When is D1352 used?
The D1352 dental code applies to preventive resin restoration in a moderate to high caries risk patient – permanent tooth. This procedure code is utilized when dental professionals place conservative resin material on permanent teeth showing initial decay signs or having elevated caries risk, without requiring complete restoration. D1352 works best for occlusal surfaces with beginning lesions or deep pit and fissure areas, particularly for patients with confirmed moderate to high decay risk. This code excludes primary teeth and teeth needing full fillings or crowns.
D1352 Charting and Clinical Use
Proper documentation ensures successful D1352 reimbursement. Dental practices should record the following patient information:
Comprehensive caries risk evaluation, covering previous decay history, oral care habits, and eating patterns.
Clinical observations about tooth surface conditions (such as deep fissures, initial demineralization, absence of obvious cavities).
X-rays or oral photographs when available to verify diagnosis.
Details regarding resin materials and application methods used.
Typical clinical situations involve teenagers with deep occlusal grooves on first molars plus restoration history, or adults experiencing dry mouth from medications with early non-cavitated lesions.
Billing and Insurance Considerations
Processing D1352 claims needs careful planning to improve reimbursement and reduce rejections. Follow these recommendations:
Check coverage: D1352 coverage varies among dental insurance plans. Confirm benefits and usage limits prior to treatment.
Include supporting materials: Attach caries risk evaluations and clinical documentation with claims. Add photographs or x-rays when available.
Apply correct CDT codes: Avoid mixing D1352 with D1351 (sealant) or filling codes. D1352 covers preventive resin treatments for high-risk patients.
Challenge rejections: When claims get denied, check EOB explanations, add extra documentation, and file prompt appeals. Highlight patient risk factors and preventive treatment goals.
Following these practices helps decrease outstanding receivables and enhance practice cash flow.
How dental practices use D1352
A 16-year-old patient presents with multiple cavity history and inadequate oral hygiene. During routine examination, the dentist finds deep, discolored fissures on tooth #19's chewing surface, showing no x-ray cavity evidence. The patient receives high caries risk classification. The provider records risk evaluation, captures intraoral images, and places flowable resin to seal and protect the area. The treatment gets coded as D1352, with complete documentation sent with the claim. Insurance initially rejects payment, but following appeal submission with expanded clinical notes and risk details, the claim receives full approval and payment.
Common Questions
Is it appropriate to use D1352 alongside other preventive procedures on the same tooth?
D1352 cannot be billed on the same tooth surface when other preventive treatments such as sealants (D1351) or fluoride varnish are applied during the same appointment. When performing multiple preventive procedures, each must have clear clinical justification, be documented individually, and avoid duplication of services. Always verify payer-specific guidelines regarding bundling restrictions or frequency limitations.
What are the billing frequency limitations for D1352 per patient or individual tooth?
Billing frequency for D1352 varies based on the patient's caries risk assessment, clinical requirements, and specific insurance coverage policies. Most insurance providers restrict preventive resin restorations to once per tooth over several years, unless documented new carious lesions or elevated risk factors warrant additional intervention. Always consult plan-specific guidelines and maintain thorough documentation of any changes in patient risk status or tooth condition to justify repeat treatments.
Which materials are recommended for preventive resin restorations billed under D1352?
Preventive resin restorations coded as D1352 typically utilize flowable composite resins or specialized sealant materials engineered for long-term retention within pits and fissures. Material selection should consider the specific tooth anatomy, fissure depth characteristics, and manufacturer specifications. The chosen material must deliver reliable sealing properties and effectively prevent caries development over time.