Billing Guide for D1120 (Prophylaxis - Child)
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Description
Billing Guidelines, Tips and Reminders for D1120 (Prophylaxis - Child)
February 03, 2025
Removal of plaque, calculus and stains from the tooth structures and implants in the primary and transitional dentition. It is intended to control local irrational factors.
COMMENTS:
1. Primary dentition refers to the first set of teeth. These are also called baby teeth, or deciduous teeth. Transitional dentition begins with the appearance of the first permanent tooth and ends with the exfoliation (loss) of the last deciduous tooth. D1120 includes prophylaxis of implant crowns in conjunction with the primary and transitional dentition.
2. Child prophylaxis (D1120) may be used to report a prophylaxis of both primary and transitional (mixed) dentitions including implant crowns. On the other hand, an adult prophylaxis (D1110) reports both permanent and transitional (mixed) dentitions. See D1110 for further comments in reporting transitional (mixed) dentitions as an adult prophylaxis.
3. Child prophylaxis (D1120) does not include the topical application of fluoride. Report fluoride treatments, when applied separately from the prophylaxis paste, using either code D1208 topical application of fluoride or D1206, if fluoride varnish is applied. D1208 would include any prescription strength fluoride products excluding varnish (swish, trays, isolate and paint on). D1206 specifically requires application of fluoride varnish. Fluoride must be applied separately from the prophylaxis paste. See D1206 and D1208 for additional information.
LIMITATIONS
1. Appropriate reporting of D1120 should be based on the patient's developing dentition. Benefits may be defined by age in the plan document, however dentition defines code usage. If a patient has no primary teeth remaining, an adult prophylaxis (D1110) is appropriate regardless of age. See D1110.
2. Child prophylaxis (D1120) may be reimbursed on either a "one per six months" (to the day!) or on a "two per year" basis.
TIPS
If a patient with a transitional dentition presents with "challenging" prophylaxis, regardless of age, consider reporting adult prophylaxis (D1110). See D1110 for details of this scenario as it applies to the transitional dentition.
COMMENTS:
1. Primary dentition refers to the first set of teeth. These are also called baby teeth, or deciduous teeth. Transitional dentition begins with the appearance of the first permanent tooth and ends with the exfoliation (loss) of the last deciduous tooth. D1120 includes prophylaxis of implant crowns in conjunction with the primary and transitional dentition.
2. Child prophylaxis (D1120) may be used to report a prophylaxis of both primary and transitional (mixed) dentitions including implant crowns. On the other hand, an adult prophylaxis (D1110) reports both permanent and transitional (mixed) dentitions. See D1110 for further comments in reporting transitional (mixed) dentitions as an adult prophylaxis.
3. Child prophylaxis (D1120) does not include the topical application of fluoride. Report fluoride treatments, when applied separately from the prophylaxis paste, using either code D1208 topical application of fluoride or D1206, if fluoride varnish is applied. D1208 would include any prescription strength fluoride products excluding varnish (swish, trays, isolate and paint on). D1206 specifically requires application of fluoride varnish. Fluoride must be applied separately from the prophylaxis paste. See D1206 and D1208 for additional information.
LIMITATIONS
1. Appropriate reporting of D1120 should be based on the patient's developing dentition. Benefits may be defined by age in the plan document, however dentition defines code usage. If a patient has no primary teeth remaining, an adult prophylaxis (D1110) is appropriate regardless of age. See D1110.
2. Child prophylaxis (D1120) may be reimbursed on either a "one per six months" (to the day!) or on a "two per year" basis.
TIPS
If a patient with a transitional dentition presents with "challenging" prophylaxis, regardless of age, consider reporting adult prophylaxis (D1110). See D1110 for details of this scenario as it applies to the transitional dentition.
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