Blue Cross Blue Shield FEP Dental
Class B Intermediate
Class B Intermediate
Periodontal Services
D4341 Periodontal scaling and root planing - four or more teeth per quadrant - Limit 1 every 24 months
D4342 Periodontal scaling and root planing - one to three teeth per quadrant - Limit 1 every 24 months
D4346 Scaling in presence of generalized moderate or severe gingival inflammation - Full mouth, after oral exam - Limited 3 in combination with D1110 and/or D1120 during calendar year
D4381 Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth
D4910 Periodontal maintenance - Limit 4 every12 months combined with adult prophylaxis, and scaling in presence of generalized moderate or severe gingival inflammation, after the completion of active periodontal therapy
D7921 Collect - Apply Autologous Product - Limit 1 in 36 months
D4342 Periodontal scaling and root planing - one to three teeth per quadrant - Limit 1 every 24 months
D4346 Scaling in presence of generalized moderate or severe gingival inflammation - Full mouth, after oral exam - Limited 3 in combination with D1110 and/or D1120 during calendar year
D4381 Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth
D4910 Periodontal maintenance - Limit 4 every12 months combined with adult prophylaxis, and scaling in presence of generalized moderate or severe gingival inflammation, after the completion of active periodontal therapy
D7921 Collect - Apply Autologous Product - Limit 1 in 36 months