Summary & Overview
CDT D1351: Sealant - per tooth
CDT code D1351 denotes a per-tooth dental sealant procedure used to prevent occlusal caries by sealing pits and fissures on tooth surfaces. As a common preventive intervention in both pediatric and general dental practice, sealants play a significant role in reducing the incidence of dental caries and subsequent restorative needs nationwide. The code is widely used across dental practices and appears in commercial payer coverage policies and fee schedules.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise description of the clinical purpose of the procedure, common billing relationships with related preventive services, and insurer considerations that typically affect coverage and claims handling. The publication outlines typical sites of service and situates D1351 beside related preventive dental procedures such as topical fluoride applications and prophylaxis to clarify clinical context.
This summary equips billing staff, dental administrators, and policy analysts with an overview of where D1351 fits within preventive dentistry, common payer coverage expectations, and the types of documentation and coding relationships that frequently accompany sealant services. Data not available in the input is noted where applicable.
Billing Code Overview
CDT code D1351 represents Sealant - per tooth, a preventive dental procedure involving the application of a protective resin material to the occlusal surfaces of a tooth to reduce the risk of dental caries. This procedure is categorized under Dentistry services.
Typical site of service: Dental Office (POS 11).
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A pediatric patient presents to a dental office (POS 11) for a routine preventive visit. The dentist performs an oral examination and determines a posterior molar has deep pits and fissures at elevated risk for occlusal caries but without cavitation, or the tooth has arrested caries amenable to sealing. After discussing the procedure with the parent and obtaining consent, the dentist performs prophylaxis as indicated, isolates and dries the tooth, applies an etchant if used by office protocol, and places a pit-and-fissure sealant on the affected tooth. The visit is documented with tooth number, surface, materials used, and rationale (preventive sealant for high caries risk or sealant placement over arrested caries). Billing is submitted using CDT code D1351 (Sealant - per tooth) with the appropriate modifier if services were reduced or repeated during the same encounter.
Coding Specifications
-
Modifier
52— Reduced Services -
Use when the dentist performs a service that is less than full description of
D1351(for example, partial sealant application due to patient tolerance) and documentation supports why full service was not rendered. -
Modifier
76— Repeat Procedure by Same Dentist -
Use when the same dentist repeats
D1351on the same tooth within the same course of treatment or during a re‑treatment encounter and documentation supports the need for the repeat application. -
Associated Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
122300000X | General Practice Dentist |
1223P0221X | Pediatric Dentist |
1223D0001X | Dental Public Health |
-
Notes:
-
Use of modifiers must be clearly supported in the clinical record. Documentation should state the reason for reduced service (
52) or for repeating the procedure (76).
Related Diagnoses
-
K02.3— Arrested dental caries- Clinical relevance: An arrested lesion may be sealed to prevent progression;
D1351can be used when sealing over inactive caries is clinically appropriate and documented.
- Clinical relevance: An arrested lesion may be sealed to prevent progression;
-
K02.9— Dental caries, unspecified- Clinical relevance: An unspecified carious lesion on a pit or fissure surface may prompt preventive sealant placement when decay risk or early non‑cavitated lesions are identified.
-
Z01.20— Encounter for dental examination and cleaning without abnormal findings- Clinical relevance: A routine preventive visit with no abnormal findings can include sealant placement for caries prevention on at‑risk teeth, documented as a preventive procedure using
D1351.
- Clinical relevance: A routine preventive visit with no abnormal findings can include sealant placement for caries prevention on at‑risk teeth, documented as a preventive procedure using
-
Z01.21— Encounter for dental examination and cleaning with abnormal findings- Clinical relevance: When an examination reveals findings such as incipient lesions or areas at high risk for decay, sealant placement with
D1351may be part of the treatment provided during the visit.
- Clinical relevance: When an examination reveals findings such as incipient lesions or areas at high risk for decay, sealant placement with
Related Codes
| Code | Description | Relationship to D1351 |
|---|---|---|
D1206 | Topical application of fluoride varnish | Often performed during the same preventive visit; topical fluoride is complementary to sealants for caries prevention and may be billed separately when criteria for both are met. |
D1208 | Topical application of fluoride | Alternative topical fluoride application commonly provided in preventive visits; may be used in lieu of or in addition to D1206 depending on material and protocol. |
D1120 | Prophylaxis - child | Commonly performed immediately prior to sealant placement to remove plaque and improve retention; often billed in the same visit when indicated. |
D1110 | Prophylaxis - adult | Same relation as D1120 but for adult patients; used when sealant placement occurs in adult preventive care scenarios. |
- Common co‑usage:
D1351is frequently performed alongsideD1120orD1110(prophylaxis) and may be billed with topical fluoride codes (D1206orD1208) when documentation supports distinct services. Modifiers such as52or76are applied toD1351as described in Coding Specifications when warranted.
National Reimbursement Benchmarks
National commercial mean rates for CDT code D1351 vary substantially: UnitedHealthcare and Blue Cross Blue Shield report the highest mean rates at $37.45 and $35.42 respectively, while Aetna and Cigna Health cluster near $19.50–$19.79. BUCA (average commercial) sits between commercial and the highest payers at $26.59. Medicare is not provided in the input, so a direct numeric comparison with Medicare is not available.
Rate dispersion (P75 minus P25) is widest for Blue Cross Blue Shield and UnitedHealthcare (both showing a 12.5 dollar interpercentile spread for UHC and 12.5 for BCBS), indicating greater variability in paid rates. BUCA shows a moderate spread of $15.50, while Aetna and Cigna Health are the tightest, with spreads of $4.00 and $4.00 respectively. The table and chart below present the full breakdown.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.