Comprehensive oral evaluation note template
A complete, fill-in-the-blank D0150 note written around what insurance reviewers ask for — with the documentation checklist, the denial patterns, and an Open Dental auto-note format built in.
01 · Before you bill it
Know what the payer wants first.
The note should answer every item on the left — and read so that nothing on the right applies.
What documentation D0150 requires
Missing any of these is why the claim pends for records.- Full-scope exam findings — extraoral, intraoral, occlusal, and periodontal — matching the "comprehensive" descriptor
- Dated medical history review with medications and ASA status
- Radiograph type, count, date, and the findings you read from them
- An oral cancer screening result, positive or negative
- A written diagnosis list, not just charted findings
- A sequenced treatment plan with evidence the patient discussed it
Why D0150 gets denied
The denial patterns payers actually use for this code.- Billed within the frequency window of a prior D0150/D0180 at the same office (commonly once per provider per patient, then periodic exams)
- Note scope reads like a limited exam — one tooth, one complaint — while billed comprehensive
- No radiographic findings documented despite films billed the same day
02 · The template
Copy it, chart with it.
Square brackets are the blanks — replace each one as you chart. Switch the format to turn every blank into an Open Dental auto-note prompt.
MEDICAL HISTORY: Reviewed and updated [date]. Medications: [list]. Allergies: [NKDA / list]. ASA [I/II/III]. VITALS: BP [___/___] Pulse [__] CHIEF COMPLAINT: [Patient's words, or "new patient comprehensive evaluation; no acute complaint"]. EXTRAORAL EXAM: [WNL / findings]. TMJ: [no deviation, clicking, or tenderness / findings]. Lymph nodes: [non-palpable / findings]. INTRAORAL EXAM: Soft tissue: [WNL / findings]. Oral cancer screening: [negative / describe]. Occlusion: [class, wear, notes]. DENTITION: Existing restorations: [chart]. Caries: [teeth and surfaces]. Defective restorations: [teeth]. PERIODONTAL SCREENING: [PSR sextant scores / full chart completed]. Bleeding: [localized/generalized/none]. Recession: [notes]. RADIOGRAPHS: [FMX ## films / panoramic / BWX] taken [date] and reviewed: [findings; note bone levels and pathology or absence of pathology]. DIAGNOSIS: [Caries by tooth/surface; periodontal diagnosis with stage and grade if applicable; other findings]. TREATMENT PLAN: [Sequenced plan discussed, including alternatives and no-treatment consequences]. Patient questions answered; patient [accepts / will consider]. NEXT VISIT: [Hygiene / restorative sequencing and interval].
03 · Common questions
Frequently asked about D0150
D0150 or D0180?
Can I bill D0150 with a same-day prophy?
New patient exam every time a patient switches offices?
More templates
Or never fill in a blank again.
Molaris listens to the visit and drafts this exact note in your wording — placeholders already filled from what was actually said. You review, you sign, it files to Open Dental.
Book a 15-minute demo →Reviewed August 2026. These templates are original Molaris reference samples showing how the scribe structures documentation. They are educational examples, not billing, coding, or legal advice; payer requirements vary by plan and state. CDT codes are maintained by the ADA.