Navigating the use of D1110 (Adult Prophy) and D4910 (Periodontal Maintenance) codes can be a clinical and administrative tightrope—especially when multiple providers are involved in a patient's care.

As general dentists, knowing when to use each code and how to manage care (especially when a periodontist is involved) is essential not just for reimbursement, but also for staying clinically and ethically compliant.

Let’s break down what every general dentist needs to know.

D1110: The Adult Prophylaxis Code

D1110 is for preventive cleanings in patients without active periodontal disease. It’s intended for those with healthy gingiva or mild gingivitis.

When to use D1110:

• Patient has never had periodontal scaling and root planing (SRP)

• No history of periodontal disease or bone loss

• No periodontal pockets >3 mm

• No bleeding on probing (or minimal)

Think of this as a “healthy mouth maintenance” visit.

D4910: The Periodontal Maintenance Code

D4910 is used after active periodontal therapy, typically scaling and root planing (SRP) or surgical treatment. It’s not a regular cleaning—it’s ongoing disease management.

When to use D4910:

• The patient has a diagnosed history of periodontitis

• The patient has completed SRP or perio surgery

• There is a documented need for continued monitoring and management (e.g., pockets, attachment loss, bleeding, inflammation)

D4910 includes scaling in the presence of inflammation, site-specific debridement, and may include root planing at select sites.

The Clinical Rule: Treatment Follows Diagnosis

If the patient has a history of periodontitis and has completed SRP or other periodontal treatment, you cannot “downgrade” to D1110 just because they’re in your general practice.

Insurance audits and professional guidelines are clear: if there is a periodontal history, ongoing care should be coded as D4910—even in a general practice setting.

What If You’re Not Providing SRP?

As a general dentist, you can absolutely manage periodontal maintenance using D4910, as long as you’re maintaining clinical documentation:

• Periodontal charting

• Clinical notes on inflammation, pocket depth, bone loss

• Maintenance intervals based on risk factors

You don’t need to be the one who performed SRP—but you do need documentation of a completed active phase of treatment (whether done by you or a periodontist).

Co-Managing with a Periodontist: How to Coordinate

Let’s say you’ve referred the patient to a periodontist, who performs SRP and begins D4910. Here’s how to manage D1110 vs. D4910 in your practice after referral.

Don’t:

• Alternate between D1110 and D4910 (e.g., perio does D4910, you do D1110 next)

• Treat the same patient with D1110 after SRP has been done elsewhere

Alternating between prophy and perio maintenance not only risks improper coding but may invalidate coverage and raise red flags for insurance audits.

Do:

• Communicate with the periodontist to define who will perform D4910 visits and at what frequency

• Follow a shared care plan, documenting clearly who is responsible for perio maintenance

• If you’re continuing D4910 visits in your office, ensure your team is trained and calibrated to deliver perio maintenance—not just a “cleaning”

Remember: Once a D4910 patient, always a D4910 patient—unless there is clear documentation of return to health, which is rare and must be evidence-based.

Insurance Considerations

• Most insurers require proof of SRP or periodontal surgery before they’ll reimburse for D4910.

• If you are billing D4910, periodontal charting must be updated regularly to support continued care.

• Billing D1110 for a patient who qualifies for D4910 is not only incorrect—it may result in denial, recoupment, or even insurance fraud if done knowingly.

Summary: Know the Code, Honor the Disease

• D1110 – Adult Prophylaxis

  • Used for: Routine cleaning

  • When appropriate: For patients with no history of periodontal disease

• D4910 – Periodontal Maintenance

  • Used for: Ongoing periodontal care

  • When appropriate: After scaling and root planing (SRP) or periodontal surgery

Final Thought: Clarity, Not Convenience

Whether you're handling periodontal care entirely in-house or co-managing with a periodontist, one principle remains:

Diagnosis drives treatment—and treatment drives coding.

When we allow convenience, insurance pressure, or coding shortcuts to drive decisions, we compromise both clinical accuracy and patient health.

Let’s continue to raise the standard of care by respecting the clinical significance of these codes, training our teams thoroughly, and collaborating with specialists intentionally.

Because when perio is handled right, everybody wins—especially the patient.