D4346 Dental Code: Scaling with generalized gum inflammation, full mouth Cost in 2026

What D4346 means on your bill

D4346 is the code for scaling with generalized gum inflammation across the full mouth: removing tartar and bacterial buildup from patients whose gums are inflamed everywhere but who have not lost supporting bone. It sits between a routine cleaning (D1110) for healthy gums and periodontal scaling and root planing (D4341 or D4342) for patients who have lost bone and need quadrant-by-quadrant work below the gumline. Because D4346 covers the whole mouth in one visit rather than by quadrant, it is billed differently from either neighbor, and a hygienist decides which code applies only after examining the gums that day. Its middle position is why it is not tracked as its own line in federal claims data. Context: deep cleaning cost.

D4346 cost: cash fair price vs what Medicaid paid (2026)

D4346 sits between a routine cleaning and the more advanced scaling codes, and the cash side of the chart reflects that middle position: the fair price runs $169–$352, typical $242. Medicaid paid dentists a national average of $78 per claim line across 1,428,344 claim lines in 2023-2024 for the closest published codes, a gap of 3.1x against the cash figure. That paid amount is a weighted-average program payment to the dentist, drawn from HHS T-MSIS, not a bill sent to the patient. Only about 20% of active dentists billed Medicaid at all in 2023-2024, and this code is not separately reported, so the true pattern is harder to see.

What Medicaid paid dentists for D4346, by state (2023-2024)

43 states publish a figure below for the scaling codes closest to D4346; the rest fail the data-quality gate or report too few claim lines. Payment ranges from $18 in Louisiana to $213 in Missouri for those neighboring codes. The cash column beside each state is that state's independent average outside insurance, listed for comparison. A high payment for the neighboring codes in a given state says nothing about whether that state's Medicaid program covers adult periodontal care broadly; see Medicaid adult dental by state for coverage rules. D4346 is not in the T-MSIS extract, so every figure here uses D4341 and D4342 as a stand-in. The Official Medicaid fee column follows the same proxy as the paid column, D4341 (a quadrant of scaling and root planing), because D4346 has no publishable T-MSIS series: Ohio prints $189 and New Jersey $38 for that heavier procedure, so read it as a ceiling for gingivitis scaling, not its own rate.

Medicaid paid: per claim line, weighted average 2023-2024, derived from HHS T-MSIS Medicaid provider spending (Real Dental Costs, DOI 10.7910/DVN/7F2BZI); states with a data-quality flag or too few lines are omitted. Official Medicaid fee: the fee-for-service rate for this code on the state's published Medicaid dental fee schedule (captured for Alaska, Alabama, Arkansas, Arizona, California, Colorado, District of Columbia, Delaware, Georgia, Hawaii, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Maine, Michigan, Minnesota, Missouri, Montana, North Carolina, North Dakota, Nebraska, New Jersey, New Mexico, Nevada, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Virginia, Vermont, Washington, Wisconsin, West Virginia; effective dates, source URLs and file hashes in the API file); "—" where no schedule was captured or the code is not on it. Schedule rate shown for the closest scaling code (D4341), like the paid figures. Alabama publishes $129 on its schedule but has no publishable paid row here (data-quality flag or too few claim lines). Arizona publishes $139 on its schedule but has no publishable paid row here (data-quality flag or too few claim lines). Michigan publishes $170 on its schedule but has no publishable paid row here (its Medicaid claims cannot be geolocated). Oregon publishes $188 on its schedule but has no publishable paid row here (data-quality flag or too few claim lines). Virginia publishes $125 on its schedule but has no publishable paid row here (data-quality flag or too few claim lines). Fee and paid differ by design: paid mixes managed-care encounters, reduced and bundled lines and 2023-2024 rates, while the schedule is the current fee-for-service rate. Schedule notes: Alaska: fee_usd = Services for Adults amount; code priced only under Services for Children -> fee_usd = null and fee_alt_usd = children's rate (ages 0-20) (column fix 2026-09-18); Arizona: fee_usd = statewide FFS rate; fee_alt_usd = Flagstaff rate when different; source = AHCCCS Dental FFS schedule effective 2026-07-01; BR (By Report) = null; California: fee_usd = adult / general row; D1206-D1208 fee_alt_usd = children's rate, D4341-D4342 fee_alt_usd = SNF/ICF resident rate, D8080/D8670 = handicapping malocclusion row (column fix 2026-09-18 on 10 codes); Colorado: fee_usd = fee column; codes with Max Age below 21 -> fee_usd = null and fee_alt_usd = children's rate with the printed age band; manually priced = null (column fix 2026-09-18); District of Columbia: fee_usd = Fee 21 Or Over of the row in force (BegDate/EndDate); fee_alt_usd = Fee Under 21 when different = children's rate (ages 0-20); 21+ fee $0.00 -> fee_usd = null (column fix 2026-09-18); Illinois: fee_usd = adult (21+) Maximum Allowance; when the adult column is N/A, fee_usd = null and fee_alt_usd = children's rate (ages 0-20); pregnant-women column ignored; source = HFS dental fee schedule xlsx effective 2026-07-01 (column fix 2026-09-18); Kentucky: fee_usd = OVER AGE 21 rate; when the adult column is n/c, fee_usd = null and fee_alt_usd = children's rate (ages 0-20); oral surgeon rate ignored (column fix 2026-09-18); Maine: fee_usd = Maximum Allowance 7/1/2026 when filled, else 1/1/2026; fee_prev_usd = 1/1/2026 amount when different (column fix 2026-09-18); Minnesota: fee_usd = printed TOTAL ALLOW x 1.98 (page 1: an additional 98% must be added to the fee schedule total amount for dental services on or after 01/01/22); fee_alt_usd = printed TOTAL ALLOW; APC/ASC facility column not used (column fix 2026-09-18); Montana: fee_usd = Office Fee; codes with Max Age below 21 -> fee_usd = null and fee_alt_usd = children's rate with the printed age band (column fix 2026-09-18); New Jersey: fee_usd = non-specialist adult column; fee_alt_usd = specialist adult column; when no adult rate, fee_usd = null and fee_alt_usd = children's non-specialist rate (column fix 2026-09-14); New York: fee_usd = Fee; codes with Max Age below 21 -> fee_usd = null and fee_alt_usd = children's rate with the printed age band (column fix 2026-09-18); Ohio: fee_usd = Current Maximum Payment (BR / NC / D / PA = null); fee_prev_usd = Previous Maximum Payment when different; no second fee column (column fix 2026-09-18); Oregon: fee_usd = Price of the latest dated row per code; 'Manual' = null (column fix 2026-09-18); Pennsylvania: fee_usd = MA Fee; codes limited '(under 21 years of age only)' -> fee_usd = null and fee_alt_usd = children's rate (ages 0-20) (column fix 2026-09-18); Rhode Island: fee_usd = MAX_ALW_AMT of the row in force; fee_prev_usd = previous period amount; no row in force or $0.01 placeholder = null (column fix 2026-09-18); Texas: Texas Health Steps children-only schedule (ages 0-20), not adult Medicaid coverage; 45 THSteps codes revised effective 2026-09-01 per HHSC Special Review (TMHP dental_services.xlsx), other codes 2025-09-01 ADA compilation; Utah: fee_usd = standard row (Enhancement = None); fee_alt_usd = Rural Enhancement rate; DENTAL_ADULT Excluded or covered ages below 21 -> fee_usd = null and fee_alt_usd = children's rate (column fix 2026-09-18); Wisconsin: fee_usd = general dentist rate (ForwardHealth PT 27, adult 21+, no BAF/modifier); fee_alt_usd = child rate when different (age band in label); source = ForwardHealth Max Fee extract 2026-09-05; effective_date = latest active rate begin date (per-code date in fee_effective; most rates unchanged since 2022-01-01); West Virginia: fee_usd = 2026 fee when the code is covered for adults 21+ per BMS Chapter 505 Appendix 505B (emergent services, effective 2026-01-01) or Appendix 505C (preventative and restorative services, effective 2025-05-01, $2,000 per two fiscal years); other codes -> fee_usd = null and fee_alt_usd = children's rate (ages 0-20); an N/A adult effective date in the fee schedule does not mean not covered (column fix 2026-09-18). Cash: Real Dental Costs procedure API, full-mouth scaling for generalized gum inflammation proxy = Deep cleaning (SRP, per quadrant) (basis estimated). Program payments, not patient bills; not a quote.

How insurance classes D4346

Plans usually class D4346 as either a basic or a periodontal service depending on the policy, reimbursed at 50-80% after the deductible, and many plans limit how often it can be billed or require X-rays showing gum inflammation first. A pre-treatment estimate filed on this exact code, rather than on a routine cleaning, is the only way to see which tier a plan applies and whether the frequency limit is already used. The annual maximum, commonly $1,000-$2,000 for the year, applies here alongside any other restorative work done in the same period. If a cleaning turns into D4346 mid-visit, ask what the hygienist found. Coverage explained: dental insurance guide.

Chains, schools and where D4346 costs less

No national chain publishes a price for this exact code, since D4346 falls between the routine cleaning and the periodontal scaling codes that chains do sometimes advertise separately. Dental school clinics, where supervised students perform the same procedure, typically charge 30-60% below private-practice fees; see dental school cost. Every other procedure price tracked on this site, by CDT code, is listed at every procedure price. Cash averages for this code range from $200 in Alabama to $305 in California.

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