D6049 - Implant Scaling
Scaling/debridement of a single implant.
- Procedure Code
- D6049
- Clinical Category
- Implant Services
- Primary ICD-10 Justification
- See mapped diagnoses below
- Reference Fee & Claim Types
- DENTAL
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D6049.
- Frequency Limitation
- 1 per tooth/site in a 60-month interval (5 years) (rolling_12_months)
- Age Limitation Criteria
- Restricted to patients age 19 or older. Implants are not a benefit for patients under 19 years of age.
Required Claim Attachments & Pre-Submission Checklist
- Post-operative radiograph or surgical operative report
Bill When (Allowable Clinical Criteria)
- When covered, benefits are limited to once per tooth per 24 months.
Restrictions & Clinical Exclusions
- Fees for D6049 are NOT BILLABLE TO THE PATIENT when performed in the same quadrant by the same dentist/dental office as D4341/D4342 or D4240/D4241, D4260/D4261 or D6101/D6102.
- Fees for retreatment by the same dentist/dental office within 24 months of initial therapy is not billable to the patient, if different dentist/dental office then benefits are denied.
- Fees for D6049 are not billable to the patient when performed within 12 months of restoration (D6058-D6077, D6085, D6094,6118, D6119, D6194).
- For benefit purposes, anesthesia is an integral part of the procedures being performed and additional fees are not billable to the patient.
- Benefits are denied, unless the group/individual contract specifies that implant services are a benefit.
- All services and treatment provided remotely via tele-health modalities, be they synchronous or asynchronous, must be performed by a licensed dentist or their supervised staff, acting within the scope of applicable law. Services and treatment delivered virtually are only a benefit when the elements included in the descriptor of the CDT procedure code are completed and only when they meet generally accepted clinical guidelines.
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-CM Justification & Crosswalk Mappings for D6049 (0)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
No direct ICD-10 mappings recorded for D6049.
Frequently Asked Questions — D6049 (Implant Scaling)
Quick answers for dental billers and treatment coordinators submitting claims for D6049.
What ICD-10 diagnosis codes link to dental procedure D6049?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D6049.
Can CDT code D6049 be billed to medical insurance?▾
Billing CDT D6049 (Implant Scaling) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: DENTAL.
What attachments and documentation are required for billing CDT D6049?▾
Required claim attachments for CDT D6049 (Implant Scaling) include: Post-operative radiograph or surgical operative report.
What is the insurance frequency limitation for CDT D6049?▾
Standard commercial insurance frequency for D6049: 1 per tooth/site in a 60-month interval (5 years) (rolling_12_months). Age criteria: Restricted to patients age 19 or older. Implants are not a benefit for patients under 19 years of age..
What are common insurance denial reasons and appeal tips for CDT D6049?▾
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.