D0180 - Perio Eval
Comprehensive periodontal evaluation for new/established patient.
- Procedure Code
- D0180
- Clinical Category
- Diagnostic
- Primary ICD-10 Justification
- See mapped diagnoses below
- Reference Fee & Claim Types
- DENTAL
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D0180.
- Frequency Limitation
- 1 per 36 months per dentist/office (rolling_12_months)
Required Claim Attachments & Pre-Submission Checklist
- Full-mouth periodontal charting with 6-point probing depths and bleeding points
Bill When (Allowable Clinical Criteria)
- Benefits for D0180 performed without an intent to provide dental services to meet the patient’s dental needs will be processed as D0190. Code evaluation of current dental conditions.
Restrictions & Clinical Exclusions
- Infection control is included in the fee for the dental services provided. Separate fees are not billable to the patient.
- Oral evaluations are only a benefit when the elements included in the descriptor are completed.
- All services and treatment provided remotely via tele-health modalities, be they synchronous or asynchronous, must be performed by a licensed dentist or their supervised staff, acting within the scope of applicable law. Services and treatment delivered virtually are only a benefit when the elements included in the descriptor of the CDT procedure code are completed and only when they meet generally accepted clinical guidelines.
- Benefits for restorations for altering occlusion, adjusting vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion, abfraction, corrosion, TMD, or for periodontal, orthodontic, or other splinting are denied, unless covered by group contract.
- If a D0180 is submitted with a D4910 on the same date of service by the same dentist/dental office it is benefited as a D0120 and the difference in the approved amount between the D0120 and the D0180 is not billable to the patient.
- Fees for D0180 are not billable to the patient when done on the same date of service as D4355 by the same dentist/dental office.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
ICD-10-CM Justification & Crosswalk Mappings for D0180 (0)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
No direct ICD-10 mappings recorded for D0180.
Frequently Asked Questions — D0180 (Perio Eval)
Quick answers for dental billers and treatment coordinators submitting claims for D0180.
What ICD-10 diagnosis codes link to dental procedure D0180?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D0180.
Can CDT code D0180 be billed to medical insurance?▾
Billing CDT D0180 (Perio Eval) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: DENTAL.
What attachments and documentation are required for billing CDT D0180?▾
Required claim attachments for CDT D0180 (Perio Eval) include: Full-mouth periodontal charting with 6-point probing depths and bleeding points.
What is the insurance frequency limitation for CDT D0180?▾
Standard commercial insurance frequency for D0180: 1 per 36 months per dentist/office (rolling_12_months).
What are common insurance denial reasons and appeal tips for CDT D0180?▾
Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.