What ICD-10 diagnosis codes link to dental procedure D4211?

Common ICD-10 justification codes for CDT D4211 (Gingivectomy (1-3 Teeth)) include: K05.30 - Chronic periodontitis, unspecified (Primary); K05.31 - Chronic periodontitis, localized; K05.311 - Chronic periodontitis, localized, slight; K05.312 - Chronic periodontitis, localized, moderate; K05.313 - Chronic periodontitis, localized, severe; K05.319 - Chronic periodontitis, localized, unspecified severity; K05.32 - Chronic periodontitis, generalized; K05.321 - Chronic periodontitis, generalized, slight; K05.322 - Chronic periodontitis, generalized, moderate; K05.323 - Chronic periodontitis, generalized, severe; K05.329 - Chronic periodontitis, generalized, unspecified severity; K06.1 - Gingival enlargement.

Can CDT code D4211 be billed to medical insurance?

Billing CDT D4211 to medical insurance depends on the underlying medical necessity. Linked claim types: BOTH.

What attachments and documentation are required for billing CDT D4211?

Required claim attachments for CDT D4211 (Gingivectomy (1-3 Teeth)) include: Full-mouth periodontal charting with 6-point probing depths and bleeding points.

What is the insurance frequency limitation for CDT D4211?

Standard commercial insurance frequency for D4211: Subject to group/individual contract frequency limitations (none).

What are common insurance denial reasons and appeal tips for CDT D4211?

Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.

D4211 - Gingivectomy (1-3 Teeth)

Gingivectomy per quadrant (1-3 teeth).

Procedure Code: D4211
Category: Periodontics

Insurance Verification Benchmarks & Billing Guidelines

Benchmark Policy Source: Delta Dental 2026

Frequency Limitation: Subject to group/individual contract frequency limitations (none)

Required Claim Attachments & Pre-Submission Checklist

Full-mouth periodontal charting with 6-point probing depths and bleeding points

Bill When (Allowable Clinical Criteria)

Benefits are limited to one D4210 or D4211 per quadrant per 36 months.

Restrictions & Clinical Exclusions

Periodontal surgical procedures include all necessary postoperative care, finishing procedures, oral evaluations for three months. Soft tissue grafts may be allowed on the same teeth/sites within 36 months with supporting documentation. When a surgical procedure is billed within three months of the initial surgical procedure in relation to both natural teeth and implants by the same dentist/dental office, the fee for the surgery is not billable to the patient. In the absence of documentation of extraordinary circumstances, the fee for additional surgery by the same dentist/dental office for three years is not billable to the patient. If extraordinary circumstances are present, the benefits will be denied and is chargeable to the patient up to the approved amount for the surgery. not billable to the patient
Periodontally involved teeth which would qualify for surgical pocket reduction benefits under these procedure codes must be documented to have at least 5 mm pocket depths and bone loss beyond 1-1.5 millimeters. If pocket depths are under 5 mm, then benefits are denied.
If surgery is performed less than four weeks after scaling and root planing, fees for the surgical procedure or the scaling and root planning by the same dentist/dental office are not billable to the patient following consultant review.
Periodontal surgical procedures include all necessary postoperative care, finishing procedures, oral evaluations for three months, as well as any surgical re-entry for three years. When a surgical procedure is billed within three months of the initial surgical procedure by the same dentist/dental office, the fee for the surgery is not billable to the patient. In the absence of documentation of extraordinary circumstances, fees for additional surgery are not billable to the patient for three years.
Gingivectomy or gingivoplasty (D4211) performed on the same date of service as the preparation of a crown or other restoration is included in the fee for the restoration, and separate fees from the same dentist/dental office are not billable to the patient.
Fees for D4211 are NOT BILLABLE to the PATIENT when performed within 36 months by the same dentist/dental office. If done by a different dentist, the benefits are denied.

Common Claim Denial Codes & Overturn Strategies

Denial Code	Denial Reason	Appeal & Overturn Strategy
CO-119	Benefit maximum or frequency limitation exceeded for procedure	Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.

ICD-10 Justification & Crosswalk Mappings

ICD-10 Code	Diagnosis Name	Category	Primary Justification	Claim Type	Clinical Scenario
K05.30	Chronic periodontitis, unspecified	Gingivitis and periodontal diseases	Yes (Primary)	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, unspecified
K05.31	Chronic periodontitis, localized	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, localized
K05.311	Chronic periodontitis, localized, slight	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, localized, slight
K05.312	Chronic periodontitis, localized, moderate	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, localized, moderate
K05.313	Chronic periodontitis, localized, severe	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, localized, severe
K05.319	Chronic periodontitis, localized, unspecified severity	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, localized, unspecified severity
K05.32	Chronic periodontitis, generalized	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, generalized
K05.321	Chronic periodontitis, generalized, slight	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, generalized, slight
K05.322	Chronic periodontitis, generalized, moderate	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, generalized, moderate
K05.323	Chronic periodontitis, generalized, severe	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, generalized, severe
K05.329	Chronic periodontitis, generalized, unspecified severity	Gingivitis and periodontal diseases	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Chronic periodontitis, generalized, unspecified severity
K06.1	Gingival enlargement	Other disorders of gingiva and edentulous alveolar ridge	Secondary	BOTH	gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant indicated for Gingival enlargement