When is D0365 used?
Staying up-to-date with CDT coding is essential for dental practices to maintain accurate billing and maximize revenue. The D0365 code specifically applies to cone beam computed tomography (CBCT) of the mandibular arch. This guide explains the proper application of dental code D0365, documentation requirements, billing strategies, and includes a real-world example to help your practice improve efficiency and maintain compliance.
Appropriate Uses for Dental Code D0365
Code D0365 applies to CBCT imaging that captures and interprets a complete view of one dental arch—the mandible (lower jaw). This diagnostic code should be used when three-dimensional imaging of the lower jaw is clinically necessary for accurate diagnosis, treatment planning, or surgical preparation. Typical applications include:
Pre-surgical implant planning for the lower jaw
Diagnostic evaluation of impacted lower teeth or mandibular pathology
Bone density and structure assessment before extractions or bone grafting procedures
Comprehensive orthodontic or endodontic evaluation of the mandible
Remember to differentiate D0365 from similar codes like those for the maxilla or D0367 (dual arch imaging) to prevent coding errors and claim rejections.
Required Documentation and Common Clinical Applications
Comprehensive documentation is essential for claim approval. When billing D0365, ensure your patient records contain:
Clinical justification (such as implant assessment, suspected pathology investigation)
Specific anatomical region (verification of complete mandibular arch coverage)
Professional interpretation completed by the treating dentist or qualified radiologist
Treatment planning impact showing how the CBCT findings influenced patient care decisions
Including copies of the diagnostic report and relevant imaging studies with your claim submission can strengthen medical necessity documentation, particularly when insurance carriers request additional supporting materials.
Effective Insurance Billing Strategies
Implement these proven methods to optimize D0365 reimbursement:
Confirm coverage prior to scheduling by checking patient benefits and any limitations on imaging frequency.
Obtain pre-authorization when mandated by the insurer, particularly for expensive diagnostic procedures.
Apply accurate coding—avoid using D0365 as a substitute for other CBCT codes unless the imaging field precisely matches your clinical needs.
Include comprehensive documentation (treatment notes, diagnostic reports, imaging studies) with your initial submission to prevent processing delays.
For claim denials, file appeals quickly with enhanced documentation that clearly explains the patient's condition and medical necessity for mandibular CBCT imaging.
Taking a proactive approach to benefit verification and maintaining detailed records helps minimize outstanding receivables and enhances practice cash flow.
Clinical Example Using D0365
Scenario: A patient requires implant treatment in the lower left molar area. The treating dentist orders a comprehensive 3D CBCT scan of the entire mandible to evaluate available bone volume and identify the location of the inferior alveolar nerve. The practice bills D0365 along with thorough documentation explaining the clinical rationale, imaging scope, and diagnostic findings. The claim package includes the complete radiology report and benefits from having pre-authorization already secured. The insurance company approves and pays the claim efficiently.
This example demonstrates how proper implementation of D0365, combined with comprehensive documentation and streamlined insurance processes, results in timely payment while supporting high-quality patient treatment.
FAQ
Are there frequency restrictions when billing D0365 to insurance carriers?
Yes, most dental and medical insurance providers impose frequency limitations on CBCT imaging procedures, including those coded as D0365. Typically, coverage is restricted to one scan annually or within a specified timeframe, unless there is clear documentation establishing medical necessity for additional imaging. It's essential to verify the patient's specific benefit coverage and maintain thorough clinical documentation to support any repeat imaging requirements.
Is it possible to bill D0365 alongside other CBCT procedure codes during the same appointment?
Typically, D0365 cannot be billed concurrently with other CBCT codes covering the same anatomical area or field of view within a single visit, as this would constitute duplicate billing practices. However, when separate scans are performed for different arches—such as mandibular imaging (D0365) and maxillary imaging (D0367)—both procedures may be appropriately billed, assuming each scan serves a distinct medical purpose and is thoroughly documented.
What equipment specifications are required for performing and billing D0365 procedures?
To appropriately bill D0365, dental facilities must utilize cone beam computed tomography (CBCT) equipment specifically designed to capture comprehensive mandibular arch imaging. The imaging system must comply with current industry standards for both image resolution and radiation safety protocols. Additionally, all scans must undergo professional interpretation by a qualified dental practitioner or certified radiologist, with appropriate documentation maintained as part of the billing requirements.