Billing Code Overview

CDT code D1110 represents prophylaxis for adults, specifically the professional service of cleaning and polishing the teeth. The procedure is delivered within the field of dentistry and is typically performed in a dental office (POS 11). This service focuses on removal of plaque, calculus, and stains to maintain oral health and prevent disease.

Clinical Context

An adult patient presents to a dental office (POS 11) for routine preventive care consisting of scaling, cleaning, and polishing of the teeth. The patient may be asymptomatic and seeking routine maintenance, or may have plaque/calculus or early signs of decay or periodontal inflammation identified on examination. The clinical workflow typically includes patient arrival and registration, medical history review, intraoral examination by the dentist or dental hygienist, prophylaxis treatment (removal of plaque and calculus, scaling and polishing), documentation of findings, and any preventive recommendations. Vital signs and informed consent for standard prophylaxis are recorded, and follow-up or adjunct procedures (for example, topical fluoride application or a comprehensive oral evaluation) are scheduled as clinically indicated.

Coding Specifications

• CDT code D1110: Prophylaxis - adult; cleaning and polishing of the teeth.

• Common Modifiers

• 52 - Reduced Services

• Use when the prophylaxis service is partially reduced or not performed to full extent. Document the reason for reduction and the portion of the service performed.

• 76 - Repeat Procedure by Same Dentist

• Use when the same dentist performs the prophylaxis procedure more than once for the same patient on the same day; document justification and clinical circumstances.

• Associated Provider Taxonomies

• 122300000X — General Practice Dentist: General dental practitioners providing comprehensive dental care including prophylaxis.

• 1223G0001X — General Practice: General dental practice taxonomy representing clinicians in general dentistry settings.

• 1223D0001X — Dental Public Health: Practitioners focused on population-based oral health and preventive services.

Related Diagnoses

• Z01.20 — Encounter for dental examination and cleaning without abnormal findings

• Clinical relevance: Represents routine preventive visit where D1110 prophylaxis is performed and no abnormal findings are documented.

• Z01.21 — Encounter for dental examination and cleaning with abnormal findings

• Clinical relevance: Represents preventive visit with findings (for example, caries or periodontal changes) identified during the visit; prophylaxis D1110 may still be performed as part of care.

• K02.9 — Dental caries, unspecified

• Clinical relevance: Presence of carious lesions identified during or prior to the visit that may coexist with prophylaxis; documentation should note caries status when billing preventive services.

• K05.6 — Periodontal disease, unspecified

• Clinical relevance: Periodontal disease may be identified in conjunction with prophylaxis; more extensive periodontal treatment codes may be required if active therapy beyond prophylaxis is provided.

• K03.6 — Deposits [accretions] on teeth

• Clinical relevance: Tooth deposits such as calculus or stains are addressed during prophylaxis D1110, supporting medical necessity for cleaning when documented.

Related Codes

• D1120 - Prophylaxis - child

• Relation: Age-based counterpart to D1110; used instead of D1110 for pediatric patients and serves as an alternative based on patient age.

• D1206 - Topical application of fluoride varnish

• Relation: Adjunct preventive procedure often performed in the same visit after prophylaxis for additional caries prevention; commonly used together when clinically appropriate.

• D1208 - Topical application of fluoride

• Relation: Alternative topical fluoride application method to D1206; may be used instead of or in addition to prophylaxis-dependent preventive measures.

• D0150 - Comprehensive oral evaluation - new or established patient

• Relation: A diagnostic evaluation that may precede or accompany D1110 when a full assessment is required; can be used in the same visit when a comprehensive exam is performed prior to prophylaxis.

National mean rates show a clear gap between Medicare and the BUCA (average commercial) benchmark: Medicare has no localities reported in the input, so Data not available in the input., while BUCA (average commercial) reports a mean of $49.56. Among commercial payers, UnitedHealthcare ($68.51) and Blue Cross Blue Shield ($60.71) sit above the BUCA mean, while Aetna ($40.65) and Cigna Health ($36.58) sit below it.

Dispersion measured as P75 minus P25 varies across payers. UnitedHealthcare has a relatively tight spread (75.13 - 62 = $13.13), Cigna Health is also tight (41 - 33 = $8.00), while Blue Cross Blue Shield shows a wider spread (71 - 46 = $25.00). Aetna's spread is $12.00 and BUCA's spread is $26.20. The table and chart below present the full breakdown.