre-op photos and periodontal charting, the provider performs a gingivectomy on four contiguous teeth. The claim is submitted with D4210, including clinical notes, photos, and a narrative describing the failed non-surgical therapy and medical necessity. The insurer approves the claim based on the comprehensive documentation and clear clinical rationale.