Let’s talk about D4346, a code that sits in your software like a fire extinguisher behind glass.

Everyone knows it’s there.
Everyone hopes they never have to touch it.
And somehow the office keeps “accidentally” filing D1110 on patients who very clearly needed something more.

If you’ve ever heard:

• “Insurance never pays that.”

• “The patient might have a copay and get mad.”

• “Let’s just prophy it and move on.”

Then congratulations, you’ve met the three biggest reasons D4346 gets ignored.

And here’s the punchline. Undercoding doesn’t prevent problems, it creates them. It can also create liability because your record and claim no longer match what was actually done. Meanwhile, the practice wonders why collections feel like trying to fill a bucket with a hole in it.

So let’s make D4346 feel less like a scary insurance code and more like what it actually is.

A clinically accurate way to report full mouth scaling when there’s generalized moderate or severe gingival inflammation without attachment loss or periodontitis.

What D4346 Actually Is (In Plain English)

ADA definition (paraphrased):
D4346 is for removal of plaque, calculus, and stains supra and subgingivally when there is generalized moderate or severe gingival inflammation, in the absence of periodontitis (no bone loss or attachment loss). Full mouth, after oral evaluation.

Think of it like the Goldilocks code:

• D1110 = Everything’s generally healthy or localized mild gingivitis.

• D4341 or D4342 (SRP) = Periodontitis with bone or attachment loss and root surface instrumentation.

• D4346 = Not healthy, but not perio. The gums are angry everywhere.

And importantly, D4346 is not a hard prophy. Even some payer policies explicitly say that if it’s just a tougher than usual prophy, you’re still in D1110 land. It’s also worth saying out loud that supervised neglect is not a strategy, and it’s not legal either.

Why Insurance Downgrades D4346 to D1110 (And How To Stop Feeding the Beast)

Many plans downgrade or deny D4346 because they’re essentially saying, prove it wasn’t just a prophy.

And prove it usually means documentation, especially periodontal charting.

Several payer policies and ADA guidance emphasize that documentation should include things like:

• Perio charting with probing depths and bleeding on probing

• Evidence the condition is generalized, not just a few bleeding sites

• Radiographs to support no bone loss

• Sometimes photos can help

Aetna, for example, is unusually specific. They want periodontal charting with bleeding on probing, and they define generalized as more than 50 percent of the mouth or dentition. Some clinical conversations use 30 percent or more for generalized, so always document clearly either way.

Translation:
If you submit D4346 with no perio charting, some carriers’ systems basically say, no charting, congrats on your D1110.

The D4346 “Get Paid” Recipe (A.K.A. What To Send So It Doesn’t Get Auto Spit Out)

Here’s a practical, repeatable workflow your admin team can follow without needing a PhD in insurance wrestling.

1. Chart like you mean it
   Include:

• Probing depths (often up to 4mm can exist without attachment loss)

• Bleeding on probing documented across the mouth

• Note inflammation level (moderate or severe)

2. Add diagnostic support
   Attach recent radiographs. Bitewings may be sufficient in many cases to show no bone loss.
   Add intraoral photos if inflammation is visually obvious. Some payers even invite this.

3. Write a narrative that does your arguing for you
   Use a short, factual narrative. Example:

Narrative sample (steal this):
“Patient presents with generalized moderate or severe gingival inflammation with bleeding on probing throughout the dentition. No radiographic bone loss or clinical attachment loss noted. Full mouth scaling performed supra and subgingivally to remove plaque and calculus and reduce inflammation. Perio charting and radiographs attached.”

That’s it. Not a novel. Not an emotional plea. Just clear clinical justification.

4. Don’t code conflict yourself into denial
   D4346 is full mouth and generally should not be billed with other prophylaxis or scaling codes the same date. A common mistake is trying to bill D1110 and D4346 together like a combo meal.

The Real Practice Problem: “We’re Afraid of the Patient’s Copay”

This is where undercoding quietly becomes a customer service strategy that backfires.

If the patient ends up with a copay, the goal isn’t to hide the ball with D1110. The goal is to explain the service like a clinician, not like a claims form.

A patient friendly way to say it (without saying deep cleaning):

“Today your gums are very inflamed and bleeding in many areas. This isn’t a routine preventive cleaning. This is a therapeutic full mouth scaling to get the inflammation under control and prevent it from turning into gum disease. Your plan may process it differently than a routine cleaning, so there could be a copay, but clinically this is the right procedure for what you have today.”

Bonus points. Your team sounds confident, the patient feels informed, and nobody has to pretend this was a regular cleaning that just took longer.

Also please retire the phrase deep cleaning for D4346. It confuses patients and muddies the clinical story.

“But Insurance Makes It Hard!”

Yes. Some payers do.

The point of D4346 isn’t that it’s easy, it’s that it’s accurate.

The ADA’s own education around D4346 emphasizes that it helps fill a real reporting gap and helps practices avoid inappropriate documentation and claim reporting pitfalls.

So instead of “We don’t use it because insurance is annoying,” the office standard becomes:

“We code what we did, and we document it so the claim survives.”

Quick Recap

• D4346 is therapeutic full mouth scaling for generalized moderate or severe gingival inflammation without periodontitis.

• It gets downgraded to D1110 most often when offices don’t attach perio charting and support.

• Your best defense is a simple bundle: perio charting, bleeding on probing, radiographs, and a short narrative.

• Undercoding to avoid a copay can create documentation and claims mismatch and revenue leakage. Teach the team to explain it clinically instead.

Benjamin Tuinei
Founder, Veritas Dental Resources, LLC
888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com