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Important Insurance Information – Eugene, OR
Important Insurance Changes for United Healthcare
UnitedHealthcare Medicare Advantage & Periodontal Maintenance (code D4910)
We want to help you understand how your dental insurance benefits relate to your recommended care.
Insurance Coverage Update
UnitedHealthcare Medicare Advantage plans no longer include Periodontal Maintenance (code D4910) as a standard covered benefit. Under the base plan, periodontal maintenance visits are not covered and will be the patient’s responsibility.
Optional Coverage Rider
UnitedHealthcare offers an optional rider that may be purchased separately within a short 3-month window
- With this rider, Periodontal Maintenance is covered at 50%
- Coverage is subject to plan terms, frequency limits, and annual maximums
Our team is happy to help you review your benefits and estimate your portion before treatment.
Understanding the Difference Between Types of Dental Cleanings
Dental Prophylaxis (code D1110)
Dental prophylaxis is a preventive cleaning for patients with healthy gums or very mild gingivitis. It focuses on removing plaque, tartar, and surface stains above the gumline to help prevent cavities and gum disease.
Periodontal Maintenance (code 4910)
Periodontal maintenance is recommended for patients who have been treated for gum (periodontal) disease. Because gum disease can return, this type of cleaning involves thorough cleaning above and below the gumline, especially in areas where bacteria re-accumulate. These visits help control gum disease and protect the bone and teeth.
In simple terms:
- Dental prophylaxis helps prevent gum disease
- Periodontal maintenance helps manage gum disease after treatment
What’s Important to Know
- The type of cleaning recommended is based on your clinical condition, not insurance coverage
- Periodontal maintenance is considered medically necessary for patients with a history of gum disease
- Insurance benefits may change, but your oral health needs remain the same
If you have questions about your insurance benefits, recommended treatment, or estimated costs, please let us know — we’re here to help.
Frequently Asked Questions
Why does my insurance cover a dental prophylaxis but not periodontal maintenance?
Dental prophylaxis is considered preventive care for healthy gums. Periodontal maintenance is treatment for an existing medical condition (gum disease). Some Medicare Advantage plans exclude this service unless an optional rider is purchased.
If insurance doesn’t cover it, do I still need periodontal maintenance?
Yes. Periodontal maintenance is recommended based on your clinical condition. Skipping or delaying this care can allow gum disease to return and may lead to bone loss or tooth loss.
Can I switch to a dental prophylaxis instead?
The type of cleaning is determined by your gum health, not insurance coverage. If you have a history of periodontal disease, a dental prophylaxis would not adequately treat the condition.
How often is periodontal maintenance needed?
Most patients need periodontal maintenance every 3–4 months. The frequency is based on how your gums respond to treatment and your risk of disease returning.
What is the optional rider and how does it help?
UnitedHealthcare offers an optional rider that can be added to some Medicare Advantage plans. With this rider, periodontal maintenance may be covered at 50%, subject to plan limits.
Will my insurance ever cover periodontal maintenance again?
Insurance benefits can change from year to year. Our team checks your benefits regularly and will inform you of any updates that may affect your coverage.
