Let’s talk about the black sheep of dental codes—D4346—also known as the scaling in presence of generalized moderate or severe gingival inflammation. Sounds fancy, right? That’s probably why so many practices have no idea how to use it correctly.

Despite being introduced in 2017, this code is still often misunderstood, misused, and tragically underutilized. But when used properly, D4346 can be your secret weapon for better clinical documentation, accurate reimbursement, and improved patient care.

🦷 What Is D4346 Really For?

Let’s clear the air: D4346 is not a prophy, and it’s not SRP (D4341/D4342) either. It’s in a category of its own. It’s used when:

• There is generalized moderate to severe inflammation

• There is no clinical attachment loss

• It’s more than a routine prophy, but not quite periodontal therapy

Think of it like this: If prophy is a car wash and SRP is a full-body engine overhaul, D4346 is the deep detail job before things get worse.

📊 What Documentation Do You Need?

This is where most offices mess up. Insurance will not pay for this code unless you give them the evidence.

Perio Charting:
At minimum, record probing depths. Even though this is a gingivitis code (not periodontal disease), most payers still require a perio chart. Why? Because they want to see there’s no clinical attachment loss.

Gingival Descriptions:
Use the magic words:

• Generalized

• Moderate to Severe

• Edema, erythema, bleeding, etc.

Document bleeding on probing, inflammation indices, and any contributing medical conditions.

Radiographs:
You’ll need radiographs that show no bone loss. If there’s bone loss, you’re likely looking at SRP instead.

Narrative Note (for insurance submission):
Example:

“Patient presents with generalized moderate to severe gingival inflammation with no radiographic or clinical attachment loss. Probing depths within normal limits (3mm or less). Gingiva exhibits bleeding on probing, erythema, and edema. D4346 is being performed in lieu of prophy due to clinical findings.”

💰 How to Get Insurance to Pay for D4346

Even when everything is charted correctly, many claims get denied. Here’s how to fight that:

• Always attach perio charting and radiographs

• Include a strong narrative—don’t just rely on code definitions

• Appeal denied claims and cite the CDT code verbatim if needed

• Pre-authorize when unsure

• Check payer policies—some allow it once per 12 or 24 months, some exclude it

👥 What Should Team Members Tell Patients?

This code can be a little... awkward. Patients hear “cleaning” and assume it’s the $0 covered prophy. Here’s how to explain it clearly without sounding salesy:

Sample Script:
🦷 “Today, we found that your gums are really inflamed—not just a little bit, but enough that doing a regular cleaning could actually cause more damage than good. You’re not in full periodontal disease yet, and that’s the good news! But we need to do a deeper, more comprehensive cleaning to remove the bacteria before things get worse. This is a medically necessary step to stop the progression to gum disease.”

If needed, add:
“Some insurance plans do cover this type of cleaning, but we always check ahead of time and provide you with all the details. Your health comes first.”

🛠 Pro Tips for Implementing D4346 in Your Practice

• Train your team on clinical indicators
  Swollen gums, bleeding, poor hygiene, and no attachment loss

• Create a visual chart for your op rooms
  List D1110, D4346, D4341/4342 side-by-side

• Reassess hygiene patients every visit
  Some bounce between D1110 and D4346

• Use intraoral photos
  They help justify the treatment and are great for appeals

🚫 Common Mistakes to Avoid

• Submitting D4346 without perio charting

• Billing D4346 and D1110 on the same visit (not allowed)

• Using D4346 when there’s any clinical attachment loss

• Calling it a “deep cleaning” (confuses patients and can be misleading)

📦 Quick Recap

Use D4346 when the patient has generalized moderate to severe gingivitis with no clinical attachment loss. To get it paid, make sure your documentation includes perio charting, detailed gingival notes, supporting radiographs, and a strong narrative. Don't assume it's just a fancy prophy—this code is for when inflammation is significant but full-blown periodontal disease hasn’t set in yet. When explaining it to patients, keep it simple: it’s a more advanced cleaning meant to prevent gum disease. And finally, make sure your team is trained on what to look for and how to code it properly—visual guides and clinical checklists can make a big difference.

🧠 Final Thoughts

D4346 may be the underdog code in dentistry—but it's also one of the most powerful tools we have to intervene early, prevent disease, and generate accurate reimbursement. It’s time to stop fearing it and start mastering it.

Need help training your team or writing strong narratives to get D4346 paid consistently? That’s what Veritas Dental Resources is here for. We'll help you build the workflows, documentation systems, and communication strategies that get you paid for what you already do best: caring for your patients.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com