What is the difference between D4267 and D4266?

The barrier material, and nothing else. Both codes report guided tissue regeneration at a natural tooth, billed per site. D4266 is a resorbable barrier, usually collagen, that the body breaks down on its own. D4267 is a nonresorbable barrier, typically expanded PTFE, that stays put and has to be taken out surgically at a later visit. Pick the code from the operative note, not from the treatment plan, because a case planned for one membrane and delivered with the other has to be coded the way it was actually done.

Is the membrane removal included in D4267, or do I bill D4286?

D4286, removal of a nonresorbable barrier, is a real CDT code added in 2023, so the removal has a code of its own. Whether it produces a payment is a different question. Delta Dental Insurance Company states the removal fee is included in the D4267 fee at the same tooth site when the same dentist or office submits both, and is not billable to the patient within 36 months. Hawaii Dental Service says the same thing more bluntly: removal by the office that placed the barrier is not billable to the patient. What happens when a different office removes it varies, and this is where the Delta member companies split. HDS makes it a benefit once per 36 months per site. Delta Dental Insurance Company does not pay it either way, but on reconsideration with documentation the fee may shift to the patient. Northeast Delta Dental, a separate member company, denies it outright in that situation. So check which Delta entity is on the card, verify the specific plan, and plan on the removal being an adjustment when you placed the membrane yourself.

Can I bill D4267 and a bone graft on the same site?

Usually yes, and some carriers require it. D4267 reports the barrier only. It does not include the flap entry and closure, the wound debridement, the osseous contouring, or the bone replacement graft placed under the membrane. At a retained natural tooth the graft is D4263 for the first site in a quadrant and D4264 for each additional site. Hawaii Dental Service goes further and makes a bone graft a condition of benefiting the guided tissue regeneration at all. Bill the lines separately and document each procedure separately in the note.

Does D4267 apply around an implant?

Not since CDT 2023. The guided tissue regeneration codes were rebuilt that year and split by site family. D4266 and D4267 are the natural-tooth pair, D6106 and D6107 are the per-implant pair, and D7956 and D7957 are the edentulous-area pair. Within each pair the first code is the resorbable barrier and the second is the nonresorbable one. Billing D4267 around an implant misreports the site, and carriers that still carry the pre-2023 descriptor text in their manuals will often deny it as a specialized technique anyway.

Why was D4267 paid at the D4266 rate?

That is an alternate benefit, not a processing error. Hawaii Dental Service publishes it directly: for most plans, after reviewing the documentation, the D4266 allowance may be applied to a D4267 claim, and the patient is responsible for the difference if they elect the nonresorbable membrane. Other carriers apply the same logic, treating the resorbable barrier as the least expensive adequate alternative. Catch it at treatment planning and get financial consent in writing, because a downgrade explained after the fact reads to the patient as a surprise bill.

How many D4267 sites can I bill in one quadrant?

Clinically, one line per treated site. What gets paid is narrower. Hawaii Dental Service caps the guided tissue regeneration benefit at two sites per quadrant and denies additional sites to the maximum plan allowance. Northeast Delta Dental treats more than two of the periodontal surgical procedures within a single quadrant as highly unusual and reviews anything beyond that by report. Bill the sites you actually treated, itemize the tooth numbers, and expect a records request past two.

D4267 Dental Code: Nonresorbable Barrier GTR Billing Guide

D4267 is the CDT code for placing a barrier membrane that does not dissolve at a periodontal defect around a natural tooth, so bone and attachment can regrow underneath it, reported once per site.

The membrane has to come back out, and that second visit is where the money goes missing. CDT 2023 gave the removal its own code, D4286, which reads like a new line to bill. Delta Dental Insurance Company and Hawaii Dental Service both treat that removal as already paid for inside the original D4267 fee when your office placed the barrier, so the follow-up surgery is an adjustment, not a second claim. Name the member company rather than the brand, because Delta entities do not write this the same way as each other. The other frequent hit is the alternate benefit, where a plan pays D4267 at the resorbable D4266 allowance and leaves the patient the difference.

On this page

What D4267 covers
Which GTR code: site family first, then barrier
D4286 and the removal visit
When to bill D4267
Coverage and how carriers treat it
Documentation that supports the claim
What to get right in your PMS
FAQs

What D4267 covers

D4267 reports placing a barrier membrane that does not resorb at a periodontal defect around a natural tooth. The membrane sits between the gum flap and the root surface, holds space over the defect, and keeps fast-growing epithelial and connective tissue out long enough for bone, cementum, and periodontal ligament to regenerate underneath. It is reported per site, not per tooth and not per quadrant.

Nonresorbable means what it says. The material, usually expanded PTFE, stays in the body until someone takes it out. That second surgical visit is part of the treatment plan from day one, and it is the single biggest difference between this code and D4266.

The code reports the barrier work only. It does not cover:

The flap entry and closure that exposed the defect. That is D4240 or D4241 when the surgery is a flap procedure, or D4260 and D4261 when bone was reshaped.
The bone replacement graft placed under the membrane. At a retained natural tooth that is D4263 for the first site in a quadrant and D4264 for each additional site.
Biologic materials placed to aid regeneration, which is D4265. Reporting it is correct; getting paid for it alongside the membrane is plan-dependent, and HDS denies D4265 outright when it lands on the same day as D4266 or D4267 in the same surgical site.
Wound debridement and osseous contouring.

Each of those is its own line when it was actually performed and documented.

Which GTR code: site family first, then barrier

CDT 2023 rebuilt the guided tissue regeneration set into three site families, each with a resorbable and a nonresorbable member. Picking the barrier before you have settled the site family is how claims land on the wrong code, so answer the questions in this order.

Step one, where did the membrane go?

Natural tooth with periodontal attachment loss: the D4266 and D4267 pair.
Around a dental implant: D6106 and D6107.
Edentulous ridge, no tooth and no implant at the site: D7956 and D7957.

Step two, what was the membrane made of?

Resorbable, dissolves on its own: D4266, D6106, D7956.
Nonresorbable, has to be removed later: D4267, D6107, D7957.

There is also D3432, a resorbable barrier placed during periradicular surgery, which lives in the endodontic section because the surgery it accompanies is an apical procedure rather than a periodontal one.

D4286 and the removal visit

Before 2023 the nonresorbable code carried a parenthetical saying the removal was included in it. The ADA dropped that language and created D4286, removal of a nonresorbable barrier, on the reasoning that the removal happens at a separate visit and sometimes by a different dentist entirely. So the removal now has a code.

What it does not automatically have is a payment. The published carrier policies converge on the same-office case and scatter on the different-office one:

Delta Dental Insurance Company states the removal fee is included in the fee for D4267, D6107, and D7957 at the same tooth site when the same dentist or office submits both, and is not billable to the patient within 36 months. On reconsideration with supporting documentation, the fee may become the patient’s responsibility when a different office removed the barrier.
Northeast Delta Dental, a separate member company under the same brand, denies D4286 outright when a different office removes the barrier.
Hawaii Dental Service states that D4286 by the same office that placed the barrier is not billable to the patient, and that removal by a different office is a benefit once per 36 months per site.

The same-office pattern generalizes even where a plan has not published it. The office that placed the membrane was paid for a course of treatment that always included taking it back out. The office that inherits a patient with someone else’s membrane was not, and that is the claim with an argument behind it. Whether the argument works is the part that varies, so pull the policy for the specific entity on the card rather than for the brand. See D4286 for how the four published positions line up.

When to bill D4267

Confirm the site is a natural tooth. An implant site is D6107 and an edentulous ridge is D7957. This is the axis carriers check first.
Confirm the barrier is nonresorbable. From the operative note, not the treatment plan.
Count the sites. One line per treated site, with tooth numbers itemized. Two sites in a quadrant is the practical ceiling on most plans.
Bill the entry and the graft on their own lines. Flap or osseous surgery, bone graft, and biologic materials are separate codes, and omitting the graft can cost the GTR benefit outright on plans that require one.
Check the soft tissue graft conflict. HDS denies guided tissue regeneration billed in the same surgical area as the soft tissue graft codes, including D4273 and D4275. If both were done, the GTR line is the one that gets denied.
Plan the removal visit as an adjustment. Schedule it, code it D4286, and know before you send it whether it will pay.

Coverage and how carriers treat it

Guided tissue regeneration is a reviewed benefit almost everywhere, so treat coverage as something to establish before surgery rather than discover afterward.

The alternate benefit to D4266 is the most common surprise. Hawaii Dental Service publishes that most plans may apply the D4266 allowance to a D4267 claim after reviewing the documentation, with the patient responsible for the difference. This is a least-expensive-alternative provision, not a denial, and it is entirely plan-dependent, so read the group benefit language before quoting the case.

Clinical criteria are published and narrow. UnitedHealthcare’s dental policy on barrier membranes lists intrabony or infrabony vertical defects and Class II furcation involvements as indications, and excludes teeth with a poor or hopeless prognosis, osseous defects with fewer than two walls, crater defects, and lesions that are endodontic in origin. Other carriers write similar criteria. A case that does not fit one of the indicated defect types is a hard denial no matter how good the narrative is.

Some plans require a bone graft alongside it. HDS makes the graft a condition of benefiting the GTR. Where that rule applies, a membrane billed alone will not pay even when the surgery was appropriate.

Site limits are real. Two sites per quadrant is a common ceiling, and additional sites are reviewed by report or reduced to the plan allowance.

Documentation that supports the claim

A periapical radiograph showing the defect. The carrier is looking for the bony architecture, so the image has to show the depth and the walls.
Periodontal charting for the site. Probing depths and attachment levels around the treated tooth, dated close to the surgery.
A narrative naming the defect type and the membrane. Say whether it is an intrabony defect or a furcation, how many walls, and that the barrier placed was nonresorbable and will require removal.
The prognosis. Policies exclude hopeless teeth by name, so a note that the tooth is restorable and maintainable answers the objection before it is raised.
The tooth number for every site line. Per-site billing without itemized teeth is what triggers the records request at three or more sites.
On the D4286 claim, who placed the barrier and when. That is the fact the removal benefit turns on.

What to get right in your PMS

The menus differ across Open Dental, Dentrix, Eaglesoft, Curve, and Carestream, but the setup that prevents these denials is the same:

Label D4266 and D4267 by material, not by “GTR.” If both read as guided tissue regeneration in the pick list, someone will grab the first one. Put “resorbable” and “nonresorbable” in the description.
Carry all six site-family codes. D4266, D4267, D6106, D6107, D7956, and D7957 should all be in the list, or implant and edentulous cases quietly get billed on the natural-tooth codes.
Add D4286 and attach a note to it. The code exists, it should be entered so the clinical record is complete, and the fee schedule or adjustment rule attached to it should reflect that it usually pays nothing when you placed the barrier.
Set D4267 to prompt for a tooth number. Per-site codes that default to quadrant entry produce claims the carrier cannot match to the radiograph.
Flag the case at treatment planning. A D4267 plan should carry a note about the alternate-benefit risk and the removal visit so the financial conversation happens once, before surgery.

For how the tooth numbers, quadrant fields, and remarks are filled in on the claim itself, see the ADA dental claim form guide.

FAQs

What is the difference between D4267 and D4266?: The barrier material, and nothing else. Both codes report guided tissue regeneration at a natural tooth, billed per site. D4266 is a resorbable barrier, usually collagen, that the body breaks down on its own. D4267 is a nonresorbable barrier, typically expanded PTFE, that stays put and has to be taken out surgically at a later visit. Pick the code from the operative note, not from the treatment plan, because a case planned for one membrane and delivered with the other has to be coded the way it was actually done.
Is the membrane removal included in D4267, or do I bill D4286?: D4286, removal of a nonresorbable barrier, is a real CDT code added in 2023, so the removal has a code of its own. Whether it produces a payment is a different question. Delta Dental Insurance Company states the removal fee is included in the D4267 fee at the same tooth site when the same dentist or office submits both, and is not billable to the patient within 36 months. Hawaii Dental Service says the same thing more bluntly: removal by the office that placed the barrier is not billable to the patient. What happens when a different office removes it varies, and this is where the Delta member companies split. HDS makes it a benefit once per 36 months per site. Delta Dental Insurance Company does not pay it either way, but on reconsideration with documentation the fee may shift to the patient. Northeast Delta Dental, a separate member company, denies it outright in that situation. So check which Delta entity is on the card, verify the specific plan, and plan on the removal being an adjustment when you placed the membrane yourself.
Can I bill D4267 and a bone graft on the same site?: Usually yes, and some carriers require it. D4267 reports the barrier only. It does not include the flap entry and closure, the wound debridement, the osseous contouring, or the bone replacement graft placed under the membrane. At a retained natural tooth the graft is D4263 for the first site in a quadrant and D4264 for each additional site. Hawaii Dental Service goes further and makes a bone graft a condition of benefiting the guided tissue regeneration at all. Bill the lines separately and document each procedure separately in the note.
Does D4267 apply around an implant?: Not since CDT 2023. The guided tissue regeneration codes were rebuilt that year and split by site family. D4266 and D4267 are the natural-tooth pair, D6106 and D6107 are the per-implant pair, and D7956 and D7957 are the edentulous-area pair. Within each pair the first code is the resorbable barrier and the second is the nonresorbable one. Billing D4267 around an implant misreports the site, and carriers that still carry the pre-2023 descriptor text in their manuals will often deny it as a specialized technique anyway.
Why was D4267 paid at the D4266 rate?: That is an alternate benefit, not a processing error. Hawaii Dental Service publishes it directly: for most plans, after reviewing the documentation, the D4266 allowance may be applied to a D4267 claim, and the patient is responsible for the difference if they elect the nonresorbable membrane. Other carriers apply the same logic, treating the resorbable barrier as the least expensive adequate alternative. Catch it at treatment planning and get financial consent in writing, because a downgrade explained after the fact reads to the patient as a surprise bill.
How many D4267 sites can I bill in one quadrant?: Clinically, one line per treated site. What gets paid is narrower. Hawaii Dental Service caps the guided tissue regeneration benefit at two sites per quadrant and denies additional sites to the maximum plan allowance. Northeast Delta Dental treats more than two of the periodontal surgical procedures within a single quadrant as highly unusual and reviews anything beyond that by report. Bill the sites you actually treated, itemize the tooth numbers, and expect a records request past two.

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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.