Understanding Dental Code D9952

When to Use D9952 dental code

The D9952 dental code is designated for an occlusal adjustment, which involves selective reshaping of the biting surfaces of teeth to improve how they come together. This code should be used when occlusal discrepancies are causing discomfort, functional issues, or are contributing to the progression of periodontal disease or restorative complications. Common clinical indications include jaw pain, TMJ symptoms, uneven wear patterns, or after major restorative work such as crowns or bridges. It is important to distinguish D9952 from other occlusal-related codes, such as D9951 (limited occlusal adjustment), to ensure accurate billing and documentation.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement and compliance. When billing D9952, dental teams should include:

• A clear clinical rationale for the adjustment (e.g., occlusal interference, patient-reported symptoms).
• Pre- and post-adjustment findings, such as occlusal markings, photos, or bite analysis records.
• Details of the procedure performed, including which teeth were adjusted and the method used.
• Patient consent and education notes, especially if the adjustment is part of a larger treatment plan.

Typical scenarios for D9952 include post-orthodontic finishing, after placement of multiple crowns or bridges, or when addressing chronic headaches linked to malocclusion. Always ensure the clinical notes justify the necessity of the adjustment and differentiate it from routine polishing or minor bite checks.

Insurance Billing Tips

Billing for D9952 requires attention to detail and proactive communication with payers. Here are best practices:

• Verify coverage: Not all dental plans cover occlusal adjustments. Check benefits prior to treatment and inform patients of potential out-of-pocket costs.
• Submit comprehensive documentation: Attach clinical notes, diagnostic images, and a narrative explaining why the adjustment was medically necessary.
• Use correct CDT code: Ensure D9952 is not confused with similar codes. If multiple adjustments are needed, clarify whether they are part of a single comprehensive session or separate limited adjustments.
• Appeal denials: If an Explanation of Benefits (EOB) denies the claim, review the reason, supplement with additional documentation, and submit a timely appeal. Reference clinical guidelines and patient symptoms in your appeal letter.

Staying organized with Accounts Receivable (AR) follow-up and tracking claim status can help reduce delays and improve reimbursement rates for D9952 claims.

Example Case for D9952

A 52-year-old patient presents with jaw discomfort and reports difficulty chewing on one side. Examination reveals uneven occlusal contacts following recent placement of multiple crowns. The dentist documents pre-adjustment occlusal markings and explains the need for a comprehensive occlusal adjustment. After performing the adjustment, the dentist records improved occlusal balance and patient symptom relief. The claim is submitted with D9952, including clinical notes and intraoral photos. Insurance initially denies the claim, but after submitting a detailed narrative and supporting documentation, the claim is approved and reimbursed.

This example highlights the importance of thorough documentation, proactive communication, and persistence in the billing process for D9952.