Dentovio public answer
D4341 documentation requirements
Payer documentation thresholds for scaling and root planing genuinely differ: Cigna's published guidelines pay at pocket depths of 4 mm or deeper with radiographic bone loss, Aetna's claim-documentation guidelines state that documented 5–8 mm pockets generally determine benefits, and DentaQuest's Colorado manual requires radiographic bone loss of 2.5 mm or greater from the CEJ and rejects PSR screening outright. Submit 6-point periodontal charting, diagnostic radiographs showing bone loss, and quadrant tooth counts that match the code — then confirm the current rule in the payer's own policy document linked on this page.
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- Last verified
- 2026-08-28
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Source citations
- CLAIMDOC-SRP-AETNA Aetna DCPB041 — Scaling and Root Planing (aetna.com)
- CLAIMDOC-SRP-CIGNA Cigna Dental Coverage Determination Guidelines — DPPO, 2026 edition (PDF) (campaigns.cigna.com)
- CLAIMDOC-SRP-DELTA-DENTAL Delta Dental Ins. Clinical Criteria / Utilization Management (PDF) (www1.deltadentalins.com)
- CLAIMDOC-SRP-METLIFE MetLife Preferred Dentist Program Resource Manual (archived public PDF) (web.archive.org)
- CLAIMDOC-SRP-UNITED-CONCORDIA United Concordia — Scaling and Root Planing Claims: Getting It Right (PDF) (unitedconcordia.com)
- CLAIMDOC-SRP-DENTAQUEST DentaQuest Colorado Health First Office Reference Manual (PDF) (dentaquest.com)