Scaling and Root Planing Cost in 2026: Per-Quadrant Breakdown (D4341 / D4342)

What scaling and root planing is

Scaling and root planing is a non-surgical periodontal therapy used to treat gum disease. The word "scaling" refers to the removal of plaque and tartar from the tooth surface above and below the gumline; "root planing" refers to smoothing the root surface below the gumline to remove bacterial toxins and to allow the gum tissue to reattach to the tooth. SRP is performed using ultrasonic scalers and hand instruments, under local anesthetic, with the mouth divided into four quadrants (upper right, upper left, lower right, lower left). Each quadrant is treated separately, and the billing is per quadrant.

SRP is clinically and billably different from a routine prophylaxis (D1110). A prophylaxis is a preventive cleaning that removes deposits from above the gumline and along the gumline itself; it takes 30 to 45 minutes and is typically covered at 100% by dental insurance preventive coverage. SRP is a therapeutic procedure for patients with periodontal disease; it takes 2 to 4 hours total (usually split across 2 visits), is typically covered at 80% by dental insurance basic restorative coverage, and is followed by indefinite periodontal maintenance (D4910) every 3 to 4 months instead of the standard 6-month prophylaxis interval.

The clinical threshold for recommending SRP is generally pocket depth of 4mm or more on multiple teeth, with bleeding on probing, as documented in periodontal charting. The American Academy of Periodontology provides clinical guidelines and patient information about periodontitis staging and SRP. Insurance carriers require periodontal charting (six pocket-depth measurements per tooth) to justify SRP claims; if the charting doesn't support the diagnosis, the insurer will deny the claim and reprocess as a routine prophylaxis. This page is not clinical advice; the decision to undergo SRP is between you and your dentist.

D4341 vs D4342: the two CDT codes

Scaling and root planing is billed under two distinct CDT procedure codes depending on the number of teeth in the quadrant that require the procedure:

• D4341: Periodontal scaling and root planing, four or more teeth per quadrant. The "full quadrant" code. Used when 4 or more teeth in the quadrant have periodontal pockets of 4mm or deeper. This is the most commonly billed SRP code. Cash range: $200 to $400 per quadrant in 2026.
• D4342: Periodontal scaling and root planing, one to three teeth per quadrant. The "limited quadrant" code. Used when 1 to 3 teeth in the quadrant require SRP but the rest of the quadrant is periodontally healthy. Cash range: $150 to $320 per quadrant in 2026.

A patient with generalized periodontitis affecting all four quadrants will typically be billed for D4341 x 4 (full-mouth SRP). A patient with localized periodontitis affecting only the back molars in two quadrants might be billed for D4341 x 2 (the affected quadrants) or for D4342 x 2 if fewer than 4 teeth are affected per quadrant. The dentist's clinical judgment, supported by the periodontal chart, determines which code applies per quadrant.

2026 SRP pricing by scenario

The table below shows the typical 2026 cost ranges for SRP across the most common billing scenarios. Cash ranges are sourced from the ADA HPI 2025 fee survey projected forward, cross-checked against FAIR Health Consumer median paid amounts.

Insurance coverage of SRP by plan type

Dental insurance plans almost universally classify SRP as a "basic" restorative service rather than a "preventive" service. Basic services are typically covered at 80% after meeting the annual deductible, with the insurer paying up to the annual maximum (usually $1,000 to $2,500). Some older plan generations (legacy employer plans, certain individual market plans) cover basic services at 50% rather than 80%. The table below shows how a full-mouth SRP plays out across plan types.

Verify with your insurance: most carriers require pre-authorization for SRP (the dentist submits the periodontal chart, X-rays, and treatment plan to the insurer for approval before treatment). Pre-authorization is not a guarantee of payment but is a strong predictor; the carrier reviews the chart for medical necessity. If your insurer denies pre-authorization, ask your dentist to appeal with additional documentation or request a peer-to-peer review.

The annual maximum trap

A common patient surprise: even with PPO insurance covering SRP at 80%, the annual maximum can absorb most of your year's dental benefit on a single full-mouth SRP. If your plan's annual maximum is $1,500 and your full-mouth SRP costs $1,200, the insurer pays $960 (80% of $1,200), leaving you with $240 out-of-pocket on the SRP and only $540 remaining in your annual benefit for any other dental work that calendar year. A subsequent filling, crown, or root canal in the same year may come substantially out-of-pocket because your annual max is mostly consumed.

Two practical responses: ask your dentist whether the SRP can be split across two calendar years (2 quadrants in December, 2 quadrants in January) to draw on two separate annual maximums; and check whether your plan resets on a calendar year (January 1) or a benefit year (varies by plan and employer). Some plans run a benefit year July 1 to June 30, which changes the timing math.

What happens after SRP: periodontal maintenance (D4910)

Once you've had SRP for periodontitis, you do not go back to standard 6-month routine cleanings (D1110). Instead, the standard of care is periodontal maintenance (D4910) every 3 to 4 months, indefinitely. The shorter interval reflects the elevated re-deposition risk for periodontally-treated patients; bacteria recolonize the deepened pockets faster than they form fresh deposits on healthy teeth. The closer surveillance interval is intended to prevent disease progression.

Cost of periodontal maintenance: $100 to $300 cash per visit, $50 to $150 with PPO insurance covering 80% after deductible. Most plans cover D4910 at 80% rather than the 100% applied to routine prophylaxis, so periodontal maintenance is a real recurring out-of-pocket cost for insured patients with periodontitis. See our periodontal maintenance cost page for full detail.

The SRP-vs-debridement question (D4341 vs D4355)

A few patients present with so much accumulated tartar that the dentist cannot perform a routine cleaning or a meaningful periodontal evaluation until the gross deposits are removed first. In this scenario, the dentist may bill D4355 (full mouth debridement) as a precursor visit, followed by SRP or routine prophylaxis at the subsequent appointment. D4355 typically costs $150 to $300 cash; it is a one-time procedure, billed once per patient per dentist per lifetime in most plans.

D4355 and SRP are not interchangeable. D4355 is a removal of gross deposits to enable a future periodontal evaluation; SRP is a therapeutic procedure performed once that evaluation has confirmed periodontal disease. Patients with very heavy tartar from many years without dental visits will sometimes need both: D4355 first (one visit), then full-mouth SRP (one or two subsequent visits), then ongoing periodontal maintenance every 3 to 4 months. See our full mouth debridement page.

Cost-of-skipping framing

The cost-of-skipping math on SRP is real but should be discussed with your dentist, not inferred from a website. Untreated periodontitis is the leading cause of adult tooth loss in the US; the CDC estimates that 47% of US adults over 30 have some form of periodontal disease, and 8% have severe periodontitis. A single skipped SRP recommendation, followed by 5 to 10 years of disease progression, can lead to tooth mobility, attachment loss, eventual tooth extraction, and a need for implant or denture replacement (each implant runs $3,000 to $5,500; a partial denture $1,000 to $3,000; a full set of implants $20,000 to $60,000). See our cost of skipping page.

This is not clinical advice. Periodontitis severity, progression rate, and treatment response vary widely between individuals. The decision to undergo SRP, the choice of treatment frequency, and any restorative implications are between you and your dentist. A second opinion is your patient right if the recommendation feels uncertain.

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