When is D1110 used?
The D1110 dental code represents the CDT code for adult prophylaxis, which is the standard routine dental cleaning. This code applies to patients aged 13 years and above who have healthy gums or mild gingivitis without needing periodontal treatment. D1110 should not be used for patients displaying moderate to severe periodontitis symptoms; instead, alternative codes like D4346 (scaling with inflammation present) or D4910 (periodontal maintenance) would be more appropriate. Choosing the right code ensures proper billing practices and meets insurance requirements.
D1110 Charting and Clinical Use
Thorough documentation is crucial for successful claims processing and preventing denials. When using D1110, your clinical records must clearly show:
Patient age verification (13 years or older)
No signs of moderate or severe periodontal disease
Evidence of healthy gums or only mild gum inflammation
Services provided: plaque, tartar, and stain removal from tooth surfaces
Typical clinical situations for D1110 include adult patients coming for their regular six-month cleanings without periodontal disease history, or patients showing mild gum swelling but no bone deterioration. Make sure to record periodontal measurements and X-ray findings to justify your code choice.
Billing and Insurance Considerations
Correct billing of D1110 helps ensure maximum reimbursement and reduces claim rejections. Follow these recommended practices:
Check patient coverage: Confirm timing restrictions (typically twice yearly) and age criteria with the insurance company before appointments.
Provide thorough documentation: Include clinical records, gum measurements, and X-rays when requested by insurance providers.
Apply the right CDT code: Avoid using D1110 for periodontal maintenance or deep cleaning services; select D4910 or D4346 when needed.
Monitor EOBs and AR: Keep track of Explanation of Benefits and Accounts Receivable to spot underpayments or rejections promptly.
Submit appeals when needed: For denied claims, examine the insurer's guidelines, compile supporting evidence, and file a prompt appeal with comprehensive clinical reasoning.
How dental practices use D1110
Case Study: A 35-year-old patient arrives for their regular dental visit. Gum measurements show 2-3 mm pocket depths, X-rays reveal no bone loss, and there's slight gum redness. The dental hygienist cleans away plaque and tartar above and below the gum line, then polishes all teeth. Clinical records confirm no periodontal disease is present. D1110 is the appropriate code for this appointment. The claim gets processed with proper documentation, and the insurance company pays based on the patient's preventive care benefits.
Learning the proper application of D1110 dental code helps dental professionals maintain accurate billing practices, minimize claim rejections, and deliver excellent preventive care to adult patients.
Common Questions
Is D1110 appropriate for patients who have dental implants or crowns?
D1110 can be used for adult patients with dental implants or crowns, provided there is no active periodontal disease present and the procedure is preventive in nature. Having dental restorations does not disqualify the use of D1110, however, clinical documentation should include notes about the condition of implants or crowns and verify that only standard prophylaxis was completed.
What are the billing frequency limitations for D1110?
Billing frequency for D1110 varies according to individual dental insurance plans. Most insurance plans permit D1110 billing twice annually (approximately every 6 months), though some plans may have different restrictions. It's essential to verify each patient's specific coverage benefits and frequency limitations prior to scheduling appointments and submitting claims for prophylaxis services.
What steps should be taken when a D1110 claim receives a medical necessity denial?
When a D1110 claim is denied for lack of medical necessity, first examine the submitted documentation to confirm it adequately demonstrates the need for preventive treatment. If required, file an appeal including supplementary clinical notes, radiographic images, or a detailed letter describing the patient's oral health condition and justifying the necessity of routine prophylaxis. Comprehensive documentation and clear communication with the insurance provider can often result in successful claim reversals.