Deep Periodontal Cleaning Costs About $225 per Quadrant

Cost of periodontal treatmentWhen we asked dentists about their average fee for one quadrant of deep perio cleaning, the answer was about $225. Full-mouth debridement costs, on average, about $175.

“There is some abuse of this code, making it harder for our office to get reimbursement from third party providers,” said a periodontist.

Cost of periodontal cleaningNot surprisingly, a periodontal cleaning costs somewhat more from a periodontist than a general dentist.

Here are some comments from dentists and periodontists:

  • “Doing this in conjunction with a Laser gets better results.” (California dentist)
  • “It’s easy money done in conjunction with quadrant dentistry.” (District of Columbia dentist)
  • “There is room for adjusting that default fee – number of teeth, difficulty of patient compliance, etc.” (Oklahoma dentist)
  • “Full moth debridement is only rarely used the way the code is written and is (ab)used by dentists as a code for a ‘difficult prophy.’ It is a code that should be changed or deleted.” (Indiana periodontist)
  • “We need a code or severity grading of the ‘prophy’… There has to be some indication of conditions somewhat between relative health and full-blown disease.” (Maryland dentist)
  • “This may not be definitive care for a periodontal inflammatory periodontal response (acute or chronic) and is only of value in an overall treatment plan of reevaluation.” (Ohio periodontist)
  • “With completion of 4 quads of scaling and root planing we give a Sonicare toothbrush.” (Texas dentist)

Read more: Cost of Periodontal Cleaning for Gum Disease

About Julie Frey

+Julie Frey is the Editor of blog. She has dedicated her career to Internet marketing and communications, working side-by-side with dental marketing guru Jim Du Molin since 2006. She has a degree in Linguistics from Stanford University, has a passion for language and writing, and lives in San Francisco.

  • Dr. Ron Schefdore

    I am finding about 20% + of the patients I do scaling on have a underlying medical issue found with a finger stick blood test ( Many also have nutritional issues(

    With dental maximum payouts being so low for shouldn’t scaling/blood screening/ evidance based supplemntation/laser therapy be covered under medical insurance? The connections of perio and overall health are very clear today.

    Very Interesting new research(below).


    Ron Schefdore D.M.D.

    Gene links heart and gum disease

    A genetic link between dental disease and heart attacks has been found by German researchers.

    Gum disease – periodontitis – is known to be associated with heart disease but how exactly they are linked is unknown.

    Now the University of Kiel team has found a common gene mutation in people with periodontitis and heart attack patients, a conference heard.

    Study leader Dr Arne Schaefer said gum disease should be taken very seriously and treated as early as possible.

    Both coronary heart disease (CHD) and periodontitis are associated with the same risk factors – most importantly smoking, diabetes and obesity.

    “ Now we know for sure that there is a strong genetic link, patients with periodontitis should try to reduce their risk factors and take preventive measures at an early stage ”
    Study leader, Dr Arne Schaefer

    Researchers have shown similarities between the bacteria found in the oral cavity and those in coronary plaques and both diseases are characterised by an imbalanced immune reaction and chronic inflammation.

    One theory is that the bacteria involved in gum disease trigger a low grade inflammatory response throughout the body, prompting changes in the arteries leading to strokes and heart attacks.

    Another possibility is that bacteria disturbs the way blood vessels dilate directly, since some bacteria can enter the bloodstream.

    Genetic link

    Speaking at the annual conference of the European Society of Human Genetics in Vienna, study leader Dr Arne Schaefer from the University of Kiel said his team found the gene linking the conditions on chromosome 9.

    It had already been associated with heart attacks but in the latest study was found both in a group of 1,097 patients with heart disease and in 151 patients with the most aggressive early-onset forms of periodontitis.

    The genetic variation was identical in both diseases and the researchers confirmed the association in further groups of 1,100 CHD patients and 180 periodontitis patients.

    Although it is known what protein the gene encodes it is not yet clear how this is linked with the conditions.

    “Now we know for sure that there is a strong genetic link, patients with periodontitis should try to reduce their risk factors and take preventive measures at an early stage”, said Dr Schaefer.

    “We hope that our findings will make it easier to diagnose the disease at an early stage, and that in future a greater insight into the specific pathophysiology might open the way to effective treatment before the disease can take hold.”

    “In the meantime, because of its association with CHD, we think that periodontitis should be taken very seriously by dentists and diagnosed and treated as early as possible.”

    Dr Francesco D’Aiuto, clinical lecturer at the UCL Eastman Dental Institute, said the study had focused on a particularly aggressive form of periodontitis but the findings take researchers a step closer to working out how the two diseases are linked.

    “We will be looking closely looking at this novel genetic variant to see if the finding can be replicated in the UK population.

    “There is great interest whether this genetic locus is associated not only with aggressive forms of periodontitis but also with the more common chronic form, which is present in some form in at least 10-20% of the UK population.”

  • George McKee DDS

    What is a deep perio cleaning? Is this root planing? If not it is either a gross scale in preparation for root planing or a simple prophy (scale and poish). This should not be a billable code as it only invites abuse.

  • Keith Hollander DDS

    I agree that there needs to be additional codes between a rotine prophy and quad scaling. Heavy Prophy, massive calculus BU without bone loss, etc.

    The gross debridement code is so limited on scope and If you need to do it you almost always have periodontal disease. If you have perio then why reeval after the gross debridement? All you do is trap the remaining toxins under the now much tighter gums now necessitating LA. Flicking off the superficial calculus is not therapy.
    For years, We have been complaining about the poor selections of codes to describe what we do.

    I know most periodontist start with quads for any new patient even if it was just done at the GPs office. Maybe this coding needs to be GP not periodontist driven.

  • Dental Hygiene Excellence

    We definately do not have a accurate code for gingivitis therapy since the 4345 code is discontinued. There are some plans that give benefit for the 4355 with limitations like once in a lifetime, but this code is for debriedment when the deposits are so heavy you can not do an exam. It is not a code for therapeutic scale in the presence of bleeding. 4999 is a code for unspecified periodontal treatment which some plans will give benefit for with a NARRATIVE attached.
    Some hygienists are so insurance driven that they try to treat gingivitis with a preventive prophy(1110) excellerated to therapeutic scale for free. This is not good for the patient, the hygienist or the practice!
    Many practices actually make up a code for the “Difficult Prophy” and use it when they want to give away gingivitis therapy! Most of the time this procedure causes the hygienist to get behind in the schedule and next patients delay and frustration. Some hygienists hate to charge the patient too much for the “difficult cleaning” yet sometimes the patient has missed several cleanings and paid nothing for dental care for an extended period of time. This gingivitis patient probably will be uncomfortable due to the difficult cleaning which may be why they did not come in regularly. The patient will not understand the importance of the oral health and overall health connection. A preventive treatment is not approiate to treat disease.
    There are at least four critical steps to gingivitis therapy.
    1.Patient education: Teach patient oral health and overall health connection,cause of gingival disease, effective plaque control and how to make healthy nutritional choices
    2.Therapeutic scaling: Remove the deposits and biofilms and make the sulcular environment unfriendly for plaques of biofilms.
    3.Chemotherapies: use antimicrobials and fluorides applicable for each case
    4.Repetative treatment: Recommend regular dental check up appointments specific to patient’s needs
    The average fee for ginigvitis is $250-$300.

    We recommend educating the patient to value dental health,explaining why they should pay for the much needed gingivitis therapy not allowing their employer and insurance company to dictate their health and how to start better dental health habits.

    Dental Hygiene Excellence L.L.C.

  • Mobosaty

    I take my diabled 82 year old husband to a detnal clinic that gives good service for a discount price. However he is in need of perio work and they charge $110 per quad. for scale and root pin +$30 each for”irrigation/antimicrobil”. He has only 2 teeth in each of two of the quads to attach his plates, Should there be discount for number of teeth. Is there a code?

  • Liren Chen

    I believe in dental hygiene and practice good daily routine at home with brushing, flossing and waterpick. Dental and medical services are fundamentally business services hiding behind a supposedly good cause that no one can easily say no to. When we go buy something we shop around and evaluate. For most of the things we buy we have a clear expectation of the cost and the end product. Some how when it comes to health issues people become completely illogical on cost and service. Surely doctors are suppose to do what’s best for patients but at end of the day what really matters are their bank accounts. Countless studies have proven over and over again that our society as a whole have a serious problem on over prescribing (and we wonder why our healthcare costs are so high). This happens in all area of medicine from childbirth methods to joint and hip replacements. The second myth is that people have misconception that higher cost doctor/facilities offer better service/care. Studies have disproved that and showed that in controlled studies patients actually gave better feedback for lower paid residents or government subsidized outreach programs because those medical professionals on average spent more time with the patients to listen and evaluate their illnesses. We have a long way to go in consumer education when it comes to medical care. Health can be an emotional issue but it shouldn’t be misguided. This is not to say that all healthcare professionals are corrupted by greed but nevertheless in a fee for service pay structure there is always an incentive to up sell. Today I refused a deep cleaning from my dentist. I feel fine with my teeth and I only wanted a regular cleaning that is covered by my health insurance. It was completely frustrating that I was told I had no control over neither my teeth nor my money. Just as I was ready to walk out of the office the dentist changed his mind and said he’ll make an exception and give me a regular cleaning (which wasn’t regular at all since all they did was a light polishing that lasted at most 5 minutes). We spent a whole hour talking about it and exactly 5 minutes for a “regular cleaning.” I’ve had a lot of terrible experiences with dentists charged for services they didn’t perform and insurance unwilling to reimburse for treatments because they see them as unnecessary. No matter what the patients always loose. It doesn’t help that I went to school for economics and the class on Health Economics by Charles Phelps was the most interesting and shocking.

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