D1720 - Influenza Vaccine
Influenza vaccine administration.
- Procedure Code
- D1720
- Category
- Preventive
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- Frequency Limitation
- 1 per arch per lifetime except under unusual circumstances (lifetime)
- Age Limitation
- 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 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| Z23 | Immunization | Encounter for immunization | Yes (Primary) | BOTH | influenza vaccine administration indicated for Immunization |