Reviewed by Morgan Heminger · Updated September 23, 2026
What Is D1110? (CDT Code Overview)
CDT code D1110 is the dental procedure code for adult prophylaxis: the routine cleaning that removes plaque, calculus and stains from the teeth of a patient with permanent or transitional dentition. It belongs to the Preventive category of CDT codes (Dental Prophylaxis subcategory). Children's cleanings use D1120, and a cleaning with generalized gum inflammation is D4346. Billers also search for it as dental code 1110 or D1110 prophylaxis.
When Should You Use D1110?
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.
Quick reference: Use D1110 when the clinical scenario specifically matches adult prophylaxis. Do not use this code as a substitute for related procedures in the same category. Consider whether D1120 (Child Prophylaxis Cleaning) might be more appropriate instead.
D1110 vs. Similar CDT Codes: Key Differences
Dental teams frequently confuse D1110 with other codes in the prophylaxis range. Here is how D1110 differs from the most commonly mixed-up codes:
Code | Procedure | Use it for |
|---|---|---|
D1110 | Adult Prophylaxis | The CDT code for adult prophylaxis, which is the standard routine dental cleaning |
Child Prophylaxis Cleaning | The CDT (Current Dental Terminology) designation for "Prophylaxis – Child." This code applies when performing routine dental cleanings for patients younger than 14 years old |
Documentation Requirements for D1110
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.
Documentation checklist for D1110:
Patient chief complaint and relevant medical/dental history clearly recorded.
Clinical findings that support the use of D1110 specifically (not a more general or more specific code).
Any diagnostic tests, imaging, or supplementary data that justify the procedure.
Treatment plan with rationale connecting the diagnosis to the procedure coded as D1110.
Post-procedure notes, including outcomes and follow-up recommendations.
For a deeper look at documentation best practices, see our guide on How Clinical Documentation Quality Drives Dental Claim Approvals.
Insurance and Billing Guide for D1110
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.
Common denial reasons for D1110: Lack of clinical documentation, frequency limitations exceeded, code mismatch with diagnosis, or missing prior authorization. When appealing a denied D1110 claim, include a detailed narrative explaining why the procedure was necessary, supporting clinical evidence, and relevant imaging or test results. Many practices find that well-documented first submissions dramatically reduce the need for appeals.
What major payers publish about D1110:
Delta Dental of Virginia does not pay D1110 alongside D4346 from the same office, and counts D4346 and D4910 toward the plan's cleaning frequency (Delta Dental of Virginia Participating Dentists' Handbook, 2026).
Aetna says a cleaning that takes longer than usual because of heavy plaque, calculus or stain is still D1110; D4346 is not meant for a harder-than-usual prophylaxis (Aetna Dental Clinical Policy Bulletin 042, May 2025).
Cigna lists D1110 and D4346 on the same date as a combination where plan guidelines apply, so check the patient's plan before billing both (Cigna Dental Coverage Determination Guidelines, 2026).
Frequency is set by the plan. As one example, the MetLife FEDVIP plan covers 2 cleanings in 12 months (MetLife Federal Dental Plan (FEDVIP) 2026 brochure).
These are the payers' published policy documents; the patient's own plan can set different frequencies and alternate benefits, so confirm them during insurance verification.
For more billing strategies, check out How Clinical Documentation Quality Drives Dental Claim Approvals.
Real-World Case Example: Billing D1110
A patient presents requiring a procedure consistent with D1110 (adult prophylaxis). The treating dentist documents the clinical findings, performs the procedure as indicated, and records detailed notes including the diagnosis, technique, and outcome. The billing team verifies insurance coverage, submits the claim with D1110 and supporting documentation, and follows up to ensure timely reimbursement. When the initial claim is processed, the practice reviews the Explanation of Benefits and addresses any discrepancies promptly.
Related CDT Codes to D1110
If you are researching D1110, you may also need to reference these related CDT codes in the prophylaxis range and beyond:
D1120: Child Prophylaxis Cleaning — Learn when to use D1120 and how it differs from D1110.
D1206: Fluoride Varnish Application — Learn when to use D1206 and how it differs from D1110.
D1208: Topical Fluoride Application — Learn when to use D1208 and how it differs from D1110.
D1310: Nutritional Counseling for Dental Disease Control — Learn when to use D1310 and how it differs from D1110.
D1320: Tobacco Counseling for Oral Disease Prevention — Learn when to use D1320 and how it differs from D1110.
Frequently Asked Questions About D1110
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. Always verify with the specific insurance carrier, as policies and coverage rules can vary significantly between payers. Maintaining thorough documentation for D1110 will strengthen your position in any audit or appeal scenario.
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. Always verify with the specific insurance carrier, as policies and coverage rules can vary significantly between payers. Maintaining thorough documentation for D1110 will strengthen your position in any audit or appeal scenario.
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.
What is the typical reimbursement range for D1110?
2026 Medicaid fee schedules give a public reference point for D1110: Medi-Cal Dental allows up to $40.00 (Medi-Cal Dental Schedule of Maximum Allowances, July 2026), New York Medicaid pays $45.45 for patients 13 and older (New York Medicaid dental fee schedule, January 2026), Florida Medicaid pays $42.70 for patients under 21 (Florida AHCA Dental Fee Schedule, January 2026) and Texas Medicaid pays $58.19 for patients 13 to 20 (Texas Medicaid (TMHP) THSteps dental fee schedule). Commercial PPO reimbursement depends on the payer contract, your region and network status, so the most reliable number for your practice is the allowed amount on your recent EOBs for D1110.
Does D1110 require prior authorization?
Prior authorization requirements for D1110 depend on the patient's specific insurance plan. Some carriers require advance approval for procedures coded under D1110, while others process claims without it. Best practice is to verify authorization requirements during insurance eligibility checks before the appointment. If prior authorization is required, submit the request with detailed clinical notes and supporting documentation to avoid delays in patient care and claim processing.