Understanding Dental Code D9943

When to Use D9943 dental code

The D9943 dental code is designated for the adjustment of an existing occlusal guard, also known as a night guard or bite splint. This CDT code should be used when a patient returns to the dental office for a follow-up visit specifically to modify the fit, comfort, or function of a previously delivered occlusal guard. It is not intended for the initial delivery or fabrication of the guard—that would be coded as D9944 (occlusal guard – hard appliance, full arch) or D9945 (occlusal guard – soft appliance, full arch). Use D9943 only when an adjustment is clinically necessary due to changes in the patient’s bite, discomfort, or wear of the appliance.

Documentation and Clinical Scenarios

Proper documentation is critical for successful reimbursement and audit protection. When reporting D9943, your clinical notes should include:

• The patient’s chief complaint or reason for the adjustment (e.g., discomfort, tightness, looseness, or bite changes).
• A description of the adjustment performed (e.g., relieving pressure points, reshaping acrylic, or correcting occlusal contacts).
• Details on the outcome or patient response after the adjustment.
• The date of the original occlusal guard delivery and the CDT code used for that service.

Common clinical scenarios for D9943 include patients experiencing jaw soreness after wearing their guard, reporting a change in bite alignment, or noticing that the guard no longer fits as intended due to dental work or tooth movement.

Insurance Billing Tips

Billing D9943 requires attention to payer policies, as not all dental insurance plans cover occlusal guard adjustments. Here are best practices to maximize reimbursement and minimize denials:

• Verify benefits before the appointment. Confirm whether the patient’s plan covers occlusal guard adjustments and if there are frequency limitations.
• Submit detailed clinical notes with the claim, emphasizing the medical necessity of the adjustment and referencing the original guard delivery date and code.
• Use accurate CDT coding and avoid unbundling. Only use D9943 for adjustment visits, not for repairs or relines, which may require different codes.
• Monitor EOBs (Explanation of Benefits) for denial reasons. If denied, file a claim appeal with supporting documentation and a narrative explaining the necessity of the adjustment.

Successful dental offices often create templates for occlusal guard adjustment notes and train front desk teams to ask about insurance coverage during scheduling to avoid surprises for patients and the practice.

Example Case for D9943

Case Example: A patient returns three weeks after receiving a hard acrylic occlusal guard (coded as D9944). The patient reports pressure on the upper right molars and mild jaw discomfort. The dentist examines the fit, identifies high spots, and adjusts the guard’s occlusal surface. After the adjustment, the patient reports improved comfort and function. The provider documents the adjustment, patient’s complaint, and outcome, then bills D9943 for the visit, including a narrative and reference to the original delivery date and code.

By following these steps, dental teams can ensure accurate billing, proper reimbursement, and high-quality patient care when using the D9943 dental code.