When is D1355 used?
The D1355 dental code applies to the placement of caries preventive medicaments on individual teeth. This code is best suited for patients, especially children or adults with high caries risk, who receive topical treatments other than standard fluoride varnishes or gels. Apply D1355 when using substances like silver diamine fluoride (SDF) or alternative non-fluoride agents designed to prevent tooth decay on cavity-free teeth. This code should not be applied for restorative work or fluoride applications covered by D1206 or D1208.
D1355 Charting and Clinical Use
Proper record-keeping is essential for effective billing and claim approval. Key documentation practices include:
Recording the exact tooth number treated with the preventive agent.
Including the patient's caries risk evaluation and justification for selecting a specialized preventive treatment.
Identifying the specific agent applied (such as SDF) and clinical reasoning (including deep fissures, initial demineralization, elevated decay risk).
Recording patient or parent authorization for treatments like SDF that may cause side effects including tooth discoloration.
Typical clinical situations involve young patients with newly erupted permanent teeth, adults showing root exposure, or patients with special needs who cannot undergo conventional restorative treatment.
Billing and Insurance Considerations
Successfully billing D1355 demands careful attention to insurance policies and comprehensive documentation. Consider these practical approaches:
Confirm benefits through pre-verification, since coverage for D1355 varies among insurance plans. Specifically inquire about non-fluoride preventive treatment benefits.
Include comprehensive clinical documentation with claims, featuring risk evaluations and treatment specifics.
Bill per individual tooth: D1355 allows per-tooth charges, so specify each treated tooth on claim submissions.
Challenge claim rejections using supporting materials like risk assessments, treatment records, and clinical evidence supporting the chosen intervention.
Review benefit explanations carefully for partial approvals or denials, and respond quickly to requests for additional documentation.
Proactive insurance verification and thorough documentation help minimize outstanding receivables and enhance payment success rates.
How dental practices use D1355
A 7-year-old child comes in for regular check-up. During examination, the dental hygienist notices deep grooves and pits in recently erupted first permanent molars, showing no current decay but presenting high risk factors including family dental history and poor dietary patterns. The dentist treats teeth #3 and #14 with silver diamine fluoride, carefully documenting the treatment approach, risk factors, and obtaining parental approval. Claims are filed using D1355 for both treated teeth, including detailed clinical notes. After initial claim denial, successful appeal with comprehensive documentation results in full reimbursement.
This practical example demonstrates the critical role of accurate coding, detailed documentation, and thorough insurance follow-up in achieving successful D1355 reimbursement.
Common Questions
Can D1355 be billed together with sealants on the same tooth?
D1355 cannot be billed for the same tooth on the same date as sealant placement. These procedures serve different clinical purposes and have separate CDT codes, so billing both may be viewed as duplicate coding by insurance carriers. Review individual payer guidelines for specific bundling restrictions.
Is informed consent necessary prior to D1355 preventive medicament application?
Informed consent is strongly advised before applying preventive medicaments coded as D1355. Healthcare providers should document the consent process, including discussion of potential risks, clinical benefits, and treatment alternatives in the patient record to ensure proper compliance and patient awareness.
What are the billing frequency limits for D1355?
D1355 billing frequency varies based on patient caries risk assessment and insurance plan restrictions. Many carriers limit coverage to annually or restrict benefits to high-risk patients only. Verify coverage frequency limits with the patient's dental insurance carrier prior to providing treatment.