D4346 is the CDT code for scaling in the presence of generalized moderate or severe gingival inflammation, performed full mouth after an oral evaluation. It applies when significant gingival inflammation exists but periodontal bone loss does not. This distinction is what separates D4346 from both scaling and root planing (D4341/D4342) and from adult prophylaxis (D1110).
Last updated June 2026 ยท Reviewed by the PracticeAlpha billing team
Get help with D4346 claims →The patient presents with generalized moderate or severe gingival inflammation affecting multiple areas of the mouth. Clinical signs include erythema, edema, bleeding on probing, and increased probing depths due to edematous tissue, but radiographs show no bone loss.
Radiographic evidence confirms no alveolar bone loss. The condition is gingivitis, not periodontitis. If bone loss is present in any quadrant, the affected quadrant(s) require D4341 (scaling and root planing, 4 or more teeth) instead.
The CDT descriptor requires D4346 to be performed after an oral evaluation. A comprehensive (D0150), periodic (D0120), or comprehensive periodontal (D0180) evaluation must precede or accompany the procedure. Document the evaluation date and findings clearly.
Do NOT use D4346 for: Patients with healthy or only mildly inflamed gingiva (use D1110 prophylaxis). Patients with radiographic bone loss in any quadrant (use D4341 scaling and root planing per affected quadrant). Localized gingival inflammation affecting only one or two teeth. Perio maintenance visits for patients previously treated for periodontitis (use D4910).
D4346 requires no bone loss. If the x-rays show any alveolar bone loss, the diagnosis shifts to periodontitis, and D4341 per quadrant (or D4342 for 1-3 teeth) is the appropriate code. Billing D4346 when bone loss is documented is a coding error that auditors and payers flag. Review radiographs carefully before choosing between D4346 and D4341.
The clinical notes must support generalized moderate or severe gingival inflammation. Vague charting such as "patient has some gum issues" does not meet the standard. Document probing depths, bleeding on probing sites, presence of edema, erythema, and that the involvement is generalized (affecting multiple quadrants or a majority of sites). A full periodontal chart is the strongest supporting record.
The CDT descriptor ties D4346 to a prior oral evaluation. If an evaluation has not been billed or documented, many payers will deny D4346 outright. Schedule and document the evaluation before performing the scaling. Keep the evaluation date in the patient record and reference it in the clinical note for D4346.
D4346 was introduced in 2017 and some plans have not added it to their benefit tables. When a payer receives a code outside its schedule, it returns a non-covered denial. Verify coverage during eligibility checks. If the payer does not cover D4346, consider whether D1110 or D4341 (if clinically appropriate) would be covered, and have a financial conversation with the patient before treatment.
Six-point probing per tooth, bleeding on probing, recession, and furcation involvement. This is the primary clinical record that supports the diagnosis of generalized moderate or severe gingival inflammation and the absence of bone loss.
Full-mouth series or panoramic radiograph taken within an appropriate time frame. Radiographs must show no alveolar bone loss. Include the image date in the clinical record. If bone loss appears on x-rays, D4346 is not the correct code.
Document the date and type of evaluation (D0120, D0150, or D0180) that preceded the D4346 scaling. Reference this in the clinical note. If the evaluation and scaling occur on the same day, confirm the patient's plan allows same-day billing before submitting.
State the diagnosis explicitly: generalized moderate gingivitis or generalized severe gingivitis. Describe the clinical findings supporting the diagnosis. Note that the condition is generalized (not localized to one area). Reference the probing data, bleeding index, and tissue appearance.
Some payers request a narrative explaining why D4346 was chosen over D1110 or D4341. Prepare a brief clinical summary: inflammation severity, probing findings, absence of bone loss on radiographs, and why a standard prophylaxis was not sufficient.
Perio claims getting downgraded or denied? We audit the coding, documentation, and follow-up that cause it.
Learn about our billing servicesD4346 is the CDT code for scaling in the presence of generalized moderate or severe gingival inflammation, full mouth, after an oral evaluation. It is used when significant gingival inflammation is present but no periodontal bone loss exists. It sits between a routine prophylaxis (D1110) and scaling and root planing (D4341) on the clinical severity spectrum.
D4341 is scaling and root planing per quadrant and requires documented periodontal bone loss. D4346 is full-mouth scaling for generalized moderate or severe gingival inflammation with no bone loss. If radiographs show bone loss, D4341 applies to the affected quadrant(s). If there is no bone loss, D4346 applies for the full mouth.
D1110 is an adult prophylaxis appropriate for patients with healthy gingiva or mild gingivitis. D4346 is reserved for patients with generalized moderate or severe gingival inflammation. The clinical distinction is severity and extent. Billing D1110 when the chart documents moderate or severe generalized inflammation is a coding error.
The CDT descriptor requires D4346 to be performed after an oral evaluation. Many payers require the evaluation to be a separate visit, though some allow same-day billing. Always verify with the patient's specific plan before scheduling both procedures on the same day.
Common reasons include: bone loss visible on radiographs (D4341 applies instead); insufficient documentation of generalized moderate or severe inflammation; no prior oral evaluation on record; frequency conflicts with a recent prophylaxis or scaling; and payer non-coverage of the code.
Coverage varies. D4346 was added to the CDT in 2017, and some older or budget-tier plans may not include it in their benefit tables, resulting in a non-covered denial. Others classify it under periodontics at the basic or major benefit level. Verify coverage and frequency limitations during eligibility verification before treatment.
Search all 206 CDT codes in our dental coding guide.