Purpose
Understand the main categories of dental procedures — what each CDT code does, how to communicate with the clinical team, and how to classify procedures when verifying insurance.
Time: 15–20 min ·
Audience: Insurance verification, billing, front desk
Main categories
| Category | Spanish | Typical insurance coverage |
|---|---|---|
| Preventive / Diagnostic | Preventivo / Diagnóstico | 80–100% (highest) |
| Basic / Restorative | Básico / Restaurativo | 50–80% |
| Major / Prosthodontic | Mayor / Prostodoncia | 30–50% |
| Cosmetic | Cosmético | 0% (not submitted to insurance) |
| Orthodontic | Ortodoncia | Variable + lifetime max + age limit |
Preventive / Diagnostic
Exams
- Comprehensive (COMPEX) — D0150: Full exam for new patient or every 5 years
- Periodic — D0120: Recall exam every 6 months
- Limited — D0140: Emergency exam
- Detailed — D0180: Periodontal evaluation
X-rays
- FMX — D0210: Full Mouth X-ray (18 films). 1 every 3-5 years
- BWX — D0274: Bitewings (4 films). Once per year
- PA — D0220/D0230: Periapical (individual)
- Pano — D0330: Panoramic
Cleanings and prevention
- Adult prophy — D1110: Regular cleaning every 6 months
- Child prophy — D1120: Pediatric cleaning
- Fluoride — D1208: Topical application (typically kids)
- Sealants — D1351: Caries prevention on molars
Basic / Restorative
Fillings
Treatment for caries. Codes vary by surface and material:
- D2140-D2161: Amalgam (silver, posterior)
- D2330-D2394: Composite/Resin (tooth-colored)
- Typical surface: B (buccal) or F (facial)
Periodontal treatments
- SRP — D4341 / D4342: Scaling and Root Planing ("deep cleaning"). Logged by quadrants UR/UL/LR/LL. D4341 = 4+ teeth per quadrant; D4342 = 1-3 teeth
- D4910: Periodontal maintenance (post-SRP)
Common rule: SRP can't repeat within 24 months. Max 2 quadrants per date of service in some plans.
Basic endodontics (anterior / premolar)
- D3310: Anterior root canal
- D3320: Premolar root canal
Major Services
Complex endodontics (molars)
- D3330: Molar root canal
- D3346-D3348: Retreatment
Crowns and bridges
- D2740-D2792: Crown (porcelain, metal, zirconia, etc)
- D6240-D6253: Bridge pontic + abutments
- D2950: Build-up
- D2954: Prefabricated post & core
Crown on prep: Many plans pay the crown on prep day (not seat). Confirm during verification.
Dentures and prosthetics
- D5110/D5120: Complete upper/lower denture
- D5211-D5214: Partial
Implants
- D6010: Surgical placement
- D6056-D6057: Abutment
- D6058-D6094: Implant crown
- D7953: Bone graft (ridge preservation). Only billable same day as extraction.
Oral surgery
| Code | Procedure |
|---|---|
D7140 | Simple extraction, erupted |
D7210 | Surgical extraction |
D7240 | Wisdom tooth extraction, fully bony impaction |
D7311 | Alveoloplasty, same day as extraction |
Orthodontics
For ortho verification always include:
- Lifetime maximum
- Age limit (typically up to age 19)
- Coverage percentage
- Whether predetermination is required
Cosmetic Services (NOT submitted to insurance)
- Whitening / Bleaching
- Veneers — D2960-D2962
- Cosmetic Bonding
BrandaCare rule: Cosmetic = patient pays 100% out of pocket. Do NOT submit to insurance.