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.”

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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)

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.

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CDT D1120: Prophylaxis—Child

Headline: CDT code D1120: Pediatric dental prophylaxis defined and used across major payers

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.

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Sign up for D1120 policy alerts

Get alerted when payer policies referencing D1120 are released or updated.

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Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service Type: Preventive dental service

Typical Site of Service: Dental office (CDT/ADA typical setting)

National Reimbursement Benchmarks

National Mean Rates for CDT code D1120 by Payer

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.

Related Codes

D1110 - Prophylaxis - adult

This is the adult counterpart to D1120; used for routine prophylaxis in adult patients. D1110 and D1120 are alternatives based on patient age and are not reported together for the same visit.
D1208 - Topical application of fluoride

Fluoride varnish or topical fluoride may be provided during the same preventive visit as D1120 and is reported separately when performed.
D0145 - Oral evaluation for a patient under three years of age

An age-specific evaluation code used for very young patients; for children under three, the evaluation may accompany preventive services but D0145 is separate from D1120.
D0272 - Bitewings - two radiographic images

Bitewing radiographs may be obtained as part of the dental assessment during a prophylaxis visit when indicated; radiographs are reported separately from D1120.

CPT D2393: Resin-Based Composite Restoration, Three Surfaces, Posterior

D4910-PERIODONTAL-MAINTENANCE

CPT D4910: Periodontal Maintenance Procedures

D1206-TOPICAL-FLUORIDE-TREATMENT-EXCEPT-VARNISH-THERAPEUTIC

CPT D1206: Topical Fluoride Treatment for Moderate to High Caries Risk Patients

D1110-PROPHYLAXIS-ADULT-CLEANING-AND-POLISHING-OF-THE

CPT D1110: Adult Dental Cleaning and Polishing

D2140-AMALGAM-ONE-SURFACE-PRIMARY-OR

CPT D2140: Amalgam Restoration, One Surface, Primary or Permanent Tooth

D1351-SEALANT-PER

CPT D1351: Dental Sealant Application, Per Tooth

D2330-RESINBASED-COMPOSITE-ONE-SURFACE

CPT D2330: Resin-Based Composite Restoration, One Surface, Anterior

D7210-EXTRACTION-ERUPTED-TOOTH-REQUIRING-REMOVAL-OF-BONE-ANDOR

CPT D7210: Surgical Extraction of Erupted Tooth with Bone Removal

D0220-INTRAORAL-PERIAPICAL-FIRST-RADIOGRAPHIC

CPT D0220: Intraoral Periapical First Radiographic Image

D7140-EXTRACTION-ERUPTED-TOOTH-OR-EXPOSED-ROOT-ELEVATION-ANDOR

CPT D7140: Extraction of Erupted Tooth or Exposed Root

Showing 1–10 of 24

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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