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Policy No:  33

Originally Created: 01/01/2000

Section: Periodontics

Last Reviewed:  01/01/2019

Last Revised:  01/01/2018

Approved: 01/01/2018

Effective:  01/01/2018


Apically positioned flap (D4245)

Procedure is used to preserve keratinized gingiva in conjunction with osseous resection and second stage implant procedure. Procedure may also be used to preserve keratinized/attached gingiva during surgical exposure of labially impacted teeth, and may be used during treatment of peri-implantitis.


Procedure is in accordance with generally accepted standards of dental practice.

Procedure is considered inclusive of D4240, D4260, D4261 or D7280.

Administrative guidelines

Process to contract benefits.


CDT - D4000-D4999 - see above


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