Understanding and correctly using D4910 – Periodontal Maintenance is essential for both clinical continuity and financial health in your dental practice. But many providers face challenges when trying to get insurance plans to recognize and reimburse for this code—even when it’s clearly the right treatment for the patient.

Let’s clarify when and how to use D4910, how to properly transition a patient to this code after scaling and root planing (SRP), and what documentation is needed to get insurance plans on board.

📘 What is CDT Code D4910?

D4910: Periodontal Maintenance

"This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site-specific scaling and root planing where indicated, and polishing the teeth."

✅ Key Points:

D4910 is not a cleaning (D1110).

It’s only appropriate after active periodontal therapy, such as SRP (D4341/D4342) or periodontal surgery.

It's meant to maintain periodontal stability, not treat active disease.

🧠 When Can You Start Using D4910?

After completing active periodontal therapy (typically SRP), a patient is re-evaluated to assess healing and determine ongoing care needs. If signs of inflammation, pocketing, or bone loss remain controlled, and the patient is stable, you transition to D4910.

🗓️ Typical Sequence:

Diagnosis of periodontal disease (typically generalized/moderate/severe)

Scaling and root planing by quadrant (D4341/D4342)

Periodontal reevaluation (often 4–6 weeks post-SRP)

Transition to periodontal maintenance (D4910) every 3–4 months

📌 Important: D4910 is a permanent maintenance code—not a temporary one. Once a patient has had SRP and you’ve transitioned them, they remain on D4910 indefinitely unless they return to health.

🔐 How to Get Insurance to Approve and Reimburse D4910

This is where it gets tricky. Many plans won’t pay for D4910 unless:

There is documented history of periodontal therapy,

SRP has been billed and processed within the last 12–24 months,

You submit proper clinical documentation or attach a narrative.

Here’s how to improve your success rate:

📄 1. Submit Proof of Prior Periodontal Treatment

If you did the SRP in your office, make sure the prior claim history includes:

D4341/D4342 (scaling and root planing by quadrant)

Clinical notes supporting diagnosis (pocket depths, bleeding, bone loss)

Full periodontal charting

Radiographs showing bone loss

✅ Tip: If the SRP was done at another office, request copies of the claim, charting, and narrative. You may need to resubmit or reference those details in your claim.

📝 2. Include a Narrative with the First D4910 Claim

Insurance doesn’t automatically recognize that a patient is in periodontal maintenance without a trail of documentation. The first time you submit D4910, include a short but clear narrative:

Sample Narrative:

“Patient completed active periodontal therapy (D4341/D4342) on [dates]. Periodontal reevaluation completed [date]. Patient now in maintenance phase with stable probing depths and no active disease. D4910 recommended every 3–4 months to maintain periodontal health.”

🖼️ 3. Attach Radiographs and Charting If Requested

Some plans will request:

Full-mouth radiographs showing bone loss

Periodontal charting showing 4mm+ pockets at time of diagnosis

Be proactive. If the plan is strict or previously denied claims, include them with your first D4910 submission.

🚩 4. Watch for Denials When There’s a Long Gap After SRP

If more than 12–24 months have passed since the last SRP—and no D4910 claims were filed in between—some insurers will reject D4910 and default to D1110.

✅ Tip: Educate your team to keep patients on a 3-4 month maintenance cycle and avoid skipping visits that might cause a lapse in documentation.

🚫 Common Mistakes to Avoid

Using D4910 on patients who never had SRP

➤ Insurance will likely deny the claim. Stick with D1110 unless there’s proof of prior therapy.

Switching back to D1110 “for coverage”

➤ This creates clinical inconsistency, confuses insurance history, and may lead to denial of future D4910 claims.

Failing to re-evaluate after SRP

➤ A periodontal reevaluation (not currently a separate CDT code) is essential for proper transition.

🦷 Clinical Tip: Use Your Diagnosis Codes (If Your Software Supports It)

Using ICD-10 diagnosis codes for periodontal disease (e.g., K05.32 – Chronic periodontitis) on claims can help justify D4910 use. While not mandatory, it adds clinical weight—especially for tough insurance plans.

🎯 Final Thoughts: Don’t Leave D4910 Unpaid

If you’ve done the work—and the patient truly needs ongoing periodontal maintenance—then you deserve to be reimbursed appropriately. The key is in:

Proper sequencing of SRP → Re-eval → Maintenance

Thorough documentation and narratives

Clear communication with both the patient and the insurance company

Insurance may create obstacles, but when you play the game strategically, D4910 becomes a reliable and billable part of your ongoing periodontal care.