D1330 - Oral Hygiene Instr
Oral Hygiene Instructions.
- Procedure Code
- D1330
- Category
- Preventive
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
- 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.
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 |
|---|---|---|---|---|---|
| K03.6 | Deposits [accretions] on teeth | Other diseases of hard tissues of teeth | Yes (Primary) | BOTH | oral hygiene instructions indicated for Deposits [accretions] on teeth |
| E10.9 | Type I diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | oral hygiene instructions indicated for Type I diabetes mellitus without complications |
| E11.A | Type 2 diabetes mellitus without complication in remission | Diabetes mellitus | Secondary | BOTH | oral hygiene instructions indicated for Type 2 diabetes mellitus without complication in remission |
| E11.9 | Type 2 diabetes mellitus without complications | Diabetes mellitus | Secondary | BOTH | oral hygiene instructions indicated for Type 2 diabetes mellitus without complications |
| K02.3 | Arrested dental caries | Dental caries | Secondary | BOTH | oral hygiene instructions indicated for Arrested dental caries |
| K02.52 | Dental caries on pit and fissure surface penetrating into dentin | Dental caries | Secondary | BOTH | oral hygiene instructions indicated for Dental caries on pit and fissure surface penetrating into dentin |
| K02.61 | Dental caries on smooth surface limited to enamel | Dental caries | Secondary | BOTH | oral hygiene instructions indicated for Dental caries on smooth surface limited to enamel |
| K02.62 | Dental caries on smooth surface penetrating into dentin | Dental caries | Secondary | BOTH | oral hygiene instructions indicated for Dental caries on smooth surface penetrating into dentin |
| K02.63 | Dental caries on smooth surface penetrating into pulp | Dental caries | Secondary | BOTH | oral hygiene instructions indicated for Dental caries on smooth surface penetrating into pulp |
| K02.7 | Dental root caries | Dental caries | Secondary | BOTH | oral hygiene instructions indicated for Dental root caries |
| K02.9 | Dental caries, unspecified | Dental caries | Secondary | BOTH | oral hygiene instructions indicated for Dental caries, unspecified |
| K03.2 | Erosion of teeth | Other diseases of hard tissues of teeth | Secondary | BOTH | oral hygiene instructions indicated for Erosion of teeth |
| K05.00 | Acute gingivitis, plaque induced | Gingivitis and periodontal diseases | Secondary | BOTH | oral hygiene instructions indicated for Acute gingivitis, plaque induced |
| K05.01 | Acute gingivitis, non-plaque induced | Gingivitis and periodontal diseases | Secondary | BOTH | oral hygiene instructions indicated for Acute gingivitis, non-plaque induced |
| K05.10 | Chronic gingivitis, plaque induced | Gingivitis and periodontal diseases | Secondary | BOTH | oral hygiene instructions indicated for Chronic gingivitis, plaque induced |
| K05.30 | Chronic periodontitis, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | oral hygiene instructions indicated for Chronic periodontitis, unspecified |
| K05.311 | Chronic periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | oral hygiene instructions indicated for Chronic periodontitis, localized, slight |
| K05.312 | Chronic periodontitis, localized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | oral hygiene instructions indicated for Chronic periodontitis, localized, moderate |
| K05.313 | Chronic periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | oral hygiene instructions indicated for Chronic periodontitis, localized, severe |
| K05.319 | Chronic periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | oral hygiene instructions indicated for Chronic periodontitis, localized, unspecified severity |
| K05.5 | Other periodontal diseases | Gingivitis and periodontal diseases | Secondary | BOTH | oral hygiene instructions indicated for Other periodontal diseases |
| M35.00 | Sjögren syndrome, unspecified | Systemic involvement of connective tissue | Secondary | BOTH | oral hygiene instructions indicated for Sjögren syndrome, unspecified |
| M35.0C | Sjögren syndrome with dental involvement | Systemic involvement of connective tissue | Secondary | BOTH | oral hygiene instructions indicated for Sjögren syndrome with dental involvement |
| Z33.1 | Pregnant state, incidental | Pregnant state | Secondary | BOTH | oral hygiene instructions indicated for Pregnant state, incidental |
| Z72.0 | Tobacco Use | Problems related to lifestyle | Secondary | BOTH | oral hygiene instructions indicated for Tobacco Use |