Tips to avoid claim denials due to common coding mistakes

ADA provides guidance to code correctly

With the launch of the latest CDT Code just around the corner, the American Dental Association hopes to help dentists avoid common coding mistakes as they begin using CDT 2026 on Jan. 1.

“Often, denial and delayed payment of claims occur due to common coding errors. Always refer to the code’s full nomenclature and descriptor, and code for what you do,” said Paula Crum, D.D.S., chair of the ADA Council on Dental Benefit Programs’ Coding and Transactions Subcommittee.

Below are examples and explanations of some common miscoding issues to help address potential misinterpretation during claims processing.

Example 1

The ADA is often asked if code D7210 extraction (erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated) can be reported for all extractions. In the past, this code was often referred to as the “surgical extraction code” since all extractions are essentially surgeries.

Code D7210 is appropriate when the clinical circumstances involve the removal of bone and/or sectioning of tooth. However, code D7140 extraction, erupted tooth or exposed root (elevation and/or forceps removal), may be the appropriate code to use when such bone removal is not indicated and the erupted tooth is removed using an elevator or forceps. Both codes include the removal of the tooth structure, minor smoothing of the socket bone and closure of the extraction site.

“Always refer to the code’s full nomenclature and descriptor regarding the differentiation between D7210 and D7140,” Dr. Crum said. “It is imperative that each tooth is coded accurately according to clinical circumstances.”

Example 2

Coding for the extraction of impacted teeth often raises questions. The CDT Code includes four different codes for the extraction of an impacted tooth — D7220, D7230, D7240 and D7241 — and none of them are based on difficulty. Each captures a different clinical presentation of the tooth and the procedural differences required to remove that tooth.

“Yes, removal of a tooth impacted in soft tissue is typically easier than a completely bony impacted tooth, but that difference in effort is implicit, not explicit,” Dr. Crum said.

Example 3

The ADA often receives questions about the appropriate way to document a “difficult” prophylaxis, meaning a cleaning that takes longer than expected. Can code D4341 periodontal scaling and root planing — four or more teeth per quadrant, or code D4342 periodontal scaling and root planing — one to three teeth per quadrant, be used for a difficult cleaning, considering the amount of calculus present on the coronal surfaces of the teeth and the intensity required to remove it?

The descriptors for codes D4341 and D4342 say they are indicated for patients with periodontal disease, so without that, the codes are not appropriate. Scaling and root planing is indicated for patients with periodontal disease and is therapeutic, not prophylactic. The ADA Council on Dental Benefit Programs has developed a detailed guide on coding for scaling and root planing available at ADA.org/dentalinsurance.

Code D4346 scaling in presence of generalized moderate or severe gingival inflammation — full mouth, after oral evaluation, may be applicable if there is generalized moderate to severe gingival inflammation. This code is often an appropriate choice because a patient with heavy buildup of plaque and calculus might also have generalized moderate or severe inflammation. A complete guide for using code D4346 is available at ADA.org/publications/cdt/coding-education.

Code D4355 full mouth debridement is another option if debridement of buildup is needed to enable a comprehensive periodontal evaluation and diagnosis. However, this code is not intended to be used to describe a difficult prophy. It should only be used if the debridement is needed to enable the periodontal evaluation. A complete guide for using code D4355 is also available at ADA.org/publications/cdt/coding-education.

“This issue as outlined illustrates what is most important in coding,” Dr. Crum said. “That is, the only way to code is by the literal definition of the procedure as seen in the full CDT Code entry.”

Example 4

Can dentists report code D3331 treatment of root canal obstruction; non-surgical access, with every root canal procedure? The answer is no. This code is appropriate only when it is necessary to create a pathway for an apical seal without surgical intervention because of a nonnegotiable canal obstructed by foreign bodies such as separated instruments, fractured posts or significant calcifications.

“Clinical documentation and radiographic evidence must substantiate use of this code,” Dr. Crum said.

Example 5

If a provider wants to use an expensive adjunct irrigant or irrigating device instead of or in addition to the traditional sodium hypochlorite that is commonly used in root canals, there is no code that can be used to reflect the additional expertise and expense. Irrigation and other aspects of endodontic therapy are considered part of the root canal procedure itself and included in the code set for the type of tooth being treated.

Similarly, alveoloplasty is a distinct procedure from extractions that is usually performed in preparation for a prosthesis or other treatments such as radiation therapy and transplant surgery. Any minor smoothing of the socket bone or bone removal to enable or facilitate an extraction is included within the extraction procedure code.

Some “golden rules” of procedure coding include:

• Code for what you do. This is the fundamental rule to apply in all coding situations.
• After reading the full nomenclature and descriptor, select the code that matches the procedure delivered to the patient.
• If there is no applicable code, document the service using an “unspecified … procedure, by report” code (ends in “999”) and include a clear and appropriate narrative.
• Understand that the existence of a procedure code does not mean the procedure is a covered or reimbursed benefit in a dental benefit plan.
• Plan treatment based on clinical need, not covered services. 
• Discuss common coding situations with office team members so that everyone understands how to use the CDT Code, and review coding for complex treatment plans before claims are submitted to payers. 

If dentists have difficulty finding an appropriate CDT code, they should consider whether there may be another way to describe the procedure. The CDT manual’s alphabetic index and the glossary of clinical terms available online at ADA.org/CDT may be helpful in these situations. Dentists can also reach out to the ADA for help at dentalcode@ada.org.