Opening an Explanation of Benefits (EOB) only to find a denied claim is one of the most frustrating experiences in a dental practice.
You did the work, yet the insurance company is refusing to pay. It feels like money is slipping right through your fingers, and often, it comes down to a simple coding error.
For something as common as a night guard, the billing process should be straightforward. But with annual CDT code updates and the nuances between hard, soft, and partial appliances, choosing the right occlusal guard dental code can feel like a guessing game.
Partnering with a dental insurance billing company can help practices handle complex claims and get payments processed faster.
But if you’d like to do it yourself, we’re here to help walk through exactly which codes to use, when to use them, and how to document your clinical notes so your claims get paid the first time.
What Are the Current Dental Codes for Occlusal Guards?
In the past, we relied on a generic code for most guards, but the ADA has since updated the CDT codes to be much more specific.
To get paid, you need to match the code to the material of the appliance and the coverage of the arch.
Here are the three primary codes you need to know:
D9944: Occlusal Guard – Hard Appliance, Full Arch
This is likely the most common D9944 dental code you will use in your practice. It describes a removable dental appliance that covers the entire arch (upper or lower) and is made of rigid material.
It is designed to minimize the effects of bruxism or other occlusal factors.
Use D9944 when:
- The lab fabricates a hard acrylic guard.
- The guard covers all teeth in the arch.
- The patient is being treated for bruxism (grinding) or clenching.
D9945: Occlusal Guard – Soft Appliance, Full Arch
If you are fabricating a soft guard, perhaps for a patient who cannot tolerate rigid acrylic or for temporary use, this is your code. Like D9944, it must cover the full arch.
Use D9945 when:
- The appliance is made of a soft, pliable material.
- It covers the full arch.
- You are treating bruxism or protecting teeth from trauma.
D9946: Occlusal Guard – Hard Appliance, Partial Arch
This code is often overlooked but is critical for specific therapies. It refers to a hard appliance that does not cover all the teeth in the arch.
Use D9946 when:
- You are delivering an anterior deprogrammer (like an NTI device).
- The appliance only covers the anterior teeth to disclude the posterior teeth.
- The goal is to reduce muscle tension or protect teeth from grinding.
Previously, D9942 was commonly used as a general occlusal appliance code, but the ADA now recommends using D9944, D9945, or D9946 based on the appliance’s material and coverage.
How Do I Distinguish Between Bruxism and TMD Appliances?
One of the biggest reasons for claim denials is mixing up the diagnosis. The codes listed above (D9944, D9945, D9946) are specifically for "occlusal guards." In the eyes of insurance carriers, an occlusal guard is primarily for protecting teeth from the wear and tear of bruxism.
If you are treating a patient specifically for Temporomandibular Joint Dysfunction (TMD), you should not use the night guard dental code.
Instead, you should look at orthotic device codes, such as D7880 (occlusal orthotic device).
Using a bruxism code for a TMD diagnosis - or vice versa - is a red flag for auditors.
If your clinical notes talk exclusively about jaw pain, clicking, and popping, but you bill D9944, the carrier may deny it, stating the procedure does not match the diagnosis.
Always ensure your primary reason for the device aligns with the code you select.
Why Does the Material of the Guard Matter for Billing?
You might wonder why insurance companies care if the plastic is hard or soft. It often comes down to longevity and cost.
A hard appliance (D9944) generally has a higher lab fee and is expected to last longer than a soft appliance (D9945).
If you bill D9944 but deliver a vacuum-formed soft suck-down guard made in-house, you are technically misreporting services. This is considered non-compliant billing.
When selecting your dental code for night guard, look at the lab slip. Did you prescribe hard acrylic? Did you ask for a soft liner?
A hard occlusal guard with a soft liner is typically billed as D9944 because the structural component is hard. Accurate code selection helps maintain compliance and reduces the risk of audits.
When Should I Use the Partial Arch Code D9946?
The D9946 dental code is your go-to for "anterior deprogrammers" or NTI-tss devices. These are small, hard plastic devices that fit over the front teeth only.
They prevent the back teeth from touching, which can significantly reduce the intensity of clenching.
Because these devices look and function differently than a full-arch guard, they have their own category.
If you bill a full arch code (D9944) for an NTI device, you are billing incorrectly. The reimbursement rates for partial and full arch guards may differ, so accuracy here helps you maintain compliance and ensures you are paid fairly for the specific device delivered.
What Documentation Is Required to Get Paid?
You can pick the perfect code, but if your documentation is weak, you will still face a denial.
What Every Dental Team Should Know About Clinical Notes
The must-have guide for 100% collections and compliance.
Insurance carriers want proof that the dental night guard code you billed was medically or dentally necessary.
Your clinical notes should tell a story. Avoid generic phrases like "patient needs guard." Instead, be specific about the objective findings that led to that decision.
Your notes should include:
- Diagnosis: Bruxism, clenching, or attrition.
- Clinical Findings: "Wear facets noted on teeth #3, #14, and #19,” “Patient reports jaw muscle fatigue upon waking,” “Fractured cusp on #30 due to parafunctional habits,” supported by intraoral scans or imaging (iO) documenting occlusal wear or damage."
- Treatment Plan: Why an occlusal guard is the best option to prevent further damage.
- Type of Device: Specify if it is hard, soft, or partial, and which arch (maxillary or mandibular).
Accurate dental bookkeeping helps practices track revenue from occlusal guards and other procedures, making it easier to reconcile claims and spot gaps in insurance payments.
The more detail you provide, the harder it is for a claims adjuster to say "not medically necessary."
What Are the Best Practices for Coding Occlusal Guards?
Beyond documenting the diagnosis and appliance type, it helps to have a clear process for verifying patient coverage and lab instructions, keeping internal notes on coding decisions, and making sure staff are aware of CDT updates and insurance rules.
Following these steps makes it easier to submit correct claims and avoid preventable denials.
If you’re looking for more insights on mastering dental billing, our Exclusive Guide to Dental Billing Secrets is the perfect resource.
Learn how to collect up to 98% with proven tips from Wisdom’s experts.
Can I Bill Medical Insurance for an Occlusal Guard?
This is a common question, and the answer is "sometimes." While most occlusal guards are billed to dental insurance, there are instances where medical insurance may cover them.
If the guard is considered "medically necessary" to treat a condition like severe migraines caused by bruxism or specific jaw disorders, you might be able to cross-code.
However, medical billing requires a completely different set of codes (CPT codes for the procedure and ICD-10 codes for the diagnosis).
Before you go down this road, verify the patient’s medical benefits. Many medical plans have exclusions for "dental devices" or "TMJ treatment."
If you do bill medical, ensure you are not billing dental for the same date of service to avoid duplicate billing issues.
How Do I Handle Upgrades and Patient Preferences?
Sometimes a patient’s insurance covers a standard soft guard, but the patient wants a premium, hard acrylic guard that costs more. Or perhaps the insurance downgrades the fee to a cheaper alternative.
In these cases, transparency is your best friend. You should provide the patient with a detailed treatment plan that shows the occlusal guard dental code you intend to bill and the estimated insurance coverage.
If the patient opts for a higher-end guard that their insurance does not fully cover, you may be able to bill the difference depending on your contract with the carrier (PPO contracts vary wildly on this).
Always check your PPO fee schedule and rules regarding "optional services" or upgrades. You never want a patient to be surprised by a balance bill they didn't expect.
What Are the Most Common Reasons for Denials?
Knowing why claims get rejected is the first step to fixing them. Here are the frequent offenders when billing for night guards:
- Missing Tooth Clause: Some plans will not pay for a guard if the patient has missing teeth in the arch being treated, arguing the guard won't fit or function properly.
- Frequency Limitations: Many plans only pay for one guard every 3 to 5 years. If the patient had one made at a previous office two years ago, your claim will be denied. Always verify history before starting.
- Invalid Diagnosis: As mentioned, using a TMD diagnosis for a bruxism code (or vice versa) causes mismatches.
- Lack of Narrative: Sending a claim without a short narrative explaining the necessity (e.g., "Patient suffering from severe attrition due to bruxism") is a missed opportunity to justify the treatment upfront.
Should I Use a Narrative on Every Claim?
Yes. It takes an extra thirty seconds, but adding a short narrative to Box 35 of the ADA claim form (or the electronic equivalent) can save you weeks of appeals.
A simple template like this works wonders for claims narratives:
"Patient presents with generalized attrition and wear facets consistent with nocturnal bruxism. Occlusal guard indicated to prevent further tooth structure loss and fracture of existing restorations."
This connects the dental night guard code directly to the patient's condition, making it clear to the adjuster why the device is necessary.
How do I troubleshoot occlusal guard coding errors?
If you receive a denial, look at the remark code first.
- "Not medically necessary": Resubmit with a stronger narrative and photos of wear.
- "Frequency limit reached": Check the patient's history; you may need to bill the patient if they exceeded their plan limit.
- "Procedure inconsistent with diagnosis": Check if you used a TMD diagnosis with a bruxism code. Correct the diagnosis to match the clinical need (e.g., bruxism/attrition) and resubmit.
How Wisdom Can Help You Get Paid Faster
Managing all these codes, narratives, and frequency limitations takes time. And time is exactly what most front desk teams don't have. If you are struggling with a backlog of denials or just want to ensure your billing is bulletproof, you do not have to do it alone.
Wisdom provides expert dental billing services that act as an extension of your practice. We focus on the revenue cycle so you can focus on patient care.
Our US-based team of dental billing specialists understands the nuances of the d9944 dental code and every other complexity of dental insurance. We fight the denials for you, ensuring you collect what you have earned.
We like to say: You care for patients. We chase the insurance companies.
