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 $41 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 Illinois, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, Texas, Wyoming; 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. Michigan publishes $170 on its schedule but has no publishable paid row here (its Medicaid claims cannot be geolocated). Wyoming publishes $146 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: Illinois: first two fee columns captured (fee_usd = first column); New Jersey: fee_usd = specialist adult column; fee_alt_usd = non-specialist adult column (child columns not captured); Ohio: first two fee columns captured (fee_usd = first column); Texas: no single effective date printed on the schedule; fee = most frequent non-zero rate across provider types; Wyoming: XLSX master schedule substituted for the ADA-indexed PDF (which carries no dental codes); effective date = latest active rate begin date. 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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