Let’s be honest: Being referred to a specialist is stressful enough. You are likely worried about a complex problem—maybe a root canal that’s too difficult for your regular dentist, or gum issues that need a periodontist.
Then, you get to the front desk and see a charge for “D9310 – Consultation.”
You might think, “Wait, didn’t I just pay for an exam at my regular dentist? Why am I paying for another one?”
This is a common frustration. D9310 is a unique code that sits in the gray area between a standard check-up and a specific treatment. It is the code used when your dentist says, “I need a second pair of eyes on this,” or when you seek a second opinion to avoid expensive surgery.
However, insurance companies love to flag this code. If submitted incorrectly, or if your plan has strict “frequency limitations,” you could be stuck paying the specialist’s high office fee entirely out of pocket.
This guide will decode the D9310 “Consultation,” explain how it differs from a regular exam, and provide a financial playbook to ensure your insurance—not your bank account—covers the bill.
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Decoding D9310: What Are You Actually Buying?
(External Information: Definition based on standard CDT coding standards) CDT Code D9310 stands for “Consultation – diagnostic service provided by dentist or physician other than requesting dentist or physician.”
In plain English, this isn’t just a “check-up.” It is a targeted investigation.
• The Referral: It typically happens when your General Dentist sends you to a Specialist (like an Endodontist for a root canal or an Oral Surgeon for an extraction).
• The Second Opinion: It is also the code used if you decide to go to a different doctor to see if you really need that expensive treatment plan the first dentist proposed.
• The Difference: Unlike a periodic exam (D0120) which looks at everything, or a limited exam (D0140) which looks at one emergency, D9310 is an advisory service. The specialist examines the problem, analyzes the data, and provides a written report back to your general dentist or to you.
Why it matters: You aren’t paying for the treatment yet. You are paying for the expert strategy on how to treat the problem.
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The “Financial Reality”: Costs, Traps, and Secrets
Since D9310 is usually performed by specialists (who charge higher fees than general dentists), the cost can be surprising. Here is how to navigate the financial landscape using current market data.
1. Estimated Costs: Cash vs. Insurance
If you walk into a specialist’s office without insurance, a D9310 consultation generally costs significantly more than a regular dental exam.
• The Cost Factor: Specialist fees can be 30% to 50% higher than general dentist fees.
• How to Find Fair Prices: Don’t guess. You can use the Delta Dental Cost Estimator. This tool allows you to input your specific ZIP code to see estimated cost ranges for common dental care needs1. Even if the exact specialist code isn’t listed, checking the cost of a “comprehensive exam” in your area gives you a baseline, and you should expect the D9310 to be slightly higher.
2. The “Frequency” Trap
Here is the secret insurers won’t tell you: Many plans bundle D9310 into the same category as regular exams.
• The Limit: Most plans cover “two exams per year.”
• The Gotcha: If you already had your two cleanings and check-ups this year, and then you get referred to a specialist for a D9310 consultation, your insurance might deny it because you hit your frequency limit.
• The Fix: Ask the specialist if they can bill it as a D0140 (Limited Exam) if you have maxed out your “Consultation” benefits. Many plans treat D0140 differently.
3. Waiting Periods: The Hidden Barrier
If you need to see a specialist now, you cannot afford a plan that makes you wait. Standard insurance often puts a 6-month hold on non-preventive services.
• The Solution: You need a plan with No Waiting Periods.
◦ Spirit Dental: According to their policy details, they offer plans with “No Waiting Periods” for preventive, basic, and major services2. This is crucial for D9310, as some carriers classify consultations as “Basic” or even “Major” depending on the policy.
◦ Humana: Their “Preventive Plus” plans often have no waiting periods for preventive care, and plans like Loyalty Plus are designed to provide immediate access to benefits3,4.
4. Deductibles: The Entry Fee
Because a consultation is often the first step in a new treatment plan, you will likely have to pay your deductible during this visit.
• Standard: Most deductibles are $50 to $100.
• The Hack: Look for plans with lower barriers. Cigna offers plans with deductibles ranging from $0 to $505. If you choose a plan with a $0 deductible for diagnostic services, your D9310 visit could be fully covered from day one.
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Financing Options: When You Can’t Pay Upfront
If you are uninsured and need a specialist’s opinion, the out-of-pocket cost can be a barrier to getting the right diagnosis.
1. Dental Savings Plans (The “Not-Insurance” Route)
If you are worried about “Frequency Limits” or “denials,” skip insurance entirely.
• What it is: A membership card where you pay an annual fee.
• The Benefit: As noted by Dentaly.org, these plans save members 10–60% on the average cost of dental care6.
• Why it works for D9310: There are no “medical necessity” reviews. You simply present the card at the participating specialist’s office and pay the discounted rate instantly.
2. Third-Party Financing
Specialist treatments (like implants or gum surgery) are expensive. The consultation is just the start.
• Credit Options: Many offices accept third-party financing.
• Bad Credit: If traditional credit is an issue, some offices offer in-house payment plans or work with lenders that specialize in “compassionate finance”7.
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Frequently Asked Questions (FAQ)
1. Is D9310 covered as a “Preventive” or “Basic” service? It varies by plan. While exams (D0120) are usually “Preventive” (100% covered), D9310 is often classified as “Basic” (80% covered) because it is problem-focused. Always check your “Summary of Benefits.”
2. Can I use D9310 for a second opinion? Yes. In fact, that is one of its primary uses. If you don’t trust your first diagnosis, you can see another dentist for a D9310. However, be aware that you will likely pay for this visit if your insurance limits exams to “one every 6 months.”
3. Why did my insurance deny code D9310? The most common reason is that the insurance company “downcoded” it. They may claim that a “Limited Exam” (D0140) would have sufficed. They might pay the D0140 rate, which is lower, leaving you to pay the difference.
4. How much does a consultation cost without insurance? While prices vary by ZIP code, specialist consultations typically range from $100 to $200. Using the Delta Dental Cost Estimator can help you find a specific range for your area1.
5. Does Spirit Dental cover specialist consultations immediately? Yes. Spirit Dental advertises “No Waiting Periods” for their plans8. This implies that diagnostic services, including consultations, would be eligible for coverage effective the next day after enrollment.
6. Do I need a referral to see a specialist? If you have a PPO plan (like those from Cigna or Humana), you generally do not need a referral to see a specialist3. However, if you have a DHMO plan, you strictly need a referral from your primary dentist, or the D9310 visit will be 100% your cost6.
7. Can I get a D9310 consultation via Teledentistry? Increasingly, yes. Anthem promotes “24/7 Teledentistry” as a way to access virtual care9. A virtual consultation might be billed under a different code (like D9995), but it serves the same purpose of getting an expert opinion without leaving home.
8. What if the specialist is out-of-network? Specialists are often out-of-network. Cigna notes that you can see any dentist you’d like, but you save more with an in-network provider5. If you see an out-of-network specialist for a D9310, you may be “balance billed” for the difference between what they charge and what insurance pays.
9. Can I negotiate the price of D9310? Yes. If you are paying cash, ask for a “prompt payment discount.” Many specialists will knock 5-10% off the fee if you pay in full at the time of the visit, saving them the hassle of billing.
10. Does Medicaid cover D9310? In many states, yes, but strict rules apply. For example, Iowa’s Dental Wellness Plan provides extensive services10, but you may need a referral from your assigned dentist for the specialist visit to be covered.
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Conclusion: The Value of Expert Advice
Seeing D9310 on your bill means you are taking a serious step toward resolving a complex dental issue. While it is an extra cost, it is often the most valuable appointment you will have—because it ensures you are getting the right treatment before you spend thousands on surgery.
To protect your wallet, verify if your plan categorizes this as “Basic” or “Preventive,” check for frequency limits, and if you are uninsured, consider a plan like Spirit Dental to bypass waiting periods2. Expert advice is worth paying for, but with the right strategy, you don’t have to pay full price.
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Disclaimer: This article is for informational purposes only and does not constitute medical or financial advice. We are not dentists or insurance agents. Dental codes and insurance benefits vary by year, state, and provider. Always verify coverage with your insurance carrier and consult a licensed professional for treatment.
