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Dental coding with Kyle: Occlusal guards

Jan. 18, 2019
Dental coding can cause a lot of headaches in dental practices, especially when the codes are updated. Staying up-to-date can be hard. Here's a code change for 2019.
Kyle L. Summerford, Editorial Director
The reasons for determining insurance coverage and non-coverage have not changed, but the CDT codes have.

Out with the old CDT code!

D9940 Occlusal guard, by report

In with the new CDT codes!

• D9944 Occlusal guard–Hard appliance, full arch
• D9945 Occlusal guard–Soft appliance
• D9946 Occlusal guard–Hard appliance, partial arch

The reasons that insurance companies may cover include:

• Some plans will provide a benefit for a patient suffering the effects of bruxism.
• Some plans will provide a benefit for an occlusal guard, but only if the patient has a six-month prior to fabrication history of periodontal treatment, such as scaling and root planing and osseous surgery.

The reasons insurance companies may deny include:

• Failure to use one of the new 2019 CDT codes listed above
• Failure to indicate on the ADA claim form the reason for fabrication of the appliance
• Annual maximum has been absorbed
• Frequency and limitations play an important role in coverage. Be sure to find out if the patient has a fabrication history of an occlusal guard appliance.

Always keep in mind that it is recommended the office send in a pretreatment authorization, which includes radiographs and periodontal charting, to ensure a smooth claim determination process.

2019 coding changes
Code 4346 still causing confusion
Full orthodontic treatment

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About the Author

Kyle L. Summerford | Editorial Director

Kyle L. Summerford is president of Summerford Solutions Inc. Being a dental office manager, dental practice consultant, and dental coding educator has enabled him to guide his company to provide services to dental practices and their staffs nationwide. Kyle has lectured at many CE events and academic institutions—Stony Brook University, New York City County Dental Society, and Georgia Regents University. He’s authored many Dental Coding with Kyle articles. He’s the founder of Dental Office Managers Facebook Community and Dental Manager Connect. Contact him at [email protected].