Coding Sub-Gingival irrigation

Here he covers D4921: Gingival irrigation—per quadrant.

D4921: Gingival irrigation—per quadrant


This code is used when irrigating a periodontal pocket with a solution such as chlorohexidine (Peridex). By placing the medication directly into the gum pocket, the hygienist is targeting the bacteria in the pocket and hoping to reduce the amount of bacteria and alleviate the area of inflammation. Placement usually occurs during a scaling and root planning and/or a full-mouth debridement.


Submitting the claim with x-rays is not enough to facilitate coverage and payment:


This code should be applied only when the procedure involves debridement and/or scaling and root planing.

Dental insurance companies will refer to the patient's plan limitations and exclusions when considering the dental claim.

When submitting multiple procedures on the same date of service as D4921: Gingival irrigant, such as D4341/2: Scaling and root planing and/or D4355: Full-mouth debridement, you should report these procedures on a separate claim form, otherwise the entire claim may be rejected and payment denied.

Pre-op and post-op x-rays must always accompany the claim form. In addition, periodontal charting should be included.


A narrative should be included indicating the following:

  • The severity of gingival inflammation

  • The level of sensitivity

  • Bleeding on probing



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