Insurance narrative for periodontal maintenance

A letter to the dental claims consultant supporting code D4910, periodontal maintenance. It records the patient’s name, date of birth, and member ID, describes a history of progressive bone loss and prior periodontal care, and lists blanks for extractions, bone grafts, periodontal surgery, and implant placement with dates. It explains that the completed treatment supports maintenance every three months, four times a year, and closes with the doctor’s signature.

Use it when a carrier limits or denies the number of perio maintenance visits per year. Fill in the treatment history from the chart, adjust the wording to the patient’s records, and have the doctor sign before sending.