The American Dental Association (ADA) introduced significant updates to the Current Dental Terminology (CDT) code set in 2026. These changes reflect an industry shift toward advanced technology and a more nuanced approach to patient care. However, if these new codes aren’t monitored, it could lead to improper payments.
What to Look For
The 2026 update includes 31 new codes, 14 revisions, and 6 deletions. These changes come with some risk of improper billing by providers. Here are two examples involving new codes and potentially new schemes, however, as a reminder check your respective plans and reimbursement policies:
D0461, Cracked tooth testing: Some providers may attempt to bill separately during a routine comprehensive evaluation (D0150 or D0160). This code is typically billed when a patient presents with specific symptoms rather than as a routine screening. Watch for this code being added to every routine visit. Also watch for the number of units being billed. This diagnostic procedure involves evaluating one or more teeth—including contralateral comparisons.
D0426, Point-of-Care Saliva Analysis: This code is defined as the collection, preparation, and analysis of saliva sample – point-of-care. Watch for potential double billing with dental code D0417 (collection and preparation of saliva sample for laboratory analysis). A provider should not bill for an in-office analysis while also sending a sample to a lab for the same diagnostic purpose.
HCFS Has You Covered
Combating improper dental billing requires a multi-layered approach. Payers need to leverage advanced data analytics to identify suspicious billing patterns and inappropriate services. If you’re using the HCFSPlatform™, we’ve got you covered. Our Artificial Intelligence (AI) models can identify spikes and other anomalous billing patterns. We can also help identify new provider billing patterns to potentially catch any inappropriate billing quickly. Some examples of our alerts for new 2026 Dental Codes include:
[4128-20] – OUTLIER, COMPREHENSIVE ORAL EVALUATION AND SALIVA TESTING (PEER COMPARISON)
[4128-30] – OUTLIER, COMPREHENSIVE ORAL EVALUATION AND SALIVA TESTING (INDIVIDUAL TIER)
[4129-01] – INAPPROPRIATE NUMBER OF UNITS, TESTING FOR CRACKED TOOTH
If you’re not using the HCFSPlatform™ and you’re interested in knowing more, email us at [email protected].
If you have questions or comments, you may email us at [email protected].
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