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What is the Insurance Code for a Dental Cleaning?

A deep dental cleaning is recommended when certain conditions exist.  Deep pockets, inflamed gums that bleed easily or heavier than normal amount of plaque, calculus (tarter) or stain on the teeth are all reasons to recommend a deep cleaning.

Depending on the condition of your teeth, there are several insurance codes that can be used when a deep cleaning is needed.

The level of insurance coverage varies and the codes used by your dentist for billing purposes can vary as well making things all the more confusing.

This question is a good example of what can happen.

Darcy's question

Was I charged for a deep dental cleaning?

What is the difference between these two procedures...

Periodontal maintenance/D4910 vs full mouth debridement/D4355

My insurance only covers D4910 and my dentist billed for D4355. 

I don't have periodontal disease and when I talked to my dentist, they said it was just a sonic cleaning. 

I was there for my routine exam. I feel caught in the middle. Can you help answer the dental side questions please? 



My Reply

Hi Darcy, Your dentist should know what code was billed.  It is the dentist's responsibility to bill the correct code.  If they billed it incorrectly it could be resubmitted under the correct code.

A periodontal maintenance visit D4910 is a cleaning that follows 3 months after a deep dental cleaning aka scaling and root planning and then every 3 to 6 months going forward.   D4910 is only covered if you had scaling and root planning (also called quadrant scaling or deep cleaning)

A full mouth debridement  D4355 is done when there are no deep pockets but is more tarter or calculus than can be removed in the time allowed for a regular cleaning. A full mouth debridement is normally the first of two visits the second of which is called a fine scaling.

Some insurance plans do not cover full mouth debridement.

If you have never had gum disease or never had a deep cleaning, you should not need periodontal maintenance D4910. If you see your dentist  twice a year you should not need a full mouth debridement D4355. 

For those who are in good periodontal health (no gum disease) and who have their teeth cleaned at least twice a year the proper insurance code is D1110.

It doesn't matter if the sonic cleaner or hand instruments are used. 

Almost all dental insurance plans consider a regular cleaning-D1110 preventative treatment and cover it twice a year along with a set of dental X-rays and a dental exam.

Why are other codes used?

The codes are there because some people really need more than just a routine cleaning and check up. Insurance plans allow for this.

The additional revenue from deep cleaning procedures makes it tempting for some dentists to use the deep cleaning codes when they shouldn't. 

Unfortunately, it has led to some dental clients being told they need more than a routine cleaning when they really don't.

Here is an article about deep cleanings and how to know if you really need it.

There are many dental offices (mine included) that still use the code D1110 for most dental cleanings.

It is possible that you really needed a full mouth debridement but you should have been informed and given an estimate before it was done.

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