For years, dental professionals have navigated a fine line between preventive cleanings and periodontal therapy. But what happens when a patient presents with significant gingival inflammation—more than what a routine prophylaxis can address, yet without the attachment loss that defines periodontitis? That’s where D4346 comes in.

What is D4346, and Why Does It Matter?

D4346 is a therapeutic procedure specifically designed for patients with generalized moderate to severe gingival inflammation in the absence of bone or attachment loss. Unlike D1110 (prophylaxis) or D4341/D4342 (scaling and root planing), this code bridges the gap between preventive care and periodontal therapy.

When Should You Use D4346?

If a patient presents with:
✅ Generalized gingival inflammation (redness, swelling, bleeding) beyond what’s expected in routine cleanings.
✅ No clinical attachment loss or radiographic evidence of bone loss—periodontal disease is not yet present.
✅ Heavy plaque and calculus deposits requiring therapeutic intervention beyond a standard prophylaxis.

In these cases, D4346 is the appropriate treatment to reduce inflammation, restore gingival health, and prevent progression to periodontitis.

Common Misuse of D4346

🚫 For patients with bone loss or attachment loss – These cases require scaling and root planing (D4341/D4342).
🚫 For routine prophylaxis patients – If the patient has minimal inflammation, stick with D1110.
🚫 For periodontal maintenance cases – Patients with a history of periodontal disease should be coded under D4910.

Billing and Documentation: The Key to Claim Approval

One of the biggest challenges with D4346? Insurance reimbursement. Since many plans don’t routinely cover it, you need to document thoroughly to support the claim:
📌 Comprehensive periodontal charting – Record inflammation levels, bleeding index, and plaque scores.
📌 Intraoral photos and radiographs – Provide visual evidence showing gingivitis without bone loss.
📌 Detailed clinical notes – Describe why a prophylaxis was insufficient and why a therapeutic approach was necessary.

🛑 Important: D4346 is a one-time procedure—once inflammation is controlled, patients transition to either routine prophylaxis (D1110) or periodontal maintenance (D4910). Also, D4346 cannot be billed with D1110 or D4910 on the same day.

Final Thoughts

D4346 is an essential yet underutilized code that allows dental professionals to appropriately diagnose and treat patients in the early stages of gingival disease. By implementing this code correctly—paired with solid documentation and patient education—dentists can deliver better care, prevent unnecessary disease progression, and ensure fair compensation for their work.

It’s time to stop overlooking D4346 and start using it as the clinical tool it was meant to be.