Some dental procedures are often very similar in nature thus, confusing even the most experienced dental experts. Hence, understanding the differences between these dental codes is very crucial for you and your patients. Identifying the dental procedures and services correctly will thus help you in efficient dental billing and smoother cash flows.

D4249 Dental Code

According to the ADA, the D4249 (Clinical crown lengthening — hard tissue) is a restorative procedure performed on a tooth with little to no exposure of tooth structure in the oral cavity. It is a surgical procedure which involves creation of a full thickness flap (usually mesial and distal) and the removal of hard tissue or bone to expose more tooth surface so that it may be properly restored. This crown lengthening ada code is only to be used if there exists a healthy periodontal environment, otherwise if a periodontal disease is present then d4249 may not be the correct code instead D4260/d4261 (Osseous surgery – one to three contiguous teeth per quadrant) may be used.

The aim of this procedure is to create a sound base or foundation for the support of the new crown. While it can provide a greater surface area for the installation of a prosthetic device, it can also be used to correct a gummy smile or for aesthetic benefits. 

Hard Tissue vs. Soft Tissue Crown Lengthening

While both the codes are used for crown lengthening, the only difference that exists between them is the type of tissue that the procedure tackles with. D4249 is a hard tissue – crown lengthening procedure while D4212 (Gingivectomy to allow access for restorative procedure, per tooth) is a ‘soft tissue’ crown lengthening treatment. The former engages in hard tissue and bone removal while the latter trims soft tissue to expose more tooth structure. Insurance carriers often include soft tissue crown lengthening as part of the crown treatment and do not consider it as a separate payment.

Why Do D4249 Claims Get Denied?

There are multiple reasons that may result in your dental code d4249 claims being rejected. Some of these may be:

  • If the clinical crown lengthening is performed on the same service date as the crown preparation. A minimum of six weeks of healing time prior to the crown preparation day is required by most dental plans. The failure to do so may result in a claim denial.
  • The treatment performed is soft tissue crown lengthening (D4212) but the claim involves D4249 (hard tissue crown lengthening). This would be an incorrect claim and thus would be rightfully denied.
  • When D4274 (distal or proximal wedge surgery) is combined with hard tissue crown lengthening on the same day. This is usually considered part of the combined surgery and is thus not reimbursed separately.
  • If D4260/D4261 (osseous surgery) is performed jointly with a crown lengthening procedure, then it is often considered part of the osseous surgery service and is not paid separately.

Documentation requirements for Crown Lengthening Dental Code

Most dental plans compensate D4249 “once in a lifetime, per tooth”. Additionally, it is not reimbursed for cosmetic reasons and thus requires extensive detailed explanation of why and how the procedure was performed. These plans also typically ask for at least six weeks of healing time prior to scheduling the crown preparation session.

The required documentations involve site periapical radiographs, current periodontal charting (to prove the area has a healthy periodontal environment) and a detailed crown lengthening narrative derived from detailed clinical notes and supporting evidence. In case of a fractured tooth, it is better to provide prior and post treatment photographs as fractures are often not visible on x-rays. Additionally, a statement containing a minimum of six weeks of healing period should be provided combined with a final service date for the crown procedure.

The clinical notes must be very comprehensive. Since D4249 crown lengthening requires a full-thickness flap, healthy periodontal area, and hard tissue/bone removal, these must be described in detail to prevent any claim denials.

If all these details are provided on time while keeping the claim denial factors provided above in mind, you probably will not face any problems relating to reimbursements. In case you’re still confused over the billing procedures, you may consider outsourcing your billing procedures to a trusted dental billing company, saving you both time and ensuring a smoother inflow of cash.


To summarize, the ada code for hard tissue clinical crown lengthening is D4249. It is performed on a tooth with slight exposure of tooth structure. It requires the creation of a full thickness flap and the removal of hard tissue or bone to expose more tooth surface and needs to be performed in an existence of a healthy periodontal environment. In case of an existence of periodontal disease, the dental code D4260/d4261 (Osseous surgery) is the correct option. Moreover, in case of a soft tissue crown lengthening D4212 (Gingivectomy to allow access for restorative procedure, per tooth) needs to be used. It is imperative to know the differences between these procedural codes to prevent any claim rejections. 

If you have any further questions regarding other dental codes, procedures or dental billing, Zap Dental Billing is here to help. Don’t forget to contact us in case of any queries.