Dr. 1010 begins with an blank 10x10 grid of squares and three colored, irregularly shaped figures at the bottom of the screen. These figures are an arrangement of blocks the same size as the blank squares in the 10x10 grid. The player must drag these blocks onto the grid, and after the blocks are dropped, they are unable to be moved from where they were placed. As soon as the three figures were placed on the grid, three new figures appear to be placed. This continues for as long as the game is being played.
Once a row or a column of 10 on the grid is filled entirely with blocks, that row or column is cleared of blocks and appears blank again. As the game is played, there are less and less possible spaces to place blocks, so clearing rows and columns is the only way to gain area back on the board.
The goal of this game is to get as many points as possible. The points for each block placed on the board corresponds to the number of squares that the block covers. Blocks range from 1 to 5 squares.