Let’s talk about the code that’s been hiding in plain sight—D4346: Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation.

Wait, what? Scaling, but not a prophy? And not SRP? Welcome to the mysterious gray zone of hygiene coding that too many dental offices either misuse… or ignore completely.

If you’re skipping over D4346 because you “aren’t sure how to bill it,” or your insurance coordinator gave you the side-eye last time you mentioned it, this article is your official guide to mastering D4346 and getting paid for work you’re already doing.

🚨 First, What Exactly is D4346?

D4346 is for patients who have generalized moderate to severe gingival inflammation without bone loss (i.e., they don’t qualify for SRP) and with more than just a little plaque (i.e., they don’t qualify for a simple prophy either).

This patient lives in the limbo between “you’re fine” and “you need a full-blown periodontal treatment plan.” Their gums are inflamed, possibly bleeding, and their oral hygiene is screaming for help—but there’s no attachment loss.

🧠 ADA’s Official Definition:

“Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation. Intended for patients who have generalized moderate or severe gingival inflammation but do not have bone loss. This procedure is not performed in conjunction with D1110 or D4910.”

🔁 Read that last part again. No bundling with prophy or perio maintenance. This is its own standalone treatment and should be billed as such.

🤔 Why Are So Many Offices NOT Using This Code?

Here are the usual excuses:

• “It’s not covered by insurance.”

• “I don’t know how to document it.”

• “We just downgraded it to a prophy to avoid a denial.”

And yet… many insurance plans do cover D4346—if you provide the right documentation. Offices that learn how to use this code correctly often find that:

• Reimbursement is better than a D1110.

• The code is more clinically appropriate.

• It helps patients understand that their oral condition is serious.

📋 Documentation Requirements (or Why You Keep Getting Denied)

🔍 What most plans want to see:

• Full periodontal charting
  Even though this isn’t SRP, most carriers still want probing depths to rule out bone loss.

• Document bleeding points, inflammation, and plaque index scores

• Clinical notes showing generalized inflammation
  Be specific. “Generalized moderate gingivitis noted, with spontaneous bleeding in multiple quadrants” is better than “Patient has gingivitis.”

• No radiographic evidence of bone loss
  Attach recent radiographs to support that this isn’t periodontitis.

• Clear notation of diagnosis and treatment rationale
  This should match your perio charting and evaluation.

⚠️ Submitting D4346 without perio charting is a recipe for denial.
Many insurance companies auto-deny this code unless they see a full periodontal chart and supporting notes. If you’ve ever gotten that “we need more information” letter… yeah, that’s why.

💰 What Happens When You Do It Right?

When billed correctly, D4346 is often reimbursed at a higher rate than a prophy (D1110) and can be the gateway to proper diagnosis, patient education, and eventually even perio therapy if things don’t improve.

Insurance companies don’t want to pay for SRP when it’s not needed, but they’re also catching on to practices who’ve been billing prophys for patients with generalized bleeding gums and inflammation. D4346 is a middle-ground, and it’s clinically accurate.

🧠 Expert Tips to Make D4346 Work in Your Office

1. Train Your Team
Your hygiene team and front desk need to know when to use this code, how to explain it to patients, and how to appeal denials. Create scripts, role-play scenarios, and build confidence.

2. Pre-diagnose at the new patient exam
Spot signs of generalized inflammation early and plan for D4346 on their next visit. This sets expectations for both treatment and insurance.

3. Use it as a diagnostic bridge
Patients not ready for SRP but clearly beyond a prophy? D4346 gives you a clinical path that’s covered, reasonable, and sets the stage for future care.

4. Appeal with confidence
Got denied? Most denials stem from lack of documentation, not lack of coverage. Resubmit with a narrative, perio chart, and intraoral photos. Many offices report success on appeal.

🗂 Quick Billing Snapshot

• Code: D4346

• Description: Scaling in presence of generalized gingival inflammation

• Used For: Generalized moderate/severe gingivitis with no bone loss

• Can’t Combine With: D1110 (prophy), D4910 (perio maintenance)

🧼 The Hygiene Hero You Didn’t Know You Needed

Imagine your hygienist just spent 45 minutes doing bloody battle with inflamed tissue, only for the claim to go out as a… prophy?
It’s time to stop undervaluing clinical care and start coding correctly.

D4346 is a powerful tool that protects your providers, your revenue, and your patients. And once you learn how to master it, you’ll wonder why your practice didn’t use it sooner.

✅ Quick Recap:

• D4346 is for full-mouth scaling when generalized moderate to severe gingival inflammation is present without bone loss.

• It cannot be performed on the same date as a prophy or perio maintenance.

• Most insurance carriers require full periodontal charting, radiographs, and clinical notes.

• Appeals work when proper documentation is provided.

• When used correctly, it can improve case acceptance, insurance reimbursement, and clinical accuracy.

🎯 Need help with documentation, appeal letters, or coaching your team on how to use D4346 properly?
Reach out to the insurance nerds at Veritas Dental Resources — we’re here to make sure you stop leaving money (and clinical accuracy) on the table.

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