D4260 is the CDT code for osseous surgery including elevation of a full-thickness flap and closure on four or more contiguous teeth per quadrant. The procedure involves surgically reshaping or resecting the alveolar bone to create favorable bone architecture, in addition to root debridement under direct vision. Billed per quadrant.
Last updated June 2026 · Reviewed by the PracticeAlpha billing team
Get help with D4260 claims →Irregular bone morphology, vertical bone defects, ledges, or craters that cannot be corrected non-surgically. After non-surgical treatment and re-evaluation, surgical access is needed to reshape the bone and create an environment that supports long-term periodontal stability.
Pockets associated with infrabony defects where the base of the pocket extends below the level of the alveolar crest. Bone recontouring under direct vision is required to eliminate the defect and allow proper healing and pocket reduction.
Scaling and root planing completed and re-evaluated, but significant bone defects remain that contribute to persistent pocketing. Osseous surgery addresses the underlying bone architecture that non-surgical treatment could not correct.
Do NOT use D4260 for: Flap procedures without bone surgery (use D4240 or D4241). Procedures involving one to three teeth per quadrant (use D4261). Non-surgical scaling and root planing (use D4341 or D4342). Regenerative procedures that include bone grafts or membranes (those have separate codes such as D4263, D4264, D4266).
D4260 is among the most scrutinized periodontal surgical codes. Payers almost universally require evidence of completed scaling and root planing with a documented re-evaluation showing persistent disease before approving osseous surgery. Missing this step-therapy history is the single most common cause of denial. Include SRP dates, quadrants, and re-evaluation findings explicitly.
The claim needs full periodontal charting with six-point pocket depths, bleeding on probing, recession, and furcation status for every tooth in the treated quadrant. Multiple charting dates showing the disease course and the post-SRP re-evaluation chart are expected. Single-date or incomplete charting is a reliable path to denial.
Many plans require prior authorization before any periodontal surgical procedure. For D4260 specifically, the complexity and cost make pre-auth a near-universal requirement at major carriers. If authorization was required and not obtained before treatment, the claim may be denied or reimbursed at a reduced rate. Always verify before scheduling.
Payers expect radiographic evidence of alveolar bone loss consistent with the clinical findings and the quadrant treated. Bitewings or periapicals that are outdated, do not cover the surgical area, or do not demonstrate bone defects significant enough to warrant surgical intervention will trigger a denial or request for additional information.
Six-point pocket depths, bleeding on probing, recession, furcation classification, and mobility for all teeth in the quadrant. Include the initial diagnosis chart, the pre-SRP chart, and the re-evaluation chart taken after non-surgical treatment. The progression or persistence of disease across multiple dates is critical documentation.
Full-coverage periapical films of the treated quadrant showing alveolar bone levels, defect morphology, and root anatomy. Radiographs should be recent enough to reflect the current clinical presentation. Submit digital images where possible. Annotate or note which films correspond to the surgical site.
Dates and quadrants of scaling and root planing (D4341 or D4342) plus re-evaluation appointment notes documenting persistent pocket depths and bone defects after non-surgical treatment. The re-evaluation is what establishes that conservative therapy was attempted and was insufficient.
Detailed operative notes describing flap design, tissue reflected, bone defects encountered on direct visualization, osseous surgery performed (recontouring, resection, defect morphology addressed), root planing, and closure. Notes must confirm four or more contiguous teeth in the quadrant and explicitly describe the bone surgery component that differentiates this from D4240.
Obtain prior authorization before scheduling osseous surgery. Submit the auth request with charts, radiographs, and SRP history. Once approved, record the authorization number in the patient file and include it on the claim form. Do not proceed with surgery if authorization was required and not yet received.
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Learn about our billing servicesD4260 is the CDT code for osseous surgery including elevation of a full-thickness flap and closure on four or more contiguous teeth per quadrant. The procedure involves surgically reshaping or resecting the alveolar bone in addition to root debridement to create favorable bone architecture for periodontal health. Billed per quadrant.
D4240 involves reflecting a flap and root planing without surgically altering bone. D4260 is used when the procedure includes actual osseous recontouring, resection, or reshaping of the alveolar bone. If bone surgery is performed, D4260 is correct. If the flap is only for root access without bone work, D4240 applies.
Most denials stem from missing prior SRP documentation, incomplete periodontal charting, lack of pre-authorization, or radiographs that do not demonstrate bone defects supporting the need for osseous surgery. A well-documented treatment sequence from initial diagnosis through SRP re-evaluation is essential.
Multi-date periodontal charts with six-point pocket depths; current periapical radiographs showing bone defects; prior SRP records with re-evaluation notes; detailed surgical notes documenting flap design, osseous defects, bone surgery performed, and closure on four or more contiguous teeth; and prior authorization with the approval number recorded.
D4341 is non-surgical, closed debridement of root surfaces without a flap or bone surgery. D4260 is a surgical procedure involving full-thickness flap elevation and osseous recontouring. D4341 is the conservative first-line treatment. D4260 is indicated when re-evaluation after D4341 shows that bone defects require surgical correction.
Most plans require prior authorization for D4260. Submit the pre-auth package with periodontal charts, current radiographs, and prior SRP history before scheduling surgery. Missing required authorization is one of the most preventable causes of denial for osseous surgery claims.
Search all 206 CDT codes in our dental coding guide.