CODE SERVICE FREQUENCY BENEFIT DETAILS D9930 Treatment for 1 procedure per Not covered for dry socket complications after a tooth calendar year treatment within 30 days of an extraction (including dry extraction sockets) or other surgical procedure D9944 Top or bottom hard 1 nightguard every 5 Only covered for patients who nightguard that is used to calendar years clench and/or grind their teeth, protect the teeth from does not cover appliances for clenching and/or grinding treating sleep apnea, snoring or complex temporomandibular disorders D9995 Virtual/remote dental 2 procedures per Only covered if a D0140 or D0191 D9996 exams calendar year exam is performed on the same day Devoted Health is an HMO and/or PPO plan with a Medicare contract. Our D-SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. 12