D1110 - Prophylaxis (Adult)
Removal of plaque, calculus and stains.
- Procedure Code
- D1110
- Clinical Category
- Preventive
- Primary ICD-10 Justification
- K03.6 (Deposits [accretions] on teeth)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D1110.
- Frequency Limitation
- 2 per calendar year or 1 per 6 consecutive rolling months (CALENDAR_YEAR)
- Age Limitation Criteria
- Mandatory age 14 and older. Patients under 14 must be billed as D1120.
Required Claim Attachments & Pre-Submission Checklist
- Clinical chart note confirming removal of plaque, calculus, and stains
- Patient age verified as 14 or older
Bill When (Allowable Clinical Criteria)
- Preventive cleaning on patient with healthy periodontium or localized mild gingivitis
- Adult dentition (age 14+)
Restrictions & Clinical Exclusions
- Do NOT bill on same day as scaling and root planing D4341/D4342
- Do NOT bill on same day as D4346 (scaling in presence of generalized gingivitis)
- Do NOT bill for active periodontitis patients (use D4910 maintenance instead)
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Exceeded 2 per year benefit limit | Check if plan has rolling 6-month rule vs calendar year rule. |
| CO-97 | Bundled into periodontal therapy performed on same date | Cannot bill prophylaxis with SRP on same date. Fees are not billable to patient. |
ICD-10-CM Justification & Crosswalk Mappings for D1110 (14)
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 |
|---|---|---|---|---|---|
| K03.6 | Deposits [accretions] on teeth | Other diseases of hard tissues of teeth | ★ Yes (Primary) | BOTH | prophylaxis – adult indicated for Deposits [accretions] on teeth |
| E10.9 | Type I diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | prophylaxis – adult indicated for Type I diabetes mellitus without complications |
| E11.A | Type 2 diabetes mellitus without complication in remission | Diabetes mellitus | Secondary | BOTH | prophylaxis – adult indicated for Type 2 diabetes mellitus without complication in remission |
| E11.9 | Type 2 diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | prophylaxis – adult indicated for Type 2 diabetes mellitus without complications |
| K05.1 | Chronic gingivitis | Gingivitis and periodontal diseases | Secondary | BOTH | prophylaxis – adult indicated for Chronic gingivitis |
| K05.10 | Chronic gingivitis, plaque induced | Gingivitis and periodontal diseases | Secondary | BOTH | prophylaxis – adult indicated for Chronic gingivitis, plaque induced |
| K05.11 | Chronic gingivitis, non-plaque induced | Gingivitis and periodontal diseases | Secondary | BOTH | prophylaxis – adult indicated for Chronic gingivitis, non-plaque induced |
| K05.30 | Chronic periodontitis, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | prophylaxis – adult indicated for Chronic periodontitis, unspecified |
| K05.311 | Chronic periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | prophylaxis – adult indicated for Chronic periodontitis, localized, slight |
| K05.312 | Chronic periodontitis, localized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | prophylaxis – adult indicated for Chronic periodontitis, localized, moderate |
| K05.313 | Chronic periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | prophylaxis – adult indicated for Chronic periodontitis, localized, severe |
| K05.319 | Chronic periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | prophylaxis – adult indicated for Chronic periodontitis, localized, unspecified severity |
| Z33.1 | Pregnant state, incidental | Pregnant state | Secondary | BOTH | prophylaxis – adult indicated for Pregnant state, incidental |
| Z72.0 | Tobacco Use | Problems related to lifestyle | Secondary | BOTH | prophylaxis – adult indicated for Tobacco Use |
Frequently Asked Questions — D1110 (Prophylaxis (Adult))
Quick answers for dental billers and treatment coordinators submitting claims for D1110.
What ICD-10 diagnosis codes link to dental procedure D1110?▾
Common ICD-10-CM justification codes for CDT D1110 (Prophylaxis (Adult)) include: K03.6 - Deposits [accretions] on teeth (Primary); E10.9 - Type I diabetes mellitus without complications; E11.A - Type 2 diabetes mellitus without complication in remission; E11.9 - Type 2 diabetes mellitus without complications; K05.1 - Chronic gingivitis; K05.10 - Chronic gingivitis, plaque induced; K05.11 - Chronic gingivitis, non-plaque induced; K05.30 - Chronic periodontitis, unspecified; K05.311 - Chronic periodontitis, localized, slight; K05.312 - Chronic periodontitis, localized, moderate; K05.313 - Chronic periodontitis, localized, severe; K05.319 - Chronic periodontitis, localized, unspecified severity; Z33.1 - Pregnant state, incidental; Z72.0 - Tobacco Use.
Can CDT code D1110 be billed to medical insurance?▾
Billing CDT D1110 (Prophylaxis (Adult)) 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 D1110?▾
Required claim attachments for CDT D1110 (Prophylaxis (Adult)) include: Clinical chart note confirming removal of plaque, calculus, and stains; Patient age verified as 14 or older.
What is the insurance frequency limitation for CDT D1110?▾
Standard commercial insurance frequency for D1110: 2 per calendar year or 1 per 6 consecutive rolling months (CALENDAR_YEAR). Age criteria: Mandatory age 14 and older. Patients under 14 must be billed as D1120..
What are common insurance denial reasons and appeal tips for CDT D1110?▾
Denial Code CO-119 (Exceeded 2 per year benefit limit): Overturn appeal strategy - Check if plan has rolling 6-month rule vs calendar year rule. | Denial Code CO-97 (Bundled into periodontal therapy performed on same date): Overturn appeal strategy - Cannot bill prophylaxis with SRP on same date. Fees are not billable to patient.