CDT-2019 D4212


© 2018 American Dental Association

  1. Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant (D4210) and gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant (D4211) report periodontal related procedures.  Do not report D4210 or D4211 for restorative access, only for periodontal treatment.
  2. D4212 allows access for a restorative procedure, and is reported "per tooth."
  3. When removing inflamed or hypertrophied tissue around partially erupted or impacted teeth, report excision of pericoronal gingiva (D7971), also known as an operculectomy.


    1. D4212 reports gingivectomy or gingivoplasty to allow access for a restorative procedure, per tooth. The D4212 gingivectomy removes gingival tissue to provide access to the margins of a crown preparation or cavity preparation and may aid in placing a restoration or to improve the isolation of the preparation while taking an impression.
    2. Gingivectomy D4212 is reported on a “per tooth” basis.
    3. During the gingivectomy procedure (D4212) healthy gum tissue is removed to reduce pocket depths around teeth making the area easier to access and restore or to take an impression.  The gingivectomy is performed to access and restore suprabony pockets (pockets that are coronal to the bone level).
    4. For anatomical crown exposure, removing both gingival tissue and supporting bone, see D4230 and D4231.
    5. For gingivectomy to treat purely periodontal conditions, see D4210 or D4211.
    6. For clinical crown lengthening - hard tissue, see D4249.


    1. Most payers include "all soft tissue management procedures" in the global restorative fee.    Gingivectomies to allow access for restorative procedures (D4212) are not typically reimbursed in conjunction with routine crown preparations or other restorative procedures.  Gingivectomies may be considered a part of the crown procedure (soft tissue management or periodontal management) or restorative procedure by most payers when performed on the same day as the preparation of the crown or restorative procedure. Most PPO payers "disallow" the D4212 procedure. 
    2. Gingivectomy D4212 for restorative access is silent regarding how tissue is removed.  It may be removed by a variety of methods, including scalpel, electrosurgery, laser, etc.



    Gingivectomies for restorative access should ideally be followed by an appropriate healing period.  Failure to allow for an adequate healing period may result in the denial of the gingivectomy for restorative access (D4212) with some payers.  However, many payers will disallow D4212 even if the restoration is done on a subsequent date.




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