D4355 - Full Debridement
Full mouth debridement for comprehensive eval.
- Procedure Code
- D4355
- 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 once per lifetime unless defined by group/individual contract.
Restrictions & Clinical Exclusions
- The fee for D0180 is not billable to the patient when performed by the same dentist/dental office on the same date of service as D4355.
- 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.
- Benefits for laser biostimulation 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 |
|---|---|---|---|---|---|
| K03.6 | Deposits [accretions] on teeth | Other diseases of hard tissues of teeth | Yes (Primary) | BOTH | full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit indicated for Deposits [accretions] on teeth |
| Z72.0 | Tobacco Use | Problems related to lifestyle | Secondary | BOTH | full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit indicated for Tobacco Use |
| Z87.891 | Personal history of nicotine dependence | Personal history of certain other diseases | Secondary | BOTH | full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit indicated for Personal history of nicotine dependence |