When is D0601 used?
The D0601 dental code applies to caries risk assessment and record-keeping when a patient shows low risk for developing dental caries. This CDT code is utilized during regular checkups when the dentist performs a systematic risk evaluation—employing established tools or methods—and determines that the patient has minimal likelihood of forming new cavities. D0601 works for both children and adults, and is generally billed once per patient during each benefit period, unless there's a change in the patient's risk level.
D0601 Charting and Clinical Use
Proper record-keeping is essential for correct D0601 usage. Dental staff must document which risk evaluation tool was employed (like CAMBRA or ADA Caries Risk Assessment protocols), the results that justify a low-risk classification, and preventive guidance given to the patient. Typical clinical situations involve patients without recent cavities, effective oral care habits, limited sugar consumption, and consistent dental appointments. Records should contain:
Assessment date
Evaluation method or standards applied
Results supporting low risk (such as no active tooth decay, no caries history within 24 months)
Prevention strategies or treatments discussed
Billing and Insurance Considerations
When submitting D0601 claims, dental practices should confirm coverage through each patient's insurance provider, since not every plan pays for caries risk assessment procedures. Attach comprehensive clinical records and the filled risk assessment document with your claim to minimize rejection chances. When claims are rejected, examine the EOB (Explanation of Benefits) for denial reasons, and prepare to file an appeal with extra documentation when needed. Recommended practices include:
Confirm D0601 benefits during insurance verification processes
Include supporting records with original claim submission
Monitor AR (accounts receivable) for outstanding claims and follow up quickly
Inform patients about caries risk assessment benefits and possible personal expenses
How dental practices use D0601
Take a 28-year-old patient coming for a standard recall visit. The dental hygienist conducts a caries risk evaluation using ADA protocols, recording no current or recent decay, superior oral care habits, and nutritious eating patterns. The dentist records these observations, classifies the patient as low-risk, and submits D0601 along with the routine examination code. The insurance submission contains the filled assessment document and thorough clinical records. Should the insurer reject the code, the practice examines the EOB, validates that documentation meets standards, and files an appeal when appropriate. This careful method ensures proper payment and shows comprehensive patient treatment.
Common Questions
Is D0601 appropriate for patients across all age groups?
D0601 can be utilized for patients of any age group, including pediatric, adolescent, adult, and geriatric populations, provided that the clinical evaluation indicates the patient has a low caries risk profile. The determining factor is the assessed risk level rather than the patient's chronological age.
Can D0601 be submitted to medical insurance carriers or is it limited to dental coverage?
D0601 is classified as a CDT (Current Dental Terminology) procedure code and is designed specifically for dental insurance billing. Medical insurance carriers typically do not recognize this code. Healthcare providers should submit D0601 claims to dental insurance carriers and confirm benefit coverage through the patient's dental plan.
What are the billing frequency limitations for D0601 per patient?
Billing frequency for D0601 varies according to individual dental insurance policy terms. Certain plans permit billing once per benefit cycle (typically semi-annually or annually), while others may impose different frequency restrictions. It is essential to review the patient's specific plan provisions to prevent claim denials related to frequency violations.