D4245 is the CDT code for an apically positioned flap, a periodontal surgical procedure. The flap of gum tissue is reflected and repositioned toward the root apex, which helps preserve or increase the band of attached gingiva while the underlying condition is treated. It is a distinct procedure from gingival flap surgery and from crown lengthening, each of which has its own code.
Last updated June 2026 · Reviewed by the PracticeAlpha billing team
Get help with D4245 claims →Use D4245 when performing an apically positioned flap as a periodontal surgical procedure. A flap is raised and repositioned apically toward the root apex, which is done to preserve or increase the zone of attached gingiva while managing the periodontal condition at the site. The repositioning of the flap is the defining feature of this code.
Common clinical scenarios: A periodontal surgical site where maintaining or increasing attached gingiva is a goal of the flap design. A surgical procedure where the tissue is intentionally repositioned apically rather than replaced at the original level. A periodontal case where the apically positioned flap is the chosen surgical approach.
Do NOT use D4245 for: Gingival flap surgery with root planing on contiguous teeth (use D4240). Functional crown lengthening (use D4249). Soft tissue grafting procedures (use the appropriate graft codes such as D4273). A non-surgical periodontal procedure such as scaling and root planing.
Click any code to see the difference.
A flap is raised and repositioned toward the root apex to preserve or increase attached gingiva. The apical repositioning is the defining feature of this surgery.
Flap surgery including root planing for four or more contiguous teeth or bounded spaces per quadrant. The flap is reflected for access and replaced, not repositioned apically.
Billing tip: The flap design separates these codes. If the flap is repositioned apically, it is D4245. If it is access flap surgery with root planing that is replaced at the original level, it is D4240. The operative note should make the flap design and goal clear.
Periodontal surgery claims need supporting charting. Without probing depths and a diagnosis that supports surgical intervention, the payer cannot see why the apically positioned flap was indicated. Include the periodontal charting and the rationale for surgery in the record.
Reporting D4245 when the procedure was actually access flap surgery or crown lengthening is a coding error. Gingival flap surgery with root planing is D4240, and functional crown lengthening is D4249. The documented flap design and goal must match the code reported, or the claim is denied.
The operative note should describe the flap and its apical repositioning. A vague note that does not explain the surgery performed gives the payer no basis to approve it. Describe the flap design, the repositioning, and the management of the site.
Plans apply criteria for periodontal surgery coverage. If the site does not meet the plan's thresholds, the procedure may be denied even when clinically appropriate. Verify the plan's periodontal surgery criteria before treatment and document how the case meets them.
Include probing depths and the periodontal diagnosis that supports surgical intervention at the treated site.
Identify the specific teeth or area where the apically positioned flap was performed so the claim and record are consistent.
Describe the flap and its apical repositioning. This is what distinguishes D4245 from access flap surgery and crown lengthening.
Document the purpose, such as preserving or increasing attached gingiva, so the goal matches the code reported.
Note the plan's periodontal surgery criteria and how the case meets them, and keep the verification in the record.
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Learn about our billing servicesD4245 is the CDT code for an apically positioned flap, a periodontal surgical procedure. The gum tissue is reflected and repositioned toward the root apex to preserve or increase the band of attached gingiva while addressing the underlying condition.
D4240 is gingival flap surgery including root planing for four or more contiguous teeth or bounded spaces per quadrant. D4245 is specifically an apically positioned flap, where the flap is repositioned apically. The flap design and goal differ, so the procedures are coded separately.
No. Functional crown lengthening is reported with its own code, D4249. D4245 is an apically positioned flap performed as a periodontal procedure. While both can involve repositioning tissue, they have distinct codes and clinical purposes, so the documentation should match the code reported.
Yes. As a periodontal surgical procedure, D4245 needs charting that supports the diagnosis, such as probing depths, and a description of the surgical site. Payers expect documentation showing why the apically positioned flap was indicated.
D4245 is reported for the surgical site as defined in the code. Verify the plan's expectations for how the procedure is reported and ensure the documentation identifies the specific teeth or area treated so the claim is consistent.
Common reasons include insufficient periodontal documentation, confusing it with gingival flap surgery or crown lengthening, missing probing depths, no clear surgical description, and not meeting the plan's criteria for periodontal surgery.
Search all 206 CDT codes in our dental coding guide.