D9950 Occlusion Analysis — Mounted Case Template

What should the D9950 chart note include?

Pick your PMS to format the placeholders, then copy.

PMS format

[Prompt:"name"]

Occlusion analysis (mounted case).

RMH: Medical history reviewed/updates

Indication: Indication/diagnosis
Reason for analysis: Reason for analysis
CC: Chief complaint

Records Obtained:
Facebow transfer: Facebow transfer
Centric relation record: Centric relation record
Protrusive record.
Lateral records (R/L).
Impressions/scans: Upper/lower records.
Photographs: Intraoral/extraoral photos taken.

Articulator Mounting:
Articulator type: Articulator type
Condylar settings: Condylar settings
Incisal guidance: Incisal guidance

Analysis Findings:

Centric Relation:
CR to CO slide: CR to CO slide
First point of contact in CR: #Tooth number(s)
Bilateral simultaneous contacts: Bilateral simultaneous contacts

Vertical Dimension:
VDO assessment: VDO assessment
Freeway space: Freeway space

Anterior Guidance:
Overbite: Overbite
Overjet: Overjet
Incisal guidance angle: Incisal guidance angle

Lateral Excursions:
Right working: Right working
Right non-working interferences: Right non-working interferences
Left working: Left working
Left non-working interferences: Left non-working interferences

Protrusive: Protrusive
Anterior guidance: Anterior guidance
Posterior interferences: Posterior interferences

Occlusal Plane:
Curve of Spee: Curve of Spee
Curve of Wilson: Curve of Wilson

Dx: Diagnosis

Treatment recommendations: Recommendations
Patient discussion: Findings/recommendations reviewed; questions answered

Documentation: Documentation
Mounted models retained.
Photos of mounted case.
Report generated.

NV: Next visit

What do the D9950 placeholders mean?

What each placeholder represents.

Medical history reviewed/updates
Confirm RMH reviewed today and note relevant findings — bruxism medications, GERD, sleep-disordered breathing, neuromuscular conditions, history of trauma, or new diagnoses since last visit.
Indication/diagnosis
The specific clinical reason a mounted occlusal analysis is required (e.g., 'pre-restorative full-mouth rehabilitation with planned VDO change,' 'TMD workup to assess occlusal contribution,' 'evaluation of recurrent crown fracture'). Generic 'for treatment planning' fails review.
Reason for analysis
The narrative explanation of what specifically must be evaluated on the articulator that cannot be evaluated in the mouth (CR-CO discrepancy, anterior guidance scheme, posterior interferences, occlusal plane, curve of Spee/Wilson). This is the heart of the 'by report' justification.
Chief complaint
Patient's reason for the visit in their own words. Even on a planned referral or records workup, the patient's complaint is part of the documentation.
Facebow transfer
Facebow system used (e.g., Kois, Panadent, Whip Mix, Denar) and any relevant landmarks — typically anterior reference point, axis pins, and orbital pointer.
Centric relation record
CR technique used — bimanual manipulation, leaf gauge with deprogramming, anterior deprogrammer / Lucia jig, Best-Bite, or anterior jig — plus any verification (repeat record, deprogramming time, leaf-gauge confirmation).
Upper/lower records
Impressions or digital scans used to make the working casts (PVS, alginate, Trios / iTero / Medit / Primescan). Note material or scanner.
Intraoral/extraoral photos taken
Photo series collected for the records workup — intraoral, extraoral, smile, profile, and photos of the mounted case on the articulator (right / left / frontal).
Articulator type
Articulator brand and model (Panadent, Whip Mix 8500/2240, Denar Mark II, Kois, SAM, Stratos). The semi-adjustable / fully adjustable distinction is relevant for complex cases.
Condylar settings
Programmed condylar inclination (degrees) calculated from the protrusive record, plus immediate side shift, progressive side shift, and Bennett angle as applicable. Bilateral values.
Incisal guidance
Whether a custom incisal table was fabricated from the patient's existing anterior guidance or a standard guide pin / incisal table was used. Custom is preferred for guidance-dependent rehabilitation.
CR to CO slide
Direction (anterior, posterior, lateral) and magnitude in mm of the slide from CR to MIP / centric occlusion. Document both anteroposterior and lateral components if present.
Tooth number(s)
Tooth or teeth contacting first when the mandible is in centric relation (universal numbering). Often a deflective contact that forces the mandible into MIP.
Bilateral simultaneous contacts
Whether bilateral simultaneous posterior contacts are present in CR at the desired vertical dimension — yes, no, or limited to specific teeth.
VDO assessment
Vertical dimension of occlusion findings — adequate, reduced (attritional or congenital), or excessive. Note phonetic or esthetic concerns relevant to a planned VDO change.
Freeway space
Measured freeway space (rest VDO minus occlusal VDO) in mm. Normal is 2-4 mm; reduced or excessive freeway space informs VDO planning.
Overbite
Vertical overlap of the maxillary anterior over the mandibular anterior teeth in mm or percentage of mandibular incisor coverage.
Overjet
Horizontal distance between maxillary and mandibular incisor edges in mm.
Incisal guidance angle
Anterior guidance angle in degrees. Note presence or absence of canine guidance, group function, or balanced occlusion.
Right working
Right lateral excursion working-side contacts — canine guidance, group function (which teeth), or balanced.
Right non-working interferences
Non-working (balancing) interferences during right lateral excursion, by tooth (e.g., '#2 distolingual,' '#15 mesiolingual').
Left working
Left lateral excursion working-side contacts — canine guidance, group function (which teeth), or balanced.
Left non-working interferences
Non-working (balancing) interferences during left lateral excursion, by tooth.
Protrusive
Behavior of the dentition in protrusive movement — anterior guidance present or absent, posterior contacts that disclude or interfere.
Anterior guidance
Summary of anterior guidance — adequate, shallow, worn, or absent. Relevant when the rehabilitation plan involves rebuilding anterior coupling.
Posterior interferences
Posterior teeth that interfere during excursive or protrusive movements, by tooth and movement.
Curve of Spee
Anteroposterior curvature of the occlusal plane — normal, flattened, exaggerated. Note any plane discrepancy that affects restorative planning.
Curve of Wilson
Mediolateral curvature of the posterior occlusal plane — normal, flattened, reverse curve. Relevant for posterior restoration planning.
Diagnosis
Occlusal diagnosis derived from the analysis findings — specific (CR-CO slide direction and magnitude, deflective contacts by tooth, guidance scheme, plane discrepancies). This is the diagnostic conclusion that drives the treatment plan.
Recommendations
Sequenced treatment plan that flows directly from the mounted-case findings — splint / deprogrammer therapy, equilibration plan, diagnostic wax-up, provisional phase, definitive restorative phase.
Findings/recommendations reviewed; questions answered
Confirmation that the mounted-case findings and the proposed treatment plan were reviewed with the patient, that alternatives were discussed, and that questions were answered before the patient consented to the plan.
Documentation
Note that a written occlusal analysis report has been generated, signed, and filed in the patient's chart. The written report is the deliverable that supports the 'by report' code on records review.
Next visit
What is scheduled next — diagnostic wax-up appointment, splint or guard delivery, provisional phase, or follow-up consultation.

What documentation is required for D9950?

D9950 is "by report" on virtually every plan that recognizes it. The narrative must establish (1) clinical necessity for a mounted analysis, (2) the records actually obtained, (3) the articulator and mounting technique, and (4) the analysis findings that drive treatment. Templated default-normal entries fail review.

Medical and dental history reviewed — pertinent systemic findings (bruxism medications, GERD, sleep-disordered breathing, neuromuscular disorders, history of trauma) and dental history relevant to the occlusal workup (prior ortho, prior equilibration, prior splint therapy, history of fractures or restoration failures suggestive of occlusal overload)
Indication / clinical necessity — the specific reason a mounted analysis is required rather than an in-mouth evaluation. Examples: "planning full-mouth rehabilitation with VDO change," "TMD workup to assess occlusal contribution," "evaluating CR-CO discrepancy before extensive restorative." Generic language like "for treatment planning" reads as fishing and gets denied
Chief complaint — the patient's words, even on a planned referral workup ("my bite feels off after the new crowns," "jaw pain when I chew," "I want to fix all my teeth")
Records obtained — facebow transfer (which facebow system used — Kois, Panadent, Whip Mix, Denar), centric relation record (technique — bimanual manipulation, leaf gauge, anterior deprogrammer / Lucia jig, Best-Bite, anterior jig), protrusive interocclusal record, right and left lateral interocclusal records, full-arch upper and lower impressions or intraoral scans, and intraoral / extraoral photographs of the existing dentition
Articulator and mounting — articulator brand and model (Panadent, Whip Mip 8500/2240, Denar Mark II, Kois, SAM, Stratos), condylar inclination settings (degrees) calculated from the patient's protrusive record, immediate side shift / progressive side shift / Bennett angle, and incisal guidance (custom incisal table or standard guide pin) when applicable
CR record verification — explicitly note that the CR record was verified (deprogrammed patient, repeat record, leaf gauge confirmation) before mounting. CR record reliability is the most common audit point and the most common reason analysis findings don't translate to the mouth
Analysis findings — the structured findings that justify the code. Each of the following should be addressed in the report:
- Centric relation findings — first point of contact in CR, CR-to-CO slide direction and magnitude (mm), bilateral simultaneous contact at desired VDO
- Vertical dimension — VDO assessment, freeway space, phonetic and esthetic considerations if a VDO change is planned
- Anterior guidance — overbite, overjet, incisal guidance angle, presence/absence of canine guidance, group function, or balanced occlusion
- Lateral excursions — working-side contacts (canine guidance vs group function), non-working (balancing) interferences by tooth
- Protrusive — anterior guidance during protrusion, posterior interferences
- Occlusal plane — curve of Spee, curve of Wilson, plane discrepancies relevant to planned restoration
Diagnosis — occlusal diagnosis derived from the analysis (e.g., "CR-CO slide 2 mm anterior with first point of contact #2-#31; non-working interferences #2 and #15 in left lateral excursion; loss of anterior guidance with posterior interferences in protrusion")
Treatment recommendations — sequenced plan that flows from the findings (e.g., equilibration on the cast first, then deprogrammer / splint, then prosthetic phase). The clinical necessity narrative is hollow without recommendations that obviously depend on the mounted analysis
Patient discussion — findings reviewed with the patient, alternatives discussed, questions answered
Records retained — explicit notation that mounted casts are retained in the patient's records (state board records-retention applies) and that photos of the mounted case have been taken; a separate written occlusal analysis report is generated. Carriers requesting documentation will ask for the report and photos of the mounted case
Provider signature — the diagnosing/planning dentist, with operator initials for any auxiliary who took records or poured/mounted models

The deliverable is a written occlusal analysis report kept with the chart. Practices that bill D9950 without producing a written report — relying on a one-line "occlusion analysis performed" entry — lose the audit every time. The report does not have to be lengthy; it does have to be present, dated, and signed.

Why does D9950 get denied?

Common reasons D9950 is denied, downcoded, or recouped:

Plan does not cover D9950 as a benefit — by far the most common denial; the service is non-covered rather than denied for clinical reasons. Patient is responsible (subject to written financial agreement and state balance-billing rules)
Records were unmounted — submitted documentation shows impressions, scans, or stone models without facebow / CR-mounted casts. Carriers downgrade or recharacterize as D0470 (study models)
Missing facebow or CR record — chart and report don't reference a facebow transfer and a centric relation interocclusal record. The analysis cannot be a true mounted-case analysis without these inputs
No written occlusal analysis report on file — chart contains a single line ("occlusion analysis performed") but no separate report describing the findings. Records request returns no usable narrative; carrier denies for insufficient documentation
Clinical necessity not established — the indication / reason for analysis is generic ("for treatment planning") rather than specific (TMD workup, full-mouth rehab with VDO change, equilibration planning). "By report" claims are evaluated on the strength of the narrative
Same-DOS conflict with D0470 — submitting D0470 (study models) and D9950 (mounted analysis) on the same date without distinguishing the two services. Many plans pay one or the other, not both, when documentation doesn't separate them
Submitted alongside D9952 (complete occlusal adjustment) without separate dates of service — D9952 is the in-mouth equilibration; performing it the same day as the planning analysis without distinct documentation looks like double-billing
Repeat D9950 within carrier lookback window — a second D9950 on the same patient soon after a first, without documented change in circumstances, is denied as duplicative
Templated / default-normal findings — every parameter listed as "WNL" with no patient-specific values (CR-CO slide magnitude, interference teeth, condylar settings) reads as fabricated and is a recurring audit pattern across adjunctive codes

What do practices ask about D9950?

What's the difference between D9950 and D0470?+

D0470 is unmounted diagnostic casts or study models — impressions or digital scans rendered as casts and reviewed extraorally. D9950 is mounted study casts on an articulator with a facebow transfer, centric relation record, and a written occlusal analysis. The presence of the facebow, the CR record, the articulator mounting, and the written analysis report is what differentiates D9950 from D0470. A practice billing D9950 without any of those elements will be downgraded to D0470 on records review.

Is D9950 typically covered by insurance?+

Coverage is plan-specific and many PPO and Medicaid plans do not cover D9950 at all — it is treated as a non-covered planning service. Where it is covered, it is almost always 'by report,' meaning the carrier requires a written narrative establishing clinical necessity and a copy of the analysis report before payment. Because of the high non-coverage rate and the heavy documentation burden, most billing experts recommend a pre-determination before performing the service so the practice and the patient know what to expect financially.

Can I bill D9950 and D0470 on the same date of service?+

It depends on the plan and the documentation. Some carriers consider the unmounted casts inclusive in the mounted-case analysis and pay only one of the two. Others permit both when the chart distinguishes the unmounted study models (e.g., for ortho or surgical workup) from the mounted occlusal analysis. The safest approach is to bill D9950 alone for a mounted-case workup, document the impressions / scans as part of the records collection, and reserve D0470 for situations where the unmounted models serve a separate purpose. Confirm with the carrier in advance.

What records are required to support a D9950 claim?+

Carriers typically expect: a facebow transfer, a centric relation interocclusal record, protrusive and lateral interocclusal records, full-arch impressions or digital scans, intraoral and extraoral photographs, photos of the mounted case on the articulator, and a written occlusal analysis report covering CR-CO slide, anterior guidance, lateral excursions, protrusive, occlusal plane, curves of Spee and Wilson, and treatment recommendations. The written report is the deliverable that distinguishes a real mounted analysis from a one-line chart entry, and is the most common item requested on records review.

Can a hygienist or assistant collect the records for a D9950?+

Auxiliaries can take impressions or scans, expose photographs, and pour and trim models within their scope of practice. The facebow transfer, the centric relation record (especially when bimanual manipulation or deprogrammer technique is used), the articulator mounting verification, the analysis itself, and the written report should be performed and signed by the dentist. State scope-of-practice rules vary; check the state dental practice act before delegating.

Is D9950 the same as TMD evaluation?+

No — they are different services that are sometimes performed together. TMD evaluation is the cognitive workup of the temporomandibular joint, masticatory muscles, and orofacial pain — typically reported under D0160 (detailed and extensive evaluation, by report) or as part of a comprehensive evaluation. D9950 is the mounted-case occlusal analysis. A patient with suspected occlusal contribution to TMD may legitimately have both: D0160 for the cognitive workup and D9950 for the mounted analysis. Each requires its own narrative.

How is D9950 different from D9952?+

D9950 is the planning service performed on mounted study casts before any in-mouth equilibration. D9952 is the actual complete occlusal adjustment of the dentition performed in the mouth, after planning. The typical workflow is D9950 (mounted analysis to plan adjustments) → deprogrammer or splint therapy if indicated to confirm CR → D9952 (in-mouth complete equilibration). They report different services on different dates and are not duplicative when both are clinically warranted.

D0150·Diagnostic