follow up visit dental code

• DCS Patient Billing
• DCS Insurance Billing
• DCS OMS Billing
• DCS Credentialing
• DCS Patient Scheduling
• Private Practice Pricing
• DSO/Group Pricing
• OMS Pricing
• Dental Billing Books
• DCS on YouTube
• Case Studies
• Testimonials

«  View All Posts

Defining CDT Codes: What is CDT code D9430?

• Share This Article

March 7th, 2024 | 6 min. read

Dilaine Gloege

Print/Save as PDF

Current Dental Terminology (CDT) coding is no easy walk in the park. There are dozens of codes to choose from when creating an insurance claim, and codes are changed, added, and deleted every year.

With their intricacies and frequent changes, code selection can be confusing when a patient’s treatment and reason for treatment are not straightforward. 

But as a dental professional, it’s vital to get these CDT codes right — your insurance claims revenue depends on it. Dr. Bicuspid explains it well: 

“Choosing the correct code is about selecting the most current code that fits the procedure, not a code that paid in the past or one that you have always used in the same circumstance.”

Code D9430 is a code we see questioned pretty often, so we’re clearing up the confusion with this article. But how do we know what’s correct?

Well, since 2012, we’ve helped dental teams understand and stay current with CDT codes. Our billing experts are part of what we call The DCS Knowledge Network . It’s our pool of insurance billing specialists who confidently stay up to date on all things dental insurance — including coding.

This article will explain the difference between the often mismanaged: CDT code D9430, CDT code D0140, and CDT code D0171. Recognizing the difference between these CDT codes will ensure proper use of each code to avoid claim denials due to coding errors. 

• CDT Code D9430 explained — Understanding the observation visit

Let’s first look at the descriptor of D9430 . 

D9430 office visit for observation (during regularly scheduled hours) ⎼ no other services performed

Two key phrases in the D9430 nomenclature are “during regularly scheduled hours” and “no other services performed”. No other services performed includes evaluations in addition to any treatment. The phrase “no other services” does not include post-operative oral hygiene home care instructions. 

Sometimes you just need to bring the patient back for observation following treatment when the office is usually open. This is a common use of code D9430, and it seems simple enough. But….

Related: CDT Codes: Current Dental Terminology explained

How does CDT Code D9430 relate to D0140, D0171, and D9440?

Next, let’s define code D0140 .

D0140 limited oral evaluation – problem focused

This suits an evaluation limited to a specific oral health problem or complaint, and it may require interpretation of information acquired through additional diagnostic procedures. Be sure to report additional diagnostic procedures separately with their appropriate codes. 

Definitive procedures may be required on the same date as the evaluation. Typically, patients receiving this type of evaluation present with a specific problem and/or dental emergencies, trauma, acute infections, etc. 

D0140 may be reported for a new or established patient. This is not to be reported when a comprehensive oral evaluation was actually performed, however. A few examples of a limited oral evaluation include:

• Evaluation of an emergency patient presenting with a problem or pain
• Evaluation of tooth replacement such as implant placement
• Any other specific problem where the evaluation specifically addresses one problem, limited area of the oral cavity, or complaint.

But what about D0171 ?

D0171 re-evaluation – post-operative office visit

This code was created to give providers a way to document post-operative visits. Most dental plans consider a re-evaluation post-operative visit inclusive to the procedure being performed.

Consider that the global period for inclusive follow-up care may be defined as 30 days for restorations such as fillings, or 6 months following delivery of appliances such as dentures. 

And what is D9440 ?

D9440 office visit – after regularly scheduled hours

Similar to D9430, but the difference here is the office visit is completed after hours.

How do I apply CDT Code D9430 in my dental office?

Now that we’ve defined each code, let’s go through a scenario in which you could apply CDT code D9430 instead of the others.

The patient presented for two post-operative visits. At the first post-operative visit, sutures were removed and oral hygiene home care instructions related to the surgical area were provided.

The CDT code for oral hygiene instructions is D1330. Most dental plans consider instructions a part of the visit, so they are not billed separately. Still, you would include D1330 for documentation purposes.

So, for post-op visit #1, you would use the codes:

D1330 oral hygiene instructions were reported for the first post-operative visit

Six weeks later, at the second post-operative visit — the final post-operative appointment — either D0171 or D9430 can be used, depending on whether additional treatment was performed or not. If there was additional treatment, then the following codes would be appropriate::

D0171 re-evaluation post-operative office visit

D1330 oral hygiene instructions

Or if additional treatment wasn’t performed, the appropriate codes would be:

D9430 office visit for observation (during regularly scheduled hours) – no other services performed

Remember to include D1330 and other non-billable codes even though they aren’t reimbursed. Precise documentation is necessary for both medical and legal reasons, so it’s important to code everything that was performed, whether or not insurers will pay foor it.

Now, here’s a scenario where D9430 would not be used…

The patient presented for an emergency visit complaining of pain in the lower right, pointing to tooth #31. One periapical radiograph was captured, and the doctor performed an evaluation.

A radiographic image revealed a suspicious area at the apex of the tooth. No treatment was performed. The patient was referred to the endodontist for further evaluation of possible abscesses. The following codes would be used to document and report this emergency visit.

D0140 evaluation – problem focused

D0220 periapical x-ray – first image

Note that code D9430 could not be billed in this circumstance, because D9430 specifies no other services were performed, and D0220 is considered another service.

Confused? Access our DCS Knowledge Network

Documentation is key to claim acceptance, and as you see in the examples above, it can be quite specific. Your team should always document and report what was performed by following the current CDT code set. Train them on accurate code selection and maintain a current CDT manual for their reference. 

It is worth noting that D0171 is most often considered part and parcel of the original treatment, and with a PPO plan, D0171 will be denied and written off. However, codes D9430 and D9440 are usually considered a non-covered service, and they can be billed to the patient, even with a PPO plan. 

As always, coding should be determined by what was actually done. A patient’s available dental benefits, or lack thereof, should not determine the code used to document and report. But if there is an opportunity to decide which code to choose, knowing your compliant alternative code options will be useful.

Code confidently with the DCS Knowledge Network on your side

At DCS, we know CDT coding is challenging and oftentimes confusing. As we mentioned in the beginning of this article, we’ve been helping dental teams sort out code confusion since 2012 — we may not have seen it all, but we have certainly seen a lot!

To recap, in this article on CDT Code D9430, we covered:

• How CDT Code D9430 relates to Codes D0140, D0171, and D9440
• How to apply CDT Code D9430 in your dental office

Accurate coding keeps your dental practice compliant, leads to faster reimbursement on insurance claims, and also helps your practice stay out of legal trouble. It’s crucial that your team understands the nuances of these codes and stays current on CDT coding changes and updates.  

If you still feel a lost or overwhelmed by these CDT codes or others, don’t worry! The DCS Knowledge Network is here to support your team through the entire insurance claims process. 

Our full-service revenue cycle management services include experts checking that your team is coding correctly. Our team’s support will increase your team’s confidence and lead to higher collections, plus more consistent revenue for your practice. 

Don’t let CDT coding keep you down: Book a free 30-minute call with DCS today.

Related Posts

Dental billing resources

Coding the Dental Examination Visit Correctly

by Outsource Strategies International | Posted: Nov 2, 2016 | Industry News , Resources

Coding dental examination visits correctly is crucial for proper dental billing . However, there is a lot of confusion about the right medical codes to use. The American Dental Association (ADA) recommends that people should have regular dental visits and that the frequency of these visits should be adapted by dentists based on patients’ current oral health status and health history. There are six different dental examination codes and knowing what each one indicates is necessary:

• D0120 – Periodic Oral Exam, established patient: This evaluation is done on an established patient to determine changes in dental and medical health status since a previous assessment. It includes oral cancer evaluation and periodontal screening, where indicated, and may require interpretation of information obtained from additional diagnostic procedures. A screening is distinct from a full-mouth periodontal probing and charting. Sometimes, the PSR Periodontal Screening and Recording tool in conjunction with the D0120 code.
• D0180 – Comprehensive Periodontal Evaluation – new or established patient: This code is used to report evaluation of periodontal conditions, probing and charting, evaluation and recording of new or established patients’ dental and medical history and general health assessment. Patients showing signs or symptoms of periodontal disease and patients with risk factors such as smoking or diabetes would require comprehensive periodontal evaluation. This may also include evaluation and recording of dental caries, missing or unerupted teeth, restorations, occlusal relationships and oral cancer evaluation. This code should not be used along with a comprehensive oral evaluation (D0150) by the same dentist on the same visit.
• D0150 – Comprehensive Oral Evaluation, new or established patient: This code applies when a general dentist and/or dental specialist examines the patient. It applies to: new patients, established patients who have had a significant change in health conditions or other unusual circumstances, by report, or established patients who have not had active treatment for three or more years. D0150 indicates that a diagnostic treatment plan and an extensive evaluation assessment was performed, which includes all soft tissue, hard tissue, and oral cancer screening. It may include a periodontal screening and report any soft tissue irregularities, but does not require any recording.
• D0160 – Detailed and extensive oral evaluation, problem focused by report: This code indicates extensive diagnostic and cognitive modalities based on the findings of a comprehensive oral evaluation (D0150). It indicates that integration of more extensive diagnostic modalities is needed to develop a treatment plan for a specific problem. Description and documentation of the condition requiring this type of evaluation is necessary. Examples of conditions requiring this type of evaluation include: dentofacial anomalies, complex perio-prosthetic conditions, and conditions requiring multi-disciplinary consultation.
• D0170 – Re-evaluation, limited problem focused (established patient, not post-operative visit): This code is appropriate when assessing a previously existing condition related to trauma, or a follow-up evaluation for continuing issues, but should not be used to report a post-operative visit. Documentation can be included to justify necessity.

Using the appropriate codes to report the dental exam visit is crucial to indicate the work performed and ensure proper reimbursement. In an experienced dental billing company, expert medical coders are knowledgeable about the ADA’s guidelines. Dental medical billing professionals help client practices report the dental exam correctly using the latest CDT code sets, thereby avoiding complications, inconsistencies, and other barriers to payment.

Related Posts

Essentials of Dental Billing: A Comprehensive Guide

Dental billing is the process of submitting and managing claims for dental services provided to patients. Ensuring efficiency in the process is a critical aspect of managing a dental practice efficiently and obtaining proper reimbursement. Dental practitioners, office...

Emerging Trends and Innovations in Insurance Verification

The insurance industry is undergoing a significant transformation driven by technological advancements and changing consumer expectations. Staying ahead of the curve is crucial for efficient and secure operations. Emerging trends and innovations in insurance...

Patient Communication in Insurance Verification

Insurance verification is a critical process in medical billing. It ensures that healthcare practices have the correct coverage details to streamline claims processing. Insurance verification services safeguard against errors, reduce claim rejections, and accelerate...

Generic selectors Exact matches only Search in title Search in content Post Type Selectors

Comprehensive Guide to D0170 Dental Code and Exams

What ada cdt dental code is d0170.

D0170 is the ADA CDT dental code for a dental exam to follow up an existing problem (i.e. pain, injury) which did not receive prior dental treatment. It is often used as a follow-up code but should not be used as a “post-op” visit after a surgery. The code is officially known as “Re-evaluation – limited problem focused (established patient; not post-operative visit).”

Frequently Asked Questions About D0170 Dental Code

What procedure does d0170 refer to.

This code refers to a re-evaluation of a specific problem after an initial assessment and treatment.

What are the documentation requirements and best practices for D0170?

Documentation should include the initial assessment details, treatment provided, and current findings related to the specific problem.

What are the typical costs, reimbursement rates and guidelines for D0170?

Costs typically range from $50 to $100, depending on the complexity of the issue. Reimbursement varies by provider, and it may be covered as part of follow-up care.

Are there any common errors or pitfalls to avoid with D0170?

Common errors include inadequate documentation of the initial problem and treatment, leading to difficulty in justifying the re-evaluation.

How should D0170 be submitted on an insurance claim, and should a site be included?

Submit with detailed notes on the initial problem, treatment, and findings of the re-evaluation. Site-specific details may be necessary based on the issue.

Is D0170 often used with other codes, and how does it fit into the overall coding system?

Often used with treatment codes specific to the problem being re-evaluated. It helps in tracking the effectiveness of initial treatments and making necessary adjustments.

How can I verify patient eligibility and coverage for this procedure?

Verify eligibility by contacting the insurance provider to ensure coverage for follow-up evaluations and specific problem-focused assessments.

What are the ethical considerations and common fraud indicators associated with D0170?

Maintain accurate and thorough records of the initial treatment and the findings of the re-evaluation to avoid fraud. Ensure the re-evaluation is genuinely necessary.

What are the key differences between similar codes?

D0170 is for problem-focused re-evaluations, while D0120 and D0150 are for routine or comprehensive exams. Use D0170 for specific issues requiring follow-up.

Why was D0170 specifically used for my treatment, and are there alternative treatments with different codes and costs?

D0170 is used for a targeted follow-up on a specific issue. Alternatives include D0120 for routine check-ups or D0150 for comprehensive exams if broader assessment is needed.

Search again

Partnering with you to help create healthy smiles

2024 CDT codes are here

Nov 30, 2023

By Delta Dental

The American Dental Association’s CDT procedure codes and nomenclature have been updated for 2024. This update includes 14 new codes, one new category of service (sleep apnea), two revised codes, no deletions and several policy revisions.

Please review   our summary of changes and claims processing policies (PDF) and make sure to begin using the 2024 codes on any claims submitted to Delta Dental for services performed on or after January 1, 2024. This summary also includes changes in how we will process some codes moving forward, such as:  

• Radiographic images (D0210, D0330)
• Cone beam CT capture (D0364, D0365, D0366, D0367)
• Cleanings and inspections of removable dentures (D9932, D9933, D9934, D9935)
• And more.  

CDT coding and nomenclature are the copyright and trademark of the American Dental Association. All rights reserved.

Recent posts

• Delta Dental Smile Star’s career is about making a difference
• Register to attend our new crown claims webinar on Sept. 27 to avoid claim denials
• 5 tips for ergonomic success in your office
• Get continuing education credits from webinars
• Provider Tools update – Easier to use with enhanced features
• Addressing jawbone density loss in menopausal women: what dentists need to know
• Supporting patients going through menopause: tips for dentists
• Address oral health challenges in aging populations with these five tips
• Three back-to-school to-dos for your younger patients
• Clarification on local anesthesia for scaling and root planing

Search posts

The Top 18 CDT Codes for Orthodontics: A Cheatsheet for Dental Billers

February 15, 2024

CDT codes, or Current Dental Terminology codes, are a set of standardized codes maintained by the American Dental Association (ADA). Dental professionals in the U.S. use CDT codes to describe dental procedures for billing, insurance claims, and record-keeping purposes. This system ensures consistency and uniformity in reporting dental treatments across the industry.

The first in a series of articles aiding dental billers with shortcuts to common codes, this post will list the 18 most common CDT codes for orthodontics. If you’re a dental biller or an orthodontist running a private practice, read on for a helpful database of CDT codes for orthodontics.

What are CDT codes used for?

Billing and Insurance Claims: CDT codes provide a standardized way to describe dental procedures, making it easier for dental professionals to bill insurance companies and patients. Every dental procedure has a specific CDT code, ensuring consistency across the board.

Uniformity in Treatment Description: CDT codes bring uniformity in describing dental treatment procedures. This means that the same code will refer to the same treatment, no matter which dentist or dental office you visit in the U.S.

Documentation and Records : Dental professionals can use CDT codes in their record-keeping systems. This makes it easier for them to keep track of the treatments they've provided to patients.

Data Analysis and Research : In broader research and public health contexts, standardized codes like CDT allow for the aggregation of data. For example, researchers can study trends in dental treatments, frequency of specific procedures, or assess the needs for particular dental services in specific populations.

Communication : CDT codes facilitate clearer communication between dentists, dental specialists, insurance companies, and other stakeholders. When a dentist refers a patient to a specialist, using CDT codes can provide a precise understanding of what treatments or evaluations are recommended or have been done.

Regulatory Compliance : Some state or federal programs might require the use of CDT codes to ensure compliance with rules and regulations related to dental care reimbursement or reporting.

The American Dental Association (ADA) maintains and updates the CDT codes. The updates typically include additions of new codes, revisions of existing codes, or deletion of outdated codes. These updates ensure that the CDT code system remains relevant and reflects the evolving nature of dental care.

The top 18 CDT codes for orthodontics

There are quite a few orthodontic CDT codes, but you’ll often find yourself using the same ones over and over again. Thus, memorizing or referring to this list could save you significant time. The 18 most common CDT codes are as follows:

• D8010: Limited orthodontic treatment of the primary dentition
• D8020: Limited orthodontic treatment of the transitional dentition
• D8030: Limited orthodontic treatment of the adolescent dentition
• D8040: Limited orthodontic treatment of the adult dentition
• D8050: Interceptive orthodontic treatment of the primary dentition
• D8060: Interceptive orthodontic treatment of the transitional dentition
• D8070: Comprehensive orthodontic treatment of the transitional dentition
• D8080: Comprehensive orthodontic treatment of the adolescent dentition
• D8090: Comprehensive orthodontic treatment of the adult dentition
• D8210: Removable appliance therapy
• D8220: Fixed appliance therapy
• D8660: Pre-orthodontic treatment examination to monitor growth and development
• D8670: Periodic orthodontic treatment visit (as part of contract)
• D8680: Orthodontic retention (removal of appliances, construction, and placement of retainer(s))
• D8690: Orthodontic treatment (alternative billing to a contract fee)
• D8691: Repair of orthodontic appliance
• D8692: Replacement of lost or broken retainer
• D8693: Re-cement or re-bond fixed retainer

How to look up CDT codes you don’t know

To look up CDT codes that you don't know:

CDT Manual : Purchase and consult the official CDT manual published by the American Dental Association (ADA). This manual is the definitive source for all CDT codes and contains detailed descriptions for each code.

Online Databases : Some dental software systems or online platforms offer searchable databases of CDT codes. With these tools, you can often input keywords or partial descriptions to find the corresponding codes.

ADA's Website : The ADA might offer tools or resources for members to look up CDT codes.

Consult with Peers: If you're part of a dental group or association, colleagues might be a resource for identifying unfamiliar CDT codes.

Continuing Education and Training : Stay updated with regular training or courses that might include reviews of new, removed, or changed CDT codes.

Always ensure you're using the most current version of the CDT, as codes can be added, altered, or deleted with new editions.

How SuperBill helps with dental coding

If you run a dental practice or you work as a dental biller, SuperBill may be able to help! SuperBill uses sophisticated AI to streamline the process of dental billing. We can automate your calls to insurers, saving you countless hours on the phone. Schedule a consultation to learn more today!

Ready to sign up? Use one of the buttons below to get started.

About the author.

Harry is passionate about the power of language to make complex systems like health insurance simpler and fairer. He received his BA in English from Williams College and his MFA in Creative Writing from The University of Alabama. In his spare time, he is writing a book of short stories called You Must Relax .

Optimizing Patient Experience: The Role of Healthcare Portals

Mastering electronic health records integration for improved patient care, effective health insurance denial management for an optimized revenue cycle.

American Dental Coders Association

Dental Billing & Coding Training

What Dental Code would you use for a follow-up visit for a patient that wears a sleep apnea appliance?

• Ask the Coder

Answers (1)

Post your answer, corporate profile, quick links.

• ADCA Certification Verification
• Information For the Dentist
• Dental Billing & Coding 101 for 2024
• Dentist Advisory Board
• National Member Advisory Board
• Privacy Policy
• Terms and Conditions