D9248 is the CDT code for non-intravenous conscious sedation, commonly referred to as oral conscious sedation. It covers the administration of a sedative agent by oral, sublingual, or intranasal route (not IV) that produces a conscious sedation state. D9248 is distinct from D9230 (nitrous oxide, which is inhaled) and from D9239 (IV moderate sedation, which requires intravenous access and a higher level of monitoring).
Last updated June 2026 ยท Reviewed by the PracticeAlpha billing team
Get help with D9248 claims →Use D9248 when a sedative agent was administered by oral, sublingual, or intranasal route and the patient achieved a state of conscious sedation during the dental procedure. The patient must remain conscious and responsive to verbal stimulation.
D9248 is an adjunctive code. It must be billed alongside the primary operative or surgical procedure for which the sedation was provided. Common primary procedures include surgical extractions, implant placement, periodontal surgery, and similar cases where sedation is clinically indicated.
Most states require a specific sedation permit to administer oral conscious sedation. Confirm that the treating provider holds the applicable state permit before billing D9248. Some payers will request documentation of permit status when verifying claims.
Do NOT use D9248 for: Nitrous oxide inhalation (use D9230). IV sedation (use D9239 for intravenous moderate sedation). General anesthesia requiring intubation (use D9220 or D9221). Local anesthesia alone (use D9215). Anxiolysis where conscious sedation level was not achieved.
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Sedative agent taken orally, sublingually, or intranasally. Produces a deeper level of sedation than nitrous oxide. Patient remains conscious. No IV access required. State sedation permit required in most jurisdictions.
Inhaled gas via nasal mask. Provides mild anxiolysis and analgesia but typically produces less sedation depth than oral benzodiazepines. Onset and offset are rapid. Permit requirements are typically less stringent than for oral sedation.
Billing note: D9248 and D9230 can both be billed when both modalities were used in the same appointment. They are distinct services. Some payers allow both; others bundle one into the other. Verify payer policy before submitting both codes on the same claim.
Many dental plans cover sedation only for specific procedures considered sufficiently complex or time-intensive. Routine restorative work typically does not qualify. Surgical extractions, implant surgery, bone grafting, and similar procedures are more commonly covered. If the billed primary procedure is not on the payer's approved list for sedation, D9248 will be denied.
Plans that cover sedation typically require pre-authorization before the procedure. Submitting D9248 after the fact without a prior authorization number will result in a denial. Obtain pre-auth before the appointment, confirm it includes the sedation code, and document the authorization number in the patient record.
Payers expect documentation showing why conscious sedation was medically indicated. This includes the patient's anxiety level, relevant medical history (conditions that warrant sedation for safe treatment delivery), and notes explaining why the procedure could not be completed with local anesthesia alone. A claim without supporting documentation is vulnerable to denial on review.
Using D9239 (IV sedation) when oral sedation was administered, or D9248 when IV access was established, is a coding error. The clinical record must match the billed code. If the record shows IV access was placed, bill D9239. If only an oral agent was given without IV, bill D9248. Mismatches are identified on audit.
Record the agent administered (name, dose, route), time of administration, level of sedation achieved, vital signs monitoring notes, and patient response. This is the baseline documentation for D9248.
Note in the chart why sedation was indicated. Patient anxiety, medical complexity, the extent of the procedure, or inability to tolerate treatment with local anesthesia alone are common justifications. Be specific rather than generic.
A signed sedation consent form documenting that the patient was informed of the risks, benefits, and alternatives. Most state boards and payers expect this as part of the sedation record. Retain the signed consent in the chart.
Confirm and document that the treating provider holds the applicable state sedation permit for non-IV conscious sedation. Some payers require permit documentation when credentialing or reviewing claims.
If the patient's plan requires pre-auth for sedation (most do when they cover it), include the authorization number on the claim and in the patient account notes. Retain the written authorization.
Sedation claims denied or underpaid? We review the documentation, pre-auth, and code selection to fix the pattern.
Learn about our billing servicesD9248 is the CDT code for non-intravenous conscious sedation, commonly called oral conscious sedation. It covers the administration of a sedative agent by oral, sublingual, or intranasal route (not IV) that produces conscious sedation during a dental procedure. The patient remains conscious and responsive to verbal commands.
D9230 is nitrous oxide inhalation analgesia, delivered as a gas via nasal mask. D9248 is oral conscious sedation, typically an oral benzodiazepine or similar agent. They are distinct modalities and distinct codes. Both can appear on the same claim when both were used, subject to payer policy.
D9239 is intravenous moderate sedation, which requires IV access and IV drug administration. D9248 is non-IV conscious sedation, meaning no IV is placed and the agent is given orally or intranasally. The route of administration is the defining distinction. Using D9239 when no IV was placed is a coding error.
Coverage varies. Some plans cover D9248 for surgical procedures with medical necessity documentation and pre-authorization. Many plans exclude it entirely or have a separate, limited benefit for sedation. Verify the patient's specific plan and obtain pre-auth before the appointment.
Common reasons include: the primary procedure not meeting the payer's criteria for sedation coverage, missing pre-authorization, inadequate medical necessity documentation, and code mismatch between the actual route used and the billed code.
Yes. Oral sedation and local anesthesia are complementary services. Both can appear on the same claim. D9248 covers the sedation, and D9215 covers the local anesthetic injection for operative anesthesia. Note that D9215 is often bundled by most payers, while D9248 has better separate reimbursement potential when the procedure qualifies.
Search all 206 CDT codes in our dental coding guide.