D4266 is the CDT code for placing a resorbable barrier membrane over a periodontal defect around a natural tooth, billed once per site.
- When to use: Each defect at a retained tooth that gets a resorbable membrane takes its own D4266 line, since there is no additional-site membrane code.
- When not to use: A nonresorbable barrier is D4267, an implant site is D6106, an edentulous site or fresh socket is D7956, and the graft beneath it is D4263 or D4264.
- Billing note: Published policies commonly require a pocket of 5 mm or deeper with bone loss, so send charting and a current radiograph of the site with the claim.
What D4266 covers
D4266 reports placing a resorbable barrier membrane at a periodontal defect around a natural tooth, per site. The membrane holds space over the defect and keeps fast-growing soft tissue out so bone, cementum, and attachment can regenerate underneath. Resorbable means the body breaks it down, so no follow-up surgery is needed to retrieve it.
D4266 reports the barrier and nothing else. The descriptor explicitly excludes the surrounding work, so each piece is billed on its own line:
- The flap. Opening and closing the site is not in D4266. Where the surgery included osseous recontouring, that is D4260 or D4261 by tooth count per quadrant.
- The bone graft. Graft material in the defect around a retained natural tooth is D4263 for the first site in the quadrant and D4264 for each additional site.
- Biologic material. Enamel matrix derivative, platelet concentrates, and similar regenerative agents are D4265, per site.
- Wound debridement and osseous contouring, when separately performed.
A single regenerative surgery often produces three or four lines. Dropping D4266 because the membrane “came with the graft” gives away the barrier fee on every case.
Three regenerative materials, three codes
The periodontal regeneration codes are separated by what was placed in the defect, not by severity or surgical goal.
- D4263 and D4264 report the bone replacement graft, the particulate that fills the bony defect. Neither is reported at an edentulous space or an extraction site.
- D4265 reports biologic material, per site, alone or with a graft and a membrane.
- D4266 and D4267 report the barrier membrane that covers the site.
Each descriptor states that it excludes the other two. Bill what was placed, one code per material, and let the note carry the detail. Keep the three as separate procedures in the fee schedule; a single combined regenerative line bills one code for a surgery that earned three.
Which GTR code: site family first, then barrier
Guided tissue regeneration is coded first by where the membrane went. If the site family is wrong, the barrier type still matches, so a quick number check passes on a wrong claim. For the same reason, label the GTR codes by site family in the PMS pick list. A list that reads “GTR resorbable” three times guarantees a wrong pick eventually.
Question one: what was the membrane placed against?
- Natural tooth: D4266 (resorbable) or D4267 (non-resorbable).
- Implant: D6106 (resorbable) or D6107 (non-resorbable), reported per implant.
- Edentulous site, meaning no tooth and no implant, including a socket where the tooth was just extracted: D7956 (resorbable) or D7957 (non-resorbable), reported per site. The graft under it is its own line, D7953 for ridge preservation in the fresh socket or D7950 for ridge augmentation, and both descriptors direct the membrane to be reported separately.
- With periradicular surgery: D3432, the resorbable-barrier code in the endodontic surgery family.
Question two: which membrane? Within the natural-tooth pair, D4266 is resorbable and D4267 is non-resorbable and must be removed later. The full grid, with the graft code each membrane usually accompanies, is in the bone graft dental codes guide.
The removal code D4286 exists but is not a routine second line. Cigna’s 2026 DPPO guidelines treat it as part of the primary guided tissue regeneration service, grouped with D4267, D6107, and D7957. Northeast Delta Dental splits it by who removes the barrier: not billable to the patient when the placing office removes it, denied when a different office does. Both stances are plan-specific, so know which applies before the barrier goes in.
Coverage and how carriers treat it
Guided tissue regeneration is a reviewed benefit almost everywhere. Read the plan’s policy before submitting, not after the EOB posts.
A defect threshold. Cigna’s 2026 DPPO coverage determination guidelines allow D4266 and D4267 when the pocket around a natural tooth measures 5 mm or deeper with bone loss present, and disallow them when pockets are under 5 mm or radiographs do not show bone loss. Thresholds vary by plan, but a documented pocket depth with a matching radiograph is the baseline evidence any reviewer expects.
A defect type. UnitedHealthcare’s dental barrier membrane policy indicates guided tissue regeneration for intrabony and infrabony vertical defects and Class II furcation involvements, and alongside bone grafting for ridge preservation, ridge augmentation, implant placement, and peri-implant defects. It does not consider GTR indicated for teeth with a poor or hopeless prognosis, osseous defects with fewer than two walls, crater defects, or periapical lesions of endodontic origin. A membrane at a hopeless tooth or a shallow crater is a predictable denial regardless of the note.
Site exclusions. Cigna disallows the code at the same site as a tooth removal, where no natural tooth is present, at the same site as an apicoectomy, hemisection, root amputation, or other periradicular surgery, at the same site and date as an implant placement, and at an existing implant. These are the site-family errors above, appearing as denials.
A retreatment window. Cigna treats a repeat GTR by the same office at the same tooth or site within 36 months as non-billable to the patient. Frequency rules are plan-specific but this pattern is common.
Documentation that supports the claim
The narrative should answer the reviewer’s questions before they are asked:
- The site and tooth number, with the defect described. Most policies are written around a vertical or intrabony defect, or a furcation with its grade.
- Pocket depth and bone loss, from periodontal charting and a current radiograph of the site, attached to the claim rather than sent after a records request. This clears a 5 mm threshold.
- The membrane type, stated as resorbable, so D4266 is defensible against D4267.
- The other materials placed, each named separately: graft material for the D4263 or D4264 line, biologic agent for D4265. Lines documented separately survive review separately.
- Prognosis. A tooth documented as maintainable answers the poor-or-hopeless-prognosis exclusion before it becomes a denial.
- The site count, with every membraned location itemized so the number of D4266 lines matches the operative note.
For how tooth numbers, quadrants, and the remarks field are filled in on the claim, see the ADA dental claim form guide.
FAQs
- What is the dental code for a resorbable membrane around a natural tooth?
- D4266, reported per site. It covers guided tissue regeneration at a periodontal defect around a natural tooth using a resorbable barrier, which breaks down on its own with no second surgery to remove it. It covers the barrier only: the flap, any osseous contouring, the bone graft, and any biologic material are each reported on their own lines.
- What's the difference between D4266 and D4267?
- Only the membrane material. D4266 is resorbable; D4267 is non-resorbable and has to be removed at a later visit. Both are per-site natural-tooth codes, so pick from the operative note, not the defect size. The removal code, D4286, is rarely a paid second line: Cigna's 2026 DPPO guidelines treat removal as part of the primary guided tissue regeneration service, and Northeast Delta Dental makes it not billable to the patient when the placing office removes it and denies it when a different office does. Check the plan before posting the line.
- Can I bill D4266 and a bone graft at the same site?
- Usually yes. The graft around a retained natural tooth is D4263 for the first site in a quadrant and D4264 for each additional site, D4266 is the barrier over it, and any biologic material is D4265. Each descriptor explicitly excludes the others, so they are billed separately. Whether a plan pays all of them at one site is plan-dependent, so verify before surgery and document each material in the note.
- Is D4266 billed per tooth, per site, or per quadrant?
- Per site. Two separate defects that each received a resorbable membrane are two D4266 lines, even in the same quadrant on the same day. The graft codes work differently: D4263 and D4264 sequence first and additional sites within a quadrant, but D4266 has no additional-site companion. Every membrane site is another D4266.
- Why did the carrier deny D4266?
- Usually the site or the threshold. Cigna's 2026 DPPO guidelines allow it when the pocket around a natural tooth is 5 mm or deeper with bone loss, and disallow it where the tooth is being extracted, where no natural tooth is present, at the same site as an apicoectomy or other periradicular surgery, at the same site and date as an implant placement, or at an existing implant. Cigna also treats a same-office repeat at the same tooth within 36 months as non-billable to the patient. Other carriers set their own thresholds, so read the plan before appealing.
- What's the difference between D4266, D6106, and D7956?
- The site. All three are resorbable-barrier guided tissue regeneration, which is why this is an easy miscode. D4266 is at a natural tooth, D6106 is at an implant (per implant), and D7956 is at an edentulous site with no tooth or implant. A fourth resorbable-barrier code, D3432, covers a membrane placed with periradicular surgery. Read the note for what the membrane was placed against before picking the code.
Related codes
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CDT codes are maintained by the American Dental Association. This page is an editorial billing guide, not the official ADA code descriptor. Verify current coverage policies with each carrier before submitting claims.