So you’ve just started in dental billing at a periodontal office — welcome to the world of specialty billing! Periodontics focuses on the prevention, diagnosis, and treatment of gum disease and the placement of dental implants. And while the core principles of billing are the same, periodontal billing has unique challenges and opportunities you’ll want to understand early on.

Here’s your go-to guide with essential tips for billing in a periodontal practice, especially if you’re just getting started.

1. Understand the Most Common Periodontal Procedure Codes

Periodontists perform procedures that go far beyond regular cleanings or fillings. Get familiar with these frequently used CDT codes:

• D0180 – Comprehensive periodontal evaluation (different from a regular D0150 exam)

• D4341/D4342 – Scaling and root planing (by quadrant)

• D4910 – Periodontal maintenance

• D4381 – Localized delivery of antimicrobials (Arestin or similar)

• D4260/D4261 – Osseous surgery

• D4263/D4264 – Bone grafts

• D4270 – Pedicle soft tissue graft

• D4210/D4211 – Gingivectomy

• D6100–D6199 – Implant-related codes (placement, uncovering, maintenance)

Pro tip: Many insurance companies require supporting documentation — such as perio charting, X-rays, and narratives — for procedures like scaling and root planing, osseous surgery, or grafts.

2. Always Verify Insurance — Thoroughly

With periodontics, coverage can be complex. Insurance plans often:

• Require a prior history of deep cleaning or D0180 exam to approve periodontal treatment.

• Limit frequencies for SRPs (e.g., once every 2 or 3 years).

• Require prior authorization for surgery or grafting.

• Have waiting periods for periodontal or implant services.

Make sure to ask:

• Are perio procedures covered under this plan?

• Are implants and bone grafts covered? (Many plans still exclude these.)

• What are the frequency limitations?

• Is D4910 (perio maintenance) covered, and how often?

3. Master the Difference Between Prophy, SRP, and Perio Maintenance

One of the most important things to understand is how prophylaxis (D1110), scaling and root planing (D4341/D4342), and periodontal maintenance (D4910) are billed differently — and to the right patients.

• D1110 (Prophy) – For healthy patients with no history of periodontal disease.

• D4341/D4342 (SRP) – For active periodontal disease. Requires perio charting and radiographic evidence.

• D4910 (Perio Maintenance) – Used only after SRP or surgery, and must follow a history of periodontal treatment.

Billing D4910 without documentation of prior SRP or surgery is one of the top reasons for insurance denials in perio offices.

4. Be Prepared for Medical Necessity Requirements

Many periodontal procedures — especially surgeries and grafts — may be scrutinized for medical necessity. That means you’ll need to include:

• Periodontal charting (6+ mm pockets, bleeding on probing, etc.)

• Clinical narratives

• Radiographic evidence of bone loss or other pathology

• Initial and updated diagnosis

Create a system with your clinical team to collect and organize documentation before sending claims for higher-cost procedures.

5. Track Frequencies and Tooth-Specific Benefits

Periodontal treatment is often billed by tooth or quadrant, and insurance companies:

• May limit SRPs to once per quadrant every 2-3 years.

• May limit surgical grafts to a certain number of teeth or a per-year max.

• Require a minimum pocket depth (often ≥5mm or ≥6mm) for surgical approvals.

Be precise with:

• Tooth numbers and quadrants

• Dates of service for similar procedures

• Narrative explanations of medical necessity

6. Coordinate Care with Referring Offices

Many periodontal patients come to you from general dentists, which means:

• You may not have full insurance info — always verify with the patient directly.

• You should share progress notes and treatment summaries with the referring dentist.

• When the patient returns to their general dentist for ongoing maintenance, you must track when to bill D4910 (you) vs. D1110 (them).

Clear communication ensures accurate billing and better patient care.

7. Educate Patients on Out-of-Pocket Costs

Periodontal treatment can get expensive, and insurance rarely covers 100%. Be proactive in helping patients understand:

• What their insurance will and won't cover

• Their estimated out-of-pocket for SRP, surgery, implants, etc.

• Payment options or financing plans if needed

Tip: Patients may assume that all "cleanings" are covered. Explaining the difference between a prophy and periodontal maintenance is critical for managing expectations.

Final Thoughts

Billing in a periodontal office requires attention to detail, strong communication, and a solid understanding of perio-specific codes and coverage rules. But with some training and organization, you’ll quickly become a valuable asset to the team.

Focus on verifying coverage thoroughly, documenting procedures properly, and working closely with your clinical team — and you’ll build confidence in no time.