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Coding with Kyle: What code to use for dental exam visit?

Feb. 17, 2016
Dental coding for insurance company purposes is tricky business. All dental practices experience problems now and then. This monthly Coding with Kyle column is designed to help guide practices through some of the confusion.
Kyle L. Summerford, Editorial Director

It’s no secret that dental practice team members are often confused when it comes time to submit for a dental examination visit. What code should they use, and when? This monthly column is here to help with some of the common challenges dental practices experience when it comes to coding.

Frequently used examination codes—CDT2015

D0120—Periodic oral evaluation, established patient
This code applies and should only be used to report a diagnostic treatment plan and evaluation assessment performed on a patient to gather any new changes since the patient’s last visit. *This code is to be billed only for established patients.

D0140—Limited oral evaluation, problem focused
This code specifically applies to patients who enter your practice with a specific condition, such as an emergency, infection, or something similar. The key words here are “problem focused,” so it should only be billed for patients with focused problems, not periodic evaluations.

D0150—Comprehensive oral evaluation, new or established patient
This code applies when a general dentist or dental specialist evaluates the patient. It says that not only was a diagnostic treatment plan and an extensive evaluation assessment performed, but this should also include all soft tissue, hard tissue, and oral cancer screenings.

D0160—Detailed and extensive oral evaluation, problem focused by report
This code applies when the patient has previously presented for an exam (D0150) and/or periodontal examination (D0180). It indicates the patient requires a much more extensive examination due to the condition assessed on his or her previous exam.

D0170—Re-evaluation, limited problem focused (established patient, not post-operative visit)
This code applies when assessing a previously existing condition related to trauma, or a follow-up evaluation for continuing issues. This code should not be used to report a post-operative visit. An accompanying narrative can justify the reason for necessity.

Keep in mind that insurance companies have limitations, such as “two per year” or “one per six months.” Very few companies allow for three examinations, and these are always dependent upon narratives the practice may provide to the insurance company to justify the reason for necessity. As always, make sure you refer to the most current CDT code sets to avoid complications and discrepancies.

D4341 and D4342, scaling and root planing
D4249–clinical crown lengthening
D9940-occlusal guards

This article first appeared in Dental Assisting Digest. To receive enlightening and helpful articles for assistants and office managers in this monthly e-newsletter, visit

Kyle L. Summerford is CEO and founder of Summerford Solutions, Inc. and editorial director of PennWell’s Dental Assisting Digest e-newsletter. He provides professional business coaching for dentists. Mr. Summerford is a professional speaker and author focusing on topics such as increasing practice revenue and staff efficiency training. Visit with inquiries regarding his dental practice efficiency services.