Understanding Dental Code D0601

When to Use D0601 dental code

The D0601 dental code is designated for caries risk assessment and documentation, specifically when a patient is determined to be at low risk for dental caries. This CDT code should be used during routine examinations when the provider conducts a formal risk assessment—using standardized tools or protocols—and concludes that the patient’s risk of developing new cavities is minimal. D0601 is appropriate for both pediatric and adult patients, and is typically billed once per patient per benefit period, unless the patient’s risk status changes.

Documentation and Clinical Scenarios

Accurate documentation is critical for proper use of D0601. Dental teams should record the specific risk assessment tool used (such as CAMBRA or ADA Caries Risk Assessment forms), the findings that support a low-risk determination, and any preventive recommendations provided to the patient. Common clinical scenarios include patients with no recent caries, good oral hygiene, low sugar intake, and regular dental visits. Documentation should include:

• Date of assessment
• Assessment tool or criteria used
• Findings supporting low risk (e.g., no active decay, no history of caries in past 24 months)
• Preventive advice or interventions discussed

Insurance Billing Tips

When billing D0601, dental offices should verify coverage with each patient’s insurance plan, as not all carriers reimburse for caries risk assessment codes. Include detailed clinical notes and the completed risk assessment form with the claim to reduce the likelihood of denials. If the claim is denied, review the EOB (Explanation of Benefits) for the reason, and be prepared to submit a claim appeal with additional documentation if necessary. Best practices include:

• Pre-verify benefits for D0601 during insurance verification calls
• Submit supporting documentation with the initial claim
• Track AR (accounts receivable) for unpaid claims and follow up promptly
• Educate patients about the value of caries risk assessment and potential out-of-pocket costs

Example Case for D0601

Consider a 28-year-old patient attending a routine recall exam. The hygienist performs a caries risk assessment using the ADA form, noting no new or recent caries, excellent oral hygiene, and a healthy diet. The provider documents these findings, determines the patient is at low risk, and bills D0601 alongside the periodic exam code. The insurance claim includes the completed risk assessment form and detailed clinical notes. If the payer denies the code, the office reviews the EOB, confirms the documentation meets requirements, and submits a claim appeal if necessary. This proactive approach ensures accurate reimbursement and demonstrates thorough patient care.