D4342 - SRP (1-3 Teeth)
Scaling and root planing per quadrant (1-3 teeth).
- Procedure Code
- D4342
- Category
- Periodontics
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental National / PPO Standard
- Frequency Limitation
- 1 per quadrant every 24 consecutive months (ROLLING_MONTHS)
- Age Limitation
- Same criteria as D4341.
Required Claim Attachments & Pre-Submission Checklist
- Specific tooth numbers in quadrant listed on claim (1 to 3 teeth)
- 6-point periodontal probing measurements for affected teeth
- Radiographic evidence of bone loss for affected teeth
Bill When (Allowable Clinical Criteria)
- Localized periodontal disease affecting 1, 2, or 3 teeth in a quadrant with pocket depths >= 4mm
Restrictions & Clinical Exclusions
- Do NOT bill if 4 or more teeth in quadrant need scaling (use D4341 instead)
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-16 | Missing periodontal chart or radiographs | Submit perio chart and indicate specific teeth treated in quadrant. |
ICD-10 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K05.312 | Chronic periodontitis, localized, moderate | Gingivitis and periodontal diseases | Yes (Primary) | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Chronic periodontitis, localized, moderate |
| A69.1 | Other Vincent’s infections | Other spirochetal infections | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Other Vincent’s infections |
| E10.9 | Type I diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Type I diabetes mellitus without complications |
| E11.A | Type 2 diabetes mellitus without complication in remission | Diabetes mellitus | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Type 2 diabetes mellitus without complication in remission |
| E11.9 | Type 2 diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Type 2 diabetes mellitus without complications |
| K03.6 | Deposits [accretions] on teeth | Other diseases of hard tissues of teeth | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Deposits [accretions] on teeth |
| K05.20 | Aggressive periodontitis, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Aggressive periodontitis, unspecified |
| K05.211 | Aggressive periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Aggressive periodontitis, localized, slight |
| K05.212 | Aggressive periodontitis, localized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Aggressive periodontitis, localized, moderate |
| K05.213 | Aggressive periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Aggressive periodontitis, localized, severe |
| K05.219 | Aggressive periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Aggressive periodontitis, localized, unspecified severity |
| K05.221 | Aggressive periodontitis, generalized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Aggressive periodontitis, generalized, slight |
| K05.222 | Aggressive periodontitis, generalized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Aggressive periodontitis, generalized, moderate |
| K05.223 | Aggressive periodontitis, generalized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Aggressive periodontitis, generalized, severe |
| K05.229 | Aggressive periodontitis, generalized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Aggressive periodontitis, generalized, unspecified severity |
| K05.30 | Chronic periodontitis, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Chronic periodontitis, unspecified |
| K05.311 | Chronic periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Chronic periodontitis, localized, slight |
| K05.313 | Chronic periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Chronic periodontitis, localized, severe |
| K05.319 | Chronic periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Chronic periodontitis, localized, unspecified severity |
| K05.321 | Chronic periodontitis, generalized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Chronic periodontitis, generalized, slight |
| K05.322 | Chronic periodontitis, generalized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Chronic periodontitis, generalized, moderate |
| K05.323 | Chronic periodontitis, generalized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Chronic periodontitis, generalized, severe |
| K05.329 | Chronic periodontitis, generalized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Chronic periodontitis, generalized, unspecified severity |
| K05.5 | Other periodontal diseases | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Other periodontal diseases |
| K05.6 | Periodontal disease, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Periodontal disease, unspecified |
| K06.1 | Gingival enlargement | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Gingival enlargement |
| Z33.1 | Pregnant state, incidental | Pregnant state | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Pregnant state, incidental |
| Z72.0 | Tobacco Use | Problems related to lifestyle | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Tobacco Use |
| Z87.891 | Personal history of nicotine dependence | Personal history of certain other diseases | Secondary | BOTH | periodontal scaling and root planing – one to three teeth per quadrant indicated for Personal history of nicotine dependence |