D0150 - Comprehensive Eval
New or established patient comprehensive evaluation.
- Procedure Code
- D0150
- Category
- Diagnostic
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental National / PPO Standard
- Frequency Limitation
- 1 per patient every 36 to 60 months (3 to 5 years) per provider/practice (ROLLING_MONTHS)
- Age Limitation
- Covered for ages 3 and older.
Required Claim Attachments & Pre-Submission Checklist
- Full periodontal screening (PSR or 6-point charting)
- Hard and soft tissue oral cancer screening documentation
- Full-mouth caries charting and updated medical history
Bill When (Allowable Clinical Criteria)
- New patient comprehensive initial baseline examination
- Established patient returning after an absence of 3 or more consecutive years
Restrictions & Clinical Exclusions
- Do NOT bill at routine 6-month recall visits (use D0120 instead)
- Do NOT bill more than once every 3 years for an active patient
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Frequency limit exceeded (billed within 36 months of previous comprehensive exam) | Resubmit as D0120 (Periodic Evaluation) if within the 3-year frequency window. |
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 | comprehensive oral evaluation – new or 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 | comprehensive oral evaluation – new or 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 | comprehensive oral evaluation – new or established patient indicated for Encounter screening for dental disorders |
| Z86.16 | Personal History of COVID-19 | Personal history of certain other diseases | Secondary | BOTH | comprehensive oral evaluation – new or established patient indicated for Personal History of COVID-19 |
| U07.1 | COVID-19 | Emergency use of U07 | Secondary | BOTH | comprehensive oral evaluation – new or established patient indicated for COVID-19 |