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
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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.