D4910 - Perio Maintenance
Periodontal maintenance procedures.
- Procedure Code
- D4910
- Clinical Category
- Periodontics
- Primary ICD-10 Justification
- K05.312 (Chronic periodontitis, localized, moderate)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D4910.
- Frequency Limitation
- 2 to 4 per calendar year (plan dependent) (CALENDAR_YEAR)
- Age Limitation Criteria
- Covered following active periodontal therapy.
Required Claim Attachments & Pre-Submission Checklist
- Prior history date of D4341 or periodontal surgery documented in chart note
- Current periodontal probing update
Bill When (Allowable Clinical Criteria)
- Ongoing maintenance following completed scaling and root planing (D4341/D4342) or osseous surgery
Restrictions & Clinical Exclusions
- Do NOT bill without documented prior history of active periodontal therapy
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-16 | No documented prior history of periodontal therapy (D4341) | Submit prior treatment date and carrier name if therapy was completed at a previous practice. |
ICD-10-CM Justification & Crosswalk Mappings for D4910 (29)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
| 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 maintenance indicated for Chronic periodontitis, localized, moderate |
| A69.1 | Other Vincent’s infections | Other spirochetal infections | Secondary | BOTH | periodontal maintenance indicated for Other Vincent’s infections |
| E10.9 | Type I diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | periodontal maintenance indicated for Type I diabetes mellitus without complications |
| E11.A | Type 2 diabetes mellitus without complication in remission | Diabetes mellitus | Secondary | BOTH | periodontal maintenance indicated for Type 2 diabetes mellitus without complication in remission |
| E11.9 | Type 2 diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | periodontal maintenance indicated for Type 2 diabetes mellitus without complications |
| K03.6 | Deposits [accretions] on teeth | Other diseases of hard tissues of teeth | Secondary | BOTH | periodontal maintenance indicated for Deposits [accretions] on teeth |
| K05.20 | Aggressive periodontitis, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Aggressive periodontitis, unspecified |
| K05.211 | Aggressive periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Aggressive periodontitis, localized, slight |
| K05.212 | Aggressive periodontitis, localized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Aggressive periodontitis, localized, moderate |
| K05.213 | Aggressive periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Aggressive periodontitis, localized, severe |
| K05.219 | Aggressive periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Aggressive periodontitis, localized, unspecified severity |
| K05.221 | Aggressive periodontitis, generalized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Aggressive periodontitis, generalized, slight |
| K05.222 | Aggressive periodontitis, generalized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Aggressive periodontitis, generalized, moderate |
| K05.223 | Aggressive periodontitis, generalized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Aggressive periodontitis, generalized, severe |
| K05.229 | Aggressive periodontitis, generalized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Aggressive periodontitis, generalized, unspecified severity |
| K05.30 | Chronic periodontitis, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Chronic periodontitis, unspecified |
| K05.311 | Chronic periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Chronic periodontitis, localized, slight |
| K05.313 | Chronic periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Chronic periodontitis, localized, severe |
| K05.319 | Chronic periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Chronic periodontitis, localized, unspecified severity |
| K05.321 | Chronic periodontitis, generalized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Chronic periodontitis, generalized, slight |
| K05.322 | Chronic periodontitis, generalized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Chronic periodontitis, generalized, moderate |
| K05.323 | Chronic periodontitis, generalized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Chronic periodontitis, generalized, severe |
| K05.329 | Chronic periodontitis, generalized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Chronic periodontitis, generalized, unspecified severity |
| K05.5 | Other periodontal diseases | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Other periodontal diseases |
| K05.6 | Periodontal disease, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | periodontal maintenance indicated for Periodontal disease, unspecified |
| K06.1 | Gingival enlargement | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | periodontal maintenance indicated for Gingival enlargement |
| Z33.1 | Pregnant state, incidental | Pregnant state | Secondary | BOTH | periodontal maintenance indicated for Pregnant state, incidental |
| Z72.0 | Tobacco Use | Problems related to lifestyle | Secondary | BOTH | periodontal maintenance indicated for Tobacco Use |
| Z87.891 | Personal history of nicotine dependence | Personal history of certain other diseases | Secondary | BOTH | periodontal maintenance indicated for Personal history of nicotine dependence |
Frequently Asked Questions — D4910 (Perio Maintenance)
Quick answers for dental billers and treatment coordinators submitting claims for D4910.
What ICD-10 diagnosis codes link to dental procedure D4910?▾
Common ICD-10-CM justification codes for CDT D4910 (Perio Maintenance) include: K05.312 - Chronic periodontitis, localized, moderate (Primary); A69.1 - Other Vincent’s infections; E10.9 - Type I diabetes mellitus without complications; E11.A - Type 2 diabetes mellitus without complication in remission; E11.9 - Type 2 diabetes mellitus without complications; K03.6 - Deposits [accretions] on teeth; K05.20 - Aggressive periodontitis, unspecified; K05.211 - Aggressive periodontitis, localized, slight; K05.212 - Aggressive periodontitis, localized, moderate; K05.213 - Aggressive periodontitis, localized, severe; K05.219 - Aggressive periodontitis, localized, unspecified severity; K05.221 - Aggressive periodontitis, generalized, slight; K05.222 - Aggressive periodontitis, generalized, moderate; K05.223 - Aggressive periodontitis, generalized, severe; K05.229 - Aggressive periodontitis, generalized, unspecified severity; K05.30 - Chronic periodontitis, unspecified; K05.311 - Chronic periodontitis, localized, slight; K05.313 - Chronic periodontitis, localized, severe; K05.319 - Chronic periodontitis, localized, unspecified severity; 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; K05.5 - Other periodontal diseases; K05.6 - Periodontal disease, unspecified; K06.1 - Gingival enlargement; Z33.1 - Pregnant state, incidental; Z72.0 - Tobacco Use; Z87.891 - Personal history of nicotine dependence.
Can CDT code D4910 be billed to medical insurance?▾
Billing CDT D4910 (Perio Maintenance) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: BOTH.
What attachments and documentation are required for billing CDT D4910?▾
Required claim attachments for CDT D4910 (Perio Maintenance) include: Prior history date of D4341 or periodontal surgery documented in chart note; Current periodontal probing update.
What is the insurance frequency limitation for CDT D4910?▾
Standard commercial insurance frequency for D4910: 2 to 4 per calendar year (plan dependent) (CALENDAR_YEAR). Age criteria: Covered following active periodontal therapy..
What are common insurance denial reasons and appeal tips for CDT D4910?▾
Denial Code CO-16 (No documented prior history of periodontal therapy (D4341)): Overturn appeal strategy - Submit prior treatment date and carrier name if therapy was completed at a previous practice.