By Tessina “Tess” Bullock, President of Verus Dental and Co-Founder of Veritas Dental Resources

Let’s talk about D0180, the comprehensive periodontal evaluation code. It’s the code that wants to be used more often than it is, but also the code that, if used wrong, could get you into the kind of trouble where the phrase “I was just trying to do a good exam” won’t hold up in an audit. Dentists and hygienists alike, buckle up, because we’re diving into the dos, don’ts, and dollar signs behind one of the most powerful codes in the CDT book.

What Is D0180, Really?

CDT Definition: D0180 is defined as a comprehensive periodontal evaluation, new or established patient. It is not your run-of-the-mill exam. This is the exam that says, “We’re looking at gum health, bone support, inflammation, pocket depths, attachment levels, recession, mobility, and all the other juicy details that make periodontists drool.”

Key requirement? There must be signs or symptoms of periodontal disease or a history of periodontal disease that necessitates a deeper, more comprehensive evaluation.

Why Successful Practices LOVE D0180

Used correctly, D0180:
• Reimburses higher than D0150 or D0120
• Justifies scaling and root planing (SRP) and other perio-related procedures
• Helps establish a baseline for perio maintenance patients
• Signals to insurance companies, “Hey, we’re not just polishing teeth over here!”

Pro Tip: Many hygienists are trained to identify bleeding, pocket depths >4mm, recession, and mobility during their assessments. When these indicators are present, they flag the dentist to perform D0180 instead of D0120. This builds a paper trail and supports the need for more comprehensive treatment.

When You Should Use D0180

• New patients who present with signs of periodontal disease
• Established patients showing new periodontal breakdown
• Patients returning from periodontal therapy who require a re-evaluation
• Before initiating SRP or perio surgery
• When a patient has been seeing you for cleanings but was never formally diagnosed

This code is a clinical lifesaver. It allows you to elevate the standard of care and be compensated appropriately. If you’re doing all that diagnostic work and still using D0120… you’re giving away services for free.

When You Should NOT Use D0180

• On patients with zero signs or history of periodontal disease
• As a default exam code for all new patients (tempting, we know)
• On a healthy 14-year-old whose gums are pinker than a flamingo in July
• Every 6 months just to get a few more bucks from insurance

When It’s Considered Fraud

Using D0180 without clinical justification equals fraud. That’s not a buzzword, it’s a legal problem. Submitting this code when there is no clinical evidence to support it can trigger red flags with insurance companies, audits, repayment demands, and potential fraud charges.

Billing it just to get higher reimbursement is the kind of short-term gain that leads to long-term regret, and possibly a mandatory ethics class (or worse).

Best Practices for Using D0180 (Without Losing Sleep)

• Document, Document, Document
Chart bleeding points, pocket depths, recession, mobility, radiographic bone loss, anything that justifies the code.

• Train Your Hygiene Team
Empower your hygienists to identify perio signs early and communicate the need for a D0180.

• Use Photos and Probing Charts
They help prove your case in case of audits or denials.

• Explain It to the Patient
Patients are more likely to accept treatment when you tell them:
“Today’s exam is more detailed because we’re evaluating gum health, not just looking for cavities. This is what protects your teeth long-term.”

• Know Your Payors
Some insurance plans limit the frequency of D0180, often once per year or once per provider group. Others might downgrade to a D0120. Know what you’re dealing with before you bill.

Final Thoughts: Don’t Be Afraid of D0180, Just Respect It

D0180 isn’t a scammy upsell, it’s a valuable tool that reflects the evolving standards of comprehensive dental care. Periodontal disease is an epidemic, and this code helps you catch it early, treat it thoroughly, and document it defensibly.

So, use it wisely, use it truthfully, and don’t be afraid to build your revenue while building better oral health.

Need help training your team on proper D0180 protocols or integrating it into your practice workflow?
Reach out to Veritas Dental Resources because smart billing starts with smart strategy.