A lighthearted (but very real) conversation about perio coding, billing, and why nobody should be doing dentistry for free

Let’s talk about something every dental office has seen, felt, and politely pretended not to notice.

You know the scene.

The hygienist stands up.
The patient sits up.
There’s blood on the bib.
There’s calculus on the mirror.
There are 5 to 6 mm pockets quietly screaming for attention.

And then the claim goes out as D1110, Prophylaxis (Adult).

Congratulations. You’ve just performed what the industry lovingly (and sarcastically) calls a bloody prophy.

What a Prophy Is… and What It Is Not
A prophy is defined as a cleaning for a healthy mouth.
Not a mostly healthy except for generalized bleeding, bone loss, and inflammation mouth.
Not a we know it’s perio but let’s keep things moving mouth.
And definitely not a this would be SRP if we acknowledged it mouth.

When treatment delivered doesn’t match treatment documented or billed, two things happen:

• Revenue quietly evaporates

• Liability quietly moves in and makes itself comfortable

And unlike many things in life, liability does not resolve on its own.

“But We’re Just Helping the Patient…”
Of course you are.
Everyone in dentistry is trying to help patients. No one wakes up thinking, “Today feels like a great day for supervised neglect.”

And yet, when perio exists, isn’t diagnosed, isn’t documented, and isn’t treated, that’s exactly how it can be interpreted later.

From the outside looking in (hello, attorneys), the chart reads like this:

“Patient presents with inflammation, bleeding, and disease.
Office documents a healthy mouth procedure.
Disease progresses.”

That gap between what you saw and what you recorded is where liability lives.

The HMO Elephant in the Room
Now let’s address the thing everyone whispers about but rarely writes down.

Some HMO driven practices openly admit they do not diagnose periodontal disease because:

• Reimbursement is low, and many offices actually come out of pocket to perform perio treatment on HMO patients

• Treatment takes time

• The math doesn’t work

• Productivity pressure is real

From a business standpoint, that tension is understandable.

From a clinical and ethical standpoint, that’s where things get uncomfortable.

Because when perio exists and isn’t diagnosed, not because it’s unclear, but because it’s inconvenient, the patient doesn’t just lose bone.

They lose informed consent.

And that’s the part that turns a bad insurance model into something far more serious.

Let’s Be Clear: This Is Not a Hygiene Problem
This conversation is delicate, and it should be.

Hygienists are not the villains.
Dentists are not heartless.
Everyone is navigating broken systems, bad incentives, and impossible schedules.

In many offices:

• Hygienists feel pressure to keep it light

• Doctors feel pressure to keep production flowing

• Patients feel confused when treatment suddenly changes tone

The real culprit isn’t people, it’s lack of clarity around periodontal diagnosis, coding, and communication.

When teams don’t fully understand:

• When perio begins

• Which code matches which condition

• How to explain it confidently

• How insurance actually responds

…the safest feeling option becomes:
Just bill the prophy and move on.

Unfortunately, that’s also the most expensive option long term.

The Hidden Cost of “Free Dentistry”
Every bloody prophy quietly says:

• We’ll treat disease but pretend it’s healthy

• We’ll absorb the cost instead of addressing the diagnosis

• We’ll document less than we delivered

That’s not just lost revenue, that’s free dentistry with a paper trail that works against you.

You don’t need more patients.
You don’t need more hygiene days.
You don’t need to push treatment.

You just need alignment between:

• Diagnosis

• Documentation

• Delivery

• Billing

That’s not aggressive.
That’s accurate.

A Gentle Reframe (That Protects Everyone)
Instead of asking:

“How do we avoid upsetting patients or insurance?”

Try asking:

“How do we clearly describe what we are already seeing and doing?”

Because once perio is:

• Diagnosed correctly

• Charted clearly

• Explained calmly

The codes stop feeling scary.
The conversations stop feeling confrontational.
And the practice stops quietly leaking money and assuming risk.

Final Thought (With Love)
No one in dentistry is trying to harm patients.
No one is trying to commit neglect.
But intention doesn’t protect charts, documentation does.

If you’re doing perio,
Bill perio.
Document perio.
Explain perio.

Your patients deserve clarity.
Your bank account always deserves a boost.
And your practice deserves to stop giving away dentistry while absorbing all the risk.

And hey, if the gums are bleeding, let’s at least be honest about why.

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