Understanding Dental Code D4910

When to Use D4910 dental code

The D4910 dental code is designated for periodontal maintenance procedures following active periodontal therapy, such as scaling and root planing or periodontal surgery. It is not a routine cleaning code; rather, it is reserved for patients with a documented history of periodontal disease who require ongoing care to maintain gum and bone health. Use D4910 only after the completion of definitive periodontal treatment, and ensure that the patient's chart reflects this history. Attempting to bill D4910 for patients who have not had active periodontal therapy can lead to claim denials and compliance issues.

Documentation and Clinical Scenarios

Accurate documentation is crucial when billing D4910. The patient's record should include:

• Detailed periodontal charting (probing depths, bleeding points, recession)
• History of completed periodontal therapy (e.g., scaling and root planing or surgery)
• Clinical notes describing the maintenance procedure performed, including removal of subgingival and supragingival plaque and calculus, site-specific scaling, and polishing
• Ongoing assessment of periodontal status and oral hygiene instructions

Typical clinical scenarios for D4910 include patients returning every 3–4 months after initial therapy to monitor periodontal stability and prevent disease recurrence. If a patient reverts to a healthy periodontium and no longer needs intensive maintenance, consider whether a prophylaxis code is more appropriate.

Insurance Billing Tips

Insurance carriers scrutinize D4910 claims closely. To improve claim acceptance and reduce accounts receivable (AR) delays, follow these best practices:

• Verify eligibility and frequency limits: Check the patient’s benefits for periodontal maintenance coverage and allowable intervals before scheduling.
• Submit supporting documentation: Attach periodontal charting, treatment history, and clinical notes with the claim. Many payers require proof of prior therapy.
• Use correct sequencing: Ensure that D4910 is not billed before completion of active periodontal therapy codes (e.g., D4341, D4342).
• Appeal denied claims: If a claim is denied, review the explanation of benefits (EOB), gather additional documentation, and submit a detailed appeal letter referencing the patient’s periodontal history and clinical need.

Proactive communication with patients about their insurance coverage and potential out-of-pocket costs is also essential for smooth billing and collections.

Example Case for D4910

Consider a patient who completed scaling and root planing six months ago. At their recall visit, you perform a comprehensive periodontal evaluation, remove subgingival deposits, and reinforce oral hygiene. The patient’s chart documents their periodontal history, current pocket depths, and maintenance procedures. You submit a claim for D4910, including the treatment notes and previous therapy dates. The insurance carrier approves the claim, recognizing the medical necessity and proper documentation.

By following these steps and maintaining thorough records, your dental practice can maximize reimbursement and ensure compliance when billing the D4910 dental code.