D0145 is the CDT code for an oral evaluation of a patient under three years of age, including counseling with the primary caregiver — the dedicated first-visit code for infants and toddlers.
Informational only — confirm the official CDT descriptor and your payers' rules independently. This is general guidance, not billing, coding, or clinical advice.
When to Use the D0145 Code
Use D0145 when the patient is under three years old and the visit includes both an evaluation of the child and counseling with the parent or caregiver — covering topics like caries risk, oral hygiene, fluoride, feeding, and home care. It's the age-specific evaluation for the very young child, often the "first dental visit by age one" appointment.
Once the child turns three, the routine evaluation generally shifts to the periodic exam, D0120, or the comprehensive exam, D0150, depending on the situation. Don't use D0145 for an older child, and don't substitute D0120 or D0150 for an under-three visit that includes caregiver counseling — the age limit and the counseling component are what define this code.
Documentation & Clinical Scenarios
The record should reflect both the evaluation and the caregiver counseling that D0145 requires:
- The child's date of birth/age, confirming the under-three threshold on the date of service.
- Evaluation findings — oral exam, caries risk assessment, soft-tissue review, and any concerns noted.
- The caregiver counseling provided — hygiene instruction, diet/feeding guidance, fluoride discussion, and home-care recommendations.
- The provider who performed the evaluation and counseling.
Services delivered the same day — fluoride application, a cleaning, or radiographs — are reported separately under their own codes. The counseling is part of D0145 and is not billed as a separate procedure.
Insurance & Billing Tips
- Confirm the age rule. D0145 applies only to patients under three; submitting it on or after the third birthday is a frequent denial reason.
- Verify frequency. Many plans cover D0145 on a periodic basis (often tied to a per-six-month or per-year limit) similar to other evaluations — check the specific benefit.
- Don't double-bill evaluations. D0145 and another evaluation code on the same date for the same provider are generally not both payable.
- Bill ancillary services separately. Fluoride (D1206) and any radiographs ride on their own codes; the caregiver counseling does not.
- Watch the medical-vs-dental split. Some pediatric preventive benefits sit under a medical plan, so verify which carrier processes the claim.
Example Case
A parent brings in a 20-month-old for a first dental visit. The dentist examines the child, performs a caries-risk assessment, and spends time counseling the parent on brushing, bottle and feeding habits, and fluoride. A fluoride varnish is also applied. The evaluation and caregiver counseling are coded D0145, and the fluoride application (D1206) is reported on its own line. Because the office confirmed the child was under three and within the plan's frequency limit, the claim processes cleanly.
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Frequently Asked Questions
What's the difference between D0145 and D0120?
D0145 is the evaluation for a child under three and bundles in counseling with the primary caregiver, while D0120 is the periodic recall exam for an established patient of any age (typically used once the child is three or older). The defining differences are the age threshold and the required caregiver-counseling component, both of which must be documented for D0145.
Is the caregiver counseling billed separately?
No. The counseling with the parent or caregiver is part of what D0145 covers — it isn't reported under a separate code. Other services delivered the same day, such as a fluoride application or radiographs, are billed separately under their own codes. Documenting the specific counseling topics discussed supports the claim and reflects the full scope of the visit.
How often will insurance cover D0145?
Coverage and frequency vary by plan. Many payers treat D0145 like other oral evaluations, applying a per-six-month or per-benefit-year limit, while some pediatric preventive benefits sit under a child's medical plan instead. Verifying the specific benefit and which carrier processes it before the visit helps avoid surprises.
What happens when the child turns three?
Once the patient reaches age three, D0145 generally no longer applies. The routine evaluation typically moves to the periodic exam, D0120, or a comprehensive exam, D0150, as clinically appropriate. Billing D0145 on or after the third birthday is a common denial trigger, so confirm the child's age on the date of service before coding.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.