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Guide

Scaling and root planing claims: documentation and narratives (D4341, D4342)

By the Marathon team. Checked against the sources on . Updated .

The short answer

Payers pay scaling and root planing when the perio chart, the X-rays and the narrative all show the same disease on the same teeth, with the right count of qualifying teeth for D4341 or D4342. Most of the payer documents we reviewed want a chart from the last 6 to 12 months and recent images that show the bone, though the limits differ by payer and plan. A good narrative is built from this patient's chart, not pasted from a template.

About CDT codes

CDT is a registered trademark of the American Dental Association. Code descriptors are paraphrased.

Why scaling and root planing claims come back

The ADA says scaling and root planing claims are among those payers deny or question most, and its Council on Dental Benefit Programs wrote a full claims guide on them for that reason [1]. Plans differ, and the member's plan document can override a payer's general policy, so check the current document for the patient's plan before you rely on any rule here [5] [6].

How D4341, D4342, D4355 and D4910 relate

The descriptions below are our own plain summaries, not the ADA wording [2] [5] [6].

  • D4341: scaling and root planing in one quadrant where four or more teeth qualify [5] [6].
  • D4342: the same work where one to three teeth qualify [5]. In a payer policy the ADA reproduces, only diseased teeth count, not spaces where teeth are missing [1].
  • D4355: a first, full mouth removal of plaque and calculus when deposits are too heavy to chart, with the full periodontal evaluation at a later visit. Delta Dental of California and affiliates allows it once per lifetime [2].
  • D4910: ongoing periodontal care after active therapy. UnitedHealthcare does not consider it appropriate unless scaling and root planing or perio surgery came first [6].

The ADA says pockets caused by swollen or overgrown gum tissue, without attachment loss, should be reported as a cleaning (D1110) or D4346 [1] [2].

What payers look for

The claim must prove that the patient has periodontitis and that the code matches the teeth treated [1]:

  • Pocket depth. Many payers name 4 mm as the starting point [4] [8], though Aetna says depth alone does not decide the benefit [5].
  • Attachment loss, measured from a fixed point, usually the cementoenamel junction (CEJ), so payers trust it more than probing depth [1]. Aetna requires the record to show it [5].
  • Bleeding on probing, charted [5] [9].
  • Crestal bone loss visible on the radiographs, which Aetna requires [5].
  • Root surface calculus on the radiographs [5], though heavy calculus without attachment loss is not enough at UnitedHealthcare [6].
  • A diagnosis. Delta Dental of California and affiliates may ask for stage and grade [2] [3]; Delta Dental of Michigan asks for an AAP classification with prognosis and risk factors [9].

Delta Dental's bone loss number changed between two of its own documents

The 2025 Clinical Criteria handbook from Delta Dental of California and affiliates, effective January 1, 2025, says the images must show bone loss past the usual 1 to 1.5 mm gap between the bone crest and the CEJ [2]. Its FYI article dated June 15, 2026 sets the bar at 2.0 mm or more from the crest to the CEJ [3]. Delta Dental member companies publish their own documents, so check with the one that covers the patient before you rely on either number.

UnitedHealthcare has written AAP staging into its policy. Its Non-Surgical Periodontal Therapy policy, DCP004.14, effective March 1, 2026, lists scaling and root planing for AAP Stage II to IV periodontitis with Grade B or C, or for a periodontal abscess [6]. Other payers use their own tests.

Perio chart age limits and X-ray requirements by payer

Perio chart age and X-ray requirements for D4341 and D4342, by payer document
Payer and documentPerio chart ageX-rays asked forSource
Delta Dental of California and affiliates, 2025 handbookProbing within the past 12 monthsBitewings showing bone in both arches, or periapicals; bitewings within 12 months of planned treatment[2]
Delta Dental of Michigan, February 2026 criteriaSix point charting within 12 monthsA full mouth series with bitewings, taken before treatment, showing bone loss at the treated teeth[9]
Delta Dental of Washington, clinical criteria (undated)For the treated quadrants, within 12 months of treatmentRecent dated images of the treated quadrants showing bone loss; a panoramic by itself is refused[10]
Aetna, September 2026 guidelinesCurrent and dated, six depths per tooth; no number of months statedFull mouth images with bone loss visible and no markings; general rule under 36 months[5]
Cigna, PPO and indemnity, May 2026 guidelinesCurrent, within six months, with missing teeth notedRecent full mouth series or bitewings covering the treated area, with bone loss visible[8]
UnitedHealthcare, commercial review guideline 2026Complete six point charting; no number of months statedCurrent, dated full series or panoramic; no numeric age[7]
Humana, attachment guide (October 2024)No older than one year on the date of serviceImages taken before treatment that show the mouth as it is now; no numeric age[12]
Anthem Blue Cross and Blue Shield, commercial (undated)Current and dated, with attachment levels, recession and attached gingiva in mmDated preoperative periapical within 12 months[11]

Where a row gives no age, the document states none, which is not the same as no limit. The ADA prefers bitewings showing bone height and furcations and recommends against panoramic images for this service [1].

Common denial reasons

Delta Dental of California and affiliates and the ADA have both published what goes wrong [1] [4]:

  1. No perio chart, or a chart outside the payer's date window [4] [8] [9].
  2. Images that do not show bone loss, or no attachment loss on the chart [1] [4].
  3. Images that are not diagnostic or labeled, or incomplete charts [1].
  4. A panoramic, or marked radiographs, sent to a payer that does not accept them [1] [5] [10].
  5. D4341 billed for a quadrant where fewer than four teeth qualify, so the payer pays D4342 or denies [1] [4].
  6. Pockets that read as 4 mm but come from swollen tissue rather than attachment loss [1].
  7. More than two quadrants in one day with no reason given [1].
  8. Retreatment inside the frequency window, usually 24 months [1] [8].

The narrative: facts to pull from the chart

A narrative restates what the chart and images show and adds nothing the record does not support. The treating dentist answers for the claim's accuracy, so staff should raise any doubt with the dentist before sending [1].

Why we do not give a fill-in template

Paste-ready narratives are risky. A dental billing company's guide warns that one generic narrative used again and again can catch an examiner's eye and add to audit risk, and that copying an old one forward can bring along details from someone else's case [13].

  • Diagnosis with stage and grade, and the chart date [2] [6] [9].
  • Quadrant, qualifying teeth and their count, matched to the code [1] [4] [5].
  • Per tooth: deepest probing depth, attachment loss and bleeding sites [1] [4] [5].
  • Where bone loss and calculus show on the images, bone level to the CEJ in millimeters, and the image date [1] [2] [3] [5].
  • Local anesthetic and appointment length [5].
  • The reason for more than two quadrants in one visit [1].
  • Earlier scaling and root planing dates, and risk factors such as smoking [8] [9].

If a fact is not in the chart, leave it out. Check that every number matches the attached chart and images [1].

How Marathon helps

Marathon drafts the scaling and root planing narrative from the facts in the patient's perio chart and attaches the perio chart and X-rays to the claim. Your team reviews the draft, edits it where needed, and sends the claim. The dentist stays responsible for what the claim says.

Sources

  1. Claims Submission: Scaling and Root Planing (SRP), long version, American Dental Association, Council on Dental Benefit Programs. Dated September 19, 2022. Retrieved October 22, 2026.
  2. Clinical Criteria: 2025 Claims Processing Policies and Procedures, Delta Dental of California and affiliates. Dated January 1, 2025. Retrieved October 22, 2026.
  3. CDT code spotlight: scaling and root planing (FYI Online), Delta Dental of California and affiliates. Dated June 15, 2026. Retrieved October 22, 2026.
  4. How to Avoid Common Claim Documentation Gaps (FYI Online), Delta Dental of California and affiliates. Dated July 16, 2026. Retrieved October 22, 2026.
  5. Dental Claim Documentation Guidelines, Aetna. Dated September 22, 2026. Retrieved October 22, 2026.
  6. Non-Surgical Periodontal Therapy, Dental Clinical Policy DCP004.14, UnitedHealthcare Dental. Dated March 1, 2026. Retrieved October 22, 2026.
  7. National Standardized Dental Claim Review Guidelines (Commercial Only), DRG042.21, UnitedHealthcare. Dated January 1, 2026. Retrieved October 22, 2026.
  8. Dental Clinical Coverage Determination Guidelines, Dental PPO and Indemnity Plans (05/26), Cigna Healthcare. Retrieved October 22, 2026.
  9. Clinical Criteria for Periodontal Scaling and Root Planing (282.15), Delta Dental of Michigan. Dated February 18, 2026. Retrieved October 22, 2026.
  10. Clinical criteria guidelines, Delta Dental of Washington. Retrieved October 22, 2026.
  11. Dental claims review submission requirements (Dental, Commercial), Anthem Blue Cross and Blue Shield. Retrieved October 22, 2026.
  12. Claim attachment guidelines, Humana. Dated October 9, 2024. Retrieved October 22, 2026.
  13. Building Dental Claim Narratives That Work (secondary source, vendor article), eAssist Dental Solutions. Dated July 24, 2026. Retrieved October 22, 2026.

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This article was written in collaboration with AI and checked against its sources by the Marathon team.

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