When is D0602 used?
The D0602 dental code applies to caries risk assessment and documentation when a patient shows moderate risk for developing dental caries. This CDT code fits best during regular preventive appointments, including hygiene visits or routine oral examinations, where formal caries risk evaluation takes place. Apply D0602 when clinical observations, patient background, and risk elements (including dietary habits, oral care routine, fluoride use, and health conditions) suggest a moderate probability of developing new cavities. Correct application of this code allows dental practices to customize preventive care plans and clearly convey risk levels to patients and insurance providers.
D0602 Charting and Clinical Use
Proper documentation remains crucial for D0602. The dental provider must record specific risk elements found, the evaluation method applied (like CAMBRA or ADA Caries Risk Assessment tools), and the reasoning behind the moderate risk classification. Common situations include patients showing early enamel weakening signs, irregular oral care habits, or past cavity history without current active decay. The treatment record should contain:
Evaluation tool or standards applied
Risk elements found (such as eating patterns, saliva production, past cavity experience)
Overview of results supporting moderate risk classification
Suggested preventive care (such as fluoride treatment, nutrition guidance)
Complete documentation supports insurance claims while improving patient treatment by monitoring risk changes over time.
Billing and Insurance Considerations
When submitting claims with D0602, check patient coverage beforehand since caries risk assessment benefits differ between insurance companies and plans. Certain dental insurers may restrict how often this code can be used or require combining it with comprehensive or routine exams (D0120 or D0150). Effective strategies for payment approval include:
Verify coverage or obtain pre-approval for D0602 during appointment scheduling
Include comprehensive treatment notes and assessment documentation with claims
Follow proper CDT code order when billing alongside other preventive treatments
Examine benefit explanations thoroughly and contest rejections with proper documentation when appropriate
Regular D0602 usage paired with strong documentation enhances both patient care results and practice financial management.
How dental practices use D0602
Practice Example: A 35-year-old patient arrives for regular teeth cleaning. The dental hygienist observes previous cavity history within three years, occasional consumption of sweet snacks, and irregular flossing habits. While no new decay appears, slight enamel weakening is visible. Through the ADA Caries Risk Assessment tool, the provider classifies the patient as moderate risk. The treatment record documents all findings, and D0602 gets billed with the routine exam code. The insurance submission includes assessment documentation and supporting materials, leading to approved payment.
This example demonstrates the value of complete evaluation, proper documentation, and strategic billing approaches when applying the D0602 dental code.
Common Questions
Can D0602 be billed together with other preventive dental procedures?
Yes, D0602 can typically be billed with other preventive codes like oral evaluations (D0120) or fluoride applications. Coverage and payment amounts may differ depending on your insurance plan, so it's essential to check benefits beforehand and ensure proper documentation supports each procedure performed during the appointment.
Do dental staff need specialized training to conduct caries risk assessments for D0602?
Although no formal certification is mandated for D0602 billing, dental professionals should understand standardized caries risk assessment methodologies like CAMBRA or ADA assessment forms. Adequate training helps ensure precise risk classification and comprehensive documentation, supporting quality patient care and successful insurance claims.
What should practices do when a patient's caries risk level changes during the same benefit period?
When a patient's caries risk changes during the benefit year (such as moving from low to moderate risk), update your clinical records and risk assessment documentation. Keep in mind that most insurance plans provide coverage for only one caries risk assessment annually, so subsequent assessments may not receive reimbursement. Always verify the patient's specific plan coverage and discuss potential costs before proceeding with additional assessments.