This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.

Note: Periodontal maintenance includes implant crowns.

WATCH

1. Ongoing periodontal maintenance (D4910) does not include the periodic oral evaluation (D0120) or comprehensive periodontal evaluation (D0180). The periodic oral evaluation (D0120) or D0180 is submitted as a separate procedure on the same date of service. The oral evaluation (D0120 or D0180) is generally provided twice per year, and is subject to the typical "one evaluation per six months" or "two evaluations per year" limitation. For a comprehensive periodontal evaluation of an established periodontal patient provided on a periodic basis consider reporting D0180. Note: The reimbursement for D0180 might be re-mapped as D0120 and may create patient confusion. If the more extensive and time consuming D0180 is performed, report what you do.

2. Some offices report one D0180 and one D0120 per year for periodontal recall patients. Some offices have two consistent, but different, fee levels for D0180, depending on whether the procedure is provided for the new (entering the practice) or established (recall) D4910 patient. For instance, the D0180 fee for recall might be $12-$15 higher than the D0120 fee. See D0180 for details.

MATCH

1. Periodontal maintenance (D4910) follows active periodontal therapy: scaling and root planing procedures (D4341/ D4342), gingival flap surgery (D4240/D4241) or osseous surgery (D4260/D4261). The periodontal maintenance patient (D4910) must have undergone either SRP or periodontal surgery (gingival flap or osseous surgery) prior to periodontal maintenance (D4910). Periodontal maintenance (D4910) is ongoing and therapeutic in nature, not preventive. It includes implant crowns. Typically there is a ninety day exclusion period following active treatment. Active periodontal treatment may be reported as D4341, D4342, D4240, D4241, D4260, or D4261. If a recare appointment is provided to evaluate tissue healing after SRP within the ninety day exclusion period, consider reporting D0171 re-evaluation - post operative. See D0171.

The ongoing periodontal maintenance (D4910) interval is typically ninety days but the frequency is determined by individual need. Some authorities deem it improper for the same practitioner to alternate D4910 with a prophylaxis (D1110). However, a patient alternating between the GP and periodontist might receive alternating D1110s and D4910s. The periodontist could provide ongoing periodontal maintenance (D4910) while the GP office provides prophylaxis in support of good periodontal health. Prophylaxis is preventive in nature and is not a statement of oral health. It therefore does not preclude subsequent periodontal therapy. Be advised, however, that very few payors terminate D4910 coverage if prophylaxis (D1110) is provided in the periodontal treatment sequence. Some payors assert that the patient cannot be a periodontal patient one visit, and a prophy visit the next, alternating between a diseased and healthy state, while other payors could care less, and often encourage it.

2. Once the patient is in ongoing periodontal maintenance (D4910) following active periodontal therapy, they could remain in D4910 status. While bone loss is irreversable, active periodontal disease is episodic. It can come and go. If the patient's periodontal status improves (to good health), then a return to regular prophylaxis (D1110) could be appropriate. This change may occur; however it may take one year or more for the issue to resolve following root planing and scaling (D4341) therapy. This change from periodontal disease to health is not the rule, but the exception. When the patient moves from periodontal disease to a condition of health and prophylaxis (D1110) is provided, then a subsequent sequence of SRP (D4341/D4342) could be required before D4910 would be reimbursed again. SRP (D4341 or D4342) typically has a twenty four or thirty six month frequency limitation with most plans.


3. Although most periodontal patients will require periodontal maintenance for a lifetime, the American Dental Association's Council on Dental Benefit Programs gives dentists some discretion when reporting D1110 and D4910. Per the CDT 2025 Coding Companion: "If the dentist determines that the patient's periodontal health can be augmented with periodic routine prophylaxis procedures (removal of plaque, calculus and stains from the tooth structures for the purpose of controlling local irritational factors), then this service should be performed and reported as D1110 or D1120, depending on the state of the dentition". Nothing in D4910 or D1110/D1120 code nomenclatures or descriptors make these procedures mutually exclusive.

COMMENTS

1. Patients who require periodontal maintenance have periodontal disease and have been treated non-surgically (D4341/D4342) and/or surgically (D4240/D4241 or D4260/ D4261). Periodontal maintenance is performed in the presence of active disease whereas a prophylaxis (D1110) is performed to prevent disease but does not mean no disease is present. D4910 is performed to maintain the periodontal condition of the patient as a result of prior nonsurgical and/or surgical periodontal treatment. Periodontal maintenance includes removing any new plaque and calculus that may have formed since the patient's last periodontal therapy appointment as well as site specific scaling and root planing where indicated, and polishing the teeth. The descriptor clearly states D4910 does not preclude the need for additional diagnostic and treatment procedures if new or recurring periodontal disease develops. Additional scaling and root planing, locally delivered antimicrobials (D4381), or periodontal surgery may be necessary when there is evidence of new disease that presents subsequently.

2. D4910 is a full mouth code and does not require reporting of an area of the oral cavity.

LIMITATIONS

1. Reimbursement for ongoing periodontal maintenance D4910 is highly variable. Some plans may not reimburse D4910 at all or some may reimburse D4910 two to four times during a 12-month period. The average policy provides reimbursements for two D4910 and two prophylaxes (D1110) during a 12-month period. Even though the contract reimburses certain procedures at a frequency greater than every six months, you are bound to always report what you do. Since plan limitations are highly variable when providing D4910, request an alternate benefit of a prophylaxis (D1110) in the event D4910 is not a covered benefit. Benefits are highly variable. Some plans will provide reimbursement more frequently for diabetic or pregnant patients.

2. Some payors (i.e., some Deltas) will pay D4910 indefinitely. Many other payors may only pay D4910 for a limited period of 24 or 36 months and then the patient must requalify for SRP. If they do requalify for SRP after 24 or 36 months, then typically SRP is reimbursed and can then again be followed by D'4910.

3. D4910 may be reimbursed at a 50-80% fee (unlike the typical payor's 100% reimbursement fee for a prophylaxis), and may also be subject to a deductible. Payors may reimburse D4910 as preventive, basic or major. Reimbursement for D4910 is highly variable.

4. A prophylaxis (D1110) may be considered a part of D4910 by payors in the ongoing periodontal maintenance regimen. The clinical record should reflect the fact that a prophylaxis (scaling and polishing) was completed as part of the overall D4910 procedure.

5. Some payors require that only osseous surgery (D4260/D4261) qualifies for D4910 reimbursement. However, in general SRP treatment will qualify for ongoing periodontal maintenance (D4910) reimbursement.

6. D4921 reports periodontal pocket irrigation using medicinal agents, e.g., chlorhexidine, per quadrant. However, payors typically consider gingival irrigation a part of the global D4910. PPO contracts may disallow for the use of gingival irrigation in periodontal maintenance. See D4921 for comments.

7. D9910 describes desensitizing medicaments applied to a single tooth or up to the entire mouth. Payors typically consider the application of desensitizing medicaments to the entire mouth a part of the global D4910. PPO contracts may disallow for the use of D9910 with periodontal treatments.

NARRATIVES

1. If benefit plans change administrators or there is change in employment, it is important to provide the new payor a narrative for the first D4910 claim (to turn the periodontal coverage switch "on") describing a history of active therapy (scaling and root planing (SRP) or osseous surgery). Provide the same information from the patient's history when the patient returns from the periodontal office. When previous periodontal treatment history is not noted in the "remarks" section, D4910 may be denied by the subsequent plan. For documentation, submit current periodontal charting and a.narrative stating that the patient is in ongoing periodontal maintenance therapy and the date of active treatment.

2. Consider filing a claim when reporting D4910 with the following narrative: "If periodontal maintenance (D4910) is denied, please provide the alternate benefit of a prophylaxis (D1110). The ongoing periodontal maintenance (D4910) visit included a prophylaxis (D1110)." The clinical notes should reflect the fact that a prophylaxis was provided as a part of the D4910 procedure. Because payors consider D1110 a part of periodontal maintenance, expect reimbursement of the alternate benefit of a prophylaxis.

3. When submitting the initial D4910 claim, identify the date that active treatment SRP or osseous surgery was performed. Include a current periodontal chart with a claim of D4910. Consider a narrative: "This patient underwent SRP on mm/dd/yy" or "This patient underwent osseous surgery on mm/dd/yy at Dr. Smith's office." State which quadrants had SRP and on what date. "See attached periodontal chart."