Understanding Dental Code D8070

When to Use D8070 dental code

The D8070 dental code is designated for comprehensive orthodontic treatment of the transitional dentition. This CDT code is specifically used when a patient, typically a child, is in the mixed dentition phase—meaning they have both primary (baby) and permanent teeth present. D8070 should be applied when the orthodontic treatment plan addresses the full scope of care required during this transitional period, including diagnosis, active treatment, and retention phases. It is not intended for limited or interceptive orthodontic procedures, which are covered by different codes such as D8060 for limited orthodontic treatment of the transitional dentition.

Documentation and Clinical Scenarios

Accurate documentation is crucial when submitting claims for D8070. Dental offices should ensure that the patient’s records include:

• Comprehensive orthodontic evaluation and diagnosis
• Detailed treatment plan outlining objectives and expected outcomes
• Clinical notes describing the presence of both primary and permanent teeth
• Radiographs, photographs, and study models as supporting evidence
• Progress notes throughout the active and retention phases

Common clinical scenarios for D8070 include children aged 7–12 who require full orthodontic correction due to crowding, spacing, crossbites, or other malocclusions during the transition from primary to permanent teeth. The code covers the entire course of treatment, from initial records to the final retention phase, and should not be used for partial or phase I treatments.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D8070, dental teams should follow these best practices:

• Verify coverage: Contact the patient’s insurance carrier to confirm orthodontic benefits, age limits, and any waiting periods before treatment begins.
• Pre-authorization: Submit a comprehensive pre-treatment estimate with all required documentation to obtain pre-approval and clarify patient financial responsibility.
• Submit complete claims: Include all supporting records, a clear narrative, and the correct CDT code (D8070) on the claim form. Attach progress notes and updated radiographs as needed.
• Track EOBs and AR: Monitor Explanation of Benefits (EOBs) for payment schedules and post payments accurately to accounts receivable (AR). Follow up promptly on any discrepancies or denials.
• Appeal denials: If a claim is denied, review the reason, gather additional documentation, and submit a timely appeal with a detailed explanation of medical necessity.

Consistent communication with payers and patients helps ensure transparency and reduces billing errors.

Example Case for D8070

Consider an 8-year-old patient presenting with severe crowding and a crossbite. After a comprehensive evaluation, the orthodontist determines that full treatment is necessary during the transitional dentition phase. The treatment plan includes braces, regular adjustments, and a retention phase with a removable retainer. The office submits a pre-authorization with diagnostic records and a detailed narrative. Once approved, the D8070 code is used for all claims related to this course of treatment, ensuring proper reimbursement and compliance with insurance requirements.

By understanding when and how to use D8070, dental practices can streamline billing, reduce claim denials, and provide optimal care for patients in the transitional dentition phase.