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).
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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