Ask the Coding Coach- Summer 2025
Over the last several months, osseous surgery and regeneration procedures involving both natural teeth and implants in the same area of the mouth has been a recurring problem. Let’s use an example: osseous surgery is completed in four quadrants, with only the third molars missing, as well as implants present in the areas of teeth #13, #29, and #30. Bone grafting using resorbable membranes was completed on tooth #14, and the implants for #13 and #30. Biologic material was used on tooth #14.
In most instances, the osseous surgery code is used correctly, D4260 x4. The codes for regeneration, however, are where the problems occur. In this case, the maxillary left quadrant should be coded as follows:
ULQ D4260 osseous surgery four or more contiguous natural teeth
#14 D4263 bone replacement graft -retained natural tooth -first site in quadrant
#14 D4265 biologic materials to aid in regeneration
#14 D4266 guided tissue regeneration, natural teeth, resorbable
Also, for this quadrant:
#13 D6102 debridement and osseous contouring of a peri-implant defect surrounding a single implant
#13 D6103 bone graft for repair of peri-implant defect
#13 D6106 guided tissue regeneration, resorbable, per implant
The mandibular right would be coded as follows:
LRQ D4260 osseous surgery, four or more contiguous natural teeth
#29 D6102 debridement and osseous contouring of a peri-implant defect surrounding a single implant
#29 D6103 bone graft for repair of peri-implant defect
#29 D6106 guided tissue regeneration, resorbable, per implant
#30 D6102 debridement and osseous contouring of a peri-implant defect surrounding a single implant
#30 D6103 bone graft for repair of peri-implant defect
#30 D6106 guided tissue regeneration, resorbable, per implant
The mistake occurs when it is assumed that the treatment performed will be covered by the codes for natural teeth. In these cases, although it may seem redundant, each implant must be coded individually for each procedure. It does not matter if the implants are adjacent or not since the coding is per implant. When this is not done, claims can be denied, or benefits may be reduced. It is important to remember, however, that plan limitations may also affect reimbursement. As with any claim, obtaining a pre-treatment estimate will avoid problems with both the carrier and patient.
Q: There are times when I am exposing an implant for restorative treatment and placing the abutment, and I then decide that an apically positioned flap will preserve attached tissue on the facial of the implant. How would I code for these procedures?
We always say code for what you do. The easiest way to determine if you are coding correctly is to look at the procedures you have performed in the order in which they are completed. In your case, the implant was exposed first. In most cases, this is accomplished with either a punch-type procedure or small partially elevated flap. D6011, surgical access to an implant body (second stage implant surgery), would describe this.
Since you are placing the abutment, this second step would be coded for either D6056, prefabricated abutment, or D6057, custom fabricated abutment.
The last procedure was to elevate a flap (or further elevate the small partial flap from when you exposed the implant) and position it apically to provide keratinized tissue on the facial of the implant. This would be coded D4245, apically positioned flap. In most instances, only the D6011 would be used, but if you do perform both procedures you may use both codes to describe what has been done. In many cases, a carrier will only cover the most inclusive code and may not cover both.
Q: I get confused as to the meaning of “site.” Can you explain the differences between sites for teeth, implants, and edentulous areas?
It can be confusing because the term “site” means different things in different situations. There are three times a site applies when submitting claims. The first is soft tissue grafting, which is straight forward. A single tooth is considered a site. Submit one code for each tooth.
When dealing with any procedure involving missing teeth, such as ridge augmentation, a site is considered an area of two tooth positions or less. If you are treating the mandibular posterior, for example, where teeth #29-32 previously were, then this would be submitted as two sites and thus two codes.
Osseous defects are the most confusing. Simplified, if there is a defect on only one tooth then that is a site and one code is submitted. If one defect affects two adjoining teeth, communicating, then this is also a single site and one code is used. Osseous defects on adjacent teeth that cannot be probed from one defect to the other (a section of bone is between the defects) would be two sites, and two codes would be appropriate.
This is further explained at the beginning of the Periodontics category of the CDT.
Implants are not considered by “site.” Implant codes for treatment of peri-implantitis or mucositis are submitted per implant.
2025 Annual Meeting Live Insurance Workshops
Do you prefer to learn about coding and insurance in person? The AAP’s Dental Coding and Medical coding workshops will be presented live at the AAP’s Annual Meeting in Toronto!
- Dental Coding Workshop: Friday, Oct. 17 from 2-5 pm
- Medical Coding Workshop: Saturday, Oct. 18 from 9 am to 12 pm
- Learn about best practices for submitting claims directly from the AAP’s Insurance Consultant and representatives from the insurance industry. This course will feature a case study discussion of insurance claims that will highlight the appropriateness of submission, reasons for denial, and issues to avoid when submitting a claim. There will be plenty of time for Q&A with the panel to discuss issues specific to your practice.
- Insurance Panel: Best Practices for Submitting Claims: Friday, Oct. 17 from 9 a.m.-Noon
Call-out Box:
Submit your third-party questions to [email protected]. Members with coding questions or difficulties with insurance claims can also contact the AAP’s Third-Party Specialist at 312-573-3241 or [email protected].
Over the last several months, osseous surgery and regeneration procedures involving both natural teeth and implants in the same area of the mouth has been a recurring problem. Let’s use an example: osseous surgery is completed in four quadrants, with only the third molars missing, as well as implants present in the areas of teeth #13, #29, and #30. Bone grafting using resorbable membranes was completed on tooth #14, and the implants for #13 and #30. Biologic material was used on tooth #14.
In most instances, the osseous surgery code is used correctly, D4260 x4. The codes for regeneration, however, are where the problems occur. In this case, the maxillary left quadrant should be coded as follows:
ULQ D4260 osseous surgery four or more contiguous natural teeth
#14 D4263 bone replacement graft -retained natural tooth -first site in quadrant
#14 D4265 biologic materials to aid in regeneration
#14 D4266 guided tissue regeneration, natural teeth, resorbable
Also, for this quadrant:
#13 D6102 debridement and osseous contouring of a peri-implant defect surrounding a single implant
#13 D6103 bone graft for repair of peri-implant defect
#13 D6106 guided tissue regeneration, resorbable, per implant
The mandibular right would be coded as follows:
LRQ D4260 osseous surgery, four or more contiguous natural teeth
#29 D6102 debridement and osseous contouring of a peri-implant defect surrounding a single implant
#29 D6103 bone graft for repair of peri-implant defect
#29 D6106 guided tissue regeneration, resorbable, per implant
#30 D6102 debridement and osseous contouring of a peri-implant defect surrounding a single implant
#30 D6103 bone graft for repair of peri-implant defect
#30 D6106 guided tissue regeneration, resorbable, per implant
The mistake occurs when it is assumed that the treatment performed will be covered by the codes for natural teeth. In these cases, although it may seem redundant, each implant must be coded individually for each procedure. It does not matter if the implants are adjacent or not since the coding is per implant. When this is not done, claims can be denied, or benefits may be reduced. It is important to remember, however, that plan limitations may also affect reimbursement. As with any claim, obtaining a pre-treatment estimate will avoid problems with both the carrier and patient.
Q: There are times when I am exposing an implant for restorative treatment and placing the abutment, and I then decide that an apically positioned flap will preserve attached tissue on the facial of the implant. How would I code for these procedures?
We always say code for what you do. The easiest way to determine if you are coding correctly is to look at the procedures you have performed in the order in which they are completed. In your case, the implant was exposed first. In most cases, this is accomplished with either a punch-type procedure or small partially elevated flap. D6011, surgical access to an implant body (second stage implant surgery), would describe this.
Since you are placing the abutment, this second step would be coded for either D6056, prefabricated abutment, or D6057, custom fabricated abutment.
The last procedure was to elevate a flap (or further elevate the small partial flap from when you exposed the implant) and position it apically to provide keratinized tissue on the facial of the implant. This would be coded D4245, apically positioned flap. In most instances, only the D6011 would be used, but if you do perform both procedures you may use both codes to describe what has been done. In many cases, a carrier will only cover the most inclusive code and may not cover both.
Q: I get confused as to the meaning of “site.” Can you explain the differences between sites for teeth, implants, and edentulous areas?
It can be confusing because the term “site” means different things in different situations. There are three times a site applies when submitting claims. The first is soft tissue grafting, which is straight forward. A single tooth is considered a site. Submit one code for each tooth.
When dealing with any procedure involving missing teeth, such as ridge augmentation, a site is considered an area of two tooth positions or less. If you are treating the mandibular posterior, for example, where teeth #29-32 previously were, then this would be submitted as two sites and thus two codes.
Osseous defects are the most confusing. Simplified, if there is a defect on only one tooth then that is a site and one code is submitted. If one defect affects two adjoining teeth, communicating, then this is also a single site and one code is used. Osseous defects on adjacent teeth that cannot be probed from one defect to the other (a section of bone is between the defects) would be two sites, and two codes would be appropriate.
This is further explained at the beginning of the Periodontics category of the CDT.
Implants are not considered by “site.” Implant codes for treatment of peri-implantitis or mucositis are submitted per implant.
2025 Annual Meeting Live Insurance Workshops
Do you prefer to learn about coding and insurance in person? The AAP’s Dental Coding and Medical coding workshops will be presented live at the AAP’s Annual Meeting in Toronto!
- Dental Coding Workshop: Friday, Oct. 17 from 2-5 pm
- Medical Coding Workshop: Saturday, Oct. 18 from 9 am to 12 pm
- Learn about best practices for submitting claims directly from the AAP’s Insurance Consultant and representatives from the insurance industry. This course will feature a case study discussion of insurance claims that will highlight the appropriateness of submission, reasons for denial, and issues to avoid when submitting a claim. There will be plenty of time for Q&A with the panel to discuss issues specific to your practice.
- Insurance Panel: Best Practices for Submitting Claims: Friday, Oct. 17 from 9 a.m.-Noon
Call-out Box:
Submit your third-party questions to [email protected]. Members with coding questions or difficulties with insurance claims can also contact the AAP’s Third-Party Specialist at 312-573-3241 or [email protected].