Effective with date of service Jan. 1, 2026, the following dental procedure codes descriptions were revised for the NC Medicaid Dental Program. Clinical Coverage Policy 4A, Dental Services will be updated to reflect these changes.
| Procedure Code | Description |
|---|---|
| D9222 | Administration of deep sedation/general anesthesia – first 15-minute increment, or any portion thereof *Includes the co-administration of nitrous oxide *Not allowed on the same date of service D9230 |
| D9223 | Administration of deep sedation/general anesthesia – each subsequent 15-minute increment, or any portion thereof *Includes the co-administration of nitrous oxide *Not allowed on the same date of service D9230 |
| D9230 | Administration of nitrous oxide *Allowed when nitrous oxide is administrated as a single agent *Not allowed on the same date of service as D9222, D9223, D9239, or D9243 |
| D9239 | Administration of moderate sedation – intravenous – first 15-minute increment, or any portion thereof *Includes the co-administration of nitrous oxide *Not allowed on the same date of service D9230 |
| D9243 | Administration of moderate sedation – intravenous – each subsequent 15-minute increment, or any portion thereof *Includes the co-administration of nitrous oxide *Not allowed on the same date of service D9230 |
As a result of these procedure code revisions, the NC Medicaid Dental Program implemented a new edit that will not allow nitrous oxide (D9230) on the same dates of service as other covered anesthesia and sedation services (D9222, D9223, D9239, or D9243).
Providers are reminded to bill their usual and customary charges rather than the Medicaid rate. For coverage criteria and additional billing guidelines, please refer to Clinical Coverage Policy 4A, Dental Services on the NC Medicaid Program Specific Clinical Coverage Policies webpage.
Contact
NC Medicaid Dental Program
919-855-4280