When is D1120 used?
The D1120 dental code represents the CDT (Current Dental Terminology) designation for "Prophylaxis – Child." This code applies when performing routine dental cleanings for patients younger than 14 years old. The prophylaxis procedure includes removing plaque, calculus, and surface stains from teeth to prevent oral diseases. It's important to use D1120 only when the patient falls within the specified age range and the treatment is preventive rather than therapeutic. For patients aged 14 and above, practitioners should use D1110 (Prophylaxis – Adult) instead.
D1120 Charting and Clinical Use
Proper record-keeping is vital for effective dental billing and insurance claim approval. When documenting D1120 procedures, make sure the patient's age is clearly noted in their file. Clinical records should contain:
Patient's birth date and current age on the service date
Purpose of prophylaxis (preventive maintenance, not periodontal disease treatment)
Specifics of the cleaning procedure (treatment areas, plaque/calculus levels, and significant observations)
Home care guidance given to the patient or parent
Typical situations for D1120 usage include standard six-month preventive cleanings for children, pre-orthodontic cleanings, or maintenance visits during recall appointments. Do not use D1120 when patients need periodontal scaling or root planing procedures; instead, consider codes like D4341 or D4342.
Billing and Insurance Considerations
To optimize payment and reduce claim rejections, implement these recommended practices when processing D1120 claims:
Check coverage details: Confirm the patient's age qualifications and prophylaxis benefits prior to scheduling. Most insurance plans allow two pediatric cleanings annually.
Provide comprehensive claims: Include patient birth date, clinical notes, and relevant supporting materials with your submission.
Monitor EOBs (Explanation of Benefits): Look for frequency restrictions, age limits, or waiting periods that could impact coverage decisions.
Contest rejected claims: When claims are denied for age or frequency reasons, examine plan requirements and file appeals with proper documentation when justified.
Taking a proactive approach to insurance verification and maintaining detailed records will help your practice keep accounts receivable healthy and minimize claim reprocessing.
How dental practices use D1120
Case Study: A 10-year-old patient arrives for their scheduled maintenance visit. The dental hygienist completes a prophylaxis treatment, eliminating plaque and calculus from all tooth surfaces, and reviews proper brushing techniques with the child. The treatment notes record the patient's age, confirm the preventive nature of the service, and note no signs of periodontal disease. The administrative team confirms that the patient's insurance plan allows two D1120 procedures annually. The claim gets processed with the appropriate code, patient birth date, and comprehensive documentation. The insurance carrier approves full payment without any complications or processing delays.
This example demonstrates how important it is to verify patient age, maintain accurate records, and perform thorough insurance verification when submitting D1120 claims.
Common Questions
Is D1120 appropriate for special needs patients who are 14 years or older?
D1120 is exclusively for patients under 14 years of age. Special needs patients who are 14 or older should be coded with the adult prophylaxis code D1110, unless the insurance carrier has specific guidelines that permit exceptions. It's essential to verify payer-specific policies before billing.
What are the options when a patient has exceeded their annual D1120 frequency allowance?
When the D1120 frequency limit has been met, dental offices should notify the patient that insurance may not cover additional cleanings and discuss potential self-pay options. In cases of medical necessity, some insurance plans may approve exceptions, so proper documentation of special circumstances should be maintained and submitted when requesting coverage review.
Can D1120 and D1110 codes be submitted together for one patient during the same appointment?
These codes cannot be billed simultaneously for the same patient during one visit. D1120 and D1110 are mutually exclusive based on patient age criteria: D1120 applies to children under 14, while D1110 is used for patients 14 and above. Submitting both codes for the same patient and visit constitutes incorrect billing practices.