Reminder: American Dental Association (ADA) Updated Current Dental Terminology (CDT) Code Conversion 2023 effective January 1st. Please be advised that claims must be submitted with the CDT 2023 codes for dates of service on or after January 1, 2023. If an outdated code is submitted, the claim may be returned to the dental office for correct coding. 

CDT 2023 Code and Policy Changes

As of January 1, 2023, the American Dental Association’s (ADA’s) procedure code changes will be in effect. Associated changes to Northeast Delta Dental policies will also be effective January 1, 2023. There are five (5) new standardly covered codes, twenty-two (22) new standardly non-covered codes, and two (2) deleted codes. Many of the new codes further define existing procedures.

Please be sure not to submit claims for the new codes with dates of service prior to January 1, 2023, and do not submit claims for the deleted codes for dates of service on or after January 1, 2023. Your claims will be returned to your office for resubmission with the correct codes for the dates of service involved, which results in unnecessarily delaying the processing of your claims.

 

The following are definitions of terms used in this article:

  • Denied/Deny: The procedure or service is not covered, and the approved amount is collectable from the patient.
  • Not Billable to the Patient (NBTP): The procedure is not benefited by Delta Dental nor is it billable to the patient by a participating dentist.
  • General Policy – This policy is already in place, any charges related to office overhead, including infection control/PPE, are included in the fee for the dental services provided. Separate fees are not billable to the patient.

 

New 2023 Standardly Covered Codes and Standard Delta Dental Processing Policies:

  • D0372 Intraoral tomosynthesis – comprehensive series of radiographic images
    Covered benefit as a comprehensive series (D0210) with additional fees chargeable to patient.
  • D0373 Intraoral tomosynthesis – bitewing radiographic image
    Covered benefit as a periapical (D0270) with additional fees chargeable to patient.
  • D0374 Intraoral tomosynthesis – periapical radiographic image
    Covered benefit as a bitewing – single radiographic image (D0220) with additional fees chargeable to patient.
  • D6105 Removal of implant body not requiring bone removal nor flap elevation
    Covered under Major once in a lifetime. See additional below.
  • D6197 Replacement of restorative material used to close an access opening of a screw-retained implant supported prosthesis, per implant
    Covered under Major once every 24 months. See additional below.

 

New 2023 Standardly Non-Covered Codes and Standard Delta Dental Processing Policies:

Non-covered codes which are denied and billable to the patient:

  • D0801 3D dental surface scan – direct
  • D0802 3D dental surface scan – indirect
  • D0803 3D facial surface scan – direct
  • D0804 3D facial surface scan – indirect
  • D1781 Vaccine administration – human papillomavirus – Dose 1
  • D1782 Vaccine administration – human papillomavirus – Dose 2
  • D1783 Vaccine administration – human papillomavirus – Dose 3
  • D4286 Removal of non-resorbable barrier
    Denied if done by a different dentist/dental office who placed the barrier (D4267)
  • D6105 Removal of implant body not requiring bone removal nor flap elevation
    Denied if done by a different/dental office within six months of implant placement (D6010/D6013)
  • D6106 Guided tissue regeneration – resorbable barrier, per implant
  • D6107 Guided tissue regeneration – non-resorbable barrier, per implant
  • D7509 Marsupialization of odontogenic cyst
  • D7956 Guided tissue regeneration, edentulous area – resorbable barrier, per site
  • D7957 Guided tissue regeneration, edentulous area – non-resorbable barrier, per site
  • D9953 Reline custom sleep apnea appliance (indirect)
    Denied unless covered by group/individual contract

New 2023 Non-covered Codes which are not billable to the patient

  • D0387 Intraoral tomosynthesis – comprehensive series of radiographic images – image capture only
    Not billable to the patient as D0387 is considered part of D0372
  • D0388 Intraoral tomosynthesis – bitewing radiographic image – image capture only
    Not billable to the patient when billed with D0373 by the same dentist/dental office
  • D0389 Intraoral tomosynthesis – periapical radiographic image – image capture only
    Not billable to the patient when billed with D0374 by the same dentist/dental office
  • D4286 Removal of non-resorbable barrier
    Not billable to the patient if done by the same dentist/dental office who placed the barrier (D4267)
  • D6105 Removal of implant body not requiring bone removal nor flap elevation
    Not billable to the patient if done by same dentist/dental office within six months of implant placement (D6010/D6013)
  • D6197 Replacement of restorative material used to close an access opening of a screw-retained implant supported prosthesis, per implant
    Not billable to the patient when performed by the same dentist/dental office within six months of placement of the implant prosthesis OR on the same date of service by the same dentist/dental office as implant maintenance (D6080) or repair implant supported prosthesis (D6090)
  • D9953 Reline custom sleep apnea appliance (indirect)
    Not billable to the patient if performed by the same dentist/dental office within six months of initial placement

 

Revised Standard Delta Dental Processing Policies for Existing Codes as of January 1, 2023:

  • D0251 Extra-oral posterior dental radiographic image
    If there is a history of prior extra-oral radiograph within the frequency limitation for panoramic image (D0330), the fees for D0251 are Not Billable to the Patient
  • D0270 Bitewing-single radiographic image
    The fees for additional bitewings (D0270-D0274) within 6 months of D0210 are Not Billable to the Patient by the same dentist/dental office. Benefits are denied if done by a different dentist/dental office.
  • D0272 Bitewings-two radiographic images
    The fees for additional bitewings (D0270-D0274) within 6 months of D0210 are Not Billable to the Patient by the same dentist/dental office. Benefits are denied if done by a different dentist/dental office.
  • D0273 Bitewing-three radiographic images
    The fees for additional bitewings (D0270-D0274) within 6 months of D0210 are Not Billable to the Patient by the same dentist/dental office. Benefits are denied if done by a different dentist/dental office.
  • D0274 Bitewing-four radiographic images
    The fees for additional bitewings (D0270-D0274) within 6 months of D0210 are Not Billable to the Patient by the same dentist/dental office. Benefits are denied if done by a different dentist/dental office.
  • D2929 Prefabricated porcelain/ceramic crown – primary tooth
    The fee for replacement of a porcelain/ceramic crown by the same dentist/dental office within 24 months is included in the initial crown placement and is Not Billable to the Patient.  Benefits are DENIED if done by a different dentist/dental office. D2929 is benefited once per lifetime.
  • D3221 Pulpal debridement, primary and permanent teeth
    Fees are Not Billable to the Patient when performed within 30 days on same tooth by the same dentist/dental office as root canal therapy (D3230-D3333 or D3351-D3353).
  • D3222 Partial pulpotomy for apexogenesis - permanent tooth with incomplete root development
    Fees are Not Billable to the Patient when performed within 30 days on same tooth by the same dentist/dental office as root canal therapy (D3230-D3333 or D3351-D3353).
  • D3471 Surgical repair of root resorption - anterior
    Fees are Not Billable to the Patient when performed on the same tooth by the same dentist/dental office on the same date of service as D3333, D3410-D3426, D3430, D3450, D4210-D4212, D4231, D4250-D4241, D4245, D4249, D4260-D4261, D4268, D4270, D4273-D4278, D4283, D4285.
  • D3472 Surgical repair of root resorption - premolar
    Fees for surgical repair of root resorption are Not Billable to the Patient when performed on the same tooth by the same dentist/dental office on the same date of service as D3333, D3410-D3426, D3430, D3450, D4210-D4212, D4231, D4250-D4241, D4245, D4249, D4260-D4261, D4268, D4270, D4273-D4278, D4283, D4285.
  • D4260 Osseous surgery (including elevation of a full thickness flap and closure) - four or more contiguous teeth or tooth bounded spaces per quadrant
    Benefits for osseous surgery in excess of two quadrants per date of service are Denied in the absence of clinical documentation explaining the exceptional circumstance.
  • D4261 Osseous surgery (including elevation of a full thickness flap and closure) - one to three contiguous teeth or tooth bounded spaces per quadrant
    Benefits for osseous surgery in excess of two quadrants per date of service are Denied in the absence of clinical documentation explaining the exceptional circumstance.
  • D4265 Biologic materials to aid in soft and osseous tissue regeneration, per site
    Providing more than two D4263, D4264, D4265, D4266, D4267, D4270, D4273, D4275, D4276, D4277, D4278, D4283, D4285 within any given quadrant is highly unusual and additional submissions should only be considered on a by report basis. Fees for anything more than two sites in a quadrant are Denied. When clinical documentation of exceptional circumstances is submitted, benefits may be Denied, unless covered, dependent on group/individual contract language.
  • D4266 Guided tissue regeneration, natural teeth - resorbable barrier, per site
    Providing more than two D4263, D4264, D4265, D4266, D4267, D4270, D4273, D4275, D4276, D4277, D4278, D4283, D4285 within any given quadrant is highly unusual and additional submissions should only be considered on a by report basis. Fees for anything more than two sites in a quadrant are Denied. When clinical documentation of exceptional circumstances is submitted, benefits may be Denied, unless covered, dependent on group/individual contract language.
  • D4267 Guided tissue regeneration, natural teeth - non-resorbable barrier, per site
    DDPA adding D4265 to existing General Policy – Providing more than two D4263, D4264, D4265, D4266, D4267, D4270, D4273, D4275, D4276, D4277, D4278, D4283, D4285 within any given quadrant is highly unusual and additional submissions should only be considered on a by report basis. Fees for anything more than two sites in a quadrant are Denied.
    When clinical documentation of exceptional circumstances is submitted, benefits may be Denied, unless covered, dependent on group/individual contract language.
  • D4270 Pedicle soft tissue graft procedure
    DDPA adding D4265 to existing General Policy – Providing more than two D4263, D4264, D4265, D4266, D4267, D4270, D4273, D4275, D4276, D4277, D4278, D4283, D4285 within any given quadrant is highly unusual and additional submissions should only be considered on a by report basis. Fees for anything more than two sites in a quadrant are Denied. When clinical documentation of exceptional circumstances is submitted, benefits may be Denied, unless covered, dependent on group/individual contract language.
  • D4341 Periodontal scaling and root planing - four or more teeth per quadrant
    The fees for D4341 are Not Billable to the Patient in the absence of radiographic documentation of bone loss and documentation of clinical attachment loss. Benefits will be limited to that of a prophylaxis (D1110) or scaling in the presence of generalized moderate to severe gingival inflammation (D4346)
    The fees for D4341 are Not Billable to the Patient when done on the same date of service and same tooth as a surgical repair of root resorption (D3471-D3473)
  • D4355 Full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit
    Full mouth debridement is Not Billable to the Patient when performed by the same dentist/dental office on the same date of service as D0180.
  • D7294 Placement of temporary anchorage device without flap
    Benefits are Denied as a specialized procedure, unless covered by group/individual contract.
  • D7412 Excision of benign lesion, complicated
    The fee for D7412 is Not Billable to the Patient as included in the fee for another surgery in the same area of the mouth on the same date of service by the same dentist/dental office.
  • D7413 Excision of malignant lesion up to 1.25 cm
    The fee for D7413 is Not Billable to the Patient as included in the fee for another surgery in the same area of the mouth on the same date of service by the same dentist/dental office.
  • D7414 Excision of malignant lesion greater than 1.25 cm
    The fee for D7414 is Not Billable to the Patient as included in the fee for another surgery in the same area of the mouth on the same date of service by the same dentist/dental office.
  • D9948 Adjustment of custom sleep apnea appliance
    Fees for an adjustment of a custom sleep apnea appliance if performed within six months of initial placement by a different dentist/dental office are Denied
  • D9949 Repair of custom sleep apnea appliance
    Fees for a repair of a custom sleep apnea appliance if performed within six months of initial placement by a different dentist/dental office are Denied


Deleted Codes as of January 1, 2023:

  • D0351 3D Photographic image
  • D0704 3D Photographic image-image capture only


Be sure to order your new CDT 2023 book from the ADA!  You may also order the CDT 2023 App and/or the Coding Companion Guide. These are all great resources!