Type of Dental “Cleanings” and Insurance Coverage

There are different types of teeth cleanings and this depends on whether you have a healthy mouth, gingivitis or periodontal disease. Often times a patient comes into our office with assumption that their dental insurance will pay for “two” cleanings per year. However, there are different types of cleanings which the insurance doesn’t pay the total cost. The different types of cleanings are Prophylaxis, Debridement, Periodontal Maintenance and Scaling/Root Planning.

The simplest and least expensive type of cleaning is called a prophylaxis (Prophylaxis (Prophy) D1110). This type of cleaning is what the insurance covers twice per year. A prophylaxis is the routine type of cleaning and can only be performed on a person who is in good periodontal condition (no gum disease) and who doesn’t have a large build-up of tartar, plaque or calculus. A prophylaxis is preventive and insurance companies will typically pay all or most of the cost of the prophylaxis every 181 days.

Many people, especially those who have not been to the dentist in over a year, or who do not brush and floss often enough, will have a light to moderate amount of tartar or calculus build-up on their teeth. This build-up is generally on the teeth above the gum line. These people will need a more extensive cleaning, known as a Debridement (Debridement D4355). Dental insurance companies may or may not pay for a debridement nor will they cover necessary anti-microbial medication used to irrigate and cleanse the gums.

If your gums are swollen or bleed when you brush or floss and/or there is heavy tartar build-up on your teeth, or if the x-rays show bone loss, you may have periodontal disease (gum disease). These signs and other symptoms may require what is known as scaling and root planning (Scaling/Root Planing D4341). This type of cleaning is a thorough cleaning of tartar from below the gum line. This is a type of cleaning sometimes referred to as a “periodontal cleaning”. Most dental insurances will not pay 100% for scaling and root planning and will require you to pay your deductible (if you haven’t already paid your deductible for the year) towards this type of cleaning. Most adult teeth are not lost to decay; they are lost to periodontal disease (gum disease). All of these types of cleanings help to fight against periodontal disease.

Your own home oral hygiene practices and regular dental visits are extremely important in minimizing dental expenses and assist in keeping your teeth healthy for your entire life.

Periodontal Maintenance (D4910) is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements.  It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planning where indicated, and polishing the teeth.  If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.

Taking care of your dental health is easy when you have the right team behind you. Team Shapiro is here to help you understand your dental needs. When you call our office, mention this blog post for a free exam and x-rays with Dr. Shaprio.

Husband and wife team, Drs’ Seth and Dari Shapiro have been serving the Palm Beach County area for fifteen plus years. They are both known for their compassion and personal touch, and welcome new patients to their state-of the-art dental offices.

Leave a Reply

Your email address will not be published.