Covered and Noncovered Services : Adjunctive General Services

Occlusal Guards

Occlusal guards are removable dental appliances designed to minimize the effects of bruxism (grinding of teeth) and other occlusal factors.

ForwardHealth covers occlusal guards with PA.

Coverage is limited to one occlusal guard per year.

Note: Occlusal guards are different from sports guards (procedure code D9941) and TMJ splints (procedure code D7880). ForwardHealth does not cover either sports guards or TMJ splints.

Allowable Procedure Code

Providers are required to indicate the fabrication and dispensing of occlusal guards using CDT procedure code D9944 (Occlusal guard — hard appliance, full arch), D9945 (Occlusal guard — soft appliance, full arch), or D9946 (Occlusal guard — hard appliance, partial arch), as appropriate, on all PA requests and claims.