D9933 Dental Code: Scaling and Root Planing – Per Quadrant
Periodontal disease affects nearly 50% of adults over 30 in the U.S., making scaling and root planing (SRP) one of the most common periodontal treatments. The D9933 dental code specifically refers to scaling and root planing per quadrant, a critical procedure for managing gum disease.
This guide will provide an in-depth, breakdown of D9933, including its clinical applications, billing protocols, and patient management strategies. Whether you’re a dentist, hygienist, or billing specialist, this article will help you optimize periodontal care delivery.
2. Understanding the D9933 Dental Code
Definition and Purpose
D9933 is a Current Dental Terminology (CDT) code used to report scaling and root planing (SRP) performed in one quadrant of the mouth. Unlike prophylaxis (D1110), SRP targets subgingival calculus and bacterial biofilm beneath the gumline to halt periodontal disease progression.
When Is D9933 Used?
- Periodontal pocket depths ≥ 4mm with bleeding on probing (BOP)
- Clinical attachment loss (CAL) indicating early to moderate periodontitis
- Radiographic bone loss confirming active infection
3. Difference Between D4341, D4342, and D9933
| Code | Description | Coverage |
|---|---|---|
| D4341 | Periodontal scaling (when no SRP is needed) | Full mouth |
| D4342 | SRP – Four or more teeth per quadrant | Per quadrant |
| D9933 | SRP – One to three teeth per quadrant | Per quadrant |
Key Takeaway:
- D4341 is for mild inflammation without deep pockets.
- D4342 applies when four or more teeth in a quadrant need SRP.
- D9933 is used when 1-3 teeth in a quadrant require SRP.
4. Clinical Indications for D9933
Periodontal Disease and Diagnosis
- Gingivitis vs. Periodontitis:
- Gingivitis (reversible inflammation) → D1110 prophylaxis
- Periodontitis (irreversible bone loss) → D9933/D4342 SRP
- Diagnostic Tools:
- Probing depths (4mm+ warrants SRP)
- Radiographs (horizontal/vertical bone loss)
- Bleeding Index (30%+ sites bleeding indicates active disease)
5. Step-by-Step Procedure for D9933 (Per Quadrant)
Pre-Treatment Evaluation
- Review medical history (diabetes, smoking, medications affecting healing)
- Take baseline periodontal charting
Anesthesia and Patient Comfort
- Local anesthesia (lidocaine, articaine)
- Topical numbing for sensitive patients
Instrumentation Techniques
- Ultrasonic scalers (e.g., Piezo) for efficient calculus removal
- Hand scalers (Gracey curettes) for precise root planing
Post-Treatment Care
- Antimicrobial rinse (chlorhexidine 0.12%)
- Soft diet for 24-48 hours
- Follow-up in 4-6 weeks for re-evaluation
6. Billing and Insurance Considerations
Documentation Requirements
- Pre-op periodontal charting (6-point probing)
- Narrative notes justifying medical necessity
- Radiographic evidence of bone loss
Common Denials and Solutions
| Denial Reason | Solution |
|---|---|
| “Not medically necessary” | Submit probing depths + X-rays |
| “Incomplete documentation” | Ensure full periodontal charting |
| “Frequency limitation” | Verify patient’s prior SRP history |
7. Benefits of D9933 for Periodontal Health
- Reduces pocket depths by 1-2mm
- Decreases bacterial load preventing systemic inflammation
- Slows disease progression, delaying tooth loss
8. Potential Complications and Management
- Post-op sensitivity → Desensitizing agents (Gluma, fluoride varnish)
- Temporary loosening of teeth → Reassure patient (tightens with healing)
- Infection risk → Prescribe antibiotics if needed (amoxicillin 500mg TID)
9. Patient Education and Home Care
- Proper brushing technique (Bass method)
- Interdental cleaning (water flossers, interdental brushes)
- Smoking cessation counseling (improves healing)
10. FAQs About D9933
Q: How often can D9933 be billed?
A: Typically once per quadrant every 24 months, unless recurrence is documented.
Q: Does insurance cover D9933?
A: Most PPO plans cover 80% of SRP costs if medical necessity is proven.
Q: Is D9933 painful?
A: Local anesthesia ensures comfort; mild soreness may occur post-op.
11. Conclusion
D9933 (scaling and root planing per quadrant) is essential for managing periodontitis. Proper documentation, precise instrumentation, and patient compliance determine treatment success. By following this guide, dental professionals can optimize outcomes and ensure accurate billing.
12. Additional Resources
- AAP Periodontal Classification Guidelines (American Academy of Periodontology)
- CDC Report on Periodontal Disease (Centers for Disease Control)
- ADA CDT Code Manual (American Dental Association)
