Understanding Dental Code D0395

Dental billing teams are increasingly encountering advanced imaging codes as technology evolves. One such code, D0395, is essential for practices utilizing 3D imaging in diagnostics and treatment planning. This article breaks down the D0395 dental code, offering actionable insights for accurate billing and streamlined insurance workflows.

When to Use D0395 dental code

The D0395 dental code is defined as “fusion of two or more 3D image volumes of one or more modalities.” This code is used when a dental provider combines multiple 3D datasets—such as CBCT (cone beam computed tomography) scans, MRI, or CT images—into a single, fused image for enhanced diagnostic value. Common scenarios include:

• Complex implant planning requiring the integration of CBCT and intraoral scans
• Orthodontic cases needing superimposed 3D images for precise tooth movement analysis
• Oral surgery cases where anatomical structures from different scans must be visualized together

Use D0395 only when the fusion of images is medically necessary and documented as part of the patient’s care plan. Do not use this code for simple 3D imaging or when only a single scan is performed.

Documentation and Clinical Scenarios

Accurate documentation is critical for successful reimbursement of D0395. Best practices include:

• Detailed clinical notes: Clearly state the reason for image fusion and how it impacts diagnosis or treatment.
• Imaging reports: Attach radiology or interpretation reports that reference the fused images.
• Medical necessity: Document why separate images were insufficient and how fusion improves patient outcomes.

For example, in a case where a patient requires both a CBCT scan for bone assessment and an intraoral scan for prosthetic planning, document the need for combining these images to ensure precise implant placement and avoid complications.

Insurance Billing Tips

Billing D0395 successfully requires attention to detail and proactive communication with payers. Follow these steps:

1. Verify coverage: Before performing fused imaging, check with the patient’s dental and medical insurance to confirm if D0395 is a covered benefit.
2. Submit supporting documentation: Include clinical notes, imaging reports, and a letter of medical necessity with the claim.
3. Use correct CDT codes: Pair D0395 with related imaging codes (such as D0367 for CBCT) when appropriate. For more on CBCT billing, see our guide to D0367.
4. Monitor EOBs: Review Explanation of Benefits statements for denials or requests for additional information. Respond promptly to avoid AR delays.
5. Appeal if necessary: If a claim is denied, submit a detailed appeal with additional documentation supporting the necessity of image fusion.

Example Case for D0395

Scenario: A patient presents for full-arch implant rehabilitation. The clinician performs a CBCT scan to assess bone structure and an intraoral scan for prosthetic design. To ensure optimal implant placement, the two scans are fused, allowing the surgeon to visualize bone and soft tissue in a single 3D model.

Billing workflow:

• Document the clinical rationale for image fusion in the patient’s chart.
• Submit D0395 along with D0367 and the intraoral scan code, attaching all relevant reports.
• Include a letter of medical necessity explaining how fusion improves surgical accuracy and patient safety.
• Follow up with insurance if additional information is requested or if the claim is denied.

By following these steps, dental practices can maximize reimbursement for advanced imaging services and provide the highest standard of care.