Free Periodic Dental Exam (D0120) Clinical Note Template
Periodic exam (D0120) notes still need to cover 7+ sections — interval medical history, intraoral exam, oral cancer screening, perio update, and radiographic findings. Generate a compliant note in 30 seconds.
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Replace each [bracketed field] with your specific clinical detail. Brackets are placeholders — they don't get saved into the chart.
**Chief Complaint:** Patient presents for periodic recall examination. **Medical History:** Reviewed and updated. No interval changes reported. No contraindications to treatment. **Extraoral Examination:** Head and neck exam performed. TMJ evaluation: no clicking, popping, or deviation noted. Lymph nodes: non-palpable. Facial symmetry: within normal limits. **Intraoral Soft Tissue Examination:** Lips, buccal mucosa, tongue, floor of mouth, hard palate, soft palate, oropharynx, gingiva examined: all within normal limits. Oral cancer screening performed: negative. **Periodontal Findings:** [No changes from baseline. Bleeding on probing localized to posteriors. Stable.] **Radiographic Findings:** [BW] taken and reviewed. No new caries identified. **Recall:** [6-month] recall recommended. Patient tolerated procedure well. Post-operative instructions given.
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When to use this template
Use this template for established-patient periodic oral evaluations (CDT D0120) — typically the 6-month recall visit. Covers interval medical history changes, focused extraoral and intraoral exams, oral cancer screening, periodontal update from the last comprehensive, radiographic interpretation (typically bitewings), and the recall recommendation. Adjust the bracketed bitewing-type and any noted findings.
Tips for using this template
- check_circleAlways document interval medical history changes — even "no changes reported" — to satisfy update-history requirements.
- check_circleBitewing interpretation is required when bitewings are taken at the visit. "BW reviewed; no new caries" is the standard sentence.
- check_circleRecall interval should match the patient's caries risk and perio status, not just default to 6 months.
- check_circleIf you noted plaque or calculus during the exam, document it briefly even if a separate prophy note will follow.
- check_circleFor pediatric periodics, add fluoride-varnish documentation if applied at the visit.
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