Understanding Dental Code D1110

When to Use D1110 dental code

The D1110 dental code is the CDT code designated for an adult prophylaxis, commonly referred to as a routine dental cleaning. This code should be used for patients who are 13 years of age or older and present with healthy periodontium or mild gingivitis, but do not require periodontal therapy. D1110 is not appropriate for patients who show signs of moderate to severe periodontitis; in those cases, other codes such as D4346 (scaling in presence of inflammation) or D4910 (periodontal maintenance) may be more suitable. Proper code selection ensures accurate billing and compliance with insurance guidelines.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful claim submission and to avoid denials. For D1110, clinical notes should clearly indicate:

• Patient’s age (13+ years)
• Absence of moderate or severe periodontitis
• Presence of healthy gums or mild gingivitis
• Procedures performed: removal of plaque, calculus, and stains from the tooth surfaces

Common clinical scenarios for D1110 include adult patients attending their biannual cleaning with no history of periodontal disease, or those with mild gingival inflammation but no bone loss. Always document findings from periodontal charting and radiographs to support code selection.

Insurance Billing Tips

Proper billing of D1110 can help maximize reimbursement and minimize claim denials. Here are best practices:

• Verify patient eligibility: Confirm frequency limitations (often every 6 months) and age requirements with the insurer before scheduling.
• Submit complete documentation: Attach clinical notes, periodontal charting, and radiographs if requested by the payer.
• Use correct CDT code: Do not substitute D1110 for periodontal maintenance or scaling procedures; use D4910 or D4346 as appropriate.
• Track EOBs and AR: Monitor Explanation of Benefits (EOBs) and Accounts Receivable (AR) to identify underpayments or denials quickly.
• Appeal if necessary: If a claim is denied, review the payer’s policy, gather supporting documentation, and submit a timely appeal with detailed clinical justification.

Example Case for D1110

Case Study: A 35-year-old patient presents for a routine check-up. Periodontal charting reveals 2-3 mm pocket depths, no bone loss on radiographs, and mild gingival inflammation. The hygienist removes supragingival and subgingival plaque and calculus, and polishes all tooth surfaces. The clinical notes specify the absence of periodontitis. D1110 is the correct code for this visit. The claim is submitted with supporting documentation, and the insurer reimburses according to the patient’s preventive benefits.

By understanding when and how to use the D1110 dental code, dental teams can ensure accurate billing, reduce claim denials, and provide optimal care for adult patients needing preventive services.