When is D8070 used?
The D8070 dental code applies to complete orthodontic treatment during the transitional dentition phase. This CDT code is utilized when patients, usually children, have mixed dentition—both primary and permanent teeth are present simultaneously. D8070 is appropriate when the orthodontic treatment encompasses the entire scope of care needed during this transitional stage, covering diagnosis, active treatment, and retention components. This code excludes limited or interceptive orthodontic work, which falls under separate codes like D8060 for limited orthodontic care in transitional dentition.
D8070 Charting and Clinical Use
Proper documentation is essential when filing claims under D8070. Dental practices must maintain patient records that contain:
Complete orthodontic assessment and diagnosis
Thorough treatment plan specifying goals and anticipated results
Clinical documentation confirming mixed dentition status
Supporting materials including X-rays, photos, and dental models
Treatment progress documentation through active and retention stages
Typical clinical applications for D8070 involve children between ages 7-12 requiring comprehensive orthodontic correction for issues like crowding, spacing problems, crossbites, or other bite irregularities during the primary-to-permanent tooth transition. This code encompasses the complete treatment journey from initial documentation through final retention and excludes partial or first-phase treatments.
Billing and Insurance Considerations
To optimize reimbursement and reduce claim rejections when using D8070, dental offices should implement these strategies:
Confirm benefits: Check with the patient's insurance provider to verify orthodontic coverage, age restrictions, and waiting period requirements prior to starting treatment.
Obtain pre-approval: File a detailed pre-treatment estimate with complete documentation to secure authorization and establish patient payment obligations.
File thorough claims: Ensure all supporting documentation, clear treatment descriptions, and accurate CDT coding (D8070) are included. Add progress reports and current radiographs when necessary.
Monitor payments: Review Explanation of Benefits statements for payment schedules and accurately record payments in accounts receivable. Address discrepancies or denials immediately.
Handle appeals: When claims are rejected, examine the denial reason, compile additional evidence, and file timely appeals with comprehensive medical necessity explanations.
Regular communication with insurance companies and patients promotes transparency and minimizes billing complications.
How dental practices use D8070
An 8-year-old patient arrives with significant crowding and crossbite issues. Following a thorough examination, the orthodontist concludes that comprehensive treatment during the mixed dentition period is required. The treatment approach involves braces, routine adjustments, and a retention period using a removable retainer. The practice files pre-authorization paperwork including diagnostic materials and comprehensive treatment description. After receiving approval, D8070 is applied to all treatment-related claims, ensuring appropriate reimbursement and insurance compliance.
Understanding the proper application of D8070 helps dental practices improve billing efficiency, decrease claim rejections, and deliver excellent care for patients during the transitional dentition period.
Common Questions
Is D8070 applicable for adult patients who retain some primary teeth?
D8070 is exclusively designed for comprehensive orthodontic treatment during the mixed dentition period, typically occurring in children between 6 and 12 years old. This code is not suitable for adult patients, regardless of whether they have retained primary teeth. For adult orthodontic cases, alternative codes should be selected based on the specific clinical circumstances.
Which orthodontic appliances fall under D8070 coverage?
D8070 encompasses comprehensive orthodontic treatment that may involve various appliances including full-arch braces (both metal and ceramic options), palatal expanders, and other necessary devices for correcting occlusion and alignment issues during the mixed dentition period. All appliances utilized must be thoroughly documented in the treatment plan and patient records.
What is the proper protocol when a patient moves from mixed to permanent dentition during ongoing treatment?
When a patient progresses from mixed to permanent dentition while undergoing treatment originally coded as D8070, the practice must maintain comprehensive documentation throughout all treatment phases. Should the treatment scope undergo substantial modifications, updating the treatment plan and notifying the insurance carrier may be required. Generally, the initial D8070 code encompasses the complete comprehensive treatment course that began during the transitional dentition stage.