Understanding Dental Code D0602

When to Use D0602 dental code

The D0602 dental code is designated for caries risk assessment and documentation, specifically when a patient is determined to be at moderate risk for dental caries. This CDT code is most appropriate during routine preventive visits, such as hygiene appointments or periodic oral evaluations, where a formal caries risk assessment is performed. Use D0602 when clinical findings, patient history, and risk factors (such as diet, oral hygiene, fluoride exposure, and medical conditions) indicate a moderate likelihood of developing new carious lesions. Proper use of this code helps dental teams tailor preventive strategies and communicate risk status to both patients and payers.

Documentation and Clinical Scenarios

Accurate documentation is essential for D0602. The provider should record the specific risk factors identified, the assessment method used (such as CAMBRA or ADA Caries Risk Assessment forms), and the rationale for assigning a moderate risk level. Typical scenarios include patients with early signs of enamel demineralization, inconsistent oral hygiene, or a history of caries but no active lesions. The clinical note should include:

• Assessment tool or criteria used
• Identified risk factors (e.g., dietary habits, saliva flow, previous caries experience)
• Summary of findings supporting moderate risk
• Recommended preventive interventions (e.g., fluoride varnish, dietary counseling)

Thorough documentation not only supports claim submission but also enhances patient care by tracking risk status over time.

Insurance Billing Tips

When billing with D0602, always verify patient benefits before the appointment, as coverage for caries risk assessment varies by payer and plan. Some dental insurance carriers may limit the frequency of this code or require it to be billed in conjunction with a comprehensive or periodic exam (D0120 or D0150). Best practices for successful reimbursement include:

• Pre-authorize or check eligibility for D0602 when scheduling preventive visits
• Submit detailed clinical notes and risk assessment forms with the claim
• Use accurate CDT code sequencing if submitting with other preventive services
• Review Explanation of Benefits (EOBs) carefully and appeal denials with supporting documentation if needed

Consistent use of D0602, along with robust documentation, can improve both patient outcomes and practice revenue cycle management (RCM).

Example Case for D0602

Case Example: A 35-year-old patient presents for a routine cleaning. The hygienist notes a history of caries in the past three years, occasional snacking on sugary foods, and inconsistent flossing. No new cavities are present, but mild enamel demineralization is observed. Using the ADA Caries Risk Assessment, the provider determines the patient is at moderate risk. The clinical note details the findings, and D0602 is billed alongside the periodic exam code. The insurance claim includes the risk assessment form and supporting documentation, resulting in successful reimbursement.

This scenario highlights the importance of thorough assessment, documentation, and proactive billing strategies when using the D0602 dental code.