# Scaling and root planing (SRP) claim narrative builder and templates — D4341 / D4342 > What should a scaling and root planing (D4341 / D4342) claim narrative include? Payer-checked scenario templates, the published criteria behind them, and a builder that assembles a narrative from your charted findings. URL: https://dentovio.com/dental-claim-narratives/d4341-scaling-and-root-planing Last verified: 2026-08-30 Dentovio is an independent publisher — not a dental payer, the ADA, X12, or any government agency. This page was drafted with AI assistance and verified against the primary sources linked here. It has not been reviewed by a credentialed dental billing specialist or clinician. The templates and the builder assemble sentences from entries you make; they do not generate clinical content, and they state only what you record. The payer criteria shown are those payers' published documentation rules as read on the last-verified date; individual plan contracts still control coverage, frequencies, and exclusions, and payers revise policy documents on their own schedules. Educational billing reference only, not billing, legal, or clinical advice. CDT codes are referenced by number only; CDT codes and descriptors are the property of the American Dental Association. This page provides educational billing guidance only and does not reproduce ADA copyrighted descriptors. ## Direct answer A scaling and root planing narrative should state the periodontal diagnosis, the charted probing depths and the charting method and date, the radiographic findings, the teeth and quadrants treated with the code each quadrant supports, the chart-note facts the payer asks for, and the attachments submitted. There is no pocket-depth number to hit: Aetna's DCPB041 carries no millimetre figure at all, and the ADA records that payers set their own criteria, which differ from payer to payer and from one customer to another inside a single payer's book of business. What the published criteria do share is evidence — six-point charting with bleeding on probing, radiographic bone loss, and chart notes naming the anaesthetic and the chair time. Write only what the chart documents; a narrative that outruns the chart is worse than a denial. ## Published thresholds, payer by payer | Payer | Published threshold | | --- | --- | | Aetna | No numeric threshold published; the documentation rules are listed on the criteria page | | Delta Dental (Delta Dental Ins. enterprise) | No numeric threshold published; the documentation rules are listed on the criteria page | | United Concordia | Radiographically demonstrable bone loss | | Guardian | Radiographic supporting-structure pathology plus charted findings attributable to attachment loss | ## Scenario templates ### SRP narrative example - generalized Stage II periodontitis, D4341 + D4342 Two quadrants treated on one date, one with four teeth and one with three, so the same claim carries both codes. ``` EXAMPLE - NOT A PATIENT RECORD. The findings below are a Dentovio sample written to show the shape of a narrative. No clinician charted them and no patient was examined. Do not submit this document; build your own from what your chart documents. EXAMPLE - NOT A PATIENT RECORD - CLAIM NARRATIVE - SCALING AND ROOT PLANING D4341 (upper right, 4 teeth) / D4342 (lower right, 3 teeth) Patient: [PATIENT NAME] - DOB: [DATE OF BIRTH] - Member ID: [MEMBER ID] Date of service: [DATE OF SERVICE] Treating provider: [PROVIDER NAME, CREDENTIALS] - NPI: [NPI] Diagnosis: generalized periodontitis, Stage II, Grade B. Six-point full-mouth periodontal charting completed within the past 12 months records probing depths of 4-6 mm at the qualifying sites, with bleeding on probing recorded. Full-mouth radiographs taken within the past 12 months show generalized horizontal bone loss, with calculus visible on the root surfaces. Scaling and root planing was performed on teeth #2, #3, #4, and #5 (upper right quadrant, 4 teeth - D4341) and on teeth #29, #30, and #31 (lower right quadrant, 3 teeth - D4342). Local anesthetic: 2% lidocaine with 1:100,000 epinephrine, 2 carpules. Appointment duration: 60 minutes, documented in the chart notes. No scaling and root planing has been performed in these quadrants within the past 24 months. Attachments: six-point periodontal charting (dated); full-mouth radiographs (unannotated). EXAMPLE - NOT A PATIENT RECORD. No clinician charted the findings above. Replace every one of them with what your own chart documents before anything goes to a payer. ``` Remarks-line variant (241 characters, including the EXAMPLE marker): ``` EXAMPLE - NOT A PATIENT RECORD - D4341 UR (#2-5) + D4342 LR (#29-31); gen periodontitis St II/Gr B; 6-pt charting <12mo, PD 4-6mm w/ BOP; FMX <12mo: gen horizontal bone loss + root calculus; no SRP these quads <24mo. Charting + FMX attached. ``` Before you use this, your chart must show: - the teeth treated in each quadrant, by Universal tooth number - whether these quadrants were scaled and root planed before, and when - periodontal charting, with the method recorded - the date the charting was completed - the probing depths recorded at the qualifying sites - bleeding on probing recorded at the charted sites - the periodontal diagnosis recorded in the chart notes - diagnostic radiographs of the treated quadrants - the date the radiographs were taken - radiographic evidence of bone loss - radiographic root-surface calculus, where the payer accepts it - the type and amount of local anesthetic in the chart notes - the appointment duration in the chart notes Satisfies the published criteria of: Aetna; Delta Dental (Delta Dental Ins. enterprise); United Concordia; Guardian. Criteria met is not coverage; the plan contract controls. ### SRP narrative example - four quadrants, Stage III periodontitis with vertical defects Full-mouth treatment with deeper pockets and vertical bony defects, all four quadrants coded D4341. ``` EXAMPLE - NOT A PATIENT RECORD. The findings below are a Dentovio sample written to show the shape of a narrative. No clinician charted them and no patient was examined. Do not submit this document; build your own from what your chart documents. EXAMPLE - NOT A PATIENT RECORD - CLAIM NARRATIVE - SCALING AND ROOT PLANING D4341 (upper right, 4 teeth) / D4341 (upper left, 4 teeth) / D4341 (lower left, 4 teeth) / D4341 (lower right, 4 teeth) Patient: [PATIENT NAME] - DOB: [DATE OF BIRTH] - Member ID: [MEMBER ID] Date of service: [DATE OF SERVICE] Treating provider: [PROVIDER NAME, CREDENTIALS] - NPI: [NPI] Diagnosis: generalized periodontitis, Stage III, Grade B. Six-point full-mouth periodontal charting completed within the past 12 months records probing depths of 5-8 mm at the qualifying sites, with bleeding on probing recorded. Full-mouth radiographs taken within the past 12 months show generalized horizontal bone loss with vertical defects, with calculus visible on the root surfaces. Scaling and root planing was performed on teeth #2, #3, #4, and #5 (upper right quadrant, 4 teeth - D4341), on teeth #12, #13, #14, and #15 (upper left quadrant, 4 teeth - D4341), on teeth #18, #19, #20, and #21 (lower left quadrant, 4 teeth - D4341), and on teeth #28, #29, #30, and #31 (lower right quadrant, 4 teeth - D4341). Local anesthetic: 2% lidocaine with 1:100,000 epinephrine, 4 carpules. Appointment duration: 90 minutes, documented in the chart notes. No scaling and root planing has been performed in these quadrants within the past 24 months. Attachments: six-point periodontal charting (dated); full-mouth radiographs (unannotated). EXAMPLE - NOT A PATIENT RECORD. No clinician charted the findings above. Replace every one of them with what your own chart documents before anything goes to a payer. ``` Remarks-line variant (289 characters, including the EXAMPLE marker): ``` EXAMPLE - NOT A PATIENT RECORD - D4341 UR (#2-5) + D4341 UL (#12-15) + D4341 LL (#18-21) + D4341 LR (#28-31); gen periodontitis St III/Gr B; 6-pt charting <12mo, PD 5-8mm w/ BOP; FMX <12mo: horizontal + vertical bone loss + root calculus; no SRP these quads <24mo. Charting + FMX attached. ``` Before you use this, your chart must show: - the teeth treated in each quadrant, by Universal tooth number - whether these quadrants were scaled and root planed before, and when - periodontal charting, with the method recorded - the date the charting was completed - the probing depths recorded at the qualifying sites - bleeding on probing recorded at the charted sites - the periodontal diagnosis recorded in the chart notes - diagnostic radiographs of the treated quadrants - the date the radiographs were taken - radiographic evidence of bone loss - radiographic root-surface calculus, where the payer accepts it - the type and amount of local anesthetic in the chart notes - the appointment duration in the chart notes Satisfies the published criteria of: Aetna; Delta Dental (Delta Dental Ins. enterprise); United Concordia; Guardian. Criteria met is not coverage; the plan contract controls. ### D4342 narrative example - two teeth in one quadrant, listed by tooth number A partial quadrant, where United Concordia asks for individual tooth numbers rather than a quadrant indicator. ``` EXAMPLE - NOT A PATIENT RECORD. The findings below are a Dentovio sample written to show the shape of a narrative. No clinician charted them and no patient was examined. Do not submit this document; build your own from what your chart documents. EXAMPLE - NOT A PATIENT RECORD - CLAIM NARRATIVE - SCALING AND ROOT PLANING D4342 (lower left, 2 teeth) Patient: [PATIENT NAME] - DOB: [DATE OF BIRTH] - Member ID: [MEMBER ID] Date of service: [DATE OF SERVICE] Treating provider: [PROVIDER NAME, CREDENTIALS] - NPI: [NPI] Diagnosis: localized periodontitis, Stage II, Grade A. Six-point full-mouth periodontal charting completed within the past 12 months records probing depths of 4-5 mm at the qualifying sites, with bleeding on probing recorded. Bitewing and periapical radiographs taken within the past 12 months show localized horizontal bone loss, with calculus visible on the root surfaces. Scaling and root planing was performed on teeth #18 and #19 (lower left quadrant, 2 teeth - D4342). Local anesthetic: 4% articaine with 1:100,000 epinephrine, 1 carpule. Appointment duration: 45 minutes, documented in the chart notes. No scaling and root planing has been performed in these quadrants within the past 24 months. Attachments: six-point periodontal charting (dated); bitewing and periapical radiographs (unannotated). EXAMPLE - NOT A PATIENT RECORD. No clinician charted the findings above. Replace every one of them with what your own chart documents before anything goes to a payer. ``` Remarks-line variant (227 characters, including the EXAMPLE marker): ``` EXAMPLE - NOT A PATIENT RECORD - D4342 LL (#18-19); loc periodontitis St II/Gr A; 6-pt charting <12mo, PD 4-5mm w/ BOP; BW+PA <12mo: loc horizontal bone loss + root calculus; no SRP these quads <24mo. Charting + BW+PA attached. ``` Before you use this, your chart must show: - the teeth treated in each quadrant, by Universal tooth number - whether these quadrants were scaled and root planed before, and when - periodontal charting, with the method recorded - the date the charting was completed - the probing depths recorded at the qualifying sites - bleeding on probing recorded at the charted sites - the periodontal diagnosis recorded in the chart notes - diagnostic radiographs of the treated quadrants - the date the radiographs were taken - radiographic evidence of bone loss - radiographic root-surface calculus, where the payer accepts it - the type and amount of local anesthetic in the chart notes - the appointment duration in the chart notes Satisfies the published criteria of: Delta Dental (Delta Dental Ins. enterprise); Guardian. Criteria met is not coverage; the plan contract controls. ### Medicaid SRP narrative example - full charting, AAP case type, radiographic findings The fuller documentation profile a Medicaid manual tends to want: complete six-point charting rather than a screening, the AAP case type where the chart records one, and the radiographic findings named. ``` EXAMPLE - NOT A PATIENT RECORD. The findings below are a Dentovio sample written to show the shape of a narrative. No clinician charted them and no patient was examined. Do not submit this document; build your own from what your chart documents. EXAMPLE - NOT A PATIENT RECORD - CLAIM NARRATIVE - SCALING AND ROOT PLANING D4341 (upper right, 4 teeth) / D4341 (upper left, 4 teeth) Patient: [PATIENT NAME] - DOB: [DATE OF BIRTH] - Member ID: [MEMBER ID] Date of service: [DATE OF SERVICE] Treating provider: [PROVIDER NAME, CREDENTIALS] - NPI: [NPI] Diagnosis: generalized periodontitis, Stage III, Grade B. AAP case type III is documented in the periodontal charting. Six-point full-mouth periodontal charting completed within the past 12 months records probing depths of 5-7 mm at the qualifying sites, with bleeding on probing recorded. Full-mouth radiographs taken within the past 12 months show generalized horizontal bone loss, with calculus visible on the root surfaces. Scaling and root planing was performed on teeth #2, #3, #4, and #5 (upper right quadrant, 4 teeth - D4341) and on teeth #12, #13, #14, and #15 (upper left quadrant, 4 teeth - D4341). Local anesthetic: 2% lidocaine with 1:100,000 epinephrine, 2 carpules. Appointment duration: 60 minutes, documented in the chart notes. No scaling and root planing has been performed in these quadrants within the past 24 months. Attachments: six-point periodontal charting (dated); full-mouth radiographs (unannotated). EXAMPLE - NOT A PATIENT RECORD. No clinician charted the findings above. Replace every one of them with what your own chart documents before anything goes to a payer. ``` Remarks-line variant (242 characters, including the EXAMPLE marker): ``` EXAMPLE - NOT A PATIENT RECORD - D4341 UR (#2-5) + D4341 UL (#12-15); gen periodontitis St III/Gr B; 6-pt charting <12mo, PD 5-7mm w/ BOP; FMX <12mo: gen horizontal bone loss + root calculus; no SRP these quads <24mo. Charting + FMX attached. ``` Before you use this, your chart must show: - the teeth treated in each quadrant, by Universal tooth number - whether these quadrants were scaled and root planed before, and when - periodontal charting, with the method recorded - the date the charting was completed - the probing depths recorded at the qualifying sites - bleeding on probing recorded at the charted sites - the periodontal diagnosis recorded in the chart notes - the AAP case type, where the payer requires it - diagnostic radiographs of the treated quadrants - the date the radiographs were taken - radiographic evidence of bone loss - radiographic root-surface calculus, where the payer accepts it - the type and amount of local anesthetic in the chart notes - the appointment duration in the chart notes Satisfies the published criteria of: Aetna; Delta Dental (Delta Dental Ins. enterprise); United Concordia; Guardian. Criteria met is not coverage; the plan contract controls. ### SRP retreatment narrative example - same quadrant, more than 24 months later A quadrant treated before, with the interval stated so the frequency rule can be read off the narrative. ``` EXAMPLE - NOT A PATIENT RECORD. The findings below are a Dentovio sample written to show the shape of a narrative. No clinician charted them and no patient was examined. Do not submit this document; build your own from what your chart documents. EXAMPLE - NOT A PATIENT RECORD - CLAIM NARRATIVE - SCALING AND ROOT PLANING D4341 (lower right, 4 teeth) Patient: [PATIENT NAME] - DOB: [DATE OF BIRTH] - Member ID: [MEMBER ID] Date of service: [DATE OF SERVICE] Treating provider: [PROVIDER NAME, CREDENTIALS] - NPI: [NPI] Diagnosis: localized periodontitis, Stage III, Grade C. Six-point full-mouth periodontal charting completed within the past 12 months records probing depths of 5-7 mm at the qualifying sites, with bleeding on probing recorded. Full-mouth radiographs taken within the past 12 months show vertical bony defects, with calculus visible on the root surfaces. Scaling and root planing was performed on teeth #28, #29, #30, and #31 (lower right quadrant, 4 teeth - D4341). Local anesthetic: 2% lidocaine with 1:100,000 epinephrine, 3 carpules. Appointment duration: 75 minutes, documented in the chart notes. No scaling and root planing has been performed in these quadrants within the past 24 months. Attachments: six-point periodontal charting (dated); full-mouth radiographs (unannotated). EXAMPLE - NOT A PATIENT RECORD. No clinician charted the findings above. Replace every one of them with what your own chart documents before anything goes to a payer. ``` Remarks-line variant (216 characters, including the EXAMPLE marker): ``` EXAMPLE - NOT A PATIENT RECORD - D4341 LR (#28-31); loc periodontitis St III/Gr C; 6-pt charting <12mo, PD 5-7mm w/ BOP; FMX <12mo: vertical defects + root calculus; no SRP these quads <24mo. Charting + FMX attached. ``` Before you use this, your chart must show: - the teeth treated in each quadrant, by Universal tooth number - whether these quadrants were scaled and root planed before, and when - periodontal charting, with the method recorded - the date the charting was completed - the probing depths recorded at the qualifying sites - bleeding on probing recorded at the charted sites - the periodontal diagnosis recorded in the chart notes - diagnostic radiographs of the treated quadrants - the date the radiographs were taken - radiographic evidence of bone loss - radiographic root-surface calculus, where the payer accepts it - the type and amount of local anesthetic in the chart notes - the appointment duration in the chart notes Satisfies the published criteria of: Aetna; Delta Dental (Delta Dental Ins. enterprise); United Concordia; Guardian. Criteria met is not coverage; the plan contract controls. ## What the payers require | Requirement | Payers requiring it | Which payers | | --- | --- | --- | | Periodontal charting | 4 of 4 | Aetna; Delta Dental (Delta Dental Ins. enterprise); United Concordia; Guardian | | Radiographic evidence | 3 of 4 | Aetna; United Concordia; Guardian | | Quadrant and tooth counts | 2 of 4 | United Concordia; Guardian | | Chart notes | 1 of 4 | Aetna | ### Aetna - Periodontal charting that records pocket depths at 6 points per tooth, with indications of bleeding on probing (DCPB041) - Full-mouth radiographs or digital images (unannotated/unmarked) (DCPB041) - Chart notes documenting the duration of the appointment and the type and amount of local anesthetic administered (DCPB041) - Diagnostic materials that demonstrate clinical loss of periodontal attachment, radiographic evidence of crestal bone loss or changes in crestal lamina dura, and radiographic evidence of root surface calculus Sources: - [Aetna Dental Clinical Policy Bulletins index (44 bulletins)](https://www.aetna.com/health-care-professionals/clinical-policy-bulletins/dental-clinical-policy-bulletins.html) - [Aetna Dental and Oral Surgery Claim Documentation Guidelines, last updated July 21, 2025 (PDF)](https://www.aetna.com/content/dam/aetna/pdfs/aetna-dental/claim-documentation-guidelines.pdf) - [Aetna DMO/PCD Dental Office Guide, Section VIII — Procedure Guidelines, revised December 15, 2025 (PDF)](https://www.aetnadental.com/professionals/pdf/DMO%20PCD%20DOG%20-%20Section%20VIII%20-%20Proc%20Guidelines.pdf) ### Delta Dental (Delta Dental Ins. enterprise) - Submitted periodontal charting must be dated no more than 12 months prior to the date of service Sources: - [Delta Dental Ins. Clinical Criteria / Utilization Management, Section 4, effective January 1, 2025 pending state regulatory approval (PDF)](https://www1.deltadentalins.com/content/dam/ddins/en/pdf/dentists/provider-tools/clinical-criteria-utilization-management.pdf) - [Delta Dental FYI — claim tips for core buildups and crown lengthening, December 2, 2022](https://www1.deltadentalins.com/dentists/fyi-online/2022/claim-tips-core-buildups.html) - [Delta Dental Federal Government Programs Dental Office Handbook 2026 (PDF)](https://www1.deltadentalins.com/content/dam/ddins/en/pdf/affiliate-sites/common/dental-office-handbook-2026.pdf) - [Delta Dental of North Carolina — Dentist Handbook, January 1, 2026 (PDF)](https://deltadentalnc.com/hubfs/Delta%20Dental%20Dentist%20Handbook%202026.pdf) ### United Concordia - Full-mouth series X-rays with high resolution and contrast demonstrating bone loss - Full diagnostic charting showing the pocket depth at six key points around each tooth - Individual tooth numbers — not just quadrant indicators — for D4342 Sources: - [United Concordia Dental Clinical Policy (PPO), last update 5.1.26 — public behind a no-login acknowledgement (PDF)](https://www.unitedconcordia.com/content/dam/ucd/en/commercial/website/docs/dentists/UCD-clinical-policy-PPO.pdf) - [United Concordia Dental Reference Guide — Medical Assistance DE, PA, WV, Volume 2026 Issue 1 (PDF)](https://www.unitedconcordia.com/content/dam/ucd/en/commercial/website/docs/dentists/DE-PA-WV-Medicaid-DRG.pdf) - [United Concordia — Scaling and Root Planing Claims: Getting It Right (PDF)](https://www.unitedconcordia.com/content/dam/ucd/en/commercial/website/docs/transcripts/Scaling%20and%20Root%20Planing%20Claims%20Getting%20it%20Right.pdf) - [United Concordia Dental FEDVIP brochure, 2025 plan year — Section 5, Periodontal Services (OPM)](https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/BrochureJson?brochureNumber=United%20Con&year=2025) ### Guardian - Radiographic evidence of pathology in the tooth-supporting structures - Periodontal charting with findings attributable to loss of attachment - Use D4342 when the treated quadrant contains fewer than four teeth Sources: - [Guardian provider toolkit — public clinical-guidelines link](https://www.guardianlife.com/providers/toolkit) - [Guardian Dental Clinical Guidelines 2026, updated August 12, 2026 (PDF)](https://storage.pardot.com/503851/1786988624j5KmwrmM/Dental_Clinical_Guidelines_2026_August.pdf) - [Guardian DentalGuard Preferred network dentist manual, stamped 08.25.2025 (PDF)](https://storage.pardot.com/503851/1778176336KbJRzZWQ/DENTALGUARD_PREFERRED_NETWORK_DENTIST_MANUAL.pdf) ## Why these narratives get denied ### Why SRP claims get denied for the charting The commonest documentation gap is the charting itself. Aetna's DCPB041 asks for pocket depths recorded at six points per tooth with bleeding on probing indicated, and United Concordia asks for the same six-point charting. Delta Dental Ins. adds a date requirement: scaling and root planing is not on its charting-exemption list, and submitted charting must be dated no more than 12 months before the date of service. A quadrant charted at three points, or charted two years ago, fails those rules before the reviewer reaches the narrative. ### Why the radiographs decide an SRP claim The published criteria tie the benefit to radiographic evidence rather than to a probing number. Aetna's DCPB041 asks for full-mouth radiographs or digital images, unannotated and unmarked, and for diagnostic materials showing clinical attachment loss, crestal bone loss or lamina dura change, and root-surface calculus. United Concordia asks for a full-mouth series with high resolution and contrast demonstrating bone loss, and Guardian asks for radiographic pathology in the tooth-supporting structures. Images that do not show the finding the payer names will not carry the claim, however deep the pockets are. ### Why D4341 gets downcoded to D4342 D4341 and D4342 are separated by the number of teeth treated in the quadrant, not by the difficulty of the appointment. Guardian directs D4342 when the treated quadrant contains fewer than four teeth, and United Concordia asks for individual tooth numbers rather than quadrant indicators on D4342. This builder derives the code from the teeth you select and only ever derives downward. ## Common questions ### What should an SRP narrative include? The periodontal diagnosis, the charting method and date with the probing depths recorded, the radiographic findings, the teeth and quadrants treated with the code each quadrant supports, the chart-note facts the payer names, and the list of attachments. Every one of those is a fact from the chart, which is why this builder assembles the narrative from entries rather than writing prose for you. ### Does D4342 need individual tooth numbers? United Concordia's scaling and root planing claims guide asks for individual tooth numbers rather than quadrant indicators on D4342. This builder lists the teeth by Universal number for every quadrant, so a quadrant indicator and a tooth list are satisfied by the same sentence. ### What pocket depth do payers require for scaling and root planing? None of the payer documents read for this page publishes one. Aetna's DCPB041 carries no millimetre figure anywhere; it keys on six-point charting with bleeding on probing, radiographic crestal bone loss or lamina dura change, and radiographic root-surface calculus. The 4 mm figure circulating in billing content is a literature convention the ADA itself disclaims: it records that dentistry differs on pocket-depth benchmarks, so payers establish their own criteria, which can differ from payer to payer and from one customer to another inside a single payer's book of business. Two claims to the same payer with similar charts can be adjudicated differently because the patients sit under different employer group policies. Chart the depths you actually measured and let the diagnosis and the radiographs carry the claim. ### Can I copy an SRP narrative example straight into my claim? Not without changing it to match your chart. Payer reviewers and auditors compare narratives to charts, so copying an example that says 5-6 mm pockets when the chart says 3 mm is worse than a denial. Every template on this page carries the list of findings your chart must already show, and the builder assembles the narrative from your own entries instead. ## What this builder will not do — on purpose - **It will not write findings you have not charted.** Every sentence traces to a field you filled. An unmet payer criterion becomes a warning, never wording — payer reviewers and auditors compare narratives to charts, and a narrative that outruns the chart is worse than a denial. - **It will not suggest a different code.** D4341 vs D4342 follows the CDT tooth-count definition from your entries — downward only. No upgrade prompts, no “consider billing” anything. - **It has no path for a same-day emergency-visit (D9110) narrative.** The goal is a claim that is right the first time, not a bigger one. - **It never asks for patient information.** Names, birth dates, member IDs, and dates of service render as [PLACEHOLDERS] you fill inside your own practice-management system. Nothing you type here leaves your browser. - **It does not remember your entries either.** Nothing you type is saved to this browser — reload the page and the form is empty. On a shared front-desk computer that is the point: one patient's charted findings cannot still be sitting on screen for the next one. - **A worked example is labelled as one, inside the file.** The sample findings on this page were written by Dentovio and charted by nobody. Copy or download one and the marker travels with it — in the title, in the first line, in the closing line, and in the filename — so a specimen can never be mistaken for a record of care. - **A met checklist is not a coverage promise.** These are the payers' published documentation criteria, cited with verification dates. The patient's plan contract still controls coverage, frequencies, and exclusions — and Delta Dental is 39 independent member companies; confirm yours. - **Where a payer publishes nothing, we say so.** MetLife's current criteria sit behind a provider login; we show the last public edition, dated, and tell you to confirm. We do not paraphrase billing blogs into “requirements.” - Educational reference, not billing, legal, or clinical advice. The treating provider reviews and owns every claim. CDT codes and descriptors are the property of the American Dental Association. This page provides educational billing guidance only and does not reproduce ADA copyrighted descriptors. ## Build one from your own charted findings The builder at https://dentovio.com/dental-claim-narratives/d4341-scaling-and-root-planing assembles a narrative from entries you make in the browser. It requests no patient information, transmits nothing, and states only what you record. ## Related - [All narrative templates](https://dentovio.com/dental-claim-narratives/index.html.md) - [Scaling and root planing (SRP) payer documentation requirements](https://dentovio.com/dental-claim-documentation/d4341-scaling-and-root-planing/index.html.md) - [Dental claim denial codes](https://dentovio.com/dental-claim-denial-codes/index.html.md) - [Dental billing and claims hub](https://dentovio.com/dental-billing/index.html.md)