Removal of plaque, calculus, and stains from the tooth structures and implants in the primary and transitional dentition.
Get help with D1120 claims →The age cutoff for D1120 vs D1110 is typically 14 years old, though this can vary by payer. Some use the presence of permanent dentition as the determining factor.
Scheduled prophylaxis for pediatric patients as part of their recall visits.
Patients in the transitional phase between primary and permanent teeth.
These are the denial reasons we see most often for D1120. Each one is preventable with proper documentation.
Denied when the patient has aged out of the child prophylaxis benefit. Check the plan's age threshold.
Most plans cover two prophylaxis visits per benefit year. Third cleanings are typically denied unless medical necessity is documented.
Prophylaxis and scaling/root planing on the same date will be denied. These are mutually exclusive procedures.
Confirm the patient meets the plan's age requirement for child prophylaxis.
Document the amount of plaque, calculus, and staining present and removed.
Note any hygiene education provided to the patient and parent.
Most payers set the cutoff at age 14. Patients under 14 are billed D1120. Patients 14 and older are billed D1110. This is not universal, though. Some plans use age 13, and others define "child" based on dentition stage rather than chronological age.
If you bill D1120 for a patient who is 14 or older, expect a denial. If you bill D1110 for an 11-year-old, expect a downgrade to D1120 (usually with no payment difference, but it creates a claim adjustment that slows your cash flow).
D1120 typically reimburses at a lower rate than D1110 because the procedure is generally faster and involves less calculus in pediatric patients. The clinical time is usually shorter, but the documentation requirements are the same. Record what was found, what was removed, and what was communicated to the patient and parent about home care.
Our team handles D1120 billing daily. We know the denial patterns, documentation requirements, and appeal strategies that get claims paid.
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