List of Periodontal Dental Codes by ADA

American Dental Association® | Updated October 2024

Other Periodontal Dental Codes

D4210 gingivectomy or gingivoplasty – four or more contiguous teeth or tooth bounded spaces per quadrant

D4211 gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant

D4212 gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth

D4230 anatomical crown exposure – four or more contiguous teeth or tooth bounded spaces per quadrant

D4231 anatomical crown exposure – one to three teeth or tooth bounded spaces per quadrant

D4240 gingival flap procedure, including root planing – four or more contiguous teeth or tooth bounded spaces per quadrant

D4241 gingival flap procedure, including root planing – one to three contiguous teeth or tooth bounded spaces per quadrant

D4245 apically positioned flap

D4249 clinical crown lengthening – hard tissue

D4260 osseous surgery (including elevation of a full thickness flap and closure) – four or more contiguous teeth or tooth bounded spaces per quadrant

D4261 osseous surgery (including elevation of a full thickness flap and closure) – one to three contiguous teeth or tooth bounded spaces per quadrant

D4263 bone replacement graft – retained natural tooth – first site in quadrant

D4264 bone replacement graft – retained natural tooth – each additional site in quadrant

D4265 biologic materials to aid in soft and osseous tissue regeneration

D4266 guided tissue regeneration – resorbable barrier, per site

D4267 guided tissue regeneration – nonresorbable barrier, per site (includes membrane removal)

D4268 surgical revision procedure, per tooth

D4270 pedicle soft tissue graft procedure

D4273 autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant, or edentulous tooth position in graft

D4274 mesial/distal wedge procedure, single tooth (when not performed in conjunction with surgical procedures in the same anatomical area)

D4275 non-autogenous connective tissue graft (including recipient site and donor material) first tooth, implant, or edentulous tooth position in graft

D4276 combined connective tissue and double pedicle graft, per tooth

D4277 free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft

D4278 free soft tissue graft procedure (including recipient and donor surgical sites) each additional contiguous tooth, implant or edentulous tooth position in same graft site

D4283 autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous tooth, implant or edentulous tooth position in same graft site

D4285 non-autogenous connective tissue graft procedure (including recipient surgical site and donor material) – each additional contiguous tooth, implant or edentulous tooth position in same graft site

D4320 provisional splinting – intracoronal

D4321 provisional splinting – extracoronal

D4341 periodontal scaling and root planing – four or more teeth per quadrant

D4342 periodontal scaling and root planing – one to three teeth per quadrant

D4346 scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation

D4355 full mouth debridement to enable a comprehensive oral evaluation and diagnosis on a subsequent visit

D4381 localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth

D4910 periodontal maintenance

D4920 unscheduled dressing change (by someone other than treating dentist or their staff)

D4921 gingival irrigation – per quadrant

D4999 unspecified periodontal procedure, by report