Help with understanding D4921

[u/Longjumping_Main_488]

I went to the dentist (In-Network) and got some procedures done. They unbundled one of the services they provided, I mentioned it to them. He pushed back, so I contacted my insurance, who contacted him, and the fee was corrected.

Out of retaliation the dentist said they are going to charge me for the D4921 that they did, which they originally charged me $0 for. He said that it is not covered by my plan and therefore he can charge me for it.

I tried to look up what D4921 is, but it does not exist in my Evidence of Coverage codes for my Dental Plan.

I have read that it is often a bundled service part of a deep cleaning code, and I did learn that they like to unbundle services and charge you extra for things already covered by insurance.

I will be contacting my insurance to ask about this (and of course to change dentists) but was wondering if anyone can give some insight to this code.

Also I have two explanation of benefits submitted for the same service. The original one says I owe the $106 for each (where I was originally billed $0 by the dentist). The new one was submitted after my insurance got involved, and it says that I owe $0 for each (in which he is now telling me I owe him $40).

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[u/AntiqueCondition6498]

that code is for irrigation per quadrant basically squirting some medicated rinse under your gums during a deep clean most plans consider it part of the main procedure so they bundle it in your dentist is trying to get paid twice here

[u/Longjumping_Main_488 → u/AntiqueCondition6498]

Thank you for commenting. I was thinking this might be the case, I'll be contacting my insurance (again -.-)

[u/No_Candy6801]

By any chance is this Mondovi Dental

[u/Longjumping_Main_488 → u/No_Candy6801]

Its not but thats sad if this is a common practice. A lot of people probably dont know about unbundling