D0140 - Limited Evaluation
Problem-focused limited oral evaluation.
- Procedure Code
- D0140
- Category
- Diagnostic
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental National / PPO Standard
- Frequency Limitation
- Typically 1 per emergency / problem encounter (PER_ENCOUNTER)
- Age Limitation
- Covered for all ages with emergency or specific complaint.
Required Claim Attachments & Pre-Submission Checklist
- Documented chief complaint (e.g. pain, swelling, fractured tooth #19)
- Specific tooth number and diagnostic periapical radiograph (D0220)
- Clinical diagnosis and immediate treatment recommendations
Bill When (Allowable Clinical Criteria)
- Evaluation focused on a specific problem, acute dental pain, infection, trauma, or swelling
- Emergency triage requiring diagnostic radiograph (D0220) and palliative care
Restrictions & Clinical Exclusions
- Do NOT bill on same day as routine periodic exam D0120 or cleaning D1110
- Do NOT bill as routine recall checkup
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-97 | Bundled into comprehensive or periodic exam performed on same date | Separate dates of service or verify if genuine emergency occurred on different day. |
ICD-10 Justification & Crosswalk Mappings
| 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 | limited oral evaluation – problem focused 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 | limited oral evaluation – problem focused 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 | limited oral evaluation – problem focused indicated for Encounter screening for dental disorders |
| Z86.16 | Personal History of COVID-19 | Personal history of certain other diseases | Secondary | BOTH | limited oral evaluation – problem focused indicated for Personal History of COVID-19 |
| U07.1 | COVID-19 | Emergency use of U07 | Secondary | BOTH | limited oral evaluation – problem focused indicated for COVID-19 |