Summary & Overview
CDT D1120: Prophylaxis—Child
Headline: CDT code D1120: Pediatric dental prophylaxis defined and used across major payers
Lead: CDT code D1120 denotes prophylaxis for children — a routine preventive dental cleaning performed in dental offices to remove plaque and deposits and to maintain oral health. As a common pediatric preventive procedure, D1120 is widely recognized in clinical practice and payer guidelines.
What the code represents and why it matters: CDT code D1120 covers professional prophylaxis services for pediatric patients. Preventive dental care for children is central to early detection and prevention of dental disease, reducing future treatment needs and supporting overall health. Nationally, consistent recognition of a pediatric prophylaxis code supports standardized billing, care delivery, and coverage decisions.
Key payers covered: This publication examines coverage and billing context for Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting practices among major commercial insurers.
What readers will learn: The article provides a concise clinical and billing overview of CDT code D1120, its role in preventive dental care, common clinical indications, and relationships to adjacent CDT procedures. It summarizes how major payers classify and reimburse pediatric prophylaxis services, highlights typical site-of-service expectations, and identifies common associated diagnostic contexts. Where specific operational or payer policy details are not supplied, the reader will see “Data not available in the input.”
Billing Code Overview
CDT code D1120 represents Prophylaxis–child, a preventive dental service focused on the cleaning and removal of plaque, calculus, and stains for pediatric patients. This service is typically performed to maintain oral health and reduce risk of caries and periodontal disease.
Service Type: Preventive dental service
Typical Site of Service: Dental office (CDT/ADA typical setting)
Clinical & Coding Specifications
Clinical Context
A 6-year-old child presents to a dental office for a routine preventive visit. The parent reports no current dental pain; the dentist performs an oral evaluation, records growth and eruption patterns, reviews home care, and completes a professional dental cleaning targeted to remove supragingival plaque and calculus appropriate for a child. The visit is documented as prophylaxis for a child and linked to the dental encounter diagnosis. Radiographs or fluoride application may be performed during the same visit if clinically indicated and documented separately.
Coding Specifications
-
Modifier
52– Reduced ServicesUsed when the full dental prophylaxis procedure for which CDT code
D1120is reported is partially reduced or eliminated at the dentists discretion. Documentation must support the reduction in scope and the reason for reporting reduced services. -
Modifier
76– Repeat Procedure by Same DentistUsed when the exact same CDT code
D1120has been performed previously by the same dentist during the relevant reporting period and the procedure is being repeated. Documentation must indicate date and reason for the repeat. -
Associated provider taxonomies:
| Taxonomy Code | Specialty |
|---|---|
122300000X | General Practice Dentist |
1223P0221X | Pediatric Dentist |
1223D0001X | Dental Public Health |
Related Diagnoses
-
Z01.20- Encounter for dental examination and cleaning without abnormal findingsRepresents a routine preventive visit where
D1120is commonly reported when no pathology is identified. -
Z01.21- Encounter for dental examination and cleaning with abnormal findingsRepresents a preventive visit where exam identified findings;
D1120may still be reported for the prophylaxis portion of the visit. -
K02.9- Dental caries, unspecifiedPresence of dental caries may be documented at the visit; prophylaxis
D1120addresses plaque and deposits but does not treat carious lesions. -
K03.6- Deposits [accretions] on teethDirectly relevant to prophylaxis services;
D1120is the standard code for removal of supragingival deposits in children. -
K05.6- Periodontal disease, unspecifiedIf periodontal disease is identified, it may affect the treatment plan; routine child prophylaxis
D1120is reported for preventive cleaning, while periodontal therapies are coded separately.
Related Codes
-
D1110- Prophylaxis - adultThis is the adult counterpart to
D1120; used for routine prophylaxis in adult patients.D1110andD1120are alternatives based on patient age and are not reported together for the same visit. -
D1208- Topical application of fluorideFluoride varnish or topical fluoride may be provided during the same preventive visit as
D1120and is reported separately when performed. -
D0145- Oral evaluation for a patient under three years of ageAn age-specific evaluation code used for very young patients; for children under three, the evaluation may accompany preventive services but
D0145is separate fromD1120. -
D0272- Bitewings - two radiographic imagesBitewing radiographs may be obtained as part of the dental assessment during a prophylaxis visit when indicated; radiographs are reported separately from
D1120.
National Reimbursement Benchmarks
National mean rates for CDT code D1120 place Medicare in line with the BUCA (average commercial) benchmark, both showing a mean of $34.71. Commercial payers vary around that level: UnitedHealthcare and Blue Cross Blue Shield report higher means ($50.60 and $46.58 respectively), while Aetna and Cigna Health report lower means ($26.99 and $25.13 respectively). The table and chart below present the full breakdown.
Rate dispersion (P75 minus P25) is widest for Blue Cross Blue Shield (16.0) and UnitedHealthcare (9.3), indicating broader spread in typical allowed amounts. Dispersion is tightest for Cigna Health (7.0) and Aetna (7.0). BUCA (average commercial) and Medicare share the same dispersion of 22.38, reflecting the underlying BUCA values provided. The table and chart below present the full breakdown.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.