Understanding Dental Code D4346

When to Use D4346 dental code

The D4346 dental code is designated for "scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation." This code is appropriate when a patient presents with generalized gingival inflammation, but does not have periodontitis (no bone loss or attachment loss). D4346 bridges the gap between a routine prophylaxis (D1110) and periodontal scaling and root planing (D4341 or D4342). Use D4346 when inflammation is present throughout the mouth, affecting at least 30% of the teeth, and the patient’s condition is more severe than what a standard cleaning would address, but does not warrant full periodontal therapy.

Documentation and Clinical Scenarios

Proper documentation is critical for successful reimbursement of D4346. Dental teams should record:

• Generalized moderate or severe gingival inflammation (redness, swelling, bleeding on probing)
• No evidence of attachment or bone loss (confirm with radiographs and periodontal charting)
• Full-mouth involvement (at least 30% of teeth)
• Detailed clinical notes, including probing depths, bleeding points, and intraoral photos if possible

Common clinical scenarios include patients with uncontrolled gingivitis due to poor oral hygiene, hormonal changes, or systemic conditions, where inflammation is widespread but periodontitis is not present. Always ensure the oral evaluation (e.g., D0120 or D0150) is completed prior to performing D4346.

Insurance Billing Tips

Insurance carriers may scrutinize claims for D4346, as it is a relatively new code (introduced in 2017) and often misunderstood. To improve claim acceptance:

• Submit detailed clinical documentation and radiographs with the initial claim
• Include a narrative explaining the extent of inflammation and absence of periodontitis
• Verify patient eligibility and benefits for D4346 before treatment
• Be prepared to respond promptly to requests for additional information or claim appeals
• Monitor EOBs (Explanation of Benefits) and AR (Accounts Receivable) for denials or underpayments

Establish a workflow where clinical and billing teams collaborate to ensure all required documentation is gathered and submitted. This reduces delays and increases the likelihood of reimbursement.

Example Case for D4346

Case: A 35-year-old patient presents for a recall visit. The hygienist notes generalized moderate gingival inflammation (redness, swelling, and bleeding on probing) affecting more than 30% of teeth. Periodontal charting shows no pockets over 3mm, and radiographs confirm no bone loss. The patient’s oral evaluation (D0120) was completed at the same visit. The provider documents all findings, takes intraoral photos, and submits a claim with a narrative and supporting images. The insurance carrier initially requests more information, but the office promptly responds with the full documentation, and the claim is approved for D4346.

This example highlights the importance of thorough documentation, clear communication with payers, and proactive follow-up to ensure proper reimbursement for D4346.