Ontario Dental Practice · Billing & Operations · 2026

Recall & Returning
Patient Billing —
Rules, Opportunities
& Pitfalls

A complete billing guide for recurring patients in Ontario general dental practices — ODA fee guide rules, insurance frequency limits, CDCP regulations, what codes can be layered at a recall visit, and the most common billing errors that trigger audits or leave revenue uncaptured.

ODA 2026 Fee Guide CDCP 2026 Private Insurance Healthy Smiles Ontario Compliance
"Changing the date on a past appointment, receipt, or claim is fraud. If a client ever asks you to alter dates for coverage, you must decline."
— Dental & Wellness Office Administration textbook, Ontario curriculum
Fundamentals

What Actually Happens at a Recall Visit — and What It Costs

The standard recall bundle

A "recall visit" has no single code. It is a combination of individually coded services billed on the same date. The typical bundle for an adult with private insurance:

CodeServiceApprox. 2026 fee
01202Limited oral exam — previous patient~$45
02211–02214Bitewing radiographs (2–4 films)~$56–$112
11112Scaling — 2 units (30 min)~$144
11107Polishing — ½ unit~$30
12113Fluoride varnish (if indicated)~$38
Typical private-pay recall total
$310 – $370
Before any treatment, before desensitization, before perio upgrade codes.

The ODA rule most offices misread

Only ONE exam code per patient per day
The ODA Guide is explicit: it is inappropriate to bill more than one examination code on any particular patient on any particular day.

If a recall exam (01202) and a periodontal re-evaluation (49101) fall on the same visit → bill only 49101. The recall exam is absorbed.

If a specific exam (01204) and a recall exam (01202) are needed → bill only 01204.
01202 vs 01204 vs 01205 — which to use
01202 — routine recall, all tissue checked, no specific complaint
01204 — specific situation warrants focused exam (range: ½–2 units)
01205 — localized discomfort or infection (range: ½–2 units)

01204/01205 are not substitutes for 01202 and should not be used routinely at scheduled recall visits.
Frequency Rules — Know Every Plan

Frequency Limits by Plan — Not All Plans Are Equal

Frequency limits differ dramatically by payer. Scheduling a patient before their plan renews is the single most common recall billing error. Always verify coverage before the appointment, not at the chair.

Plan / payerRecall exam (01202)Scaling units / periodPolishingBitewingsPanoramic / FMS
Government Plans
CDCP (Canadian Dental Care Plan) 1 × per 12 months (rolling) 4 units / 12 months (17+)
combined with root planing		 ½ unit / 12 months 1 × per 12 months (rolling) 1 × per 36 months
Healthy Smiles Ontario (HSO) 1 × per 12 months Age-scaled; adults ~4–6 units / year ½ unit / 12 months 1 × per 12 months 1 × per 36 months
Public Service Dental (PSDP) 1 × per 9 months (adults)
1 × per 6 months (children)		 Per plan; no absolute unit cap stated Per visit 1 × per 9 months 1 × per 36 months
Typical Private Insurance Plans
Standard employer plan (common) 1 × per 6 months No unit cap if clinically supported Per recall visit 1 × per 12 months (or per visit) 1 × per 36 months
Basic employer plan (cost-contain) 1 × per 9 months 2–3 units / visit ceiling Per recall (some cap ½ unit) 2 films / year 1 × per 36 months
Student/association plan 1 × per 12 months (calendar year) 1 polishing + 1 scaling / calendar year 1 × per year 2 films / year 1 × per 24 months
Special Rules — CDCP Rolling Period (critical)
CDCP uses rolling periods, not calendar years. A recall exam on April 1, 2025 becomes eligible again on April 1, 2026 — not on January 1, 2026. Scheduling even one day early triggers a denial. Verify the exact last-service date via the Sun Life portal or EDI estimate before booking.
Clinical Rationale — Interval Justification

Recall Interval — Clinical Evidence for Shorter Than 6 Months

Many plans default to 6 or 9 months, but clinicians can — and should — justify more frequent recalls when patient risk factors warrant it. Document the clinical rationale; pre-authorization may be required for CDCP.

3–4 month recall patients

  • Active periodontitis (Stage III–IV) post-SRP
  • Poorly controlled diabetes (HbA1c >8%)
  • Smokers with documented periodontitis
  • Pregnant patients (throughout pregnancy)
  • Ortho patients with active fixed appliances and inflammation
  • History of recurrent caries ≥2 new lesions / 3 years
  • Dry mouth (xerostomia) — Sjögren's, head/neck radiation, polypharmacy
  • Chemotherapy / immunosuppression
  • Bill: 01202 + scaling at each visit. For CDCP, submit pre-auth for additional units beyond 4/year

6 month recall patients

  • Gingivitis with improving hygiene
  • 1–4 mm pockets, non-bleeding
  • Pediatric patients (caries risk low–moderate)
  • Medically complex but stable (e.g. controlled diabetes)
  • Previous moderate periodontitis, stable for >2 years
  • Most private plans cover this interval — lowest friction billing
The Axelsson Study (landmark)
Patients on 2–3 month recall by hygienist developed virtually no new caries and no attachment loss over 6 years. The evidence base for more frequent maintenance in moderate-high risk patients is strong.

How to get CDCP to cover extra visits

Pre-authorization required for:
Scaling beyond 4 units in 12 months, recall exam more frequent than 12 months, additional polishing beyond ½ unit in 12 months.
Pre-auth documentation checklist
✦ Current 6-point perio chart (within 12 months)
✦ Radiographs showing bone loss
✦ Written periodontal diagnosis (Stage/Grade)
✦ Justification narrative from dentist
✦ Submit via EDI or mail to Sun Life (1-888-888-8110)
Private plan — no pre-auth, but document
Most private plans don't require pre-auth for extra recall visits, but may audit. The chart must show the clinical rationale. "Patient preference for more frequent cleaning" is not a clinical rationale.
Revenue Opportunities at the Recall Visit

Codes Legitimately Layered at Recall — Most Are Routinely Missed

Code
Service
Fee (approx.)
CDCP?
Documentation trigger
41231/41232
Desensitization — in-office application of Gluma, varnish, oxalate to cervical sensitivity post-SRP or post-scaling
~$66–$133
Pre-auth req'd (April 2026)
Patient reports cold/touch sensitivity; document teeth treated + agent used
13601–09 +E
SDF / remineralization agent (silver diamine fluoride, CPP-ACFP, MI Paste Plus) applied to active lesion(s)
~$78/unit +E
Yes
ICDAS score on each lesion, product name, teeth treated
12113
Fluoride varnish — adults are eligible, not just children. Clinically indicated for xerostomia, recession, root exposure
~$38
Yes (all ages)
Document: indication (dry mouth, recession, caries risk). Not to be billed just as a routine add-on without indication
13211–219
Individual oral hygiene instruction — for patients starting perio therapy, new ortho appliance, or peri-implant hygiene
~$58/unit
Yes
Document: specific devices demonstrated, patient's baseline plaque score, new condition warranting instruction
13101–109
Nutritional counselling — high-caries-risk, eating disorder, frequent snacker, pediatric rampant caries, dry-mouth patient
~$58/unit
Yes
Document: dietary risk factors, content of counselling, up to 7-day dietary intake analysis
04221
Non-ionizing caries scanning — laser fluorescence device (DIAGNOcam, SoproLife) used to detect and quantify incipient lesions
~$58/unit
Varies
Document: device name, teeth scanned, lesion scores obtained
04811–819
Diagnostic photographs — pre-op intraoral photos for perio disease, fractured cusps, wear documentation, pre-ortho records
~$11/photo
Some plans
Document: clinical indication for each photo (not marketing/education photos)
16101–104
Finishing restorations — polishing, overhang removal, marginal refining on restorations by another dentist or >2 years old
~$73/unit
Varies
Document: which tooth, type of finishing done, that restoration was placed by another dentist or is >2 years old
Prevention 10000 series · Scaling Upgrade Pathways

From Recall Scaling to Root Planing — When the Upgrade Is Justified

Recall cleaning vs root planing — the distinction

Scaling at recall (11111–11116)
Intent: supragingival and subgingival deposit removal for prevention of disease onset. Patient has gingivitis or is healthy. No attachment loss required.
Root planing (43421–43429) — periodontic series
Intent: therapeutic removal of cementum/contaminated root surface to facilitate reattachment. Patient has active periodontitis with attachment loss and pocket depths ≥4 mm with BoP.

Per sextant, per unit of time — generates 6 separate billing entries for full-mouth RP vs one time-based entry for scaling.
Revenue difference — full-mouth example
Full-mouth 2-unit scaling (11112): ~$144
Full-mouth RP, 2 units × 6 sextants (43422×6): ~$864

Same clinical time. Clinical documentation determines the code.

Minimum documentation to justify root planing at a recall-style appointment

  • Six-point perio chart with date ≤12 months — include pocket depths, BoP, CAL, recession, mobility, furcation
  • Radiographs showing horizontal or vertical bone loss in the sextant billed
  • Written periodontal diagnosis by the dentist — use 2018 AAP Stage/Grade classification
  • Sextant numbers specified on the CDAnet claim
  • A 49101 re-evaluation booked 4–8 weeks post-SRP (also billable)
The 49101 clarification (2025)
49101 is only for:
• Post-surgical re-evaluation >1 month after surgery, or
• Evaluation by a different practitioner after another's perio therapy

It is not for ongoing perio maintenance recall visits. Use 01502 for limited perio re-evaluations at maintenance visits.
CDCP note on root planing
RP counts toward the 4-unit scaling limit under CDCP. If the patient has already used 2 scaling units earlier in the year, only 2 more units of RP can be claimed without pre-authorization. Check remaining units before booking.
Two-Stream Recall System

Regular Recall vs Periodontal Maintenance — Two Completely Different Billing Streams

Stream A — Standard Recall
Patient profile: Healthy or gingivitis patient, no previous SRP, pockets ≤3mm, no BoP or minimal BoP

Interval: 6–12 months
Lead code: 01202 (recall exam)
Hygiene codes: 11111–11116 (scaling by time)
Radiographs: 02211–02214 (bitewings) per plan frequency
Fluoride: 12111–12114 if indicated
Polishing: 11101/11107

This is the routine dental recall most people think of.
Revenue/visit typical range
$200 – $380
Depending on scaling time and radiograph type.
Stream B — Periodontal Maintenance Recall
Patient profile: History of SRP or perio surgery, pocket depths 4–6mm, documented periodontal diagnosis (Stage I–IV)

Interval: 3–4 months (evidence-based for Stage III–IV)
Lead code: 01502 (limited perio exam) — NOT 01202 once the patient is in perio maintenance
Hygiene codes: 43421–43429 (root planing by sextant + time) or 11111+ (scaling) as clinically indicated per sextant
Radiographs: Vertical bitewings or PAs per plan frequency
Re-evaluation: 49101 only if post-surgical >1 month or by different provider
OHI: 13211–13219 per visit if warranted
Desensitization: 41231/41232 if cervical sensitivity present

This stream generates significantly more revenue per visit and is clinically supported.
Revenue/visit typical range
$480 – $900+
Per visit for full-mouth perio maintenance with 4–6 sextants of RP.
The most common classification error in Ontario hygiene billing: using 11111-series scaling codes for a patient who is 2 years post-SRP with persistent 5mm pockets. That patient is a periodontal maintenance patient — the 43421-series is the correct code and the per-sextant billing structure substantially increases the visit value.
— ODA Practice Advisory education materials
Radiographs at Recall — Frequency & Clinical Justification

Radiograph Billing at Recall — Frequency Rules and Missed Codes

Bitewing frequency — varies widely by plan

CodeDescriptionCommon plan frequency
022111 bitewing filmPer plan rules
022122 bitewing filmsMost common adult billing
022144 bitewing filmsNew patient or FMS year
02601Panoramic radiograph1 × per 36 months typical
02801–02821Full mouth series (FMS) / complete PA series1 × per 36 months
Vertical bitewings for perio patients (02216–02219)
Vertical bitewings show bone levels and are the appropriate radiograph for monitoring periodontal disease. Most insurers cover these at the same frequency as horizontal bitewings. Many practices bill regular bitewings and never upgrade to verticals for perio patients — a clinical and billing oversight.
Missed code — 07031 CBCT interpretation
When a CBCT taken for implant planning or other reason is reviewed at the same appointment as a recall, the interpretation (~$93/unit) can be billed separately from the acquisition. Most practices forget the interpretation code.

CDCP radiograph rules — rolling periods

  • Bitewings: 1 claim per 12 months (rolling from last service date, not calendar year)
  • Panoramic or full-mouth series: 1 per 36 months
  • Periapical films: covered when clinically indicated — no strict annual limit but must be clinically justified in the chart
  • Emergency periapical radiographs: covered without frequency restriction when associated with an emergency exam (01205)
02811–02819 — X-ray interpretation from another source (2022+)
When reviewing a CBCT, panoramic, or FMS taken by a previous dentist or specialist, the GP can bill a separate interpretation code (~$93/unit). Returned to the fee guide after a 15-year absence. Useful when a patient transfers with radiographs from a previous office.
Radiographic frequency — practical scheduling rule
Always check the patient's last bitewing date before confirming the recall appointment. If the patient is 11.5 months from their last bitewings, the most valuable time to schedule is at 12 months and 1 week — ensuring the bitewings are covered. Even one day early = denial.
Common Pitfalls — What Triggers Denials & Audits

The 10 Most Common Recall Billing Errors in Ontario Practices

  • Billing before the frequency period ends. Scheduling at 5 months 28 days on a 6-month plan, or 11 months 15 days on a 12-month rolling CDCP period. The claim is denied retroactively even if insurance initially seems to go through.
  • Altering appointment dates. Backfilling or changing a date to fit within a coverage window is insurance fraud — regardless of who asks (patient, front desk, employer). The penalty is loss of provider status and potential criminal liability.
  • Billing 01202 and 49101 on the same day. The ODA explicitly states only one exam code per patient per day. When the perio re-evaluation and recall exam overlap, only 49101 is billable.
  • Billing 14611 (night guard) and 14502 (athletic guard) interchangeably. 14502 is for sports use; 14611/14612 is for bruxism. Using the cheaper code for a bruxism appliance underbills by ~$215.
  • Billing scaling units without documenting actual time spent. The ½-unit (11117) must be used when treatment falls under 7.5 minutes. It is contrary to ODA policy to bill full-unit codes without regard to actual time.
  • Using 11111–11116 (scaling) for a patient in active periodontal maintenance. Once a patient has been diagnosed with periodontitis and treated with SRP, ongoing maintenance visits should use 43421+ (root planing per sextant), not the prevention-series scaling codes. Different intent = different code.
  • Submitting CDCP claims without verifying current eligibility. CDCP eligibility can change mid-year. Health Canada's October 2025 audit found ~70,000 incorrectly enrolled Canadians. Verify via EDI or Sun Life portal at every visit, not just at first enrollment.
  • Billing fluoride (12113) as routine without documenting clinical indication. For adults, fluoride requires a documented clinical reason (xerostomia, recession, high caries risk). Billing fluoride routinely on all adult patients without documentation is an audit risk.
  • Forgetting the +E code for materials used at recall. SDF, Icon, CPP-ACFP, and similar remineralization agents are billable as a separate material expense (+E, code 99121) in addition to the application time code (13601). Material cost is regularly absorbed into the procedure fee.
  • Billing 01103 (complete exam, permanent dentition) at a recall visit. 01103 is a complete exam — appropriate at new patient, every few years, or when a thorough new assessment is needed. Using it routinely at 6-month recall visits instead of 01202 is incorrect and will be audited.
Canadian Dental Care Plan · 2026 Rules

CDCP-Specific Rules — What Changed in 2026 That Affects Every Recall

6.3M
Canadians enrolled in CDCP (May 2026)
98%
Canadian dentists participating in CDCP
April 2026 changeImpact on recall billing
Desensitization (41231/41232) now requires pre-authorizationMust pre-auth before performing at recall visit
Complete immediate dentures no longer require pre-authFaster workflow for denture cases
Dental hygienists can now directly claim periapical radiograph codesHygienists can bill independently for PAs in their scope
CDCP fee grid updated across all provinces April 1, 2026Confirm software updated to 2026 CDCP grid — some codes shifted
Eligibility verification now critical after Oct 2025 auditVerify at every visit — ~1% of enrolled patients lost eligibility
CDCP recall exam (01202) — key restriction
Only 1 recall exam per 12-month rolling period per provider. Emergency exams (01205) do not count toward this limit. If the patient sees a specialist for a specialty exam, it also does not consume the GP's recall exam allocation — specialty exams are tracked separately.
CDCP co-payment and gap billing
CDCP does not cover the full ODA fee in most cases. The patient is responsible for:
① The co-payment (0–40% depending on income level)
② The gap between your fee and the CDCP reimbursement rate

Both must be disclosed on the patient's invoice under the Dentistry Act of Ontario. Failure to disclose is a compliance violation.
Coordination of benefits — CDCP + private insurance
A patient cannot have CDCP and a private plan simultaneously. CDCP eligibility requires no access to group dental insurance. If a patient presents with both, they are ineligible for CDCP. Billing CDCP for a patient with group coverage is a fraud risk — verify status at each visit.
Government Program · Ontario

Healthy Smiles Ontario — Recall Rules for Low-Income Patients

HSO recall structure

ServiceHSO coverage rule
01202 Recall exam1 per 12 months per provider
Scaling (11111+)Age-based annual unit limits
Polishing (11101)1 × per 12 months
Fluoride (12113)Up to age 17; adults case-by-case
Bitewing x-rays1 × per 12 months
Panoramic (02601)1 × per 36 months
Sealants (13401)Primary 1st/2nd molars, permanent 1st molars only, once per tooth lifetime
HSO vs CDCP — can patients have both?
No. HSO is an Ontario provincial benefit for low-income residents. CDCP is a federal benefit for those without dental insurance under $90K income. A patient enrolled in HSO typically cannot be enrolled in CDCP simultaneously. Verify which program the patient is currently active under before billing.

HSO-specific pitfalls

  • Only one complete exam OR recall exam per patient per provider per 12 months. Billing both 01103 and 01202 in the same year for the same patient at the same address is a common audit trigger for HSO.
  • Scaling beyond the age-based unit limit without pre-authorization will result in a clawback. HSO does not approve additional scaling on appeal in the same way CDCP does.
  • Sealants are heavily audited on HSO. Billing a sealant on a tooth that has already been sealed (once per tooth lifetime rule) or on a tooth not in the covered category is a common error.
  • PRR (13411) instead of sealant (13401): If any mechanical prep was done to the pit/fissure, code PRR — it is covered by HSO and is the correct code. Sealant implies no mechanical preparation.
  • Document the date of eruption for sealants on permanent molars — HSO coverage is time-limited relative to eruption, and documentation protects against retroactive denial.
HSO remittance review
HSO pays at a fixed schedule (below ODA). Practices billing HSO patients should review remittance statements and reconcile against submitted claims monthly. Coding errors on HSO claims can result in clawbacks rather than simple denials.
Practice Workflow · Maximizing Recall Value

The Recall Visit Workflow That Captures Every Legitimate Code

Before the appointment (front desk)

  • Verify coverage and frequency limits for every recall code (01202, bitewings, scaling, fluoride) via EDI or patient's insurance portal
  • For CDCP: confirm eligibility via Sun Life portal — not just at enrollment, at every visit
  • Check last bitewing date — if within 30 days of eligibility window, offer to reschedule to ensure coverage
  • Flag perio maintenance patients: are they in Stream A (01202 + scaling) or Stream B (01502 + root planing)?
  • Note any outstanding treatment (crown, fillings) — block additional chair time if treatment will be completed same day
  • Print patient's last perio chart — was it done within 12 months? If not, today's visit may need to include one

During the hygiene appointment

  • Record exact time: when hygienist begins, when each unit of scaling ends — this supports time-based code accuracy
  • Document any subgingival calculus encountered — required to support root planing codes if used
  • Perform and document 6-point perio chart if the patient is a perio maintenance patient or if periodontal status has worsened
  • Note patient-reported sensitivity — trigger for desensitization (41231) billing, subject to CDCP pre-auth if applicable
  • Identify white spot lesions, active cervical caries, or incipient interproximal lesions — trigger for 13601 (SDF/remineralization)
  • If DIAGNOcam or fluorescence device used — document tooth numbers and scores (04221)

At checkout (treatment coordinator)

  • Review all codes against chart notes: do the surfaces, times, and services match?
  • Confirm no duplicate exam codes billed on the same date
  • Verify +E codes are present for any materials passed through (SDF, Icon kit, fluoride agent)
  • Book next recall appointment on the spot — confirm it falls after the plan's frequency window
  • For CDCP patients: collect co-payment and gap payment today — explain the two components to the patient
  • If night guard was recommended by dentist — confirm 14611 is on the treatment plan and lab quote is documented for +L disclosure
Book-before-leave rate
Studies show practices that book the next appointment before the patient leaves achieve 60–70% return rates vs 30–40% for reminder-only recall systems. The best billing optimization is keeping the patient in the chair.
Recall Retention · Patient Communication

Why Patients Don't Return — And What to Say at the Chair

Top reasons Ontario patients skip recall

"My insurance doesn't cover it yet"
Reality: Many patients confuse frequency limits (when insurance pays) with whether the visit is needed. A patient with 5mm pockets needs to be seen in 3 months regardless of when their 6-month coverage resets. Explain: clinical need vs insurance timing are separate decisions.
"I'll wait until I'm covered again"
Train the team to say: "Your insurance covers X% of this visit. The difference is $Y. The alternative is letting the calculus build — which typically means more scaling units needed next time, at a higher total cost." Present the math, not just the instruction.
"Everything felt fine"
Periodontal disease is painless until advanced. At every recall, show the patient their own radiographs, their pocket depths, and use intraoral camera images of calculus buildup. Visual evidence drives compliance better than verbal instruction alone.
"I forgot to book / no one called me"
Prevention: book before the patient leaves (not from a recall list). Automated reminder at 1 week and 48 hours before the appointment. Confirmation via text is more effective than phone for patients under 40.

The exit conversation that retains patients

  • Name the next recommended visit date before the patient stands up: "Based on your perio status, I'd recommend coming back on [specific date range]."
  • Explain the why in one sentence: "Your gums in the lower right are showing some signs of early bone loss — 3 months is how we stop it from progressing."
  • For perio maintenance patients, distinguish the visit from a "cleaning": "This is your periodontal maintenance visit — it's therapeutic, not just cosmetic."
  • Give patients their perio chart. Patients who see their own numbers are significantly more likely to comply with recommended intervals than those who are only told verbally.
  • Have the treatment coordinator confirm the co-payment for the next visit if the patient is CDCP or has a high-deductible plan — no billing surprises = more likely to return
Compliance statistic (Wilson 1984)
Of 1,000 perio patients recommended for 3-month maintenance, only 16% fully complied over 8 years. The evidence-based response is to make the clinical rationale explicit and the booking frictionless — not to accept non-compliance as normal.
Examinations · Complete vs Recall

When to Bill a Complete Exam Instead of a Recall Exam

Complete exam (01101–01103) vs recall exam (01202)

CodeWhen appropriateFreq. typical
01201New patient, limited — first brief visitOnce (new patient)
01202Previous patient recall — hard and soft tissue check1× per 6–12 months
01101Complete oral exam — primary dentition patient1× per 36 months typical
01102Complete oral exam — mixed dentition1× per 36 months typical
01103Complete oral exam — permanent dentition1× per 36 months typical
When 01103 is appropriate at a returning patient visit
• Patient returns after an absence of 3+ years
• Significant change in medical history (new medication, cancer, diabetes diagnosis)
• Significant change in oral health status (multiple new extractions, new denture, post-radiation)
• Prior to full-mouth rehabilitation treatment planning

It is not appropriate to bill 01103 at every annual visit instead of 01202.

The 3-year complete exam opportunity

01103 at 3-year intervals for stable recall patients
Most private insurance plans allow a complete exam (01103) every 24–36 months for existing patients. Many practices never bill this — using 01202 indefinitely — and miss ~$100 per patient every 3 years.

A comprehensive 01103 includes: full medical/dental history update, all hard/soft tissue analysis, TMJ, occlusion, pulp vitality where needed — it is a substantially more thorough visit and should take 30+ minutes of dentist time.
01502 — limited periodontal exam (maintenance patients)
For patients in periodontal maintenance, 01502 is the appropriate recall exam code — not 01202. It covers an exam of hard and soft tissues specific to periodontal status monitoring. The 2025 ODA clarification confirmed: 49101 is NOT for routine perio maintenance recall visits.
Dentition stage matters — always
01101 (primary), 01102 (mixed), 01103 (permanent) — using the wrong dentition code triggers automatic insurance denial. A 7-year-old in mixed dentition billed as 01103 will be deniedpatient is responsible for the balance.
Quick Reference

Recall Visit Quick-Reference Checklists

✦ Booking checklist
  • Verify coverage + frequency eligibility for 01202, bitewings, scaling, fluoride
  • CDCP patients: check Sun Life portal eligibility at every visit
  • Confirm last service dates for all codes to be billed
  • Flag perio maintenance patients (Stream B) vs standard recall (Stream A)
  • Confirm last 6-point chart date for perio patients
  • Note outstanding treatment items — recall only, or treatment too?
✦ Chair / hygiene checklist
  • Record exact scaling start and end time → calculate units accurately
  • Document cervical sensitivity → 41231 trigger (CDCP pre-auth required)
  • Identify active/incipient lesions → 13601 SDF trigger
  • Perform 6-point perio chart if in maintenance or status changed
  • Photograph findings for clinical record (04811–04819)
  • If fluorescence/DIAGNOcam used → document scores (04221)
  • OHI given hands-on for new condition → 13211
✦ Checkout checklist
  • Only ONE exam code billed today — 01202, 01502, or 01204/01205
  • Scaling units match documented time (no rounding up)
  • +E code (99121) for any materials: SDF, fluoride agent, Icon
  • +L code (99111) for any lab work dispatched
  • CDCP: collect co-pay and gap payment today — explain both
  • Next appointment booked — confirm it falls after frequency window
  • Chart notes signed off by treating provider
The goal is not to maximize the bill — it is to accurately bill for the care delivered, document why it was needed, and collect fairly for the time and expertise provided. When documentation is complete and codes match clinical work, the revenue takes care of itself.
ODA Practice Advisory · 1-866-739-8099 ext. 3301 · Mon–Fri 8:30am–4:30pm
Summary

Key Takeaways — What Every Team Member Owns

📅
Front desk owns frequency
  • Verify eligibility before booking — not at the chair
  • CDCP uses rolling periods, not calendar year
  • Never adjust a date to fit coverage — it is fraud
  • Know Stream A vs Stream B on the schedule
  • Book next recall before patient leaves — every time
🩺
Hygienist owns documentation
  • Record exact scaling time — bill ½-unit when appropriate
  • Perio maintenance patients: 43421+ not 11111
  • Document every finding that triggers an add-on code
  • 6-point perio chart: dated, complete, on file
  • Sensitivity, white spots, active lesions = billable treatments
💳
Treatment coordinator owns compliance
  • Only one exam code per patient per day
  • +E and +L codes present for all pass-throughs
  • CDCP eligibility verified at every visit
  • Co-pay and gap payment collected and explained today
  • ODA Advisory: 1-866-739-8099 ext. 3301 when unsure
A well-run recall system is the financial spine of a general practice — generating 60–70% of annual revenue while driving early detection of treatment needs. When billed accurately, it reflects the true value of preventive care. The documentation is not a burden. It is the proof that the work was done and that it matters.
— ODA Advisory Services · Sun Life CDCP: 1-888-888-8110 · HSO Provider Line: 1-800-461-1555