8-year-old Recent Immigrant Visits Dentist for the First Time

What is Julio’s risk level?

This answer may be correct based on your clinical judgment. Julio has several risks that place him in the moderate risk category. Your clinical judgment and evaluation of Julio’s oral hygiene may determine that he is at high risk for oral disease.

Completion of the caries risk assessment tool or a similar form and documentation in the dental record are required for Julio’s Texas Health Steps oral exam to be considered complete and eligible for reimbursement. The dental procedure code which correctly identifies Julio's level of risk for dental caries must be included as part of the billing process.

  • DO601 for low risk
  • D0602 for moderate risk
  • D0603 for high risk

In Julio’s case, you would submit caries risk assessment code D0602 (moderate risk) along with examination code D0150 (comprehensive oral evaluation). Other examination codes are D0120 (periodic oral evaluation) and D0145 (First Dental Home evaluation).

The claim form for Medicaid Fee-for-Service requires at least $0.01 in the cost column. The cost column notation of $0.01 allows the claim to move through claim processing unhampered, although these codes are for information only and are not separately reimbursable. Dental managed care organizations (DMOs) do not require the $0.01 billing on the claim form. Providers should contact their DMOs for reimbursement requirements.

In Julio’s case, the billing would include codes D0150 and D0602.

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Question 2 of 3
Which of the following age-related dental guidance should you share with Julio and Mariela?

Caries Risk Assessment Tool

Caries Risk Assessment tool. Risk factor 1- Caries Activity; status is moderate (incipient lesion). Risk factor 2- Demineralized areas; status is moderate (Inactive white spot). Risk factor 3- Restorations or missing teeth due to caries; status is low (none). Risk factor 4- Parents, primary caregiver/siblings (ages 6-14); status is moderate (low caries rate). Risk factor 5-  Presence of plaque, gingivitis; status is moderate (moderate). Risk factor 6- Fluorideexposure; status is high (low/can’t confirm fluoride history). Risk factor 7- Sugar consumption; status is moderate (1-2 between meals). Risk factor 8- Dental home; status is high (none/first dental visit). Risk factor 9- Special conditions; status is high (Enamel hypoplasia/Impaired salivary flow/Recent immigrant/Recently moved from Central America.