CDT Code Q&A Reference Guide

Typically, a consultation (D9310) is reported when one dentist refers a patient to another dentist for an opinion or advice on a particular problem encountered by the patient.

Code D9310 may be used when a patient is referred to another dentist for evaluation of a specific problem. The dentist who is consulted may initiate therapeutic services for the patient. Code D0140 and D0160 are both problem focused evaluations. D0160 should be used when the evaluation is detailed and extensive and based on the findings of a comprehensive evaluation.

A series of clinical evaluation codes exist that recognize the cognitive skills necessary for patient evaluation. Codes D0120 through D0180 are available to report patient evaluations, depending on the nature of the service provided. The initial examination for a new patient may be reported using "D0150 comprehensive oral evaluation – new or established patient" or by "D0180 comprehensive periodontal evaluation – new or established patient." An examination of a patient who presents with a dental emergency may be reported using "D0140 limited oral evaluation – problem focused."

There is nothing in the descriptors of the oral evaluation code or D4355 that preclude reporting on the same day. Some benefit plans have limitations or exclusions about paying for both of these procedures on the same day.

There is no language in the descriptor of D0140 that precludes the reporting of other procedures on the same date of service. However, some benefit plans have limitations or exclusions about paying for certain combinations of codes performed on the same day.

There is no code for a periodontal re-evaluation. Procedure code D0170 may be reported when not monitoring post-operative tissue healing. Code "D4999 unspecified periodontal procedure, by report" is also an available code to report a periodontal re-evaluation.

The comprehensive periodontal procedure includes all of the components of a periodic evaluation, and adds additional requirements for periodontal charting and the evaluation of periodontal conditions. When a patient presents with signs or symptoms of periodontal disease, and all of these components were performed, D0180 would be reported.

D0180 is not limited to Periodontists. All dental procedure codes are available to any practitioner providing service within the scope of her or his license.

The procedure code for the evaluation of a child under age three and including counseling of the child's primary caregiver may be reported. This code is: "D0145 oral evaluation for a patient under three years of age and counseling with primary caregiver."

A separate evaluation code was added because of the unique procedures that are necessary when evaluating a very young child. Depending on the nature of the evaluation, a periodic evaluation (D0120) or an oral evaluation for a patient under three years of age (D0145) would be appropriate choices to consider.

No, a panoramic film and bitewings are not the same as the "D0210 intraoral, complete series…" procedure. A full mouth series is defined as "A set of intraoral radiographs usually consisting of 14 to 22 periapical and posterior bitewing images intended to display the crowns and roots of all teeth, periapical areas and alveolar bone crest." A panoramic film cannot be considered a full mouth series as it is an extraoral film and it does not reflect the FDA definition of a full mouth series.

A procedure code to report three bitewing images was approved by the Code Revision Committee effective January 1, 2007. You may report procedure code "D0273 bitewings, three films."

Three procedure codes are available. To report the patient visit when the images are taken, use code "D0360 cone beam ct – craniofacial data capture." If a traditional two dimensional view is produced, report "D0362 cone beam – two dimensional image reconstruction using existing data, includes multiple images." When a three-dimensional view is generated, use code "D0363 cone beam – three dimensional image reconstruction using existing data, includes multiple images."

The appropriate image reconstruction code should be reported. Since the data capture has already been reported it would not be appropriate to report it again.

No, they are different procedures. A caries susceptibility test is a diagnostic test for determining a patient's propensity for caries. There is no procedure code for a caries detectibility test, which aids in determining the presence of caries. "D0999 unspecified diagnostic procedure, by report" may be used to report a caries detectibility test.

Yes, you may submit this as a separate service (D0460) as it is a stand-alone code. It includes multiple teeth and contra lateral comparison(s), as indicated.

Procedure codes contained in the Code on Dental Procedures and Nomenclature as published by the ADA in the CDT manual are not product or brand-name specific. Devices such as the VelScope may be used in the delivery of procedures such as: "D0431 adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and malignant lesions, not to include cytology or biopsy procedures."

A prophylaxis is removal of plaque, calculus and stains from the tooth structures. It is intended to control local irritational factors.

The prophylaxis codes are dentition specific rather than age specific. However, third-party payers may have age restrictions in their contracts that determine the level of benefits available. The ADA's House of Delegates has adopted a policy that when dental plans differentiate coverage based on the child or adult status of the patient, this determination be based on clinical development of the patient's dentition.

There is no separate procedure code that reflects the degree of difficulty of a dental prophylaxis. The available prophylaxis codes are "D1110 prophylaxis – adult" and "D1120 prophylaxis – child".

According to third-party payer members of the Code Revision Committee "D1110 prophylaxis – adult" would be used to document and report this service.

The descriptors of the prophylaxis codes ("D1110 prophylaxis – adult" and "D1120 prophylaxis – child") include removal of factors that cause local irritations. When bone loss is present, other procedures may be appropriate to control disease factors.

There is no language in the descriptor of an adult prophylaxis that precludes the reporting of any other procedure. Some benefit plans have limitations or exclusions about paying for both these procedures on the same day.

The Code does not contain combination prophy/fluoride procedure codes. Effective January 1, 2007 a prophylaxis and a fluoride treatment are reported as two separate procedures. For a child codes "D1120 prophylaxis – child" and "D1203 topical application of fluoride-child" may be reported. For an adult codes "D1110 prophylaxis – adult" and "D1204 topical application of fluoride – adult" may be reported.

When fluoride varnish is utilized to desensitize a tooth, you may report "D9910 application of desensitizing medicament". Procedure code "D1206 topical fluoride varnish; therapeutic application for patients at moderate to high risk of developing caries" is used for therapeutic purposes with patients who are at moderate to high risk of developing caries.

The procedure codes you have used in the past for preventive topical fluoride (D1203 and D1204) do not specify the formulation or technique used for application. Procedure code D1206 should be reported for the therapeutic application of fluoride varnish for patients with moderate to high risk of caries development.

The Code does not specify delivery mechanisms for topical fluoride materials. This aspect of the procedure is best determined by the practitioner at the time of service.

All dental professionals should deliver services according to applicable state laws and within the scope of their licensure. "Direct supervision…" would be defined by state practice acts; contact your constituent or component dental society for such information.

The term "fissurotomy" is actually a trademarked name and applies to a particular kind of bur. However, "fissurotomy" is sometimes used to describe a technique utilizing the mechanical enlargement of occlusal pits and fissures. In that situation you could use "D9971 odontoplasty 1-2 teeth; includes removal of enamel projections."

The Code was revised effective January 1, 2011 to enable separate reporting of these distinct procedures. Resin used as a sealant in a pit and fissure area, limited to the enamel, would be documented using D1351. When resin is used in a pit and fissure area where there is an active cavitated lesion that does not extend into the dentin, the available procedure code is D1352. Should the lesion extend into the dentin, the procedure code for one surface composite resin restoration (D2391) would be used.

"D9215 local anesthesia in conjunction with operative or surgical procedures" is an available procedure code if you wish to report it separately. Benefit plan limitations may preclude separate reimbursement for local anesthesia.

The codes listed under the direct restorative category of service include both the primary and permanent dentitions.

Dentists should report the procedures performed, and reporting these restorations separately as a MO and a DO is appropriate. Dental plans may have clauses that restrict coverage on the same surface twice on the same date of service. This is why some carriers may apply an alternate benefit provision that recodes the two separate restorations as a single restoration.

The codes are procedure based rather then instrument based. You would report the appropriate code based on the actual procedure that was performed.

If the restoration involves the incisal angle, code "D2335 resin-based composite – four or more surfaces or involving incisal angle (anterior)" may be reported. If the incisal surface restored does not involve the incisal angle, report with the appropriate anterior procedure code that describes the number of surfaces restored.

Single crowns that are splinted together are appropriately reported as single crowns, D27xx. There is no coding mechanism to report splinting the crowns. Prosthodontic retainers are parts of a fixed partial denture that attach a pontic to the abutment tooth, implant abutment, or implant and should be used in conjunction with a pontic code.

The available procedure code is "D2740 crown – porcelain/ceramic substrate."

"D2794 crown – titanium" is the only titanium crown procedure available.

The code is "D2971 additional procedures to construct new crown under existing partial denture framework" and should be reported in addition to the crown.

Code "D2910 recement inlay, onlay, or partial coverage restoration" includes the recementation of an inlay, onlay or any other partial coverage restorations such as a veneer.

The Code Revision Committee reinstated a revised code D2970 effective January 1, 2007 and published in the CDT manual.

Both sedative filling (D2940) and palliative (emergency) treatment of dental pain (D9110) may be applicable depending on the dentist's clinical judgment. However, one would not code both simultaneously for the same procedure.

The current version of the Code does not contain a code for procedures that are started but not completed (with the exception of D3332 incomplete endodontic therapy; inoperable, unrestorable or fractured tooth). When services rendered are not addressed by a specific code, an unspecified procedure, by report code (e.g., "D2999 unspecified restorative procedure, by report") may be used.

There is no code that specifically refers to placement of a prefabricated post and core under an existing crown. When there is no procedure code whose nomenclature and descriptor reflect the service provided, an "unspecified…procedure, by report" code may be considered (e.g., D2999 unspecified restorative procedure, by report).

There is no code that specifically refers to placement of a prefabricated post without a core. When there is no procedure code whose nomenclature and descriptor reflect the service provided, an "unspecified…procedure, by report" code may be considered (e.g., D2999 unspecified restorative procedure, by report).

There is no code that specifically refers to placement of a restoration to seal an endodontic access cavity. When there is no procedure code whose nomenclature and descriptor reflect the service provided, an "unspecified…procedure, by report" code may be considered (e.g., D2999 unspecified restorative procedure, by report). Restorative codes may also be used to report sealing an access cavity.

There is no code that specifically refers to placement of a temporary restoration to protect tooth structure and surrounding tissues. When there is no procedure code whose nomenclature and descriptor reflect the service provided, an "unspecified…procedure, by report" code may be considered (e.g., "D2999 unspecified restorative procedure, by report").