When you’re managing gum disease or facing deep cleaning needs, understanding periodontal maintenance covered by insurance can save you time and money. Periodontal maintenance refers to specialized cleanings designed to control bacterial buildup in the pockets around your teeth and prevent the progression of gum disease. Nearly half of all adults aged 30 and older show signs of periodontal disease (Aflac), so knowing how to navigate your insurance benefits is crucial for both your oral health and your wallet.
In addition to standard prophylaxis, many plans offer benefits for deeper periodontal services under specific conditions. Throughout this guide, you’ll find clear explanations of coverage options, billing codes, provider networks, denture services, and strategies to maximize your benefits so you can keep your smile healthy without unexpected costs.
Periodontal maintenance is more extensive than a routine cleaning. While a standard prophylaxis appointment (code D1110) focuses on removing plaque and tartar above the gum line, periodontal maintenance (code D4910) involves deeper scaling and root planing to manage pocket depths and inflammation.
Routine cleaning (D1110)
Removes plaque and tartar from visible tooth surfaces
Typically performed twice a year
Fully covered by most preventive plans
Periodontal maintenance (D4910)
Targets subgingival areas below the gum line
Addresses residual bacterial deposits after initial therapy
Often scheduled every 3 to 4 months
During a periodontal maintenance visit, your dental team may:
These deeper cleanings help control bacterial growth in periodontal pockets, reducing inflammation and the risk of tooth loss.
Insurance coverage for periodontal maintenance depends on your plan’s benefit frequency, annual maximum, and documentation requirements. Below is a comparison of typical fees:
| Code | Description | Average patient cost |
|---|---|---|
| D1110 | Routine prophylaxis | $75–$120 |
| D4910 | Periodontal maintenance | $150–$200 |
Insurance carriers often require an examination, targeted probing, and a formal diagnosis to reimburse D4910 after initial scaling and root planing. Some payers limit coverage to a set period (often 8–12 weeks) following periodontal therapy (ADA Council on Dental Benefits).
Choosing the right plan can significantly affect your out-of-pocket costs for periodontal care. You have two main categories: private dental insurance and Medicaid.
Dental HMO
Requires in-network providers only
Fixed copays for preventive and basic services
No annual maximum, but limited specialist access
Dental PPO
Offers in-network and out-of-network benefits
Higher premiums and deductibles
Annual maximums typically range from $1,500 to $2,000 (Ocean Breeze Prosthodontics)
Aetna
Many plans include coverage for periodontal cleaning. Check your benefits at periodontal cleaning with Aetna.
Blue Cross Blue Shield
Certain policies cover deep scaling and root planing. Learn more about BCBS insurance for deep cleaning.
Cigna
Gum therapy is often included under preventative or therapeutic benefits. See details in gum therapy covered by Cigna Dental.
Delta Dental
Members frequently receive coverage for scaling and root planing. Review your plan at scaling and root planing with Delta Dental.
Medicaid programs vary by state, but many include coverage for periodontal services and dentures.
To get the most from your insurance, you’ll need clear documentation, strategic scheduling, and a plan for claim management.
If a claim is denied:
Many denials can be overturned by clarifying the therapeutic need and timing of your periodontal services.
If you require tooth replacement in addition to gum care, understanding denture benefits can guide your choice.
Medicaid
Covers basic removable dentures in most states with lifetime limits. Check your eligibility for full dentures covered by Medicaid.
Private insurance
May offer partial or full denture coverage under prosthodontic benefits, often subject to waiting periods and cost-sharing.
Aetna
Some plans cover implant-supported dentures as part of advanced prosthodontics. Explore your benefits at implant-supported dentures with Aetna.
BCBS
Snap-in overdentures may be included under specialized prosthetic benefits. See snap-in dentures covered by BCBS.
Finding the right dentist or periodontist in Charlotte ensures you receive quality care and full use of your plan.
Blue Cross Blue Shield
Locate an approved specialist by searching for a BCBS approved periodontal dentist.
Cigna
Identify providers for scaling and root planing via Cigna approved dentist for scaling and root planing.
Delta Dental
Search for a Delta Dental gum disease specialist to manage complex periodontal needs.
Regular home care and professional maintenance go hand in hand to protect your investment.
Review your dental benefits, confirm provider networks, and schedule a periodontal evaluation to protect your gums and teeth. If you’re exploring preventive strategies, learn more about gum disease prevention with insurance coverage and verify what’s covered under insurance for gingivitis and periodontitis. By proactively assessing your coverage and partnering with a qualified dental team, you can maintain a healthy smile and minimize out-of-pocket expenses.
