Optimizing D4341: A Claim Reviewer's Insight

September 2023
Dominique Fufidio, DDS, FAGD

I am a dentist, and when I introduce myself as a dentist I am inevitably asked, “Where do you practice?”  Then I explain that my expertise is now in dental insurance claims review and artificial intelligence. The ever-popular question is raised, “How do I get my claims paid?” I expect most readers to be interested in the answer. I mean, we all want to be paid for what we do! So in this article, I’m going to give you some insight into a commonly billed code: D4341/D4342 scaling and root planing.

Before I hung up the handpiece, I practiced conservative restorative dentistry and was proactive in treating early signs of periodontitis. I fought tooth and nail for my patients and for their scaling and root planing benefits reimbursement. I was largely successful, due to my attention to detail, desire for meticulous clinical documentation, and Type A nature. When I sold my practice, I transitioned to the payor market where I was clinically reviewing scaling and root planing claims. My world was turned upside down. There was a glass-shattering moment – or several – during my training sessions when I learned what insurance carriers are looking for when reviewing scaling and root planing claims for benefit reimbursement. So if you have asked the ever-popular question, “How do I get my scaling and root planing claims paid?” I encourage you to read on. 

It is a typical Monday morning in your office and you see your first new patient of the day. Your standard new patient examination includes the acquisition of a full mouth series of radiographs, 6-point periodontal probing, and complete soft and hard tissue assessment. Your new patient is 48 years old and has told you that they have not seen a dentist in 5 years. Your hygienist performs a preliminary soft tissue examination which reveals glossy gingiva with loss of stippling, rolled gingival margins, recession, and staining. Your hygienist alerts you of the inflammatory signs along with the presence of plaque, tenacious calculus, periodontal pocketing, and multi-site bleeding. Unsurprisingly, you diagnose your new patient with generalized periodontitis and the treatment recommended is scaling and root planning in all four quadrants. 

Treatment is scheduled and completed and your front office submits the periodontal charting record and the radiographs to your new patient’s dental insurance carrier for evaluation for medical necessity. Despite the             

About the Author

Dr. Dominique Fufidio, DDS, FAGD, is the founder and main coach at Fufidio Consulting Group (FCG). Dr. Fufidio has pioneered a unique coaching experience focused on teaching an understanding of the dental insurance claims review process and the rationale behind the decisions on the EOB. Dr. Fufidio has established herself as a successful, fee-for-service, former private practice owner, dental artificial intelligence co-creator, and top-performing dental claim reviewer and Utilization Review Director for the largest Utilization Review Agent in the United States. Now, she is on a mission to bring clinical alignment to dental providers and the dental insurance payor market, helping dental offices get paid for what they do!

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Fixed Partial Denture Repair

A single cast metal crown restoration that is retained, supported and stablized by an abutment on an implant; may be screw retained or cemented.

NOTE: May be orthodontic related