When is D1351 used?
The D1351 dental code applies to placing dental sealants—specifically resin-based materials on the biting surfaces of permanent molars and premolars for cavity prevention. This code is appropriate when treating patients, usually children or teens, who have recently erupted, decay-free back teeth at risk for cavities. Sealants serve as preventive treatment, so D1351 should not be used for teeth with existing decay, fillings, or incomplete eruption. Correct application of this code supports clinical standards and appropriate insurance coverage.
D1351 Charting and Clinical Use
Complete documentation supports successful claims and audit readiness. When using D1351, dental offices should record:
Specific tooth number and surface receiving treatment
Treatment date
Clinical records showing the tooth was decay-free and completely erupted during sealant placement
Patient risk evaluation (such as cavity history, deep grooves and pits)
Typical situations involve children between 6–14 years old getting sealants on newly emerged first or second permanent molars, or adults at high risk with deep grooves but no current decay. When placing sealants on teeth with current restorations or cavities, consider alternative CDT codes, such as composite resin restorations, when applicable.
Billing and Insurance Considerations
Insurance benefits for D1351 differ between plans, but most dental insurance covers sealants for children within certain age ranges (typically 14–18) and on particular teeth (commonly first and second permanent molars). To improve payment rates and reduce claim rejections, implement these strategies:
Check patient benefits and plan restrictions prior to treatment—confirm age limits, timing restrictions, and approved tooth numbers.
Include comprehensive documentation with claims, adding clinical records and intraoral images when available.
Enter correct tooth numbers and surfaces on claim submissions.
When claims get denied, examine the EOB (Explanation of Benefits) for denial reasons and file appeals with supporting records when appropriate.
Clear patient communication regarding their benefits and potential personal costs can enhance satisfaction and decrease AR (accounts receivable) challenges.
How dental practices use D1351
Scenario: A 9-year-old child comes in for regular checkup. The dentist observes that the child's first permanent molars (teeth #3, #14, #19, and #30) have completely emerged, show no decay, and display deep grooves and pits. The child previously had cavities in baby teeth. The dental staff records the clinical observations, places resin sealants on all four molars, and submits D1351 for each tooth. The claim documentation includes tooth numbers, surfaces, and notes regarding the child's cavity risk. The insurance policy covers sealants for children through age 14 on first and second molars, resulting in claim approval and timely payment.
This scenario demonstrates how proper documentation, accurate coding, and insurance verification lead to successful D1351 billing.
Common Questions
Is D1351 appropriate for billing on primary (baby) teeth?
D1351 is specifically designed for permanent teeth, particularly permanent molars and premolars. This code should not be used for sealants applied to primary (baby) teeth. Always confirm the tooth type before submitting claims using D1351.
What are the frequency limitations for billing D1351 on the same tooth?
Dental insurance plans typically impose frequency restrictions for sealant procedures, commonly allowing D1351 coverage once every 2 to 5 years per individual tooth, if covered at all. Review the patient's specific insurance benefits for frequency limitations before reapplying sealants and submitting claims for the same tooth.
What is the proper procedure when a sealant fails or is lost shortly after application?
When a sealant billed under D1351 fails or becomes dislodged shortly after placement, consult the insurance policy regarding repair or replacement coverage. Some insurance plans may provide coverage for reapplication within a specified period, while others may exclude such coverage. Maintain thorough documentation of the failure, note the reason for reapplication, and coordinate with the insurance payer prior to submitting a replacement claim.