D0602 - Caries Risk (Mod)
Caries risk assessment, moderate risk.
- Procedure Code
- D0602
- Category
- Diagnostic
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
Required Claim Attachments & Pre-Submission Checklist
- Standard ADA claim form with CDT procedure code and date of service
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- The fee for D0602 is not billable to the patient when submitted for children under the age of three.
- Benefits are limited to one risk assessment every 12 months. Subsequent risk assessment codes submissions are not billable to the patient within 12 months.
- The fee for D0602 is not billable to the patient when submitted with other risk assessment codes on the same date of service 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 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|