D9946 is the CDT code for a custom hard occlusal guard that covers only part of an arch, such as an anterior deprogrammer.
- When to use: A hard guard covers only part of the arch, including NTI-style devices and partial-arch guards with a soft liner.
- When not to use: A hard full-arch guard is D9944, a soft full-arch guard is D9945, a soft partial-arch guard goes on D9999, and a TMD orthotic is D7880.
- Billing note: Some plans that cover full-arch guards exclude partial-arch ones, so predetermine D9946 by code and confirm the span on the lab slip.
What D9946 covers
D9946 reports a custom-fabricated hard occlusal guard that covers only part of an arch. The most familiar example is an anterior deprogrammer or NTI-style device, a small rigid appliance over the front teeth that keeps the back teeth from meeting. Partial posterior coverage falls here too: the code is about span, not tooth position.
Like the full-arch guard codes, it includes the impression or scan, the lab fabrication, and the delivery and fit appointment. It is a protective appliance for a parafunctional habit, and the code set separates it from:
- Sleep apnea or anti-snoring appliances: D9947 for fabrication and placement, with D9948 and D9949 for adjustment and repair.
- Appliances made to treat a diagnosed temporomandibular disorder: generally D7880, the occlusal orthotic device reported by report, which many plans route through a separate TMD benefit or through medical.
- Athletic mouthguards: D9941.
- Reshaping the natural bite: an occlusal adjustment, D9951 or D9952.
The guard versus TMD orthotic line has payment consequences. UnitedHealthcare’s dental clinical policy on occlusal guards, effective January 1 2026, indicates guards for bruxism or clenching that is wearing or fracturing teeth and restorations, and for protecting natural teeth against opposing porcelain or ceramic. The same policy says they are not indicated for temporomandibular disorders, headaches or other craniofacial pain, orthodontic tooth movement, or sports.
Hard or soft, full arch or partial arch
Three codes replaced the old by-report guard code, D9940, in the CDT 2019 update, splitting it along two axes.
| Material | Full arch | Partial arch |
|---|---|---|
| Hard | D9944 | D9946 |
| Soft | D9945 | no code |
Two common misbills follow from that grid.
A combination hard-and-soft guard is a hard guard. Published ADA guidance says an appliance with both hard and soft components is reported as hard, because the material meeting the occlusal surface determines the therapeutic effect. A soft liner adds comfort without changing what the appliance is. A laminate full-arch guard is D9944, a laminate partial-arch guard is D9946, and neither is D9945.
There is no soft partial-arch code. D9946 does not fill the empty cell, and a material note on the claim does not turn a hard-appliance code into a soft one. A soft partial appliance goes out on the unspecified adjunctive procedure code, D9999, with full documentation. Call the carrier before submitting.
Picking the code at the delivery appointment
The clinical decision is the dentist’s. The code comes from the lab slip and the delivery note, in this order:
- Is it a guard? Protecting teeth from grinding and clenching keeps you in D9944 to D9946. A diagnosed TMD is D7880, sleep apnea is D9947, and sports is D9941.
- Does the biting surface meet hard material? If yes, it is a hard code even with a soft component. If the whole appliance is soft, it is D9945, which only exists as full arch.
- How much of the arch does it cover? Full arch is D9944. Anything less, including an anterior-only deprogrammer or NTI-type device, is D9946.
- Which arch is it on? The code does not say maxillary or mandibular, but published guard policies require arch identification and frequency limits are commonly written per arch.
- Is this a new appliance or work on an existing one? Repairing or relining an existing guard is D9942 and adjusting one is D9943. D9936, new for CDT 2026, reports cleaning and inspecting an existing guard per appliance, though early carrier treatment is mostly non-covered or bundled into the original guard fee.
Coverage and how carriers treat partial-arch guards
Guard coverage is plan-dependent, and D9946 sits at the weak end. Verify each of these patterns against the specific contract:
Plans that exclude occlusal guards entirely. A significant share treat guards as cosmetic, non-essential, or appliances for a parafunctional habit, and exclude every code in the family.
Plans that cover guards but exclude partial arch. This is the pattern specific to D9946. Utah’s PEHP 2026 CDT code guide lists partial-arch occlusal guards among its exclusions and marks D9946 not covered, while covering D9944 and D9945 at one per arch in a seven-year period. An eligibility call that answers “occlusal guards are covered” will not reveal that exclusion.
Plans that require a documented bruxism diagnosis. PEHP conditions its guard benefit on documented severe sleep bruxism and asks for a narrative describing clinical signs plus a summary of radiographic findings showing the wear. The chart has to show damage, not just a complaint.
Long frequency limits. Three to five years is the interval most offices quote, but PEHP’s seven-year-per-arch limit shows longer windows exist. Repairs and adjustments are often bundled into the original guard fee for a period after delivery. PEHP bundles them for the first six months, then allows one adjustment and one repair for the life of the appliance; look for that shape even where the numbers differ.
Predetermine D9946 by code, not “occlusal guards” generally, get the answer in writing, and have the financial agreement signed before the impression. Decide in advance how the office posts a D9946 that denies as excluded, and write it in the collections notes so the answer does not depend on who is working the account.
Documentation that supports the claim
Build the claim around the two facts the code cannot carry, then medical necessity:
- Arch identification. Maxillary or mandibular. Published guard policies require it and count frequency limits against it.
- The span. A line confirming the appliance covers only part of the arch, and which teeth. This separates the claim from a D9944 in an audit.
- The bruxism complaint and clinical findings. Wear facets with tooth numbers, attrition, fractured restorations with no traumatic cause, patient-reported or partner-reported nighttime grinding. Describe the damage specifically, not with a template sentence.
- A summary of radiographic findings. Some policies ask for it in the narrative and accept the description without images. Say what the bitewings or panoramic show.
- The delivery date. The date of service is the delivery appointment, not the impression, and it starts the clock for any later repair, reline, or adjustment.
Also record the material and the reason for a partial-arch design. Anterior-only appliances carry a documented risk of unintended occlusal change when worn unsupervised, since uncovered posterior teeth can erupt over time, so the wear instructions and follow-up schedule belong in the chart. They are also what a records request will look for.
Practice software setup
- Label guard codes by material and span. If D9944 and D9946 both read as “hard night guard” in a pick list, partial-arch appliances get billed as full arch. Put “full arch” and “partial arch” in the descriptions.
- Make arch a required field on guard procedures, so claims do not pend for missing information.
- Keep D9940 out of the fee schedule. It still resurfaces from old treatment-plan templates and rejects as discontinued.
- Set up D9942, D9943, and D9936. Offices without the repair, adjustment, and cleaning codes tend to leave that work unbilled or bill a whole new guard.
For how the arch, tooth numbers, and remarks field are filled in on the claim, see the ADA dental claim form guide.
FAQs
- What is the dental code for an NTI or anterior deprogrammer?
- D9946. An NTI-style device or anterior deprogrammer is a hard appliance covering only part of the arch, usually the front teeth, so it goes on the partial-arch guard code rather than D9944 (hard full arch) or D9945 (soft full arch). Coverage on D9946 is noticeably worse than on the full-arch codes, so verify the specific code before fabricating.
- What's the difference between D9946 and D9944?
- Arch coverage, not material. Both are hard occlusal guards: D9944 covers the full arch and D9946 covers only part of it, as an anterior deprogrammer or NTI-type device does. A chart note that only says hard acrylic does not tell you which to bill, so read the lab slip or delivery note for the span.
- The guard is hard on the biting surface with a soft liner. Which code?
- A hard code. Published ADA guidance reports a guard combining hard and soft components as a hard appliance, because the material meeting the occlusal surface defines it. A full-arch laminate guard is D9944 and a partial-arch one is D9946. The soft liner adds comfort; it does not make it a D9945.
- Is there a soft partial-arch guard code?
- No. The code set has hard full arch (D9944), soft full arch (D9945), and hard partial arch (D9946), with no soft partial-arch entry. D9946 would misreport the material. Report a soft partial appliance on D9999, the unspecified adjunctive procedure code, with full documentation, and confirm the approach with the carrier first.
- Why did the carrier deny D9946 as not a covered benefit?
- Usually plan language, not a coding error. Some plans exclude occlusal guards outright. Others cover them but exclude partial-arch appliances, so D9946 can deny for a patient on a plan that paid a full-arch guard for someone else. PEHP's 2026 guide lists partial-arch occlusal guards among its exclusions and marks D9946 not covered while D9944 and D9945 are payable. A predetermination on the exact code is the only reliable way to know.
- How often will a plan replace an occlusal guard?
- Plan-dependent, and usually every three to five years or longer. PEHP allows one per arch in a seven-year period on the full-arch codes. Repairs, relines, and adjustments are usually bundled into the original guard fee for several months after delivery and allowed sparingly after that. Verify the interval before quoting a replacement.
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.