The $2,000 Dental Cleaning - Part 1

Q: Recently I had a new dental hygienist clean my teeth and the bill was $2000! How could this be?

A: The word “cleaning” in reference to a dental procedure is an overused, useless word along the likes of the word “nice”. Anybody who has had some basic creative writing education should have been told never to use the word “nice”. It is too vague and could mean several things: fantastic, polite, attractive and twenty other things. One often hears it spoken in sarcasm after seeing someone unscrew a light bulb, having the bulb snap off from the socket; “Nice!”.

Here Are What a Lay Person Calls a Dental Cleaning and What It Really Is:

Code D1110: Prophylaxis-adult: Removal of plaque, calculus (hard tartar) and stains. This is a very superficial removal of bacteria used in completely healthy mouths.

Code D4355: Full Mouth Debridement: Preliminary removal of plaque and calculus that interferes with the ability of the dentist to perform a comprehensive oral evaluation such as periodontal pocket measurements or decay detection. (Very often needed for a patient’s first visit to an office if they have not been to the dentist for a while.)

Code D4346: Scaling in presence of generalize moderate or severe gingival inflammation-full mouth, after oral evaluation. This is the removal of plaque, calculus and stains above and below the gum line in the presence of inflamed and swollen gums with moderate to severe bleeding upon probing. This is not for those with bone loss, craters in the bone or boney pockets, called periodontitis. This is for gum disease contained to the soft tissues; just in the gums.

Code D4341 and 4342: Periodontal Scaling and root planning: Removal of plaque and calculus along the root surfaces of teeth indicated for patients with deep pocket measurements and periodontal disease. This is a treatment; not a preventive visit. Root planning removes contaminated cementum and dentin (the coatings we all have on our roots.) Some soft tissue is removed as well, called curettage. This is often done before gum surgery or as a non-surgical definitive treatment.

Code D4346: D4910: Periodontal Maintenance: This is the frequent visits set up by your dentist to perform any combinations of the above procedures AFTER definitive periodontal (gum) treatment has been rendered.

Next week we will list additional dental procedures that are often added to the above which can require a significant investment on your part, but will help save your teeth.

Dr. Mitchell Josephs practices Implant, Cosmetic and General Dentistry with an emphasis on implants, porcelain veneers, and complex crown and bridge treatment. He is on staff at JFK Medical Center and is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry. He completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.