Date: August 1, 2019
To: Enrolled Dental Providers
Re: Adult Coverage of Current Dental Terminology (CDT) D4910 - Periodontal Maintenance Procedure
This notice informs dental providers that effective with dates of service on and after July 1, 2019, CDT Code D4910 - Periodontal Maintenance Procedure will be a covered dental benefit for adults ages 21 years and older. This code was previously only available for children through age 20.
This treatment may be provided after a patient receives either D4341 (Periodontal Scaling and Root Planing – 4 plus teeth) or D4342 (Periodontal Scaling and Root Planing – 1 to 3 teeth). Providers should no longer use D1110 (Adult Prophylaxis) for this service and instead use D4910.
Claim editing will allow providers to bill either D4910 or D1110 once every 12 months. A Prior Authorization is required for D4910 with supporting documentation of pre-operative X-rays and periodontal charting.
A revised dental fee schedule is on the Illinois Department of Healthcare and Family Services’ website. HealthChoice Illinois managed care plans are covering this service at the dental fee schedule or contracted rate, as well.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service issues, your DentaQuest provider representative or to the applicable HealthChoice Illinois managed care plan.