๐Ÿฆท Welcome to The Clear Way: Dental Billing Decoded

๏ปฟ

๐ŸšซCommon Billing Misconception

In the world of dental billing, certain codes cause more confusion than others, and D4355 is right at the top. 

At Clear Way Dental Claims, we’ve helped hundreds of practices fix denied claims due to one major misconception: billing D4355 with a comprehensive exam on the same day.


Let’s clear the air and keep your claims clean, compliant, and paid.


๐Ÿงผ What is D4355?


D4355 is the Full Mouth Debridement to Enable a Comprehensive Oral Evaluation. It’s not a cleaning, and it’s not the same as scaling and root planing. It’s used when a patient’s oral condition specifically heavy plaque and calculus prevents the provider from performing a proper exam.


The ADA defines D4355 as a procedure that allows the dentist to see enough of the mouth to begin evaluation at a later visit.


๐Ÿšซ Common Misconception


“Can I bill D4355 with D0150?”

Short answer: No.


Long answer: D4355 cannot be billed with D0150, D0160, or D0180 on the same day. If a true comprehensive evaluation isn’t possible due to excessive debris, then billing a comprehensive exam on that date is incorrect and the claim will likely be denied.


โœ… Correct Billing Protocol


Day 1  - Patient presents with heavy calculus buildup:


 

  • Bill D4355
  • Use D0191 (limited assessment) if documentation is needed
  • Document with clinical notes, radiographs, and intraoral photos

 


Day 2  - After debridement heals (typically 7–14 days later):


 

  • Perform and bill D0150 or D0180 with proper diagnosis and charting
  • Continue treatment planning or move to SRP if perio is diagnosed

 


๐Ÿงพ Tips for Claims Approval


 

  • Use narratives: “Patient presented with significant plaque and calculus buildup that prevented accurate periodontal and dental charting. Debridement performed to enable comprehensive evaluation at a subsequent visit.”
  • Attach photos and radiographs if available.
  • Use correct frequency codes per plan policy (D4355 is often limited to once every 3–5 years).

 


๐Ÿ“Œ Final Thoughts


Misunderstanding how to bill D4355 can lead to claim denials, compliance issues, and reimbursement delays. When used correctly, this code supports accurate diagnoses and patient care.


Need a billing audit or coding refresher for your team? Clear Way Dental Claims has you covered. Let’s make every claim count.



References


American Dental Association. (2023). ADA guide to reporting D4355 – Full mouth debridement to enable a comprehensive oral evaluation. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/v2_d4355adaguidetoreportingfullmouthdebridement_2023jan.pdf

 

American Dental Association. (2023). CDT 2023: Dental procedure codes. Chicago, IL: ADA Publishing.


RDH Magazine. (2022, December 19). D4355 undergoes major changes in CDT 2023. https://www.rdhmag.com/career-profession/insurance/article/14291329/d4355-undergoes-major-changes-in-cdt-2023


UnitedHealthcare. (2023). Dental coverage policy: Full mouth debridement. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/dental/full-mouth-debridement.pdf

By Enjolina Collins June 21, 2025
Let’s be honest, dental billing has never been easy. From chasing down missing insurance info to fighting claim denials and waiting on hold with carriers for hours… it’s exhausting. And if you’re a small practice, it’s even worse. You’re expected to be the biller, the front desk, the coder, and the problem-solver, all at once. That’s why I built BAS with DDI, a platform that takes everything I’ve learned in this industry and turns it into a smart, compliant, AI-powered billing system that runs like your most experienced employee , but faster, sharper, and 24/7. Let’s break down the 7 game-changing ways AI is transforming dental billing forever and how BAS with DDI brings every one of these to life. 1. Real-Time Insurance Verification Forget the phone calls. Forget logging into five different portals. AI now verifies a patient’s insurance in real time before the patient even sits in the chair. Example: A patient uploads their insurance card through the BAS portal. Within seconds, the system checks eligibility, confirms active coverage, and pulls detailed benefit breakdowns. No human delay. No guessing. 2. Automated Claims Generation AI doesn’t just help you fill out claims, it writes them for you, based on your provider notes, clinical images, and procedure codes. Example: Dr. Thomas finishes a scaling and root planing procedure. BAS reads the narrative, confirms attached perio charting, auto-selects CDT D4341, and attaches X-rays then submits it instantly, error-free. 3. Predictive Denial Prevention This is where AI earns its crown. Based on historical data, payer rules, and documentation patterns, it flags claims that are likely to be denied before you hit submit. Example: Your assistant forgets to include a narrative for a crown claim. BAS alerts them: “Narrative required for D2740 with Delta Dental.” Problem solved before it costs you 30 days of cash flow. 4. Smart Payment Posting Manual payment posting is one of the most draining tasks in any office. AI does it in seconds, line by line, matching each EOB or ERA to the correct claim and CDT code. Example: Instead of spending 2 hours posting payments from 15 ERAs, your billing team clicks once. BAS matches claim IDs, verifies co-pays, logs adjustments, and posts everything seamlessly into your PMS. 5. Treatment Plan Optimization AI isn’t just about admin it can also support clinical planning by cross-referencing perio charts, X-rays, and diagnostics with coverage rules and treatment necessity. Example: DDI (Dental Diagnostic Intelligence) within BAS recommends adding D4910 (periodontal maintenance) after D4341 based on healing intervals and benefits remaining. It’s smart, legal, and boosts revenue. 6. Compliance-First Automation Too many systems are built to “work fast” without worrying about compliance. BAS was built the *other way around* HIPAA first, automation second. Example: Every action inside BAS from who accessed a claim to when PHI was updated is tracked, encrypted, and logged in real-time. No breaches. No blind spots. No excuses. 7. Scalability Without Burnout This is the one nobody talks about, AI lets your small team do the work of five, without the stress, mistakes, or turnover. It’s how you grow without breaking. Example: A two-person front office team manages 4 op chairs, 3 doctors, and 60+ patients per week, with no outside billing company and no late claims all because BAS is handling the heavy lifting. Final Thoughts AI isn’t coming , it’s here. And in dental billing, it’s the difference between surviving and thriving. Practices that embrace automation today will dominate tomorrow. Those that don’t? Well... they'll still be waiting on hold with insurance. Learn More About BAS with DDI BAS with DDI (Billing Automation System with Dental Diagnostic Intelligence) is the first HIPAA-compliant, AI-powered billing automation platform built by a dental billing and practice management expert. This platform was made for busy dental teams who are tired of the stress, errors, and burnout. ๐Ÿ‘‰ Visit www.clearwaydentalclaimsllc.com ๐Ÿ‘‰ Book a demo or join our beta program ๐Ÿ“ง Email: enjolina@clearwaydentalclaims.com Let BAS handle the billing so your team can get back to dentistry.
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