Before we take a look at frequencies, please keep in mind of the calendar year and fiscal year lessons we had. Procedures MAY or MAY NOT necessarily keep track of the calendar or fiscal year period.

COMMON FREQUENCIES OF PROCEDURES
 

• 1 in a calendar year
  • applicable to procedures under the calendar year
  • the procedure can be done only once during the current calendar year
  • example:
    • if D1208 (Fluoride) is 1 in a calendar year
      • If the current calendar year is 2023, then the provider can perform only one D1208 from January 1, 2023 to December 31, 2023.

 

• 2 in a calendar year
  • applicable to procedures under the calendar year
  • the procedure can be done twice during the current calendar period
  • example:
    • if D0180 (Perio consultation) is 2 in a calendar year
      • If the current calendar year is 2023, then the provider can perform two D0180 from January 1, 2023 to December 31, 2023.

 

• 2 in 12 consecutive months
  • usually applicable to procedures under the fiscal year plan BUT may also be applicable to procedures under the calendar year plan
  • this means that in exactly one year (12 months), two of the procedures could be done
  • most especially in fiscal year, which means that the effectivity may reach next year as long as it is part of the 12-month period
  • example:
    • if D1120 (Prophy) is 2 in 12 consecutive months
      • this means that in one contract period (e.g. July 1, 2023 – June 30, 2024) or fiscal year, the provider can perform the procedure two times
      • the next chance to do the procedure is on July 1, 2024 – June 30, 2025)

 

• every 6 months
  • this means that if the provider has performed the procedure on a specific date, the procedure can only be done again after 6 months when the procedure was previously performed
  • example:
    • if D1208 (Fluoride) is for every 6 months
      • this means that if the procedure was performed May 1, 2023, the next fluoride procedure could be done November 1, 2023 – which is 6 months from the performance of the previous procedure

 

• every 12 months
  • this means that if the provider has performed the procedure on a specific date, the procedure can only be done again after 12 months when the procedure was previously performed
  • example:
    • if D1120 (Prophy) is for every 12 months
      • this means that if the procedure was done on February 15, 2023, the  next D1120 will be done on February 15, 2024

 

• every 2 years
  • the procedure can only be done exactly 2 years or 24 months after the previous same procedure was performed
  • example:
    • if D2940 (Sedative Filling) is for every two years
      • if the procedure was done on August 24, 2023, then the next sedative filling will be on August 24, 2025

 

• every 3 years
  • the procedure can only be done exactly 3 years or 36 months after the previous same procedure was performed
  • example:
    • if D1351 (Sealants) is for every 3 years
      • if the procedure was done on August 24, 2023, then the next sedative filling will be on August 24, 2026

 

• every 5 years
  • the procedure can only be done exactly 5 years or 60 months after the previous same procedure was performed

 

• every 7 years
  • the procedure can only be done exactly 7 years or 84 months after the previous same procedure was performed

 

• every 8 years
  • the procedure can only be done exactly 8 years or 96 months after the previous same procedure was performed

 

• every 10 years
  • the procedure can only be done exactly 10 years or 120 months after the previous same procedure was performed
• downgraded to amalgam / every 2 years
  • the procedure can only be done exactly 2 years or 24 months after the previous same procedure was performed
  • Also, if this is a composite filling dental procedure such as D2330-2394, then it will be downgraded to amalgam filling – this downgrade is usually done when the procedure is to be done on posterior teeth

 

• Covered, no downgrade / every 2 years
  • the procedure can only be done exactly 2 years or 24 months after the previous same procedure was performed
  • sometimes, it is possible that the composite dental filling would have no downgrade

 

• Not covered
  • the procedure is not part of the patient’s dental plan

 

• Covered
  • the procedure is covered but no frequency has been specified

 

• No Frequency
  • the procedure has no restriction on frequency

 

• 1 per tooth per lifetime
  • the procedure can only be done one time in every tooth
  • example
    • if the sealant (D1351) is only once per tooth per lifetime, tooth letter A can only have sealant once, tooth letter B, C, D and so on also have only one sealant treatment covered by the insurance

 

• 1 per lifetime / once per lifetime
  • The procedure can only be done once in the patient
  • example
    • if the occlusal guard (D9944-D9945) is only 1 per lifetime, then the insurance only covers 1 occlusal guard service for the patient
    • in tooth extraction (D7140), this could also be the frequency – which means that once tooth number A has been extracted, tooth A cannot be extracted again (because of course, the tooth no longer exists in the patient’s mouth)

 

• subject to review
  • The procedure must be reviewed and authorized by the insurance before it gets to be performed by the provider

 

• Downgrade to DXXXX
  • Some procedures can be downgraded to a different procedure
  • In this case, you have to take note the new procedure

 

• Waiting Period to MM/DD/YYYY
  • some plans have a waiting period although this is not very common
  • in the waiting period, some procedures (especially the complex and expensive ones), cannot be done right after the plan’s effectivity – the insurance specifies a few months of the plan being effective before some procedures under the waiting period are performed