Rayan FaroukThe dentistry workload is hectic, and giving patients high-quality care entails more than solving immediate issues. Maintaining patients’ oral health and encouraging them to return for routine exams are largely made possible by preventive care, especially dental prophylaxis. Knowing how to handle dental prophylaxis and preventive treatments properly is crucial for providing excellent care—and getting paid for it—whether you’re a seasoned dentist or the owner of a busy clinic.
Dental Prophylaxis
It refers to the professional cleaning of the teeth to prevent dental diseases. It involves removing plaque, tartar and stains from teeth surfaces and polishing teeth to enhance oral hygiene. Think of it as your first line of defence in patient care. It’s a fancy term for the professional cleaning of a patient’s teeth to prevent gum disease, tooth decay and other oral health issues. It helps patients maintain their oral health.
The key CDT codes under the Dubai Health Authority (DHA) are:
- D1110: Prophylaxis for adults
- D1120: Prophylaxis for children (14 years old or younger)
Each of these codes represents a cleaning that your patient needs and is typically covered twice per year by most insurance programs.
Preventive Care
It isn’t just about cleanings – other services keep your patient’s mouth healthy and your clinic running smoothly.
Fluoride Treatments:
- For kids especially, fluoride treatments can make a big difference. The code D1206 (fluoride varnish) is used for patients up to 18 years old and helps protect against cavities.
Sealants:
- Sealants (D1351) are like protective shields for kids’ teeth and are only payable once per tooth for permanent molars. Don’t forget to document the patient’s age and the specific tooth!
By offering these services, you are helping the patient’s health and creating opportunities for future visits. After all, if the patient’s health is on an upward spike, they are more likely to trust you with their long-term oral health needs.
What to avoid when billing?
Let’s be real: billing can feel like a headache. But knowing the rules can save you from claim rejections and delays. Here are some quick tips to make sure your prophylaxis billing runs smoothly:
- Don’t Double-Bill with Periodontal Services:
If you are performing scaling and root planning (D4341/D4342) or periodontal maintenance (D4910), the prophylaxis (D1110 or D1120) is considered part of those services. You can’t bill for both on the same day. So, keep it clean – one service, one bill.
- Know Your Age Codes:
Be careful not to use the child code D1120 for adult patients. This code is specifically for patients under the age of 14. Similarly, if you’re working on an adult patient, make sure to use D1110.
- Respect the 6-Month Rule:
Prophylaxis is typically covered twice a year. If a patient comes in sooner than 6 months for another cleaning, the insurance likely won’t cover it unless there’s a medical necessity. Always check their visit history!
How to document?
Accurate record-keeping is your best friend when it comes to avoiding claims being rejected. Here’s what to document for every prophylaxis visit:
- Patient Health Record:
It is important to keep your patient’s medical history up to date, including any modifications to their medication or conditions.
- Treatment Performed:
Make sure to note whether you administered prophylaxis to an adult or a child. This can assist in preventing any misunderstandings while submitting claims later on.
- Patient’s Age:
It’s important to document the patient’s age, especially for child prophylaxis. It’s a quick check, but an important one to avoid using the wrong code.
- Frequency:
Keep an eye on how many cleanings the patient has had within the year to make sure you’re staying within coverage limits. If they’ve hit the limit, discuss any out-of-pocket costs with the patient beforehand to avoid surprises.
At the end of the day, preventive care is the foundation of a successful dental practice. Offering dental prophylaxis and other preventive services ensures that your patients stay healthy and keeps your clinic running smoothly.
By staying on top of billing codes, avoiding common pitfalls, and making documentation a priority, you can focus on what really matters—providing the best possible care to your patients.
Want to know more about how Balsam Medico can help with your billing and documentation? Contact us today, and we’ll get you started on streamlining your clinic’s workflow! Our customer success team is readily available to assist with any questions or issues, providing peace of mind and allowing clinic staff to focus on their core responsibilities.
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