D9945 - Guard Soft Full
Occlusal guard – soft full arch.
- Procedure Code
- D9945
- Clinical Category
- Adjunctive
- Primary ICD-10 Justification
- G47.63 (Sleep related bruxism)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D9945.
- Frequency Limitation
- 1 per 36 to 60-month interval (rolling_12_months)
Required Claim Attachments & Pre-Submission Checklist
- Standard ADA claim form with CDT procedure code and date of service
Bill When (Allowable Clinical Criteria)
- If covered by group contract, benefit once every five years.
Restrictions & Clinical Exclusions
- Benefits for restorations for altering occlusion, adjusting vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion, abfraction, corrosion, TMD or for periodontal, orthodontic, or other splinting are denied, unless covered by group/individual contract.
- Benefits for sleep apnea services (D9947-D9957) are denied unless covered by group/individual contract.
- Benefits for an occlusal guard are denied unless covered by group/individual contract.
- General anesthesia and intravenous sedation are limited to one hour. Any additional minutes are not billable to the patient unless clinical documentation supports more than an hour was necessary. For example, special health care needs patients may require additional units of anesthesia and may be a benefit according to group/individual contract.
- All services and treatment provided remotely via tele-health modalities, be they synchronous or asynchronous, must be performed by a licensed dentist or their supervised staff, acting within the scope of applicable law. Services and treatment delivered virtually are only a benefit when the elements included in the descriptor of the CDT procedure code are completed and only when they meet generally accepted clinical guidelines.
- Benefits for restorations for altering occlusion, adjusting vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion, abfraction, corrosion, TMD, or for periodontal, orthodontic, or other splinting are denied, unless covered by group contract.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
ICD-10-CM Justification & Crosswalk Mappings for D9945 (9)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| G47.63 | Sleep related bruxism | Sleep disorders | ★ Yes (Primary) | BOTH | occlusal guard – soft appliance, full arch indicated for Sleep related bruxism |
| F59 | Unspecified behavioral syndromes associated with physiological disturbances and physical factors | Mental and behavioral disorders | Secondary | BOTH | occlusal guard – soft appliance, full arch indicated for Unspecified behavioral syndromes associated with physiological disturbances and physical factors |
| K03.0 | Excessive attrition of teeth | Other diseases of hard tissues of teeth | Secondary | BOTH | occlusal guard – soft appliance, full arch indicated for Excessive attrition of teeth |
| M26.601 | Right, temporomandibular joint disorder, unspecified | Dentofacial anomalies [including malocclusion] | Secondary | BOTH | occlusal guard – soft appliance, full arch indicated for Right, temporomandibular joint disorder, unspecified |
| M26.602 | Left temporomandibular joint disorder, unspecified | Dentofacial anomalies [including malocclusion] | Secondary | BOTH | occlusal guard – soft appliance, full arch indicated for Left temporomandibular joint disorder, unspecified |
| M26.603 | Bilateral temporomandibular joint disorder, unspecified | Dentofacial anomalies [including malocclusion] | Secondary | BOTH | occlusal guard – soft appliance, full arch indicated for Bilateral temporomandibular joint disorder, unspecified |
| M26.609 | Unspecified temporomandibular joint disorder, unspecified side | Dentofacial anomalies [including malocclusion] | Secondary | BOTH | occlusal guard – soft appliance, full arch indicated for Unspecified temporomandibular joint disorder, unspecified side |
| M26.69 | Other specified disorders of temporomandibular joint | Dentofacial anomalies [including malocclusion] | Secondary | BOTH | occlusal guard – soft appliance, full arch indicated for Other specified disorders of temporomandibular joint |
| M26.89 | Other dentofacial anomalies | Dentofacial anomalies [including malocclusion] | Secondary | BOTH | occlusal guard – soft appliance, full arch indicated for Other dentofacial anomalies |
Frequently Asked Questions — D9945 (Guard Soft Full)
Quick answers for dental billers and treatment coordinators submitting claims for D9945.
What ICD-10 diagnosis codes link to dental procedure D9945?▾
Common ICD-10-CM justification codes for CDT D9945 (Guard Soft Full) include: G47.63 - Sleep related bruxism (Primary); F59 - Unspecified behavioral syndromes associated with physiological disturbances and physical factors; K03.0 - Excessive attrition of teeth; M26.601 - Right, temporomandibular joint disorder, unspecified; M26.602 - Left temporomandibular joint disorder, unspecified; M26.603 - Bilateral temporomandibular joint disorder, unspecified; M26.609 - Unspecified temporomandibular joint disorder, unspecified side; M26.69 - Other specified disorders of temporomandibular joint; M26.89 - Other dentofacial anomalies.
Can CDT code D9945 be billed to medical insurance?▾
Billing CDT D9945 (Guard Soft Full) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: BOTH.
What attachments and documentation are required for billing CDT D9945?▾
Required claim attachments for CDT D9945 (Guard Soft Full) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D9945?▾
Standard commercial insurance frequency for D9945: 1 per 36 to 60-month interval (rolling_12_months).
What are common insurance denial reasons and appeal tips for CDT D9945?▾
Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.