If dental exam codes had personalities, they’d absolutely sit at different tables in the lunchroom.

One is chill and dependable.

One bursts in yelling, “THIS IS AN EMERGENCY.”

One brings a full medical history binder.

And one shows up with a periodontal probe and a serious tone.

Yet somehow, all four get lumped together as “the exam.”
And that, my friends, is how insurance confusion, denied claims, and underbilling are born.

So let’s fix that without putting you to sleep.

Below is a fun, no yawn tour of the most misunderstood exam codes in dentistry, based on American Dental Association definitions, plus what seasoned industry experts actually recommend in the real world.

D0120 – Periodic Oral Evaluation
AKA: “The Regular Checkup”

ADA definition (in plain English):
An evaluation performed on a patient of record to determine changes in dental and medical health status.

What this really means:
This is your routine recall exam. The patient knows you. You know them. You’ve seen their mouth more times than their toothbrush has.

When to use it:

• Established patient

• Routine visit

• No emergency, no full re workup, no periodontal deep dive

Industry pro tip:

• Use D0120 only when it’s truly a periodic exam

• Don’t sneak it in during problem focused visits

• Don’t downgrade other exams just to “keep insurance happy”

Common mistake:
Using D0120 for everything because “insurance likes it.”
(Insurance also likes puppies and rainbows, doesn’t mean it’s realistic.)

D0140 – Limited Oral Evaluation (Problem Focused)
AKA: “Something Hurts and I Need Help Now”

ADA definition:
An evaluation limited to a specific oral health problem or complaint.

Real world translation:
The patient points. You look. You investigate. You diagnose.

“Doc, it’s this tooth… right here… no wait, the other right.”

When to use it:

• Toothache

• Swelling

• Broken tooth

• Post op complication

• Emergency walk ins

Industry pro tips:

• Document the chief complaint

• Clearly note the focused nature of the exam

• Pair with appropriate imaging when clinically justified

Big mistake to avoid:
Billing D0120 or D0150 for an emergency visit.
That’s like calling a fire drill a wellness check.

D0150 – Comprehensive Oral Evaluation
AKA: “Let’s Start From Scratch”

ADA definition:
An extensive evaluation for a new or established patient, including medical and dental history and comprehensive exam.

What’s really happening:
This is the full onboarding experience.
New patient? Long absence? Major change in health? This is your code.

When to use it:

• New patients

• Established patients not seen in a long time

• Patients with complex medical or dental histories

Industry expert wisdom:

• Use D0150 sparingly and intentionally

• Make sure your documentation supports the depth

• Don’t auto assign it to every new warm body with a clipboard

Insurance reality check:
Some plans limit frequency.
That doesn’t mean you didn’t perform it, it just means insurance won’t always clap for it.

D0180 – Comprehensive Periodontal Evaluation
AKA: “We’re Talking Gums Now”

ADA definition:
A comprehensive periodontal evaluation including probing, diagnosis, and risk assessment.

Translation:
This is not a prophy with vibes.
This is periodontal diagnosis, full stop.

When to use it:

• New patients with suspected periodontal disease

• Patients showing attachment loss, bleeding, bone loss

• When perio is actually evaluated and diagnosed

Industry gold standard tips:

• Full periodontal charting

• Clear diagnosis (not just “watch area”)

• Tie it to treatment planning

The biggest industry problem:

• Not diagnosing perio at all

• Or worse, diagnosing it but billing like it doesn’t exist

That’s not conservative care.
That’s supervised neglect in khakis.

Why Insurance Makes This Feel Harder Than It Is

Most dental teams don’t struggle with understanding these codes.
They struggle with confidence.

“What if insurance denies it?”

“What if the patient asks questions?”

“What if this causes pushback?”

Here’s the truth industry experts agree on:

You don’t bill for what insurance prefers.
You bill for what you actually did.

Insurance compliance is not the same as clinical accuracy.

Final Thoughts (Before the Torch Gets Passed)

Exam codes aren’t boring.
They’re misunderstood.

And when you use them correctly:

• Documentation improves

• Diagnoses make sense

• Revenue aligns with care

• Liability goes down, not up

If this article made you smile and rethink how exams are coded in your practice, mission accomplished.

Because dentistry is serious work.
But learning how to bill for it doesn’t have to be serious at all.

Benjamin Tuinei
Founder – Veritas Dental Resources, LLC
📞 888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com