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Dental practices handle hundreds of patient evaluations each year, and billing them correctly matters. Getting D0120 wrong can lead to claim denials, payment delays, and confusion at the front desk. This code covers one of the most common procedures in dentistry, yet it's frequently misunderstood and misapplied. D0120 represents the periodic oral evaluation—the routine checkup that keeps patients healthy and your schedule full. Understanding when to use it, how to document it, and what insurance companies expect can save your practice time and prevent billing headaches.
Oct 25, 2025
What is Dental Code D0120?
D0120 is the Current Dental Terminology (CDT) code for a periodic oral evaluation performed on an established patient. This evaluation assesses the patient's oral health status, identifies changes since the last visit, and determines if treatment is needed. The exam typically occurs every six months for patients with stable oral health.
The periodic evaluation differs from other exam types because it assumes the patient has been seen before and has an established dental history at your practice. The dentist reviews existing conditions, checks for new problems, and updates the treatment plan based on current findings.
Common Terminology
Understanding the language around D0120 helps avoid confusion at the front desk and during insurance verification. These terms appear in insurance communications, practice management software, and patient records daily.
Established patient: Someone who has received professional services from your practice within the past three years
Periodic evaluation: A routine exam for patients with known dental histories, not their first visit
Recall exam: Another term for the periodic evaluation, often used in practice management software
Prophylaxis: The cleaning procedure (D1110) that usually accompanies D0120 at routine visits
When is D0120 Used?
D0120 applies to routine dental visits for established patients who need ongoing oral health monitoring. The code covers the clinical examination, oral cancer screening, and assessment of existing restorations and periodontal status. Most practices bill this code for the majority of their preventive appointments.
Recognizing the right scenarios for D0120 prevents billing errors and claim denials. The code applies when the visit is truly routine and the patient has an established relationship with your practice.
Common Clinical Scenarios
These situations represent appropriate use of D0120 in daily practice. Each scenario involves an established patient receiving routine monitoring rather than comprehensive assessment or problem-focused care.
A patient returns for their six-month checkup with no significant changes in their oral health status
An established patient schedules a routine exam after a brief lapse in care (under three years)
The dentist performs a recall exam that includes checking existing fillings, crowns, and gum health
A patient comes in for their regular preventive visit and receives an oral cancer screening as part of the standard examination
The evaluation focuses on monitoring stable conditions rather than diagnosing complex new problems
When D0120 is NOT Appropriate
Several situations call for different evaluation codes instead of D0120. Using the wrong code leads to reduced reimbursement, claim denials, or compliance issues during audits.
New patient exams require D0150 (comprehensive evaluation) regardless of how recently they visited another practice
Problem-focused visits for specific complaints use D0140 (limited oral evaluation)
Patients who haven't been seen in three or more years typically need D0150, as they're considered new patients
Emergency visits for pain or trauma require D0140, not D0120
Comprehensive periodontal evaluations need their own specific codes (D0180)
Billing and Insurance Considerations
Insurance companies have specific requirements for D0120 that differ from other evaluation codes. Missing documentation or billing too frequently can trigger claim denials, even when the service was medically necessary. Your front desk team needs to verify coverage limits before scheduling to avoid patient surprise bills.
Proper documentation and understanding of insurance rules protect your practice revenue. These guidelines help your team bill correctly the first time and reduce claim rejections.
Documentation Requirements
Proper documentation protects your practice and supports insurance claims. Each element serves a specific purpose during audits and claim reviews.
Clinical notes needed: Record chief complaint, review of systems, intraoral and extraoral examination findings, existing restorations assessment, periodontal evaluation, oral cancer screening results, and updated treatment recommendations
Radiographic documentation: While X-rays aren't always required with D0120, document when they're taken and why; bitewings are commonly paired with periodic evaluations but use separate billing codes
Insurance Coverage
Most dental insurance plans cover D0120 with specific parameters. Understanding these rules helps your team set accurate patient expectations during scheduling and prevents billing surprises.
Two periodic evaluations per year represent standard coverage for most plans
Some plans require six months between D0120 claims for the same patient
Benefits typically cover the evaluation at 80-100% after any deductible
Prior authorization is rarely needed for D0120 when billed within frequency limits
Coordination of benefits may affect coverage if the patient has multiple insurance plans
Common Billing Mistakes
Avoid these frequent errors that lead to claim denials. Each mistake affects your practice differently, from immediate denials to delayed audits and recoupment demands.
Billing D0120 for new patients instead of D0150, which reduces reimbursement and may trigger audits
Submitting multiple D0120 claims within the same benefit period without checking plan limitations
Using D0120 for problem-focused visits that should be coded as D0140
Failing to document the exam components in clinical notes, leaving claims vulnerable to review
Not updating patient status in your system, causing established patients to be incorrectly billed as new patients
Common Questions
How often can D0120 be billed?
Most insurance plans allow D0120 twice per calendar year or once every six months, whichever is less restrictive. Some plans use a benefit period that differs from the calendar year. Check individual plan limitations before scheduling to prevent denied claims. Billing more frequently than allowed will result in patient responsibility for the full fee.
Can I bill D0120 and D0150 in the same year?
Insurance rarely covers both codes in the same benefit period for the same patient. If a patient requires a comprehensive evaluation (D0150) after a periodic evaluation (D0120), document medical necessity clearly. Most plans will deny one of the claims without proper justification. The comprehensive evaluation takes precedence when both are clinically indicated.
What if a patient hasn't been seen in exactly three years?
The three-year guideline serves as a general threshold, but clinical judgment matters. A patient who missed their six-month recall by a few weeks still qualifies for D0120. Someone who returns after two years and 11 months may need D0150 if significant changes occurred or comprehensive documentation is required. Document your clinical reasoning.
Does D0120 include radiographs?
No, radiographs are billed separately using their own codes (D0210, D0220, D0230, D0274, D0330, etc.). D0120 covers only the clinical examination. Many practices take bitewing X-rays during periodic evaluations, but they're separate services with separate billing codes. Insurance plans often bundle these services for coverage purposes but they're distinct procedures.
Can I bill D0120 if only a hygienist sees the patient?
The dentist must perform and document the evaluation for D0120 billing. Hygienists can gather clinical information and perform cleanings, but the examination component requires the dentist's direct involvement. Some states allow hygienists to perform limited screenings, but these use different codes. Your practice's billing must reflect who actually performed each service.
What happens if I bill D0120 for a new patient by mistake?
The claim may be paid initially but could be subject to later review and recoupment. Insurance companies audit claims and may request refunds years later if they discover coding errors. Correct the mistake as soon as you notice it. Accurate front desk workflows reduce these administrative errors.
Can hygienists complete the exam when we're short-staffed?
No, the dentist must perform the D0120 evaluation. When staffing shortages affect your ability to see patients, flexible staffing solutions help maintain appointment schedules without compromising billing accuracy. Hygienists can prepare patients and document findings, but the dentist must complete the examination.
Keep Your Recall Schedule Running Smoothly
Billing D0120 correctly protects your practice revenue and maintains patient trust. Understanding when to use this code, how to document it properly, and what insurance companies expect prevents claim denials and front desk confusion.
Staffing challenges shouldn't disrupt your recall system or force billing errors. When your schedule fills with routine evaluations and your team feels stretched, temporary hygienist coverage keeps patients moving through the chair without compromising care quality or documentation standards.
Teero connects dental practices with qualified hygienists who understand the clinical and administrative requirements of routine preventive visits. Your patients get consistent care, your team gets breathing room, and your recall schedule stays on track. Ready to fill your next hygiene shift? Sign up for Teero to find qualified coverage for your recall appointments and keep your practice running smoothly.