Dentists, let’s talk about a code that gets about as much attention as floss at a Halloween candy convention: D0180 – Comprehensive Periodontal Evaluation. This isn’t your typical new-patient or recall exam. Nope—D0180 is a specialist-level, gum-loving, perio-focused gem of a code that’s often misunderstood, underutilized, and tragically left on the shelf like kale at a BBQ cookout.

Let’s break it down, bust some myths, and show you how to use D0180 like a pro (even if you're not a periodontist).

What Exactly is D0180?

ADA Definition:
“Comprehensive periodontal evaluation – new or established patient. This procedure is indicated for patients showing signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes. It includes evaluation of periodontal conditions, probing and charting, evaluation and recording of the patient’s dental and medical history, and general health assessment. It may include evaluation and recording of dental caries, missing or unerupted teeth, and restorations.”

In plain English? This is not your everyday exam. This is the big leagues—the perio-focused detective work that involves probing depths, bone loss, gingival recession, mobility, bleeding points, and assessing the entire mouth for signs of current or potential periodontal disaster.

Can a General Dentist Use D0180?

YES. Absolutely. 100%.
You don’t need a specialty license or a secret handshake from a perio society. If you're a general dentist and your patient meets the criteria (signs or risk of periodontal disease), you're legally and ethically allowed to use D0180.

Think of it this way: if you’re probing, charting, and evaluating the periodontal condition in depth, you should bill for it.

Will Insurance Pay for D0180?

This is where things get spicy.

Most PPO insurance plans do cover D0180, but like anything involving insurance, there are conditions and caveats:

• Frequency limitations often apply (typically once every 12 to 24 months).

• Many carriers will not pay D0180 on the same day as D0150 or D0120, so use it wisely and document clearly.

• Some plans won’t cover D0180 at all unless it comes from a periodontist (even though they legally should—don’t get us started).

• Some carriers pay D0180 in lieu of a D0150 or D0120, while others will downgrade it and pay at a lesser rate.

Pro Tip: Always verify insurance coverage before billing D0180. When in doubt, ask your patient to sign an ABN (Assignment of Benefits Notice) or waiver acknowledging that they’re responsible for the balance if insurance denies.

How Often Can You Use It?

Here’s the deal:

• Typically once per year, though some plans may allow every 24 months, especially if there’s no documented change in condition.

• If you're transitioning a patient from health to disease (or vice versa), you can justify using D0180 again, even within the same benefit year. But documentation is EVERYTHING.

Be sure your charting includes:

• Six-point probing

• Gingival margins

• Bleeding on probing

• Furcations

• Mobility

• Risk factors like smoking, diabetes, etc.

How D0180 Can Maximize Revenue (Ethically)

Using D0180 correctly does more than just help you get paid for the work you’re already doing—it positions your office as clinically thorough, legally compliant, and financially smart.

Here’s how it helps:

1. Upgrades Your Clinical Reputation

It shows payers and auditors (yes, they exist) that you’re not slapping a D0120 on patients with 6mm pockets and hoping for the best.

2. Supports SRP Claims

If you're billing for scaling and root planing (D4341/D4342), a documented D0180 helps justify medical necessity for those procedures. Think of it as your pre-game documentation.

3. Justifies Follow-Up Re-Evaluations

Once SRPs are complete, consider using a D0180 again for the post-op reevaluation—especially if the clinical presentation has changed and you’re resetting the treatment roadmap.

4. Bridges the Gap Between Hygiene and Perio Maintenance

Not every patient with bone loss is automatically on perio maintenance. D0180 helps clarify who truly needs to cross that bridge—and when.

How to Train Your Team on D0180

Most front office team members are used to D0150 and D0120 as the exam defaults. So how do you get them to start thinking D0180 when it’s appropriate?

• Have a clinical checklist: If the patient presents with inflammation, bone loss, BOP, or known systemic risk factors, flag the case for D0180.

• Train the hygiene team to know when to document in support of D0180 (don’t rely on one probing depth to make the case—give the full story).

• Include D0180 on your verification form and ask your verification team (or Veritas Dental Resources!) to call and check if it’s covered, and how often.

Sample Scenario: When D0180 is a Must

Mrs. Johnson, age 62, returns for her first cleaning in 3 years. She has diabetes, smokes occasionally, and presents with generalized 4-6mm pockets and bleeding on probing.
She’s never had SRPs before.

Do you:

• A) Slap a D0120 on the claim and hope it gets paid?

• B) Code D0180, document thoroughly, and lay the groundwork for proper perio diagnosis, treatment, and billing?

(If you said A, go floss your soul. If you said B, you're doing it right.)

Quick Recap

• D0180 = comprehensive periodontal exam, not just for specialists!

• Use it for patients with perio disease or risk factors.

• Document deeply—six-point probings, risk history, clinical findings.

• Verify insurance limitations—many allow once per year or every 24 months.

• Ethically maximizes your revenue and supports other treatment codes.

• Train your team to recognize when D0180 is appropriate and how to explain it to patients.

Final Thought

Using D0180 isn’t “gaming the system.” It’s doing right by your patients while ensuring your practice gets paid for the complexity of care you’re already delivering. If you're still unsure how to implement this code effectively or want a customized insurance protocol for your team, reach out to Veritas Dental Resources. We train offices nationwide on maximizing insurance revenue—without compromising ethics.

Because in dentistry, getting paid well and doing good can absolutely coexist.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com