What does denial code CARC 119 mean on a dental claim, and can it be appealed?

On a dental remittance, CARC 119 means: The plan's dollar ceiling is exhausted — either the annual or lifetime allowance is spent, or the patient has already used the number of these visits the plan funds. X12 assigns it no group code, so the group code on the remittance is the payer's choice under its own contract and it, not the CARC, decides who is assigned the balance. No source read for this page pairs a specific remark code with it. Dentovio's appealability verdict — structural: verify the plan terms. When the accumulator is correct, an appeal does not restore an exhausted maximum. Check whether prior claims posted to the correct plan year and whether any benefit falls outside the maximum under the plan terms.

Necessity, frequency, and alternate benefits · Last verified 2026-08-30

CARC 119 denial code on dental claims

Independent publisher · Drafted with AI assistance, verified against primary sources · Credentialed review pending

CARC 119 is the “Benefit maximum reached” code on a dental remittance. A plan term controls, so verify the plan and the facts before appealing.

Group code: X12 places no group-code restriction on 119, and payers do send exhausted-maximum adjustments under more than one group code. A group code always travels with a CARC, and it — not the CARC — assigns financial responsibility, so read the one on your remittance rather than assuming. Offices commonly write this one as PR 119; that is search shorthand, not a statement that the payer will use PR.

Registry entry: X12 Claim Adjustment Reason Code 119 — active, with no deactivation date. Read on the list published 2025-11-01.

Verdict

Structural — verify the plan terms

The denial reflects a plan term such as an exclusion or exhausted limit. Verify that the payer used the correct plan and facts before deciding how the contract assigns responsibility.

When the accumulator is correct, an appeal does not restore an exhausted maximum. Check whether prior claims posted to the correct plan year and whether any benefit falls outside the maximum under the plan terms.

The appealability verdicts on these pages are Dentovio's editorial classification. No standards body or payer publishes an appealability taxonomy: X12 defines what a code means, not what to do about it. Each verdict is built from the code's own mechanics and the payer and federal documents cited on the page, and it is a starting point for triage rather than a prediction of any outcome.

What it means in dental

The plan's dollar ceiling is exhausted — either the annual or lifetime allowance is spent, or the patient has already used the number of these visits the plan funds.

In Delta Dental of California's 2024 individual-market plan-level filing, benefit-limit reason counts were 18.1% of all denied claims for that plan (16,581 of 91,358). When the plan-year maximum is genuinely exhausted, the contract determines the remaining responsibility.

What to do

1.Verify the payer's year-to-date accumulator against your own payment records
2.Confirm the plan year boundaries — cross-year treatment can post to the wrong year's maximum
3.Confirm the group code before treating the balance as the patient's, then move to the financing conversation

Remark codes verified with this CARC

No source read for this page pairs a remark code with CARC 119. X12 defines no CARC-to-RARC pairings at all: payer crosswalks are specific to that payer's own internal reason codes, and the CAQH CORE combination list binds only payers operating inside its business scenarios. Read the remark code on your own remittance.

Read with this code

CARC 151 — Frequency not supported

Sources

X12 Claim Adjustment Reason Codes (external code list 139) — list updated 2025-11-01
X12 Remittance Advice Remark Codes (external code list 411) — list updated 2026-07-01
45 CFR 162.1602 — HIPAA adoption of the 835 remittance standard that carries these codes
Covered California — Delta Dental 2024 individual-market plan-level claims-denied filing