D4341 Dental Code: Scaling and Root Planing for 4+ Teeth

The short version

# D4341 Dental Code: Scaling and Root Planing for 4+ Teeth

D4341 is the CDT code for therapeutic scaling and root planing on four or more periodontally involved teeth in one quadrant. The chart must support periodontal disease, not only heavy calculus or bleeding, and the claim needs the correct quadrant. One weak film or an incomplete perio chart can hold up payment for the whole quadrant.

• Bill D4341 for one quadrant when at least four teeth in that quadrant need scaling and root planing because of documented periodontal disease.
• Use D4342 when only one to three teeth qualify. Empty spaces and healthy teeth don't raise the count to four.
• Cigna's 2026 guideline requires qualifying teeth to have pockets of at least 4 mm plus radiographic bone loss. Other plans can set different benefit criteria, so check the patient's policy.
• Delta Dental asks for diagnostic bitewings or periapicals, periodontal probing from the past 12 months, and sometimes chart notes with the periodontal stage and grade.
• In a worked PPO example, a $320 quadrant fee becomes a $240 contracted allowable. At an 80% benefit, the plan pays $192, the patient owes $48, and the office posts an $80 adjustment.
• Put the quadrant, qualifying tooth numbers, six-site probing, attachment loss, bleeding, bone loss, diagnosis, and treatment plan in the submission.

What is D4341?

D4341 reports nonsurgical periodontal treatment on four or more teeth in one quadrant. The dentist or hygienist instruments the crowns and root surfaces to remove deposits and contaminated material. The service is therapeutic treatment for periodontal disease. It isn't a preventive cleaning and it isn't reported as one full-mouth unit.

The ADA's March 2026 Code Maintenance Committee report kept the existing D4341 entry after rejecting a proposed wording change.

When do you bill D4341?

Bill D4341 when four or more teeth in the same quadrant have periodontal findings that call for scaling and root planing. The ADA's SRP claim guide ties the treatment to periodontitis and says the initial definitive nonsurgical treatment can be scaling and root planing.

• Count only the diseased teeth that receive the procedure in that quadrant.
• Document clinical attachment loss or radiographic bone loss that isn't explained by a non-periodontal cause.
• Record probing, bleeding, recession, mobility, and furcation findings where they apply.
• Use the quadrant oral-cavity designator: 10 upper right, 20 upper left, 30 lower left, or 40 lower right.
• If treatment crosses the midline, count the qualifying teeth separately in each quadrant and report the code that fits each side.

Cigna publishes a clear benefit threshold: four or more teeth with pockets at least 4 mm deep and bone loss support D4341.

D4341 vs D4342, D4346, and D4355

The deciding facts are the diagnosis, the number of involved teeth per quadrant, and whether the dentist could complete the evaluation before treatment.

The common error is filling out a quadrant with teeth that didn't receive root planing. The ADA's payer examples say tooth-bounded spaces don't count and that one to three qualifying teeth belong under D4342. If a plan changes D4341 to D4342, compare its tooth-by-tooth finding with the submitted perio chart before you post the difference.

D4355 solves a different problem. It removes enough deposits for the dentist to complete an evaluation at a later visit.

What does insurance actually do with D4341?

D4341 benefits depend on the plan's clinical threshold, timing rule, and attachment review. Cigna's 2026 guidelines allow D4341 when four or more teeth in the quadrant have pockets of 4 mm or deeper plus bone loss. Cigna doesn't allow it when the films show no bone loss, when no tooth meets the pocket threshold, when it's incidental to another periodontal procedure, or when D4910 occurs on the same date.

Minnesota Health Care Programs requires authorization for D4341 and D4342, requires the quadrant designator, and bars D1110 or D4355 on the same day. The ADA's claim guide also notes that plans may limit retreatment, sometimes to one benefit in 24 months, and may question more than two quadrants completed on one date.

• Office fee: $320
• Contracted allowable: $240
• Contractual adjustment: $80
• Plan payment at 80%: $192
• Patient coinsurance: $48

Why does D4341 get denied?

• Fewer than four teeth in the reported quadrant meet the plan's criteria, so the payer considers D4342 instead.
• The perio chart shows pocketing but doesn't show attachment loss, or the submitted radiographs don't show bone loss.
• The bitewings or periapicals are too old, cut off the bone level, aren't labeled, or don't show every treated tooth.
• The claim shares a date with D1110, D4355, D4910, or a periodontal surgery that the plan treats as inclusive.
• The same quadrant was treated inside the plan's retreatment limit, or more than two quadrants were completed without an explanation.

Don't turn a clinical denial into a patient balance until you read the contract and EOB.

What documentation gets D4341 paid?

1. State the periodontal diagnosis, including stage and grade when recorded by the dentist.
2. List the treated quadrant and every qualifying tooth number.
3. Attach a complete periodontal chart from the past 12 months with six sites per involved tooth, bleeding, recession, and attachment findings.
4. Attach diagnostic bitewings or periapicals that show bone height, root surfaces, and furcations for all treated teeth. A panoramic image alone doesn't meet the ADA guide's preferred SRP image standard.
5. Include the treatment plan and a short narrative when more than two quadrants were treated on one date, including the clinical reason and anesthesia details.
6. Check prior D4341 and D4342 dates for the same quadrant before submission.

Common questions about D4341

Can you bill all four quadrants of D4341 on one day?

You can report the treatment that was completed, but some plans won't benefit more than two quadrants on one date without special circumstances. The ADA recommends a narrative when four quadrants are completed together. State why one visit was necessary, how long treatment took, and whether sedation, a medical condition, transportation, or another barrier affected the schedule.

Does a 4 mm pocket automatically support D4341?

No. A pocket number alone doesn't prove four teeth in a quadrant need root planing. Cigna requires both pockets of at least 4 mm and bone loss. The ADA guide says plans also review attachment loss, bleeding, root-surface calculus, and diagnostic images. Match the claim to the full periodontal record and the patient's plan.

Can D4341 and D4342 be billed in different quadrants on the same claim?

Yes, when the tooth count supports each code. A quadrant with four or more qualifying teeth uses D4341, while a different quadrant with one to three uses D4342. Put each code on its own claim line with the correct oral-cavity designator so the payer can see which finding belongs to which quadrant.

What happens after D4341 treatment?

The dentist reevaluates healing and sets the maintenance interval. Ongoing periodontal maintenance can be reported with D4910 when its requirements are met. Plan timing still matters: Minnesota, for example, ties D4910 benefits to a paid D4341 or D4342 line and allows one every 91 days for 730 days.

Check one SRP claim before it leaves

Don't send D4341 until you've matched four qualifying teeth to the reported quadrant.

Sources

• ADA, Claims Submission: Scaling and Root Planing
• ADA, D4341 and D4342 coding for scaling and root planing
• ADA, March 2026 Code Maintenance Committee report
• Delta Dental, clinical criteria and submission requirements
• Cigna, 2026 dental clinical coverage guidelines
• Minnesota Health Care Programs, Dental Services
• Oregon Medicaid, June 2025 fee schedule
• FAIR Health Consumer, dental cost lookup

CDT codes and nomenclature are copyright © American Dental Association. This guide explains the code in plain language; the current CDT manual is the authoritative source.