D0120 - Periodic Evaluation
Periodic oral evaluation for established patient.
- Procedure Code
- D0120
- Clinical Category
- Diagnostic
- Primary ICD-10 Justification
- Z01.20 (Encounter for dental examination and cleaning without abnormal findings)
- Reference Fee & Claim Types
- $100 • BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D0120.
- Frequency Limitation
- 2 per benefit year (1 every 6 consecutive rolling months) (ROLLING_MONTHS)
- Age Limitation Criteria
- Covered for all ages. Typically billed after age 3 (replaces infant evaluation D0145).
Required Claim Attachments & Pre-Submission Checklist
- Updated medical and dental history documented in patient chart
- Clinical examination findings recorded by licensed dentist
- Treatment plan updates documented if pathology detected
- Date of previous evaluation verified to avoid frequency denial
Bill When (Allowable Clinical Criteria)
- Patient is established and returning for a routine recall checkup
- Dentist reviews updated medical/dental history and performs a complete oral evaluation
- Patient has a comprehensive evaluation (D0150) already on file
Restrictions & Clinical Exclusions
- Do NOT bill on the same date of service as comprehensive exam D0150 or limited exam D0140
- Do NOT bill if dentist was not present (hygienist assessment alone does not qualify)
- Do NOT bill for new patients (use D0150 instead)
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Frequency limit reached (less than 6 months since last evaluation) | Verify benefit year calculation. If patient switched employers, submit prior carrier termination date. |
| CO-16 | Mutually exclusive with other exam billed on same date | Void duplicate evaluation code and submit corrected claim with single exam code. |
ICD-10-CM Justification & Crosswalk Mappings for D0120 (5)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| Z01.20 | Encounter for dental examination and cleaning without abnormal findings | Encounter for other special examination without diagnosis | ★ Yes (Primary) | BOTH | periodic oral evaluation – established patient indicated for Encounter for dental examination and cleaning without abnormal findings |
| Z01.21 | Encounter for dental examination and cleaning with abnormal findings | Encounter for other special examination without diagnosis | Secondary | BOTH | periodic oral evaluation – established patient indicated for Encounter for dental examination and cleaning with abnormal findings |
| Z13.84 | Encounter screening for dental disorders | Encounter for screening for other diseases and disorders | Secondary | BOTH | periodic oral evaluation – established patient indicated for Encounter screening for dental disorders |
| Z86.16 | Personal History of COVID-19 | Personal history of certain other diseases | Secondary | BOTH | periodic oral evaluation – established patient indicated for Personal History of COVID-19 |
| U07.1 | COVID-19 | Emergency use of U07 | Secondary | BOTH | periodic oral evaluation – established patient indicated for COVID-19 |
Frequently Asked Questions — D0120 (Periodic Evaluation)
Quick answers for dental billers and treatment coordinators submitting claims for D0120.
What ICD-10 diagnosis codes link to dental procedure D0120?▾
Common ICD-10-CM justification codes for CDT D0120 (Periodic Evaluation) include: Z01.20 - Encounter for dental examination and cleaning without abnormal findings (Primary); Z01.21 - Encounter for dental examination and cleaning with abnormal findings; Z13.84 - Encounter screening for dental disorders; Z86.16 - Personal History of COVID-19; U07.1 - COVID-19.
Can CDT code D0120 be billed to medical insurance?▾
Billing CDT D0120 (Periodic Evaluation) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: BOTH.
What attachments and documentation are required for billing CDT D0120?▾
Required claim attachments for CDT D0120 (Periodic Evaluation) include: Updated medical and dental history documented in patient chart; Clinical examination findings recorded by licensed dentist; Treatment plan updates documented if pathology detected; Date of previous evaluation verified to avoid frequency denial.
What is the insurance frequency limitation for CDT D0120?▾
Standard commercial insurance frequency for D0120: 2 per benefit year (1 every 6 consecutive rolling months) (ROLLING_MONTHS). Age criteria: Covered for all ages. Typically billed after age 3 (replaces infant evaluation D0145)..
What are common insurance denial reasons and appeal tips for CDT D0120?▾
Denial Code CO-119 (Frequency limit reached (less than 6 months since last evaluation)): Overturn appeal strategy - Verify benefit year calculation. If patient switched employers, submit prior carrier termination date. | Denial Code CO-16 (Mutually exclusive with other exam billed on same date): Overturn appeal strategy - Void duplicate evaluation code and submit corrected claim with single exam code.