Episode 88: How to Bill D4346 - From Bloody Prophy's to Perio Conversions
05/13/25 • 26 min
Got questions? Send Ericka a Text!
Are you leaving money on the table while your patients remain undertreated? After analyzing over 300 dental practices across the country, I discovered a shocking truth: the average dental practice with a full-time hygienist treats only 17% of the periodontal disease they diagnose. That means 83% of diagnosed disease goes completely untreated—a staggering gap between diagnosis and care.
This episode dives deep into the "hidden opportunity" within your hygiene department by exploring D4346: scaling in the presence of generalized moderate to severe gingival inflammation. This often-misunderstood code bridges the critical gap between a standard prophy (D1110) and scaling and root planing (D4341/D4342). For patients showing clear signs of gingivitis without bone loss—bleeding on probing, inflamed tissue, pseudopockets, and plaque that doesn't respond to routine cleaning—continuing to perform prophies isn't prevention; it's undertreatment.
I walk you through a comprehensive, step-by-step process for properly implementing D4346 in your practice, from accurate diagnosis and bulletproof documentation to effective patient education and ethical billing. We cover common challenges including insurance downgrades, particularly when carriers like Delta may pay less for D4346 than for a prophy, and how to handle these situations without compromising ethics or revenue. The key message: this code is based on diagnosis, not difficulty or time spent, and represents therapeutic care designed to heal tissue, not maintain it.
Whether you're a dental biller, office manager, hygienist, or dentist, this episode provides practical guidance for transforming your approach to gingivitis treatment. The benefits extend beyond proper coding—you'll deliver better care, improve patient outcomes, and optimize practice revenue. Pull a few charts this week and see how many of your "prophy patients" actually qualify for D4346. The results might surprise you.
Want to learn Dental Coding and Billing? Join here:
https://tr.ee/efzYrY7mp-
Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.
Email Ericka:
[email protected]
Schedule a call with Ericka:
https://calendly.com/ericka-dentalbillingdoneright/30min
Perio performance formula:
(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)
Got questions? Send Ericka a Text!
Are you leaving money on the table while your patients remain undertreated? After analyzing over 300 dental practices across the country, I discovered a shocking truth: the average dental practice with a full-time hygienist treats only 17% of the periodontal disease they diagnose. That means 83% of diagnosed disease goes completely untreated—a staggering gap between diagnosis and care.
This episode dives deep into the "hidden opportunity" within your hygiene department by exploring D4346: scaling in the presence of generalized moderate to severe gingival inflammation. This often-misunderstood code bridges the critical gap between a standard prophy (D1110) and scaling and root planing (D4341/D4342). For patients showing clear signs of gingivitis without bone loss—bleeding on probing, inflamed tissue, pseudopockets, and plaque that doesn't respond to routine cleaning—continuing to perform prophies isn't prevention; it's undertreatment.
I walk you through a comprehensive, step-by-step process for properly implementing D4346 in your practice, from accurate diagnosis and bulletproof documentation to effective patient education and ethical billing. We cover common challenges including insurance downgrades, particularly when carriers like Delta may pay less for D4346 than for a prophy, and how to handle these situations without compromising ethics or revenue. The key message: this code is based on diagnosis, not difficulty or time spent, and represents therapeutic care designed to heal tissue, not maintain it.
Whether you're a dental biller, office manager, hygienist, or dentist, this episode provides practical guidance for transforming your approach to gingivitis treatment. The benefits extend beyond proper coding—you'll deliver better care, improve patient outcomes, and optimize practice revenue. Pull a few charts this week and see how many of your "prophy patients" actually qualify for D4346. The results might surprise you.
Want to learn Dental Coding and Billing? Join here:
https://tr.ee/efzYrY7mp-
Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.
Email Ericka:
[email protected]
Schedule a call with Ericka:
https://calendly.com/ericka-dentalbillingdoneright/30min
Perio performance formula:
(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)
Previous Episode
Episode 87: Stop Verifying Insurance Like It's 1995
Got questions? Send Ericka a Text!
Dental insurance verification is stuck in the 1990s, but insurance companies have dramatically changed how they operate—leaving dentists with surprise balances, frustrated patients, and a mess of accounts receivable. In this eye-opening episode, I reveal how insurance carriers are secretly leasing networks behind the scenes and potentially pulling your practice into networks you never directly signed with.
Drawing from a recent consultation where a practice saw their AR spike by $70,000 due to inadequate verification, I walk through exactly why checking just the basics—deductibles, maximums, and coverage percentages—is no longer enough. The game has fundamentally changed. Through leased networks and umbrella plans like Connection Dental and DentaMax, carriers can apply completely different fee schedules than you expect, even when you think you're out of network.
Most importantly, I share the specific questions you must ask during insurance verification to protect your practice: Are we in-network or out-of-network with this specific plan? Are we directly contracted or leased through another network? Which fee schedule applies to our office for this plan? Does this patient's plan fall under a specific PPO tier, group or level? These questions will transform how you set up patient accounts and present treatment plans.
Ready to stop the bleeding and take control of your insurance verification process? Download my free verification checklist in the show notes and start mapping your complete network participation status today. Your billing department—and your bank account—will thank you.
Want to learn Dental Coding and Billing? Join here:
https://tr.ee/efzYrY7mp-
Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.
Email Ericka:
[email protected]
Schedule a call with Ericka:
https://calendly.com/ericka-dentalbillingdoneright/30min
Perio performance formula:
(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)
The Dental Billing Podcast - Episode 88: How to Bill D4346 - From Bloody Prophy's to Perio Conversions
Transcript
Hey friends , welcome back to another episode of the Dental Billing Podcast . I'm your host , Erika Aguilar . Before we dive into today's episode , I wanna tell you a little backstory . Before I started Fortune Billing Solutions , I worked with offices across the country to analyze their billing departments . I wasn't just logging into fixed claims or post payments like we do today . I
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