The short version
# D9230 Dental Code: Administration of Nitrous Oxide
D9230 reports administration of nitrous oxide as a single agent. CDT 2026 revised the entry to separate this service from minimal or moderate sedation that uses another drug. Nitrous can still be documented when used with another sedation procedure, but it isn't separately reported in that setting.
- Bill D9230 when nitrous oxide is administered as the single sedation or anxiolysis agent.
- Don't bill D9230 separately when nitrous is co-administered as part of a CDT minimal or moderate sedation procedure.
- D9222 and D9223 report deep sedation or general anesthesia in timed increments, not routine single-agent nitrous.
- The note should include patient assessment, consent, concentrations or flow, administration time, monitoring, response, oxygen recovery, and discharge status.
- Coverage varies widely. A clinically appropriate D9230 service can still be excluded or limited by age and treatment setting.
- In a worked claim, a $125 charge becomes an $85 allowable. The plan pays $68 at 80%, the patient owes $17, and the office adjusts $40.
What is D9230?
D9230 is the CDT procedure for administering nitrous oxide by itself.
| Fact | D9230 |
|---|---|
| CDT category | Adjunctive general services, anesthesia |
| Agent | Nitrous oxide |
| Reporting unit | One administration, not a timed increment |
| 2026 boundary | Nitrous used as a single agent |
| Public fee reference | Oregon Medicaid: $42.80 effective January 1, 2025 |
When do you bill D9230?
Use D9230 after safe single-agent nitrous administration.
- Review medical history, airway, nasal breathing, and relevant contraindications.
- Document oxygen and nitrous settings plus start and stop times.
- Monitor the patient and record response or adverse events.
- Give oxygen after discontinuation and document recovery and discharge.
D9230 vs D9222 and D9223
Agent combination, achieved level, provider role, and time decide the anesthesia code.
| D9230 | Minimal or moderate sedation code | D9222 and D9223 | |
|---|---|---|---|
| Service | Nitrous oxide as single agent | Another sedative drug, with nitrous included if co-administered | Deep sedation or general anesthesia |
| Time increments | No | Depends on route and current code | First and subsequent 15-minute increments |
| Nitrous separately billed | Yes, when it's the single agent | No | No when part of the anesthesia service |
| Main record | Nitrous administration and response | Drug, route, dose, level, monitoring | Continuous anesthesia time and monitoring |
What does insurance actually do with D9230?
Plans may limit nitrous by age, procedure, diagnosis, behavior need, or program. Verify the exact member benefit.
- Office fee: $125
- Contracted allowable: $85
- Contractual adjustment: $40
- Plan payment at 80%: $68
- Patient balance: $17
Why does D9230 get denied?
- The plan doesn't cover nitrous for the patient's age or treatment.
- Another sedation drug was administered, so a different 2026 code applies.
- D9230 is billed separately from a sedation service that already includes nitrous.
- The record doesn't include indication, agent details, monitoring, or recovery.
What documentation gets D9230 paid?
- Record the indication and relevant medical assessment.
- State that nitrous oxide was the single sedation agent.
- Record oxygen and nitrous settings, duration, and monitoring.
- Document recovery oxygen and discharge condition.
- Save the authorization and plan-specific coverage response.
Common questions about D9230
Did D9230 change for CDT 2026?
Yes. For CDT 2026, the ADA clarified D9230 around nitrous oxide used as the single sedation or anxiolysis agent. When nitrous is co-administered with a reported minimal or moderate sedation procedure, it's included in that service and isn't submitted again as D9230.
Is D9230 billed by time?
No. D9230 reports one administration of single-agent nitrous oxide and isn't a 15-minute increment code. Record start and stop times, concentrations or flow, monitoring, response, oxygen recovery, and discharge status for the clinical safety record even though claim units aren't calculated from minutes.
Can D9230 be billed with oral sedation?
The ADA says nitrous co-administered with a minimal or moderate sedation procedure is included and shouldn't be reported separately. Document the nitrous, oral drug, dose, timing, achieved sedation level, monitoring, recovery, and discharge in the anesthesia note, then report the sedation service that matches the care delivered.
Does D9230 include the dental treatment?
No. D9230 reports the administration of nitrous oxide as a single agent. The examination, preventive, restorative, surgical, or other dental treatment remains a separate procedure when delivered and supported. Document the nitrous service and dental work distinctly, then apply the member's coverage and same-day rules.
Match the agent record to the claim
Before filing, confirm single-agent nitrous, monitoring, recovery, and discharge.
Sources
- ADA, CDT Coding Guide for Nitrous Oxide, Sedation and General Anesthesia
- ADA News, revised CDT codes for 2026
- ADA, March 2025 Code Maintenance Committee decisions
- AAPD, Use of Nitrous Oxide best practice
- AAPD, pediatric sedation monitoring guideline
- AAPD, nitrous oxide occupational safety policy
- Oregon Medicaid, June 2025 fee schedule
- Georgia Medicaid, 2025 dental manual and fee material
CDT codes and nomenclature are copyright © American Dental Association. This guide explains the code in plain language; the current CDT manual is the authoritative source.
