Understanding Dental Code D4274

When to Use D4274 dental code

The D4274 dental code refers to the "mesial/distal wedge procedure, single tooth (when not performed in conjunction with surgical procedures in the same anatomical area)." This CDT code is specifically used when a dentist or periodontist removes soft tissue from the mesial or distal aspect of a single tooth, typically to gain access for restorative or periodontal purposes. It is crucial to note that D4274 should not be reported if the wedge procedure is performed in conjunction with other surgical procedures—such as osseous surgery or extractions—in the same anatomical area during the same appointment. In those cases, the wedge procedure is considered part of the primary surgical service and is not separately billable.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement of D4274. The clinical notes should clearly describe:

• The specific tooth and site (mesial or distal) where the wedge procedure was performed
• The indication for the procedure (e.g., to access a carious lesion, facilitate crown placement, or address localized periodontal defects)
• That no other surgical procedure was performed in the same anatomical area during the same visit
• Pre- and post-operative findings, including probing depths, tissue condition, and healing expectations

Common clinical scenarios for D4274 include cases where excess soft tissue impedes restorative access, or when localized periodontal issues require targeted tissue removal without the need for broader surgical intervention.

Insurance Billing Tips

To maximize claim acceptance for D4274, follow these best practices:

• Verify patient benefits prior to treatment to confirm coverage for periodontal procedures and any frequency limitations.
• Submit detailed clinical documentation with the claim, including intraoral photos, periodontal charting, and a narrative explaining the medical necessity for the wedge procedure.
• Use the correct CDT code and ensure it is not billed alongside other surgical codes in the same area, as this will likely result in a denial.
• If the claim is denied, review the EOB for the denial reason, gather any additional supporting documentation, and submit a claim appeal with a clear explanation of why D4274 is justified as a separate procedure.

Staying proactive with insurance verification and thorough documentation can significantly reduce AR and speed up reimbursement for this code.

Example Case for D4274

Consider a patient presenting with excess soft tissue distal to tooth #19, preventing proper crown margin placement. The dentist performs a mesial/distal wedge procedure to remove the tissue and gain necessary access. No other surgical procedures are performed in that area during the visit. The clinical notes detail the site, reason for the procedure, and post-op instructions. The claim is submitted with D4274, accompanied by intraoral photos and a narrative. Insurance approves the claim after reviewing the documentation, resulting in timely payment and a satisfied patient.

For cases involving other periodontal surgical procedures, refer to codes such as osseous surgery (D4260) or gingivectomy (D4210) for proper billing guidance.