Summary & Overview
CDT D0140: Limited Oral Evaluation – Problem Focused
CDT code D0140 denotes a limited, problem-focused oral evaluation performed to assess a specific dental complaint or acute condition. Nationally, this code is used to document focused diagnostic encounters that do not require a comprehensive or periodic evaluation, supporting appropriate clinical triage, treatment planning, and claims adjudication. It matters because payers and dental practices rely on accurate use of this code to reflect the scope of the visit and to align clinical documentation with billing rules. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will learn how CDT code D0140 is defined and applied in clinical practice, the typical care setting and procedural context, and how it relates to neighboring CDT evaluations. The summary highlights common clinical presentations appropriate for a limited oral evaluation and identifies the code’s role in episode workflow and billing distinction from periodic or comprehensive evaluations. The publication also outlines payer coverage considerations and documentation expectations relevant to national practice patterns. Data not provided in the source (for example, specific payer fee schedules or claim volumes) are noted as unavailable; the focus remains on code definition, clinical context, and billing classification for a national audience.
Billing Code Overview
CDT code D0140 represents a limited oral evaluation – problem focused. This service is a dental diagnostic evaluation performed to evaluate a specific oral health problem or concern. The typical site of service is a dental office (POS 11).
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents to a dental office (POS 11) with localized tooth pain and swelling after a recent injury. The dentist performs a focused, problem-oriented diagnostic evaluation to assess the specific complaint, including targeted history, limited intraoral examination, and any necessary radiographic imaging to identify caries, periapical pathology, or localized periodontal involvement. The visit documentation emphasizes the chief complaint, limited exam findings related to the problem area, differential diagnosis, and the immediate treatment plan or referral.
Coding Specifications
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Common Modifiers
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25— Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use when a distinct and documented, problem-focused evaluation is provided in addition to a procedure or other service on the same date, and the evaluation is significant and separately identifiable from the procedure. -
52— Reduced Services: Use when the service performed is partially reduced or eliminated at the physician s discretion; document what portions of the normally reported service were not performed. -
Associated Provider Taxonomies
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122300000X— General Practice Dentist -
1223D0001X— Dental Public Health -
1223E0200X— Endodontics -
1223G0001X— Oral and Maxillofacial Surgery -
1223P0106X— Pediatric Dentistry
Related Codes
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D0120— Periodic oral evaluation – established patientRelationship: Used for routine, periodic recall examinations; serves as an alternative to the problem-focused evaluation when a comprehensive periodic check is indicated.
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D0150— Comprehensive oral evaluation – new or established patientRelationship: A more extensive evaluation used for new patients or when a full comprehensive assessment is required instead of a limited, problem-focused visit.
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D0160— Detailed and extensive oral evaluation – problem focused, by reportRelationship: Used when a detailed, extensive problem-focused evaluation is required and additional documentation by report is necessary; can be used as an alternative or when the complexity exceeds the scope of the limited evaluation
D0140.
Related Diagnoses
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K08.8— Other specified disorders of teeth and supporting structuresClinical relevance: May explain localized structural or developmental issues detected during the limited, problem-focused oral evaluation.
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K04.7— Periapical abscess without sinusClinical relevance: A common acute cause of tooth pain evaluated during a limited diagnostic visit to determine need for endodontic or surgical treatment.
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K05.6— Periodontal disease, unspecifiedClinical relevance: Periodontal involvement localized to the problem area can be assessed during the focused evaluation to guide periodontal therapy or referral.
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K02.9— Dental caries, unspecifiedClinical relevance: Carious lesions causing focal pain or sensitivity are a typical finding evaluated during a limited oral evaluation.
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K12.1— Other forms of stomatitisClinical relevance: Mucosal inflammatory conditions that may present with localized symptoms assessed during the problem-focused evaluation.
National Reimbursement Benchmarks
National mean rates for CDT code D0140 show that UnitedHealthcare and Blue Cross Blue Shield sit above the BUCA average (average commercial) while Cigna Health and Aetna are below it. Medicare’s value is not provided in the input and is omitted from comparative rate-level statements.
Rate dispersion (the difference between the 75th and 25th percentiles) varies by payer: Blue Cross Blue Shield and UnitedHealthcare show wider dispersion (BCBS: $20.17; UnitedHealthcare: $11.96) while Cigna Health and Aetna are tighter (Cigna: $10.00; Aetna: $12.50). BUCA’s dispersion is $22.60, the largest among the listed commercial aggregates. The table and chart below present the full breakdown.
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