Current Dental Terminology (CDT) codes are the standardized, five-character alphanumeric codes used by dentists to communicate services to insurance companies and patients. Maintained by the American Dental Association, these codes ensure uniformity in documentation, billing, and claims processing. This common system dictates how a procedure is recognized and how coverage and payment are determined. Understanding these codes is essential for transparency in dental care expenses, and D0120 is one of the most common codes encountered in routine visits.
What a Periodic Evaluation Means
The official terminology for D0120 is “Periodic Oral Evaluation—Established Patient.” This procedure is intended for individuals already on record with the dental practice who have previously undergone a comprehensive examination. The purpose is to monitor changes in the patient’s dental and medical health since their last visit, focusing on early detection and ongoing surveillance. D0120 is the code used for routine recall appointments, typically scheduled every six months, to maintain preventive care.
What Happens During the Examination
The D0120 examination is a focused clinical procedure designed to assess the current state of the patient’s oral environment. The dentist begins by reviewing and updating the patient’s medical and dental history to note any changes in medications or health conditions. A required component is a soft tissue evaluation, which includes a thorough screening for signs of oral cancer. The dentist also performs a periodontal assessment to screen for gum disease and examines existing restorations like fillings or crowns. Finally, the dentist may review diagnostic information, such as radiographs, to look for developing decay or bone loss.
How Insurance Covers This Service
Since D0120 is categorized as a preventive service, most dental insurance plans cover it at a high percentage, often 100% of the allowed fee. This coverage is subject to frequency limitations imposed by the carrier. Most plans limit the evaluation to once every six months, or two examinations per calendar year, aligning with standard preventive care recommendations. If the evaluation is scheduled sooner than the plan allows, the claim will typically be denied, and the patient will be responsible for the full fee. It is important to note that associated procedures performed on the same day, such as cleaning or X-rays, are separate codes with their own coverage rules, which may involve copayments or deductibles.
Comparing This to Other Evaluation Codes
The D0120 code is one of several diagnostic evaluation codes, each defining a different depth and scope of service.
Comprehensive Oral Evaluation (D0150)
The Comprehensive Oral Evaluation (D0150) is a significantly more detailed examination than the periodic check-up. D0150 is typically reserved for new patients to establish an initial baseline record. It is also used for established patients who have experienced a major health change or have been absent from active treatment for three or more years. This comprehensive code covers a full-record assessment and a detailed diagnosis.
Limited Oral Evaluation (D0140)
In contrast, the Limited Oral Evaluation (D0140) is used when the patient presents with an urgent, specific, and problem-focused issue. This service is much narrower in scope than D0120, concentrating only on the specific area of complaint, such as a toothache or a broken tooth. D0120 is positioned as the standard, routine maintenance evaluation for established patients, broader than the problem-focused D0140 but less intensive than the full-scale D0150.