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In-Office Procedure
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Orafate™ In-Office Procedure

The Orafate Program 

In-Office Orafate Procedure and Out-of-Office Prescription

The Orafate Program: Heard about the new FDA prescription Oral Wound medical device 
containing enhanced potency sucralfate for In-Office Use following dental cleanings 
and extractions, reimbursable under ADA code D9630? 

In-Office Orafate Program
Orafate is an FDA cleared prescription oral wound medical device containing advanced 
potency sucralfate adapted for the treatment of gingival inflammation, wound healing, 
and implant mucositis.
Mueller Medical International (MMI) is launching Orafate as a reimbursable In-office 
procedure following all cleanings and all extractions, reimbursable under ADA procedure 
code D9630. 
(Other drugs and/or medicaments, by report. Includes, but is not limited to, oral antibiotics, oral analgesics, and topical fluoride 
dispensed in the office for home use; does not include writing prescriptions.)
Historically insurers reimburse D9630 at $18 for Medicaid patients in NC 
and $25 with ordinary BC/BS dental plan patients. MMI is providing dental practices 
interested in using the Orafate™ in their in-office procedure, with Orafate™ 
on a 1 month free trial basis.

How In-Office Orafate™ is Supplied
25 count 3ml bottles per patient 
50 count 3 ml bottles per patient 
Illustration of How to Complete ADA Claim Form for D9630 Code

ADA Dental Claim Form Following Cleaning, Scaling Procedures  
➢	Procedure Code:      D9630
➢	Quantity:  	         1
➢	Description/Report: ”300mg FDA cleared Orafate applied to gingival crevice following 
	cleaning procedure”

ADA Dental Claim Form Following Extraction Procedures
➢	Procedure Code:       D9630
➢	Quantity:  	          1
➢	Description/Report: ”300mg FDA cleared Orafate applied to extraction wound following 
	extraction procedure”

Out-of-Office Prescriptions
➢	For Gingival Health, the dentist may write for a full Orafate Prescription for patients to 
	continue use:
	-	Brushing prior to bed, 1-2 weeks after cleaning twice a year.
➢	For Peri-implant Mucositis, the dentist may write a full Orafate Prescription for daily 
	continued use.
	-	Brushing affected area prior to bed nightly.

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