Understanding Dental Code D1520

When to Use D1520 dental code

The D1520 dental code is designated for the placement of a fixed, unilateral space maintainer in pediatric and adolescent patients. This CDT code is used when a primary tooth is lost prematurely and there is a clinical need to preserve the space for the proper eruption of the permanent tooth. Space maintainers prevent drifting of adjacent teeth, which can lead to malocclusion or crowding if not addressed promptly. Dental teams should use D1520 when the device is cemented or otherwise fixed in place on one side of the arch, as opposed to bilateral or removable appliances, which have separate codes.

Documentation and Clinical Scenarios

Accurate documentation is critical for successful reimbursement and compliance. When billing for D1520, ensure the patient’s chart includes:

 
• Clinical notes detailing the reason for premature tooth loss (e.g., trauma, decay, extraction)
 
• Radiographs or intraoral photos supporting the need for space maintenance
 
• A treatment plan outlining the type and location of the space maintainer
 
• Details on the materials used and the method of fixation

Common scenarios for D1520 include early loss of a primary molar in a 6-year-old due to caries, or after extraction of a non-restorable tooth. Always document the tooth number and the quadrant to support the unilateral nature of the appliance.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D1520, follow these best practices:

 
• Verify benefits: Confirm patient eligibility and frequency limitations for space maintainers before treatment. Some plans may only cover this service for patients under a certain age or once per tooth.
 
• Submit complete claims: Include diagnostic codes, clinical notes, and supporting images with your initial claim submission. Incomplete documentation is a leading cause of denials.
 
• Use accurate CDT codes: Ensure you are not confusing D1520 with codes for bilateral or removable space maintainers.
 
• Appeal denials: If a claim is denied, review the Explanation of Benefits (EOB) for the reason, gather additional documentation if needed, and submit a timely, well-supported appeal.

Example Case for D1520

Consider a 7-year-old patient who lost their lower left primary second molar due to extensive decay. The dentist determines that a fixed, unilateral space maintainer is necessary to prevent mesial drift of the first permanent molar. The dental team documents the clinical findings, takes a pre-op radiograph, and submits a claim using D1520 with all supporting materials. The insurance carrier approves the claim, and the practice receives prompt reimbursement, demonstrating the importance of thorough documentation and proper code selection.