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Navigating Dental Codes with Kyle: D4260–Osseous Surgery Insights

• This specific code pertains to cases involving four or more contiguous teeth or tooth-bounded spaces within a quadrant.

When addressing cases with four or more teeth per quadrant, utilize this code. For situations involving fewer teeth, opt for D4261, applicable for 1-3 teeth within a quadrant.

• Before seeking benefits for osseous surgery, ensure completion of scaling and root planing and/or periodontal maintenance. Allow a minimum of six weeks for reevaluation before proceeding with osseous surgery.

• Periodontal charting must detail pocket depths of 5 mm or greater and should be dated within six months to facilitate approval for osseous surgery benefits.

• Many union plans limit reimbursement to a maximum of two quadrants per visit, and sometimes, only one quadrant per visit. Clarify these restrictions before initiating treatment.

• If multiple periodontal surgeries are performed on the same date of service and quadrant, such as osseous surgery and distal wedge, the insurance plan may only reimburse for the osseous surgery, considering the distal wedge as part of the comprehensive treatment.

Dental plans typically restrict the frequency of osseous surgery to once every 36 months. It's essential to verify your patient's insurance history for precise information.

Ensure submission of your 2024 ADA claim form, accompanied by periodontal charting, full-mouth x-rays, and a concise narrative explaining the necessity for treatment

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