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Tracking orthodontic progress requires detailed documentation. Dental code D8090 covers the records needed to monitor treatment and evaluate results throughout active care and retention phases. Proper use of this code helps practices document cases correctly while avoiding billing confusion. This guide clarifies when dental code D8090 applies and how to use it appropriately.
Oct 25, 2025
What is Dental Code D8090?
D8090 covers orthodontic treatment records beyond the initial diagnostic records. This includes progress records taken during active treatment and retention records taken after appliance removal. The code applies to photographs, radiographs, and study models created to track treatment changes.
Practices may refer to D8090 records as progress records, retention records, or treatment monitoring documentation. Some offices call them interim records or post-treatment records. All these terms describe the same category of orthodontic documentation used after the initial diagnostic phase.
When is D8090 Used?
D8090 applies during active orthodontic treatment when the orthodontist needs progress photographs or updated study models to evaluate tooth movement. The code covers retention phase records taken after braces are removed to verify stability and check for relapse. Practices also use D8090 for pre-surgical orthodontic records when orthognathic surgery is planned, and for records requested by referring dentists or specialists who need current treatment status documentation.
D8090 should not be used for initial diagnostic records taken before treatment begins—those fall under D0340 (2D cephalometric radiograph), D0350 (2D oral/facial images), or other diagnostic codes. The code doesn't apply to routine clinical photographs taken for practice marketing or general documentation purposes. Standard diagnostic radiographs taken as part of regular dental exams are billed separately under their specific radiographic codes, not D8090.
Billing and Insurance Considerations
Proper documentation supports D8090 claims and reduces the risk of denials. Understanding what insurers expect helps practices submit clean claims and get paid faster.
Clinical notes needed: Document the specific reason for taking progress records, noting what treatment changes you're evaluating. Record the stage of treatment (active phase, retention phase, or pre-surgical). Include clinical findings that justify the need for updated records at this point in treatment.
Radiographic documentation: Progress records often include updated cephalometric radiographs and panoramic films. Note any changes in root resorption, bone levels, or tooth position. Document how these images guide treatment decisions or modifications.
Justification for timing: Explain why records are needed at this specific appointment. Common justifications include evaluating treatment progress at key milestones, assessing retention phase stability, preparing for appliance changes, or documenting pre-surgical positioning.
Coverage for D8090 varies significantly between plans. Many orthodontic benefits include one set of progress records as part of the overall treatment package, while others cover progress records separately with specific frequency limitations. Some plans allow progress records only at certain treatment intervals, such as every 12 or 18 months. Retention records may have different coverage rules than mid-treatment progress records. Verify coverage before taking records, as patients may be responsible for costs if their plan doesn't include progress documentation.
Billing D8090 for initial diagnostic records is a frequent error—use the appropriate diagnostic codes instead. Some practices incorrectly bill D8090 multiple times during treatment without checking plan limitations on frequency. Submitting D8090 without adequate clinical justification often leads to denials. Another common mistake is bundling progress records into the comprehensive orthodontic treatment fee and then billing them separately, creating duplicate charges.
Common Questions
How often can D8090 be billed?
Most insurance plans limit D8090 to once every 12 to 36 months during active treatment. Plans typically allow one additional set of records during the retention phase. Check individual plan limitations, as frequency restrictions vary widely.
Are there waiting periods between D8090 submissions?
Many plans require 12 to 18 months between D8090 submissions. If records are needed more frequently for clinical reasons, document the medical necessity clearly. Some plans waive waiting periods for records taken immediately before surgical procedures.
Does D8090 apply per tooth or per case?
D8090 applies to the full orthodontic case, not individual teeth or arches. The code covers a complete set of progress records (photos, models, radiographs) taken at one appointment. You can't bill D8090 separately for upper and lower arches.
Is D8090 included in comprehensive orthodontic fees?
Many practices include all progress records in their comprehensive orthodontic treatment fee, making D8090 non-billable to insurance. If your practice bills orthodontics comprehensively, don't submit D8090 separately. If you bill records separately from treatment, verify this approach aligns with your contract terms and insurance agreements.
Can D8090 be billed if the patient transfers from another orthodontist?
Yes, you can bill D8090 for records taken at your office, even if the patient started treatment elsewhere. Document that these are your initial records for this patient, used to establish their current treatment status and plan future care.
Does D8090 cover digital records?
Yes, D8090 applies to digital photographs, digital study models, and digital radiographs. The code isn't limited to traditional film or physical models. Document the type of digital records taken in your clinical notes.
What's included in one D8090 submission?
A single D8090 code covers all records taken at one appointment, including multiple photographs (intraoral and extraoral), study models or digital scans, and any radiographs needed for progress evaluation. You bill D8090 once per record-taking appointment, not separately for each type of record.
Can D8090 be billed on the same day as other orthodontic codes?
Yes, progress records can be taken and billed on the same day as orthodontic visits (D8080) or other procedures. The services are separate and distinct, as long as clinical documentation supports the need for records at that specific appointment.
How should D8090 be documented for retention checks?
Note that appliances have been removed and the patient is in the retention phase. Document what you're evaluating (stability, relapse, retention compliance). Specify which records were taken (photos, models, radiographs) and how they inform retention management decisions.
Managing Complex Billing While Staying Fully Staffed
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