2026 ADA Code Updates: What You Need to Know

In a recent Office Hour session, I walked through the ADA code changes coming in 2026, focusing on what’s new, what’s been clarified, and what teams should realistically expect from insurance reimbursement. While there are several additions and revisions, the underlying theme remains consistent: codes exist primarily for billing and documentation, not as a guarantee of insurance payment.

Key Principles to Keep in Mind

• Codes are created for billing and tracking, not reimbursement guarantees
  The presence of a code does not mean insurance will pay for it.
• The ADA code set is not all-inclusive
  Many services still require internal codes, especially elective or patient-paid services.
• Patient billing expectations should be set upfront
  Many of the new or revised codes should be treated as patient-paid unless proven otherwise.

Notable 2026 Code Changes

Saliva Testing: D0426
This new code replaces D0417 and D0418 and is designed for in-office collection and analysis of saliva samples. While clinically relevant, insurance interest remains minimal. This should be treated primarily as a patient-billed service.

Cracked Tooth Testing: D0461
This code covers testing for a cracked tooth, such as using a Tooth Slooth. It is unlikely to be reimbursed and will typically be viewed as part of an exam. Its primary value is documentation rather than billing.

Preventive Resin Restoration (PRR): D1352 Deleted
PRRs are no longer a separate code. One-surface posterior composites no longer distinguish between enamel-only and dentin involvement. The intent is simplification, and PRRs should now be coded as single-surface posterior composites.

Vaccine Administration: D1720
A single, simplified code replaces prior product-specific vaccine codes. Dental insurance is unlikely to reimburse, as vaccines are typically considered medical. This is best handled as patient billing.

Denture Duplication Codes
New maxillary and mandibular codes were added for denture duplication. Insurance expectations are low due to frequency limitations and the elective nature of duplication when a functional denture already exists.

Overdenture Clarifications
Overdenture codes (D5863–D5867) now clearly specify natural tooth–borne overdentures. Implant-supported prosthetics should continue to use implant-specific codes. This is largely a clarification rather than a workflow change.

Maxillofacial Prosthetic Code Expansion
Previously broad codes have been split to reflect:

• With vs without flange
• Maxillary vs mandibular
• Removable vs fixed
• Partial vs complete
• Implant-supported vs non-implant-supported

These changes primarily affect specialists and are intended to improve specificity and documentation.

Implant Maintenance for Removable Prosthetics: D6280
This new code applies when a full-arch removable implant-supported prosthesis is removed, cleaned, and reinserted, including abutment maintenance. Insurance uptake may be slow. Patient prepayment is recommended, with refunds issued if insurance pays.

Peri-Implantitis Scaling: D6049
This new code distinguishes peri-implantitis from mucositis (D6081). It applies to non-surgical debridement of a single implant and cannot be billed with prophy or full-mouth scaling codes. Insurance coverage remains uncertain.

Removal of Cement-Retained Implant Restorations: D6197
This code applies only to cement-retained implant restorations, not provisional or screw-retained restorations. Insurance will almost always deny this as integral to replacement. If billed, it should be patient-paid.

Photobiomodulation Therapy
New time-based codes were introduced for photobiomodulation. Insurance coverage is unlikely. Collect payment upfront.

Sedation Code Overhaul (Major Update)
Several important clarifications and changes were introduced:

• Nitrous oxide is now explicitly defined as a single-agent code only
• Non-IV sedation has been split into:
• Minimal enteral sedation
• Moderate enteral sedation
• IV sedation codes are now clearly labeled as moderate sedation
• New distinctions exist between moderate sedation and general anesthesia
• Time-based codes now use “any portion thereof,” allowing billing in 15-minute increments more flexibly

Insurance coverage remains limited, with exceptions primarily for IV sedation during wisdom tooth extractions. Non-covered service laws apply in most states, allowing offices to set fees accordingly.

Occlusal Guard Cleaning: D9936
A new code exists for cleaning and inspecting an occlusal guard, excluding adjustments. Insurance will generally consider this elective. Many offices may choose not to charge, but the option now exists.

Final Takeaway

The 2026 code updates emphasize clarity, specificity, and documentation more than expanded reimbursement. Most additions should be viewed as tools for accurate records and patient billing rather than new insurance revenue streams. As always, setting expectations upfront and understanding non-covered service laws remains essential.