Summary & Overview
CDT D0150: Comprehensive Oral Evaluation, New or Established Patient
CDT code D0150 denotes a comprehensive oral evaluation for a new or established patient and represents a core diagnostic encounter in dental practice. Nationally, this code signals a full-mouth assessment used to establish baseline oral health, identify disease or treatment needs, and guide care planning. Its role in the care pathway makes it relevant to utilization, coding accuracy, and coverage determinations across payers.
Major commercial payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of clinical context for the service, common diagnostic scenarios that accompany comprehensive evaluations, and how this evaluation relates to other dental assessment codes. The publication summarizes payer coverage patterns, modifier usage where applicable, and common coding comparisons to related evaluation and radiography codes.
This summary provides clinicians, billing staff, and policy analysts with concise guidance on the clinical intent and administrative role of CDT code D0150, clarifies distinctions from limited or periodic evaluations, and outlines what to expect in payer interactions and documentation needs. Data not available in the input is noted where applicable.
Billing Code Overview
CDT code D0150 is a comprehensive oral evaluation performed for a new or established patient. This evaluation is a dental diagnostic service that involves a thorough assessment of the patient’s oral and dental health, typically including a complete history, assessment of hard and soft tissues, occlusion, and a treatment plan when indicated.
Service Type: Dental diagnostic service
Typical Site of Service: Dental Office (POS 11)
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to a dental office (POS 11) for a first-time comprehensive oral evaluation. The patient reports intermittent tooth sensitivity and occasional gingival bleeding. The dentist performs a full medical and dental history, a thorough extraoral and intraoral examination, periodontal assessment, and documents occlusion and existing restorations. Radiographs (as indicated) and a treatment plan are developed during the visit. The visit is coded as CDT code D0150 for a comprehensive oral evaluation for a new or established patient.
Coding Specifications
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Modifiers
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52(Reduced Services): Use when the comprehensive examination service is partially reduced or not completed as documented (for example, limited components completed compared with the full service description). -
76(Repeat Procedure by Same Dentist): Use when the same dentist repeats the comprehensive oral evaluationD0150for the same patient on the same date of service or within a clinically appropriate timeframe as documented. -
Associated Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
122300000X | General Practice Dentist |
1223D0001X | Dental Public Health Dentist |
1223E0200X | Endodontics Dentist |
Related Diagnoses
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K02.9- Dental caries, unspecifiedRelevant to
D0150because a comprehensive oral evaluation identifies carious lesions requiring diagnosis, radiographs, and treatment planning. -
K05.6- Periodontal disease, unspecifiedRelevant to
D0150because periodontal assessment during a comprehensive evaluation documents pocketing, gingival inflammation, and guides periodontal treatment planning. -
K08.8- Other specified disorders of teeth and supporting structuresRelevant to
D0150because the comprehensive exam identifies structural tooth disorders and conditions affecting supporting structures that require further management. -
K04.7- Periapical abscess without sinusRelevant to
D0150because the comprehensive evaluation may identify signs or symptoms of endodontic pathology requiring diagnostic imaging and referral or treatment. -
Z01.20- Encounter for dental examination and cleaning without abnormal findingsRelevant to
D0150when a comprehensive evaluation results in no abnormal findings; documentation supports preventive maintenance or routine follow-up.
Related Codes
| Code | Description | Clinical Relationship |
|---|---|---|
D0120 | Periodic oral evaluation – established patient | Often used for routine recall visits; alternative to D0150 when patient is established and evaluation is periodic rather than comprehensive. |
D0140 | Limited oral evaluation – problem focused | Used when the visit is focused on a specific problem rather than a comprehensive exam; may precede targeted diagnostic procedures. |
D0145 | Oral evaluation for a patient under three years of age and counseling with primary caregiver | Age-specific alternative; not used with D0150 for adults. |
D0160 | Detailed and extensive oral evaluation – problem focused, by report | Used when an in-depth problem-focused exam is required and documented by report; alternative when issues exceed the scope of D0140. |
D0180 | Comprehensive periodontal evaluation | Used when a more detailed periodontal assessment is indicated in addition to or instead of the general comprehensive exam. |
D0210 | Intraoral – complete series of radiographic images | Commonly ordered during a comprehensive exam to assess full dentition and supporting structures. |
D0220 | Intraoral – periapical first radiographic image | Used for focused radiographic evaluation of specific teeth during or following the comprehensive exam. |
D0230 | Intraoral – periapical each additional radiographic image | Billed in addition to D0220 when multiple periapical images are taken. |
D0272 | Bitewings – two radiographic images | Common adjunct radiograph during a comprehensive exam for detecting interproximal caries. |
D0274 | Bitewings – four radiographic images | Alternative bitewing series used during comprehensive diagnostic evaluation. |
- Common pairings:
D0150frequently accompanies radiographic codes such asD0210,D0272,D0274, or periapical seriesD0220/D0230.D0180may be used in addition when periodontal findings require separate detailed periodontal evaluation.
National Reimbursement Benchmarks
National mean rates for CDT code D0150 show Medicare reporting at $0.00 in the input, while the average commercial (BUCA) mean sits at $45.46. BUCA’s mean rate is higher than the Aetna and Cigna Health means ($31.07 and $29.37, respectively) and lower than Blue Cross Blue Shield and UnitedHealthcare ($64.56 and $59.00, respectively).
Dispersion (P75 minus P25) varies by payer: Blue Cross Blue Shield and UnitedHealthcare are among the tighter-to-moderate spreads (BCBS: 33.33, UnitedHealthcare: 13.50), while BUCA shows a wider spread (30.00). Aetna and Cigna Health are relatively tight (Aetna: 12.80, Cigna Health: 12.00). The table and chart below present the full breakdown.
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