D1713 - COVID Pediatric (1st)
Pfizer-BioNTech Pediatric – first dose.
- Procedure Code
- D1713
- Clinical Category
- Preventive
- Primary ICD-10 Justification
- Z23 (Immunization)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D1713.
- Frequency Limitation
- 1 per arch per lifetime except under unusual circumstances (lifetime)
- Age Limitation Criteria
- Restricted to patients under age 14. Denied for persons age 14 or older.
Required Claim Attachments & Pre-Submission Checklist
- Diagnostic pre-operative radiograph showing affected tooth/area
- Pre-operative treatment narrative and clinical rationale
Bill When (Allowable Clinical Criteria)
- Indicated for premature loss of primary teeth to preserve space for eruption of succedaneous permanent teeth.
Restrictions & Clinical Exclusions
- Benefits for the repair or replacement of a space maintainer are denied.
- Only one space maintainer is benefited per arch, per lifetime except under unusual circumstances. Otherwise, benefits are denied.
- Space maintainers for missing primary anterior teeth or missing permanent teeth or for persons age 14 or older are not covered benefits and are denied.
- only one unilateral space maintainer is benefited per quadrant, per lifetime except under unusual circumstances. Otherwise, benefits are denied.
- 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. |
| CO-16 | Patient age exceeds policy limitation (age 13 cutoff) | Verify patient date of birth and submit documentation proving developmental delay or exceptional mixed dentition retention. |
ICD-10-CM Justification & Crosswalk Mappings for D1713 (1)
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 |
|---|---|---|---|---|---|
| Z23 | Immunization | Encounter for immunization | ★ Yes (Primary) | BOTH | Pfizer-BioNTech Covid-19 vaccine administration tris-sucrose pediatric – first dose indicated for Immunization |
Frequently Asked Questions — D1713 (COVID Pediatric (1st))
Quick answers for dental billers and treatment coordinators submitting claims for D1713.
What ICD-10 diagnosis codes link to dental procedure D1713?▾
Common ICD-10-CM justification codes for CDT D1713 (COVID Pediatric (1st)) include: Z23 - Immunization (Primary).
Can CDT code D1713 be billed to medical insurance?▾
Billing CDT D1713 (COVID Pediatric (1st)) 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 D1713?▾
Required claim attachments for CDT D1713 (COVID Pediatric (1st)) include: Diagnostic pre-operative radiograph showing affected tooth/area; Pre-operative treatment narrative and clinical rationale.
What is the insurance frequency limitation for CDT D1713?▾
Standard commercial insurance frequency for D1713: 1 per arch per lifetime except under unusual circumstances (lifetime). Age criteria: Restricted to patients under age 14. Denied for persons age 14 or older..
What are common insurance denial reasons and appeal tips for CDT D1713?▾
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. | Denial Code CO-16 (Patient age exceeds policy limitation (age 13 cutoff)): Overturn appeal strategy - Verify patient date of birth and submit documentation proving developmental delay or exceptional mixed dentition retention.