D4210 is the CDT code for gingivectomy or gingivoplasty involving four or more contiguous teeth or bounded spaces per quadrant. It covers surgical removal or reshaping of gingival tissue to eliminate periodontal pockets or correct gingival architecture. Billed per quadrant.
Last updated June 2026 · Reviewed by the PracticeAlpha billing team
Get help with D4210 claims →Persistent suprabony periodontal pockets that have not responded to scaling and root planing. Tissue removal is needed to reduce pocket depth and allow the patient to maintain better hygiene access.
Drug-induced or idiopathic gingival overgrowth that causes pseudopockets, makes hygiene difficult, or creates an environment for recurring inflammation. Surgical recontouring restores normal gingival architecture.
When gingival tissue removal alone (without osseous surgery) is sufficient to expose adequate tooth structure for restorative purposes or to correct altered passive eruption.
Do NOT use D4210 for: Procedures involving one to three teeth in a quadrant (use D4211). Procedures involving bone removal or recontouring (use D4260 osseous surgery). Flap procedures designed primarily for root planing access (use D4240 or D4241). Laser de-epithelialization without tissue excision when a different code is more accurate.
Payers expect a full periodontal chart with pocket depths, bleeding on probing, and recession recorded at multiple sites per tooth. A narrative alone without charting data is routinely denied. Include the chart from the date of diagnosis and from just before surgery.
Most plans require proof that scaling and root planing (D4341 or D4342) was completed and re-evaluated before approving surgical intervention. If you perform D4210 without a documented SRP history, expect a denial. Include dates and quadrants of prior SRP.
Gingivoplasty performed solely to reshape healthy tissue for aesthetic purposes is typically not covered. If the clinical indication is genuine periodontal disease, document it explicitly. Pocket depths, bone levels, and inflammatory signs must support a non-cosmetic indication.
Current periapical or bitewing radiographs are expected to accompany surgical claims. The x-rays should show bone levels relative to the teeth involved. Radiographs older than 12 months may be rejected. Submit recent films with the claim.
Six-point pocket depths, bleeding on probing, recession, furcation involvement, and mobility for all teeth in the treated quadrant. Charting from multiple dates showing disease progression or lack of response to non-surgical treatment strengthens the claim.
Periapical films covering the quadrant being treated. Radiographs should demonstrate bone levels and any alveolar defects. Date the films. Submit images that are recent enough to reflect the current clinical presentation.
Dates, quadrants, and clinical notes from scaling and root planing, plus the re-evaluation appointment showing that pockets did not fully resolve. This establishes the step-therapy requirement most plans impose before approving surgical codes.
Document why surgical intervention is now indicated. Reference specific pocket depths that persist, tissue morphology that cannot be corrected non-surgically, or gingival enlargement characteristics. Be clinical and specific, not vague.
Verify whether the patient's plan requires prior authorization for periodontal surgical procedures. Submit with charts, radiographs, and clinical notes. Record the authorization number in the patient file and include it on the claim form.
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Learn about our billing servicesD4210 is the CDT code for gingivectomy or gingivoplasty on four or more contiguous teeth or bounded spaces per quadrant. It covers surgical removal or reshaping of gingival tissue to eliminate periodontal pockets or correct gingival contour. It is billed per quadrant.
D4210 applies when four or more contiguous teeth or bounded spaces in the same quadrant are involved. D4211 is for one to three contiguous teeth per quadrant. Count the teeth in the treated area within the quadrant to determine which code applies.
Common denials result from insufficient periodontal charting, no documented prior non-surgical treatment, the payer classifying the procedure as cosmetic, or missing radiographs. Thorough documentation including pocket depths and prior SRP records is essential.
A comprehensive periodontal chart with pocket depths, bleeding on probing, and recession; current periapical radiographs; records of prior scaling and root planing with re-evaluation; and clinical notes explaining why surgical removal or reshaping is indicated.
D4341 is non-surgical removal of calculus and root surface smoothing without cutting tissue. D4210 is surgical excision of gingival tissue. D4210 is typically indicated after D4341 has been attempted and pockets persist. Most plans require documented SRP history before approving D4210.
Coverage varies by plan. Many plans cover D4210 as a periodontal surgical benefit, commonly at 50 to 80 percent of the allowed fee after the deductible. Some plans require prior authorization or a waiting period. Verify benefits and authorization requirements before treatment.
Search all 206 CDT codes in our dental coding guide.