D0602 is the CDT code for a caries risk assessment with a documented finding of moderate risk — a structured evaluation, using recognized assessment tools, of how likely the patient is to develop new cavities, recorded as moderate for that patient at that visit.
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 D0602 Code
Use D0602 when a formal caries risk assessment is completed and the provider's finding is moderate risk. The code reflects the documented outcome of the assessment — the patient falls between low and high risk based on the criteria reviewed — not merely that a screening was attempted.
The risk-level codes form a set: D0601 (low), D0602 (moderate), and D0603 (high). Only one caries risk assessment code is reported per visit — the one matching the documented finding — so the three are mutually exclusive on the same date. These codes report the assessment itself; they are not the evaluation (D0120) and not a preventive treatment such as fluoride or sealants.
Documentation & Clinical Scenarios
Because D0602 reports a finding, the record must show the assessment was performed and how the moderate-risk conclusion was reached:
- The assessment tool or criteria used (a recognized caries risk model) and the date.
- The contributing factors reviewed — caries history, diet, fluoride exposure, salivary and clinical findings.
- The documented finding — moderate risk — recorded for the patient and any third-party payer.
- The provider who performed and signed off on the assessment.
What's billed separately: the periodic or comprehensive evaluation (D0120), the cleaning, and any preventive procedure each carry their own codes. D0602 covers only the documented risk assessment.
Insurance & Billing Tips
- Report only one risk code per date. D0601, D0602, and D0603 are mutually exclusive on the same visit; submit the one matching the finding.
- Expect variable coverage. Some plans reimburse caries risk assessment, some bundle it into the exam, and some don't cover it — verify the benefit.
- Document the finding to support the claim. A recorded assessment with a clear moderate-risk result is what justifies the code.
- Check frequency limits. Where covered, plans may limit how often a risk assessment is payable per period.
- Match the code to the chart. The risk level billed must match the documented finding; a mismatch can prompt a denial or audit flag.
Example Case
An established patient with a couple of restorations in recent years and a moderately cariogenic diet comes in for a recall. The dentist completes a structured caries risk assessment using a recognized tool, weighs the contributing factors, and documents a moderate-risk result. The visit is coded D0602 for the assessment alongside D0120 for the periodic evaluation and the cleaning. Because the office verified how the plan handles risk-assessment codes and documented the finding, the claim is submitted cleanly.
Patients call to "book my checkup" — not D0602. DentalReception AI answers and books those recall calls 24/7, captures insurance details, and routes clinical and billing questions to your team. See how it handles new patient exam calls, or book a demo.
Frequently Asked Questions
What's the difference between D0601, D0602, and D0603?
They report the same assessment with different findings: D0601 is low risk, D0602 is moderate, and D0603 is high. You report only the one code that matches the documented result for that visit. Billing more than one risk-level code on the same date for the same patient is not appropriate.
Is D0602 the same as the exam?
No. The caries risk assessment (D0602) is separate from the oral evaluation (D0120). The exam is the dentist's clinical evaluation of the mouth; D0602 is the structured assessment and documentation of the patient's risk of developing new decay. They are reported under their own codes and often occur at the same visit.
Does insurance cover a moderate-risk caries assessment?
Coverage varies. Some plans reimburse caries risk assessment codes, some bundle the assessment into the exam benefit, and some don't cover it at all. Where it is covered, there may be a frequency limit. Verify the specific plan before the visit so the patient knows whether the assessment will be a separately payable benefit.
Can the risk level change between visits?
Yes. A patient assessed as moderate (D0602) at one visit may later be reassessed as low (D0601) or high (D0603) as their diet, home care, or clinical findings change. Each visit, you report the single code matching the current documented finding, subject to the payer's frequency rules.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.