D4346 - Gingival Scaling
Scaling for generalized moderate/severe inflammation.
- Procedure Code
- D4346
- Category
- Periodontics
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- Frequency Limitation
- 1 per 12 to 24 months following comprehensive/periodic evaluation (rolling_12_months)
Required Claim Attachments & Pre-Submission Checklist
- Full-mouth periodontal charting with 6-point probing depths and bleeding points
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- D4346 includes prophylaxis, therefore fees for D1110, D1120 or D4355 are not billable to the patient when submitted with D4346 by the same dentist/dental office.
- Fees for D4346 are not billable to the patient when submitted with D4910 by the same dentist/dental office.
- Infection control is included in the fee for the dental services provided. Separate fees are not billable to the patient.
- For benefit purposes, local anesthesia is an integral part of the periodontal procedures being performed and additional charges are not billable to the patient.
- Laser disinfection is a technique, not a procedure. Fees for laser disinfection are not billable to the patient.
- Benefits for laser disinfection as a standalone procedure are denied as investigational.
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 |
|---|---|---|---|---|---|
| K05.312 | Chronic periodontitis, localized, moderate | Gingivitis and periodontal diseases | Yes (Primary) | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Chronic periodontitis, localized, moderate |
| A69.1 | Other Vincent’s infections | Other spirochetal infections | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Other Vincent’s infections |
| E10.9 | Type I diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Type I diabetes mellitus without complications |
| E11.A | Type 2 diabetes mellitus without complication in remission | Diabetes mellitus | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Type 2 diabetes mellitus without complication in remission |
| E11.9 | Type 2 diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Type 2 diabetes mellitus without complications |
| K03.6 | Deposits [accretions] on teeth | Other diseases of hard tissues of teeth | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Deposits [accretions] on teeth |
| K05.20 | Aggressive periodontitis, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Aggressive periodontitis, unspecified |
| K05.211 | Aggressive periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Aggressive periodontitis, localized, slight |
| K05.212 | Aggressive periodontitis, localized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Aggressive periodontitis, localized, moderate |
| K05.213 | Aggressive periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Aggressive periodontitis, localized, severe |
| K05.219 | Aggressive periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Aggressive periodontitis, localized, unspecified severity |
| K05.221 | Aggressive periodontitis, generalized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Aggressive periodontitis, generalized, slight |
| K05.222 | Aggressive periodontitis, generalized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Aggressive periodontitis, generalized, moderate |
| K05.223 | Aggressive periodontitis, generalized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Aggressive periodontitis, generalized, severe |
| K05.229 | Aggressive periodontitis, generalized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Aggressive periodontitis, generalized, unspecified severity |
| K05.30 | Chronic periodontitis, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Chronic periodontitis, unspecified |
| K05.311 | Chronic periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Chronic periodontitis, localized, slight |
| K05.313 | Chronic periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Chronic periodontitis, localized, severe |
| K05.319 | Chronic periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Chronic periodontitis, localized, unspecified severity |
| K05.321 | Chronic periodontitis, generalized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Chronic periodontitis, generalized, slight |
| K05.322 | Chronic periodontitis, generalized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Chronic periodontitis, generalized, moderate |
| K05.323 | Chronic periodontitis, generalized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Chronic periodontitis, generalized, severe |
| K05.329 | Chronic periodontitis, generalized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Chronic periodontitis, generalized, unspecified severity |
| K05.5 | Other periodontal diseases | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Other periodontal diseases |
| K05.6 | Periodontal disease, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Periodontal disease, unspecified |
| K06.1 | Gingival enlargement | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Gingival enlargement |
| Z33.1 | Pregnant state, incidental | Pregnant state | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Pregnant state, incidental |
| Z72.0 | Tobacco Use | Problems related to lifestyle | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Tobacco Use |
| Z87.891 | Personal history of nicotine dependence | Personal history of certain other diseases | Secondary | BOTH | scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation indicated for Personal history of nicotine dependence |