CODE CRACKER: Demystifying Dental CDT Code 1206

In our adventures helping clients with their dental accounts receivable and dental billing systems, we’ve seen a huge pitfall pop up time and time again. Hundreds, and sometimes thousands of dollars in revenue slipping through the cracks because teams are not using CDT dental codes to their fullest potential.

These elusive dental codes are like shy members of the coding family, hiding in the shadows to rob you of collections. But fear not, we’re here to help!

In our ‘Code Cracker’ series we explore and unveil some often overlooked codes and help your earnings shine brighter than a freshly polished set of pearly whites!

Let’s get some important terminology out of the way first. If you’re reading this, we’re 99.9% positive you know what CDT stands for. However, on the off chance you’re new to dental lingo, CDT stands for Current Dental Terminology, a standardized system used to code various dental procedures and services. In essence, it’s a way to ensure that dental professionals, insurance companies, and patients are all speaking the same language when it comes to treatment and billing.

Okay, back to an often overlooked CDT code D1206 “Topical Application of Fluoride Varnish”. It lives in the Preventative Code category meaning it’s typically used during routine hygiene visits although it can be used in palliative care as well.

Now, before your eyes glaze over, did you know that in the United States, over 90% of adults aged 20–64 and over 96% of adults aged 65 years and older have dental caries in their permanent teeth? That’s a lot of people!

In fact, the American Dental Association evidence-based guidelines suggest that professionally applied fluoride varnish every three to six months is effective in preventing dental caries in adults based on risk for dental caries. Fluoride varnish is especially helpful for individuals who are at a higher risk of developing cavities or have sensitive teeth.

If we can agree that nearly everyone with teeth can benefit from fluoride varnish why is this one of the most underutilized service codes?

Misconception that insurance won’t reimburse

We still encounter teams that have the misconception that insurance does not pay for fluoride treatment of any kind. This is simply no longer the case. Over the years, insurance companies have done a better job of wrapping their heads (and their wallets) around the old adage ‘an ounce of prevention is worth a pound of cure’. In fact, D1206 is even covered by many state funded plans.

And the number one, numero uno reason why this code may not be adding to your revenue is:

Lack of confidence in educating the patient on the importance of fluoride varnish

Here’s the scene:

Hygienist: “Fluoride is really important and can prevent cavities but your insurance may or may not pay for it. It’s $XX.00. Do you want a fluoride treatment today?”

Patient: “No. Not if my insurance doesn’t pay for it.”

It’s important to remember that the patient often believes that if the insurance company doesn’t pay for it, it must not be that important or beneficial. It’s the dental professionals job to educate the patient otherwise and help them understand that it’s worth the small investment now to prevent further, more costly issues down the road.

Let’s play that scene again with a more confident approach:

Hygienist: Fluoride varnish does more than just prevent cavities. It remineralizes weakened enamel, making your teeth stronger and more resistant to decay. It’s like giving your teeth a mini spa treatment, leaving them refreshed and ready to face the challenges of daily chewing and sipping. We will send it to your insurance for reimbursement, however even if they don’t pay for it, we believe it’s completely worth the small price of $XX.00 to prevent bigger dental bills in your future.

Patient: “Ok, YES! That sounds totally worth it!”

In summary, if you suspect that you or someone you know has fallen prey to the missed billing opportunities for dental code CDT D1206 or any other procedure, we can help!

Tired of dealing with all the billing hassles that come with running a dental practice? We feel you!

Picture this: No more headaches from tangled paperwork and more time to dedicate to the patient in front of you.

Let’s chat get you started on the path to easy and lucrative billing systems!