CDC CDC Dental Insurance & Billing 1 — Questions and Answers
Question 1: What CDT code is used for a complete series (full mouth) of radiographic images?
- D0210 (Correct answer)
- D0220
- D0230
- D0240
Correct answer: D0210
D0210 is the CDT code for a complete series of radiographic images, typically 14–22 periapical and bitewing images covering the entire mouth.
Question 2: Which insurance term refers to the maximum dollar amount an insurance plan will pay for covered services within a benefit year?
- Deductible
- Annual maximum (Correct answer)
- Co-insurance
- Premium
Correct answer: Annual maximum
Annual maximum is the cap on total insurance payments for covered dental services within a single benefit year.
Question 3: What is co-insurance in dental insurance?
- The monthly premium paid by the patient
- The flat dollar amount paid per visit
- The percentage of covered expenses paid by the insurer after the deductible (Correct answer)
- The maximum out-of-pocket cost for the patient
Correct answer: The percentage of covered expenses paid by the insurer after the deductible
Co-insurance is the percentage of covered dental expenses that the insurance company pays after the deductible has been satisfied.
Question 4: Which CDT code is assigned to an adult prophylaxis (routine cleaning for patients 14 and older)?
- D1110 (Correct answer)
- D1120
- D1206
- D1310
Correct answer: D1110
D1110 is the CDT code for an adult prophylaxis, intended for patients aged 14 years and older.
Question 5: What is the purpose of Coordination of Benefits (COB) rules in dental insurance?
- To set maximum benefit amounts
- To determine which plan pays first when a patient has multiple dental coverages (Correct answer)
- To establish in-network provider fees
- To govern HIPAA privacy requirements
Correct answer: To determine which plan pays first when a patient has multiple dental coverages
COB rules establish the order of payment when a patient is covered by more than one dental insurance plan to prevent overpayment of claims.
Question 6: What does UCR stand for in the context of dental insurance reimbursement?
- Universal Coverage Requirement
- Usual, Customary, and Reasonable (Correct answer)
- Uniform Claims Requirement
- Underwriting Coverage Ratio
Correct answer: Usual, Customary, and Reasonable
UCR stands for Usual, Customary, and Reasonable—the fee benchmark insurance companies use to determine reimbursement levels for dental procedures.
CDC CDC Dental Insurance & Billing 1
What CDT code is used for a complete series (full mouth) of radiographic images?