Dental Insurance and Reimbursement: From Evaluation to Perio Maintenance

Non-surgical periodontal treatment is frequently the cause of audits and overpayment requests by both third-party payers and benefit plans. Reimbursement challenges can be rapidly eliminated by accurately diagnosing and documenting the patient’s clinical condition. Accurate coding for nonsurgical periodontal treatment must begin with the doctor’s comprehensive evaluation.

This webinar will focus on both the diagnosis and treatment planning of non-surgical periodontal care. Gone are the days of all new patients being “cleaned up and x-rayed” by the hygienist prior to the doctor’s evaluation. Both administrative and clinical parameters will be discussed in addition to your submitted questions.

The questions in addition to Tom’s seven keys to reimbursement success will be presented during the webinar. Both the administrative and clinical teams are encouraged to participate. The workshop questionnaire will be forwarded to each registered attendee.

Subjects of discussion will include:

  • What is included with the various evaluation codes – be it comprehensive, periodontal or periodic. What is included vs what is billed separately?
  • When is a prophylaxis (D1110) not a prophylaxis? What if it takes multiple visits or seatings to complete the prophylaxis?
  • Is scaling in the presence of gingival inflammation (D4346) the code number for a difficult prophylaxis?
  • When is full mouth debridement (D4355) performed, coded and payable? What procedure needs to be done following debridement to make it payable?
  • What are the clinical differences between polishing, scaling and root planning? Are all teeth in the treatment area scaled in conjunction with D4341 and D4342?
  • When is the patient ready for periodontal maintenance (D4910) and for how long does it continue? Is the coding of prophylaxis and periodontal maintenance interchangeable? Does it simply require another doctor’s office?

This course is intended for dentists, specialists, dental students, hygienists and dental assistants.

Completion/Verification Code will be issued at the completion of the webinar.


Tom Limoli is the prevailing expert on proper coding and administration of dental insurance benefit claims, with over 30 years of experience. He serves as President of Limoli and Associates, LLC a company that over the past quarter century has assisted dental offices in streamlining the insurance reimbursement process.

Mr. Limoli’s no-nonsense approach to the management of third-party reimbursement has been implemented in thousands of dental practices across the United States and Puerto Rico.

Mr. Limoli received his Bachelor of Science in Criminal Justice from Valdosta State University, Valdosta, Georgia. Following his work with the U.S. Treasury Department’s Federal Law Enforcement Training Center, he has actively investigated fraudulent claims for the insurance industry, as well as numerous other third-party fiduciaries.

Mr. Limoli is a licensed Private Investigator, as well as a member of the American Association of Dental Consultants, the National Speakers Association, the National Health Care Anti-Fraud Association, and the past President of the Academy of Dental Management Consultants.

Mr. Limoli is the author of Dental Insurance and Reimbursement Coding and Claim Submission, and co-author of Fee-for-Service Dentistry with a Managed-Care Component.


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