CDT 2025 Code and Policy Changes

As of January 1, 2025, 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, 2025. There are ten (10) new codes, and two (2) deleted codes.

Please be sure not to submit claims for the new codes with dates of service prior to January 1, 2025, and do not submit claims for the deleted codes for dates of service on or after January 1, 2025. 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. 

D6180 Implant maintenance procedures when a full arch fixed hybrid prosthesis is not removed, including cleansing of prosthesis and abutments. Covered benefit once every 36 months for those age 16 and above. See Not Billable to the Patient for more information.

D6193 Replacement of an implant screw. Covered benefit once per implant every 24 months. See Not Billable to the Patient for more information.

D7252 Partial extraction for immediate implant placement. Covered benefit once per tooth in conjunction with immediate implant placement.

D8091 Comprehensive orthodontic treatment with orthognathic surgery. Covered benefit subject to orthodontic lifetime maximum. See Not Billable to the Patient for more information.

D7259 Nerve dissection. Benefits are denied as a specialized technique. See Not Billable to the Patient for more information.

D8671 Periodic orthodontic treatment visit associated with orthognathic surgery. Benefits are denied. See Not Billable to the Patient for more information.

D9913 Administration of neuromodulators. Benefits are denied.

D9914 Administration of dermal fillers. Benefits are denied.

D9959 Unspecified sleep apnea services procedure, by report. Benefits are denied. 

D2956 Removal of an indirect restoration on a natural tooth. Not billable to the patient as is included in the definitive treatment.

D6180 Implant maintenance procedures when a full arch fixed hybrid prosthesis is not removed, including cleansing of prosthesis and abutments. Not billable to the patient if done within 12 months of D6114 and D6115.

D6193 Replacement of an implant screw. Not billable to the patient if performed within six months of the initial placement of the prosthesis, by the same dentist/dental office. Not billable to the patient on the same date of service as D6193.

D7259 Nerve dissection. Nerve dissection is part of D7241 and not billable to the patient when done on the same date of service.

D8091 Comprehensive orthodontic treatment with orthognathic surgery. Fees for limited orthodontic treatment (D8010-D8040) and comprehensive orthodontic treatment (D8070-D8090) when submitted on the same date of service as D8091 are not billable to the patient.

D8671 Periodic orthodontic treatment visit associated with orthognathic surgery. Not billable to the patient when done on the same date of service as D8091.

The fees for radiographs taken during the procedures and post-operative radiographs are included in the fees for root canals, surgical and non-surgical procedures, and all indirect restorations (crowns, onlays, bridges, inlays, and implants) and are not billable to the patient.

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

D0801 3D Intraoral surface scan – direct. 3D intraoral scans are included as part of the definitive procedure and the fees are not billable to the patient.

D0802 3D dental surface scan – indirect. 3D dental surface scans are included as part of the definitive procedure and the fees are not billable to the patient.

D1352 Preventive resin restoration in a moderate to high caries risk patient- permanent tooth. Covered benefit once every 3 years on permanent molars through the age of 18 effective 1/1/2025.

D2940 Placement of interim direct restoration. Interim direct restorations are covered benefits for emergency relief of pain once per tooth. The fee for an interim direct restoration filling is not billable to the patient when performed in conjunction with definitive dental treatment by same dentist/dental office on same date of service. Fees for D2940 are not billable to the patient when performed in conjunction with any restorative codes D2000-D2999, bridge codes (D6200-D6699). Fees for D2940 are not billable to the patient when performed in conjunction with any endodontic code D3220-D3950. When a D2940 is benefitted, the fees for D3110 (pulp cap – direct) and D3120 (pulp cap – indirect) are not billable to the patient.

D2991 Application of hydroxyapatite regeneration medicament – per tooth. Benefits are denied as investigational.

D5520 Replace missing or broken teeth – complete denture– per tooth. Fees for repairs of complete or partial dentures if performed within six months of initial placement by the same dentist/dental office are not billable to the patient. Benefits are denied if done by a different dentist/dental office.

D6080 Implant maintenance procedures when a full arch fixed hybrid prosthesis is removed and reinserted, including cleansing of prosthesis and abutments. Benefits are limited to once every 36 months for those age 16 and above. Not billable to the patient if done within 12 months of D6114 and D6115.

D6089 Accessing and retorquing loose implant screw – per screw. When done on the same date of service as D6193, fees for D6089 are not billable to the patient.

D6090 Repair of implant/abutment supported prosthesis. Fees for repair of implant/abutment supported prosthesis, if performed within six months of the initial placement of the prosthesis, by the same dentist/dental office, are not billable to the patient. Covered benefit once every 24 months, per prosthesis effective 1/1/2025.

D6114 Implant/abutment supported fixed denture for edentulous arch – maxillary. Covered benefit once every 7 years for those age 16 and above effective 1/1/2025.

D6115 Implant/abutment supported fixed denture for edentulous arch – mandibular. Covered benefit once every 7 years for those age 16 and above effective 1/1/2025.

D7284 Excisional biopsy of minor salivary glands. Covered benefit, by report and subject to consultant review effective 1/1/2025.

D9994 Dental case management – patient education to improve oral health literacy. Fees for patient education to improve oral health literacy are not billable to the patient when submitted on same date of service as D1301, D1310, D1320, D1321 and D1330.