CDT 2026 Code and Policy Changes

As of January 1, 2026, 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, 2026. There are 31 new codes, and six deleted codes.

Please be sure not to submit claims for the new codes with dates of service prior to January 1, 2026, and do not submit claims for the deleted codes for dates of service on or after January 1, 2026. 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. 

Specialized Procedure: Describes a dental service or procedure that is used when unusual or extraordinary circumstances exist and is not generally used when conventional methods are adequate. 

D6049 Scaling and debridement of a single implant in the presence of peri-implantitis inflammation, bleeding upon probing and increased pocket depths, including cleaning of the implant surfaces, without flap entry and closure. Covered benefit once every 24 months. See Not Billable to the Patient for more information.

D6280 Implant maintenance procedures when a full arch removable implant/abutment supported denture is removed and reinserted, including cleansing of prosthesis and abutments – per arch. Covered benefit once every 36 months per arch for those ages 16 and above. See Not Billable to the Patient for more information.

D9224 Administration of general anesthesia with advanced airway - first 15-minute increment or any portion thereof. Benefit in conjunction with oral or implant surgical procedures when covered or when necessary due to concurrent medical conditions. See Not Billable to the Patient for more information.

D9225 Administration of general anesthesia with advanced airway – each subsequent 15-minute increment or any portion thereof. Benefit in conjunction with oral or implant surgical procedures when covered or when necessary due to concurrent medical conditions. See Not Billable to the Patient for more information.

D0426 Collection, preparation and analysis of a saliva sample – point-of-care. Benefits are denied.

D1720 Influenza vaccine administration. Benefits are denied.

D5877 Duplication of complete denture – maxillary. Benefits are denied.

D5878 Duplication of complete denture – mandibular. Benefits are denied.

D5909 Maxillary guidance prosthesis with guide flange. Benefits are denied.

D5930 Maxillary guidance prosthesis without guide flange. Benefits are denied.

D5938 Resection prosthesis, maxillary complete removable. Benefits are denied.

D5939 Resection prosthesis, mandibular complete removable. Benefits are denied.

D5940 Resection prosthesis, maxillary partial removable. Benefits are denied.

D5941 Resection prosthesis, mandibular partial removable. Benefits are denied.

D5942 Resection prosthesis, maxillary implant/abutment supported removable prosthesis for edentulous arch. Benefits are denied.

D5943 Resection prosthesis, mandibular implant/abutment supported removable prosthesis for edentulous arch. Benefits are denied.

D5944 Resection prosthesis, maxillary implant/abutment supported removable prosthesis for the partial edentulous arch. Benefits are denied.

D5945 Resection prosthesis, mandibular implant/abutment supported removable prosthesis for the partial edentulous arch. Benefits are denied.

D5946 Resection prosthesis, maxillary implant/abutment supported fixed prosthesis for edentulous arch. Benefits are denied.

D5947 Resection prosthesis, mandibular implant/abutment supported fixed prosthesis for edentulous arch. Benefits are denied.

D5948 Resection prosthesis, maxillary implant/abutment supported fixed prosthesis for the partial edentulous arch. Benefits are denied.

D5949 Resection prosthesis, mandibular implant/abutment supported fixed prosthesis for the partial edentulous arch. Benefits are denied.

D9128 Photobiomodulation therapy - first 15-minute increment or any portion thereof. Benefits are denied when billed as a standalone procedure. See Not Billable to the Patient for more information.

D9129 Photobiomodulation therapy - subsequent 15-minute increment or any portion thereof. Benefits are denied when billed as a standalone procedure. See Not Billable to the Patient for more information.

D9244 In-office administration of minimal sedation - single drug – enteral. Benefits are denied. See Not Billable to the Patient for more information.

D9245 Administration of moderate sedation – enteral. Benefits are denied. See Not Billable to the Patient for more information.

D9246 Administration of moderate sedation – non-intravenous parenteral – first 15-minute increment or any portion thereof. Benefits are denied. See Not Billable to the Patient for more information.

D9247 Administration of moderate sedation – non-intravenous parenteral – each subsequent 15-minute increment or any portion thereof. Benefits are denied. See Not Billable to the Patient for more information.

D9936 Cleaning and inspection of an occlusal guard - per appliance. Benefits are denied. See Not Billable to the Patient for more information.

D0461 Testing for cracked tooth. Testing for cracked tooth is included as part of the definitive procedure, and the fees are not billable to the patient.

D6049 Scaling and debridement of a single implant in the presence of peri-implantitis inflammation, bleeding upon probing and increased pocket depths, including cleaning of the implant surfaces, without flap entry and closure. Not billable to the patient: when performed in the same quadrant by the same dentist/dental office as D4341/D4342 or D4240/D4241, D4260/D4261 or D6101/D6102; when performed within 12 months of restoration (D6058-D6077, D6085, D6094, D6118, D6119, D6194); or when done in conjunction with D1110, D4346, or D4910.

D6196 Removal of an indirect restoration on an implant retained abutment. The removal of an indirect restoration is included in the definitive treatment, and fees are not billable to the patient.

D6280 Implant maintenance procedures when a full arch removable implant/abutment supported denture is removed and reinserted, including cleansing of prosthesis and abutments – per arch. Fees are not billable to the patient if done within 12 months of D6110 and D6111.

D9128 Photobiomodulation therapy - first 15-minute increment or any portion thereof. Fees are not billable to the patient when performed as part of another procedure.

D9129 Photobiomodulation therapy - subsequent 15-minute increment or any portion thereof. Fees are not billable to the patient when performed as part of another procedure.

D9224 Administration of general anesthesia with advanced airway - first 15-minute increment or any portion thereof. Benefits for more than one hour of deep sedation are not billable to the patient unless clinical documentation supports more than an hour was necessary.

D9225 Administration of general anesthesia with advanced airway – each subsequent 15-minute increment, or any portion thereof. Benefits for more than one hour of deep sedation are not billable to the patient unless clinical documentation supports more than an hour was necessary.

D9244 In-office administration of minimal sedation - single drug – enteral. Fees are not billable to the patient in conjunction with IV sedation (D9239 and D9243) and general anesthesia (D9222, D9223, D9224, D9225).

D9245 Administration of moderate sedation – enteral. Fees are not billable to the patient in conjunction with IV sedation (D9239 and D9243) and general anesthesia (D9222, D9223, D9224, D9225).

D9246 Administration of moderate sedation – non-intravenous parenteral – first 15-minute increment or any portion thereof. Fees are not billable to the patient in conjunction with IV sedation (D9239 and D9243) and general anesthesia (D9222, D9223, D9224, D9225).

D9247 Administration of moderate sedation – non-intravenous parenteral – each subsequent 15-minute increment or any portion thereof. Fees are not billable to the patient in conjunction with IV sedation (D9239 and D9243) and general anesthesia (D9222, D9223, D9224, D9225).

D9936 Cleaning and inspection of an occlusal guard - per appliance. Fees are not billable to the patient when done in conjunction with D9942.

D0180 Comprehensive periodontal evaluation – new or established patient. Fees for D0180 are not billable to the patient when done on the same date of service as D4355 by the same dentist/dental office.

D0502 Other oral pathology procedures, by report. Other oral pathology procedures must be accompanied by a pathology report. Fee for D0502 submitted without the report is not billable to the patient. Benefits for D0502 submitted with a pathology report are denied.

D4355 Full mouth debridement to enable comprehensive periodontal evaluation and diagnosis on subsequent visit. Fees for D0180 are not billable to the patient when done on the same date of service as D4355 by the same dentist/dental office.

D6081 Scaling and debridement of a single implant in the presence of mucositis, including inflammation, bleeding upon probing and increased pocket depths; includes cleaning of the implant surfaces, without flap entry and closure. Fees for D6081 are not billable to the patient when performed in the same quadrant by the same dentist/dental office as D4341/D4342 or D4240/D4241, D4260/D4261, D6049, or D6101/D6102.

D7953 Bone replacement graft for ridge preservation - per site. Benefits are by report and subject to coverage available under the medical plan and are denied. When covered, D7953 is limited to one per extraction site and denied when performed on third molars. Not billable to the patient: on an edentulous ridge or on the same date of service as implant placement or when done on the same site and same date of service as an extraction or removal of an implant.

D9230 Administration of nitrous oxide. Fees for D9230 are not billable to the patient in conjunction with IV sedation (D9239 and D9243) and general anesthesia (D9222, and D9223, D9224 and D9225).

D1352 Preventive resin restoration in a moderate-to-high caries risk patient - permanent tooth.

D1705 AstraZeneca Covid-19 vaccine administration – first dose.

D1706 AstraZeneca Covid-19 vaccine administration – second dose.

D1707 Janssen Covid-19 vaccine administration.

D1712 Janssen Covid-19 vaccine Administration - booster dose.

D9248 Non-intravenous conscious sedation.