How to Bill an Occlusal Guard: D9944, D9945, D9946 Explained

April 15, 2024

Updated 7/21/26

When it comes to dental billing, there are so many different procedures that it can be hard to remember how to bill each one. One unique procedure is the occlusal guard. Deceptively simple, it does require some specifics to bill it correctly…and get paid. Here are some tips on how to properly bill one. 

Watch: How to Correctly Bill an Occlusal Guard

What is an occlusal guard? 

It is a removable device that fits over your teeth to protect them from damage due to grinding and clenching, also known as bruxism. It may also be used to treat conditions such as TMJ or sleep apnea.  It’s often called a night guard because it’s frequently worn while sleeping. 

What CDT Codes are used? 

There are three different CDT codes that are used. Per the ADA, they are: 

On the claim form, always list the arch involved when billing either D9944 or D9945. List both the arch and quadrant when billing D9946. If you are struggling with coding, a good resource to have on hand is Dental Coding with Confidence from Practice Booster. 

What’s the Difference Between an Occlusal Guard and an Occlusal Orthotic Device?

It’s easy to confuse an occlusal guard with an occlusal orthotic device since both are worn over the teeth and both address teeth grinding or jaw discomfort — but they’re billed under entirely different codes, and using the wrong one is a common cause of denial.

An occlusal guard (D9944, D9945, D9946) is intended to protect the teeth from the effects of bruxism — grinding and clenching — but it isn’t designed to treat an underlying joint disorder. An occlusal orthotic device (D7880), by contrast, is used specifically to treat TMJ/TMD, where the goal is to reposition the jaw and relieve joint dysfunction rather than simply prevent tooth-to-tooth contact.

Because payors expect the diagnosis to match the code, billing D9944-D9946 for a patient whose clinical notes describe joint pain, clicking, or TMD rather than bruxism is a mismatch that carriers are likely to flag or deny. The clinical narrative should make clear which condition is being treated, since that’s what determines the correct code — not just the appliance’s physical appearance.

Do occlusal guards need pre-authorizations and referrals?

They are not specialty treatments, so there is no need for a referral. Some plans, especially active military and Medicare, may require pre-authorization. For these plans, submit the required forms for the treatment to be pre-approved before the appointment.

What x-rays are needed for occlusal guards? 

When billing occlusal guards, always include a panoramic x-ray. In addition, any other x-rays or intraoral photos showing damaged or ground-down teeth should be included. 

What do clinical narratives require?  

The narrative needs to explain exactly why the patient needs an occlusal guard. Include the arch and the teeth that have been affected. The more details supporting the need for treatment, the better the chance of getting paid. 

Do frequency limits apply? 

Depending on the plan, frequency limits may apply. Often these limits range from 1-5 years. Keep in mind that a waiting period may also apply, meaning that they may not be covered until a certain time has passed since the plan’s effective date. Verify frequency limits and waiting periods before billing claims. 

Why Do Occlusal Guard Claims Get Denied?

Even when an occlusal guard is medically necessary, claims are frequently denied due to preventable errors:

• Missing pre-authorization — for plans that require it, particularly active military and Medicare, submitting without prior approval typically results in denial regardless of clinical necessity.
• Insufficient clinical narrative — a narrative that doesn’t clearly explain the need for the guard, or that fails to specify the arch and affected teeth, gives payors grounds to deny or request more information.
• Missing or incomplete x-rays — claims without a panoramic x-ray, or without supporting images of damaged or ground-down teeth, often lack the documentation needed for approval.
• Incorrect arch or quadrant reporting — D9944 and D9945 require the arch to be listed, while D9946 requires both arch and quadrant. Omitting or misreporting this is an easily avoidable cause of denial.
• Frequency limit exceeded — many plans only cover a guard once every 1 to 5 years; billing before the patient is eligible again will result in denial.
• Waiting period not yet met — if the plan hasn’t been active long enough to satisfy a waiting period, the claim will be denied even with complete documentation.

Can I bill an occlusal guard to medical insurance? 

Medical insurance may cover an occlusal guard, but it is not guaranteed, and coverage varies significantly by plan. Some medical plans exclude these appliances entirely, while others may provide coverage only when the appliance is tied to a documented medical condition and meets the plan’s medical necessity requirements.

If the patient’s medical plan does cover the appliance, billing requires an entirely different code set than dental billing — diagnosis and procedure codes specific to medical claims, rather than CDT codes. Because these requirements vary by payer and by the condition being treated, it’s important to verify the patient’s specific medical benefits and required documentation directly with the payer before billing, rather than assuming a standard approach will apply.

When billed correctly, occlusal guards are an excellent source of income for a dental practice. Consider partnering with eAssist for all your dental billing needs. Our billing specialists are happy to bill your claims thoroughly and accurately to get them paid. To find out more, schedule a free consultation here. 

Disclaimer: Insurance administration and dental billing recommendations, as well as interpretations of the CDT codes, represent the opinions of our experts. For the latest CDT codes and official interpretations, contact the American Dental Association or visit ADA.org. You are responsible for your own use of the CDT Codes, insurance administration, and dental billing.