D4274Mesial/Distal Wedge Procedure, Single Tooth (When Not Performed in Conjunction With Surgical Procedures in the Same Anatomical Area)

What This Code Covers

D4274 covers a mesial or distal wedge procedure on a single tooth. The most common application is a distal wedge procedure behind the last molar, where excess fibrous gum tissue in the tuberosity or retromolar area creates a deep pocket that traps bacteria. The procedure surgically removes the wedge of tissue and reshapes the area to eliminate the pocket and improve hygiene access. This code is used when the wedge procedure is performed as a standalone surgery, not in conjunction with other surgical procedures in the same area.

Billing Guide

Bill this code when:

• A distal wedge procedure is performed behind the last molar to reduce a pocket
• A mesial wedge procedure is performed to address tissue excess mesial to a tooth
• The procedure is a standalone surgery, not combined with osseous surgery in the same area
• Excess fibrous tissue is surgically removed and the site is recontoured

Do not bill this code when:

• The wedge procedure is performed as part of osseous surgery in the same area (included in D4260/D4261)
• A gingivectomy covers the same area. Use D4210 or D4211
• The tissue removal is incidental to an extraction or other surgery
• No periodontal surgical intervention is performed

Insurance and Denial Prevention

Key Payer Rules:

• D4274 is billed per tooth as a standalone procedure
• The code specifies that it should not be billed with other surgical procedures in the same anatomical area
• Most payers require periodontal charting showing a deep pocket at the wedge site
• Prior scaling and root planing with re-evaluation should be documented

Common Denials and How to Respond:

• Bundled with osseous surgery - If osseous surgery (D4260/D4261) is also being performed in the same area, the distal wedge is typically included. D4274 is only billed as a standalone procedure. Clarify that no other surgery was performed in the same area.
• Not medically necessary - Submit periodontal charting showing the deep pocket at the distal or mesial site and explain that the fibrous tissue prevents adequate healing or hygiene.
• Missing documentation - Provide charting, clinical notes, and the rationale for the standalone wedge procedure.