CDT D4910: Periodontal Maintenance Procedures

CDT code D4910 represents periodontal maintenance procedures—routine, post-treatment dental services intended to maintain periodontal health following active therapy. Nationally, periodontal maintenance is a common, ongoing component of oral healthcare that supports long-term disease control and can influence utilization, access to follow-up care, and claims patterns across dental benefit plans. This code is relevant to dentists specializing in periodontics and general dental practice.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication outlines coverage contours across major commercial payers, highlights typical sites of service (dental offices), and summarizes clinical context for the procedure code.

Readers will learn: an overview of what CDT code D4910 covers clinically; which major commercial payers are referenced; how this code relates to ongoing periodontal care; and where related service-level context applies. The report notes where input data is incomplete by stating when specific metadata are not available. It does not provide clinical recommendations or state-level policy comparisons, focusing instead on national code purpose, payer coverage scope, and practical billing context for dental providers and policy analysts.

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Billing Code Overview

CDT code D4910 denotes periodontal maintenance procedures, a category of dental services focused on ongoing care following active periodontal therapy. These procedures aim to control periodontal disease, maintain oral health gains achieved through prior treatment, and prevent disease recurrence.

Service Type: Dentistry

Typical Site of Service: Dental Office (POS 11)

National Reimbursement Benchmarks

National mean allowed rates for CDT code D4910 place Medicare below commercial averages, with BUCA (the commercial average) at $72.27 and Medicare at $0.00 in the input. UnitedHealthcare and Blue Cross Blue Shield report the highest mean rates among commercial payers at $101.27 and $97.80, respectively, while Aetna and Cigna Health are lower at $52.61 and $55.40.

Rate dispersion (P75 minus P25) varies across payers: Blue Cross Blue Shield shows a wide dispersion of $37.40, UnitedHealthcare is relatively wide at $25.17, BUCA has a dispersion of $41.75, Aetna is moderate at $21.00, and Cigna Health is the tightest at $21.00. The table and chart below present the full breakdown of mean rates and percentile values.

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CDT D4910: Periodontal Maintenance Procedures

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Billing Code Overview

Service Type: Dentistry

Typical Site of Service: Dental Office (POS 11)

National Reimbursement Benchmarks

National Mean Rates for CDT code D4910 by Payer

Clinical & Coding Specifications

Clinical Context

A 56-year-old patient with a history of chronic periodontitis (K05.5) presents to a dental office (POS 11) for routine periodontal maintenance following previous active periodontal therapy. The patient undergoes a periodontal maintenance appointment that includes evaluation, removal of supragingival and subgingival plaque and calculus as indicated, and reinforcement of oral hygiene instructions. The workflow includes check-in, review of periodontal charting and previous treatment history, local anesthesia if needed, periodontal instrumentation and polishing, documentation of findings and any changes in pocket depths or bleeding on probing, and scheduling of the next maintenance interval.

Related Codes

D4920 — Unscheduled dressing change (by someone other than treating dentist or their staff)
- Relationship: An unscheduled dressing change may occur in the post-operative management of periodontal surgical sites; it is not a routine maintenance procedure and is used when a dressing placed after surgery requires change.
- Usage: Used as an adjunct service in the post-surgical period; not typically reported on the same visit as routine periodontal maintenance unless clinically indicated.
D4921 — Gingival irrigation with a medicinal agent – per quadrant
- Relationship: Gingival irrigation is a focused adjunctive procedure used to deliver a medicinal agent to the gingival crevice; it can be performed in patients who require additional antimicrobial therapy alongside mechanical maintenance.
- Usage: May be billed in addition to periodontal maintenance when irrigation is performed; can be used as an adjunct or alternative depending on clinical need.

D1208 – Topical application of fluoride - excluding varnish

D0150-COMPREHENSIVE-ORAL-EVALUATION-NEW-OR-ESTABLISHED

D0150 – Comprehensive oral evaluation – new or established patient

D2393-RESINBASED-COMPOSITE-THREE-SURFACES

CPT D2393: Resin-Based Composite Restoration, Three Surfaces, Posterior

D1206-TOPICAL-FLUORIDE-TREATMENT-EXCEPT-VARNISH-THERAPEUTIC

CPT D1206: Topical Fluoride Treatment for Moderate to High Caries Risk Patients

D1110-PROPHYLAXIS-ADULT-CLEANING-AND-POLISHING-OF-THE

CPT D1110: Adult Dental Cleaning and Polishing

D2160-AMALGAM-THREE-SURFACES-PRIMARY-OR

CPT D2160: Amalgam Filling, Three Surfaces, Primary or Permanent Tooth

D1120-

CPT D1120: Prophylaxis for Children, Preventive Dental Cleaning

D2391-RESINBASED-COMPOSITE-ONE-SURFACE

CPT D2391: Resin-Based Composite Restoration, One Surface, Posterior Tooth

D0140-LIMITED-ORAL-EVALUATION-PROBLEM

CPT D0140: Limited Oral Evaluation, Problem Focused

D4341-PERIODONTAL-SCALING-AND-ROOT-PLANING-FOUR-OR-MORE-TEETH-PER

CPT D4341: Periodontal Scaling and Root Planing, Four or More Teeth per Quadrant

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References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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