Dental code D0150 is used to report a comprehensive oral evaluation, typically for new patients or patients who have not been seen in an extended period. Proper use of this code is essential for accurate claim submission and reimbursement. Below is a guide to understanding when a dental biller should use D0150 and how to ensure successful insurance processing.

Definition of D0150

According to the CDT (Current Dental Terminology) guidelines, D0150 is defined as: A comprehensive oral evaluation – new or established patient.

This code is used when a dentist conducts a thorough evaluation of a patient’s oral health, including:

• Reviewing medical and dental history.

• Performing a full-mouth examination of teeth, gums, soft tissues, and bite alignment.

• Evaluating risk factors for disease.

• Creating a baseline for future treatment planning.

When to Use D0150

A dental biller should use D0150 in the following situations:

1. New Patient Exams

• When a patient is visiting the dental office for the first time.

• If no prior dental records exist in the practice.

2. Long-Term Returning Patients

• If an established patient has not been seen for an extended period (typically three or more years).

• If the patient’s dental history and condition require a full re-evaluation.

3. Major Health or Dental Changes

• When an existing patient experiences significant health changes (e.g., a new medical condition that affects oral health, such as diabetes or cancer treatment).

• If a patient has undergone major dental work or trauma requiring a fresh evaluation.

What’s Included in D0150?

The comprehensive oral evaluation should include:

• A full-mouth evaluation of all teeth and soft tissues.

• Periodontal assessment for signs of gum disease.

• Oral cancer screening.

• Evaluation of occlusion and TMJ function.

• Review of medical history and risk factors.

• Development of a treatment plan if necessary.

Billing Considerations and Common Issues

1. Frequency Limitations

• Many insurance companies limit D0150 to once every three to five years per patient per provider.

• If submitted too frequently, it may be denied as not medically necessary.

2. Alternative Codes

• If the patient is returning for a routine checkup and does not require a comprehensive evaluation, D0120 (Periodic Oral Evaluation) should be used instead.

• For a problem-focused exam, such as an emergency visit, use D0140 (Limited Oral Evaluation – Problem Focused).

3. Required Documentation

To avoid claim denials, always document:

• The patient’s status (new or long-term returning).

• Any changes in medical or dental history requiring a comprehensive review.

• Radiographs or periodontal charting supporting the need for a full evaluation.

Final Tips for Dental Billers

• Verify insurance policies to check frequency limits before submitting D0150.

• Educate patients about coverage and out-of-pocket costs if their plan does not cover the exam.

• Ensure detailed clinical notes justify the need for a comprehensive evaluation to support claim approval.

By properly using D0150, dental billers can ensure accurate claim submissions, minimize denials, and help patients receive the care they need.