Understanding Dental Code D0380

When to Use D0380 dental code

The D0380 dental code is used for billing a cone beam computed tomography (CBCT) image capture with a limited field of view, specifically when the scan covers less than one whole jaw. This code is appropriate when a dentist or specialist needs highly detailed 3D imaging of a localized area—such as a single tooth, quadrant, or a specific region for endodontic, implant, or surgical evaluation—without exposing the patient to a full-jaw scan. Using D0380 ensures accurate documentation and billing for focused diagnostic needs, rather than broader imaging procedures covered by codes like D0367 (full arch) or D0364 (maxillofacial area).

Documentation and Clinical Scenarios

Proper documentation is essential for successful reimbursement and compliance. When using D0380, the clinical notes should clearly indicate:

• The specific region imaged (e.g., upper right quadrant, #14 area)
• The clinical indication for the scan (e.g., evaluation of periapical pathology, implant planning, assessment of impacted tooth)
• How the limited field of view was determined to be clinically necessary
• Reference to any prior imaging and why additional, focused CBCT was required

Common scenarios for D0380 include pre-surgical implant assessment, endodontic diagnosis of a single tooth, evaluation of localized pathology, or assessment of a suspected root fracture. Always ensure that the imaging request and interpretation are documented in the patient’s chart to support the claim.

Insurance Billing Tips

Billing for D0380 requires attention to detail to avoid denials and delays:

• Verify coverage: Not all dental plans cover CBCT imaging. Check benefits and obtain pre-authorization if required.
• Submit supporting documentation: Include clinical notes, radiology reports, and a narrative explaining medical necessity. Attach the image if the payer requests it.
• Use correct CDT code: Ensure D0380 is used only for limited field scans. Using the wrong code (like a full-jaw code) can result in claim rejection.
• Appeal denials: If the claim is denied, review the EOB for the reason, gather additional documentation, and submit a timely appeal with a detailed explanation of necessity.
• Track AR: Monitor accounts receivable for unpaid claims and follow up promptly to reduce revenue leakage.

Successful dental offices establish clear protocols for insurance verification, documentation, and appeals to maximize reimbursement for advanced imaging procedures.

Example Case for D0380

Case: A patient presents with persistent pain around tooth #30 despite normal findings on traditional periapical radiographs. The dentist suspects a vertical root fracture and orders a limited field CBCT scan focused on the lower right molar area. The scan reveals a fracture line, confirming the diagnosis and guiding treatment planning.

Billing steps:

1. Document the clinical findings and rationale for limited CBCT in the patient’s chart.
2. Submit claim with D0380, attaching clinical notes and the radiology report.
3. Verify insurance coverage and obtain pre-authorization if needed.
4. If denied, review EOB and submit an appeal with additional documentation.

This approach ensures compliance, supports medical necessity, and improves the likelihood of successful reimbursement.