Network Plus Prepaid plan People First Plan Code 4004 Schedule of benefi ts ADA MEMBER CODE PROCEDURE PAYS ADA MEMBER CODE PROCEDURE PAYS 18 19 Prepaid Dental Plans State Assurant Prepaid 225 Plan Code—4025 State CIGNA Dental Plan Code—4034 State Humana Network Plus Plan Code—4004 Q: I’m in a new office and they alternate D1110 and D4910 after periodontal treatment. I know this is wrong, so how do I make the case to my doctor to change this. 2 Research Brief enrollment in Medicaid and CHIP led to a decline in the percentage of U.S. children without any form of dental benefits.7 The increase in the dental. View our complete list of discount dental services on our dental fee schedule with savings on over 105 discounted dental services and dental procedures. 11178 Huron Street, Suite 3 • Northglenn, CO 80234 303-457-9794 • 800-377-2924 • fax: 303-457-6956 • A Colorado Company Owned & Operated by. At Sage Dental, we make dental affordable by offering our patients 65% off all general and cosmetic dentistry when they enroll in our VIP Discount Program. Debridement (D4355) SRP (D4342 & D4341) and Prophy (D1110) Questions. Dental Hygienist jobs forums. Understanding how the puzzle fits together. Can you alternate the D1110 or D4910 codes? Who knows? Who cares? It makes you crazy just to think about it. rev. july 1, 2015 nebraska department of medicaid services manual letter 16-2015 health and human services 471-000-506 page 3 of 20 code.