Understanding Oral Evaluation Codes: D0120, D0140, and D0150
Accurate coding for oral evaluations helps dental practices maintain compliance, streamline dental billing, and secure appropriate reimbursement from insurance carriers. Three of the most frequently used diagnostic codes in this category are D0120, D0150, and D0140. Each serves a distinct purpose based on the patient's status and the nature of the visit.
Selecting the correct code ensures the claims process runs smoothly while reflecting the level of evaluation actually performed. Proper use of these codes supports efficient dental insurance verification and reduces the risk of denials or downcoding.
D0120: Periodic Oral Evaluation – Established Patient
This code applies to routine checkups for patients of record. The evaluation focuses on identifying any changes in the patient's dental and medical health since their last comprehensive or periodic exam.
It typically includes:
- A soft tissue evaluation (including oral cancer screening)
- Periodontal screening where indicated
- Review of existing conditions
- Interpretation of diagnostic information as needed
D0120 suits established patients returning for regular maintenance visits, often every six months. Many insurance plans cover this code twice per calendar year, making it a staple for preventive care protocols.
D0140: Limited Oral Evaluation – Problem Focused
D0140 addresses a specific oral health concern or complaint. This evaluation is limited in scope and centers on diagnosing and addressing the immediate issue.
Examples include:
- Emergency visits for pain, infection, or trauma
- A broken tooth or sudden swelling
- Evaluation of a single problem without a full comprehensive review
The code does not cover a routine checkup or broad assessment. It may be reported alongside certain procedures performed on the same date when the problem requires immediate attention. Frequency limits vary by plan, but many carriers allow this code once per calendar year per patient per dentist.
D0140 proves valuable for urgent care situations where the focus remains narrow and targeted.
D0150: Comprehensive Oral Evaluation – New or Established Patient
D0150 represents a more thorough assessment. It applies to new patients entering the practice as well as established patients under specific circumstances.
Use this code when the dentist performs a detailed examination that includes:
- Evaluation and recording of hard and soft tissues
- Assessment of dental caries, missing or unerupted teeth, restorations, and prostheses
- Review of occlusal relationships
- Periodontal screening or charting
- Oral cancer screening
- General health assessment and medical history update
Common scenarios include a patient's first visit to the office or when an established patient returns after an extended absence (typically three or more years) or after a significant change in health conditions. Insurance carriers often limit D0150 to once every 24 to 36 months per patient per dentist, with subsequent exams during that period billed as D0120.
This code provides a complete baseline for treatment planning and is essential for documenting new patient care.
Key Differences and When to Choose Each Code
Choosing between these codes depends on patient history, visit purpose, and clinical findings.
- New patient? Start with D0150 for a full baseline evaluation.
- Established patient returning for routine care? Use D0120 to document changes since the last visit.
- Patient presents with a specific issue, like pain or a broken restoration? Report D0140 for the problem-focused exam.
Avoid common pitfalls such as billing D0120 for new patients or using D0150 for routine recalls without qualifying conditions. These errors often lead to claim adjustments or requests for additional documentation.
Why Proper Coding Matters for Your Practice
Consistent and accurate selection of D0120, D0140, and D0150 supports clean claims and faster reimbursement. It also strengthens dental billing processes and simplifies dental insurance verification during patient intake.
When in doubt, refer to the current CDT manual descriptors and your patient's record. Training staff on these distinctions keeps the front office aligned with clinical decisions and helps maintain compliance.
Mastering these evaluation codes contributes to smoother operations and better financial outcomes for the practice. Review your recent claims to confirm these codes are being used appropriately and consider team discussions to reinforce best practices.
Note: This article reflects information as of January 2026. It is intended for informational purposes and does not replace professional advice. Always consult the latest ADA guidelines and payer requirements for the most accurate information.
