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FYI

Partnering with you to help create healthy smiles

CDT code spotlight: scaling and root planing

Jun 15, 2026

By Delta Dental

Are you aware of the latest guidance on how adjunctive services are handled when provided with scaling and root planing? Follow these best practices to reduce errors.
 

How should gingival irrigation and specialized techniques be billed?

No separate charge may be billed to Delta Dental or the patient for gingival irrigation (D4921) or specialized techniques such as laser therapy or perioscopy (often billed as D4999) when performed as part of scaling and root planing (D4341/D4342).

Billing these services separately can lead to member questions and complaints and may increase claim follow-up for your office.

Clinical literature indicates there is a lack of evidence supporting routine use of these adjunctive services as add-ons:
 

  1. Gingival irrigation provides minimal additional benefit and should not be routinely used.¹
  2. Laser therapy and perioscopy show limited or case-dependent effectiveness.²,³
     

Do not bill these adjunctive services separately when performed with scaling and root planing so claims process smoothly and members have a consistent experience.
 

What documents should be included with scaling and root planing claims?

To help avoid claim delays, please include the following documents with scaling and root planing claims:
 

  • Bitewing radiographs taken within 12 months of the planned treatment that show both arches and bone levels, or periapical radiographs. A loss of alveolar crest height of 2.0 mm or greater (distance to the cementoenamel junction [CEJ]) must be evident on radiographs.
  • Periodontal charting (probing) done within past 12 months.
  • Chart notes including periodontal stage and grade, regarding the necessity of the periodontal treatment may also be requested.

    ¹ Worthington HV, Clarkson JE, Bryan G, et al. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev. 2013;11:CD004625.
    ² American Academy of Periodontology. Lasers in periodontal therapy position statement. J Periodontol. 2018.
    ³ American Dental Association. Current Dental Terminology (CDT) 2024. ADA; 2024