D0145Oral Evaluation for a Patient Under Three Years of Age and Counseling with Primary Caregiver

What This Code Covers

D0145 is the evaluation code for patients under three years old. It covers an age-appropriate oral examination of the child along with counseling the primary caregiver on topics like oral hygiene techniques for infants, dietary recommendations to prevent early childhood caries, fluoride exposure, and non-nutritive sucking habits. This code is designed for the "first dental visit" or early well-baby dental checkups.

Billing Guide

Bill this code when:

• The patient is under three years of age at the date of service
• The dentist performs an oral evaluation appropriate for the child's developmental stage
• Counseling is provided to the parent or caregiver during the visit
• The visit is the child's first dental encounter or an early childhood recall

Do not bill this code when:

• The patient is three years old or older. Use D0120 or D0150 instead
• A comprehensive evaluation (D0150) is performed with full charting on an older child
• The visit is limited to a problem-focused exam for pain or injury. Use D0140 instead
• Only the hygienist sees the patient without dentist involvement in the evaluation

Insurance and Denial Prevention

Key Payer Rules:

• Most plans cover D0145 at 100% as a preventive service when the child is eligible
• Medicaid programs in most states cover at least one D0145 per year for children under three
• Some plans may not recognize D0145 and require D0150 for new patients regardless of age
• Frequency limits vary but typically allow one evaluation per six months

Common Denials and How to Respond:

• Frequency exceeded → Verify the child's last evaluation date and check if the plan uses a calendar year or rolling window. Submit corrected dates if applicable.
• Code not recognized by payer → Resubmit using D0150 if the plan does not include D0145 in their fee schedule. Include the child's age in the narrative.
• Patient age not verified → Attach documentation confirming the patient's date of birth and that they were under three at the time of service.