Understanding Dental Code D1120

When to Use D1120 dental code

The D1120 dental code is the CDT (Current Dental Terminology) code used for "Prophylaxis – Child." This code should be applied when providing a routine dental cleaning for patients under the age of 14. Prophylaxis involves the removal of plaque, calculus, and stains from the teeth to control oral diseases. It is essential to use D1120 only when the patient meets the age criteria and the procedure is preventive in nature, not therapeutic. For patients 14 and older, the appropriate code is D1110 (Prophylaxis – Adult).

Documentation and Clinical Scenarios

Accurate documentation is crucial for successful dental billing and insurance reimbursement. When using D1120, ensure the patient’s age is clearly recorded in the chart. The clinical notes should include:

• Patient’s date of birth and age at the time of service
• Reason for prophylaxis (preventive care, not treatment of periodontal disease)
• Details of the cleaning performed (areas cleaned, presence of plaque/calculus, and any notable findings)
• Oral hygiene instructions provided to the patient or guardian

Common clinical scenarios for D1120 include routine six-month cleanings for children, cleanings prior to orthodontic treatment, or as part of a recall visit. Avoid using D1120 if the patient requires periodontal scaling or root planing; in those cases, reference codes such as D4341 or D4342.

Insurance Billing Tips

To maximize reimbursement and minimize denials, follow these best practices when billing D1120:

• Verify eligibility: Confirm the patient’s age and benefits for prophylaxis before the appointment. Many plans cover two cleanings per year for children.
• Submit detailed claims: Include the patient’s date of birth, provider notes, and any supporting documentation with your claim.
• Review EOBs (Explanation of Benefits): Check for frequency limitations, age cutoffs, or waiting periods that may affect coverage.
• Appeal denials: If a claim is denied due to age or frequency, review the plan’s guidelines and submit an appeal with clear documentation if appropriate.

Staying proactive with insurance verification and thorough documentation will help your practice maintain healthy AR (accounts receivable) and reduce claim rework.

Example Case for D1120

Case Study: A 10-year-old patient presents for a routine recall appointment. The hygienist performs a prophylaxis, removing plaque and calculus from all quadrants, and provides oral hygiene instructions. The clinical notes document the patient’s age, the preventive nature of the visit, and the absence of periodontal disease. The front office verifies that the patient’s insurance covers two D1120 cleanings per year. The claim is submitted with the correct code, patient’s date of birth, and detailed notes. The insurance pays the claim in full, with no denials or delays.

This scenario highlights the importance of age verification, accurate documentation, and proactive insurance checks when billing D1120.