Understanding Dental Code D1352

When to Use D1352 dental code

The D1352 dental code is designated for preventive resin restoration in a moderate to high caries risk patient – permanent tooth. This code is used when a dental provider applies a conservative resin-based material to a permanent tooth that shows early signs of caries (decay) or is at significant risk for developing caries, but does not yet require a full restoration. D1352 is most appropriate for occlusal surfaces with incipient lesions or deep pits and fissures, especially in patients with documented moderate to high caries risk. It is not intended for use on primary teeth or for teeth that already require a full filling or crown.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement of D1352. Dental teams should include the following in the patient record:

• Detailed caries risk assessment, including factors such as past caries experience, oral hygiene status, and dietary habits.
• Clinical notes describing the tooth surface condition (e.g., deep fissures, early demineralization, no frank cavitation).
• Radiographs or intraoral images, if available, to support the diagnosis.
• Specifics about the resin material used and the technique applied.

Common clinical scenarios include a teenager with deep occlusal grooves on their first molars and a history of multiple restorations, or an adult patient with dry mouth due to medication, presenting with early non-cavitated lesions.

Insurance Billing Tips

Billing for D1352 requires a strategic approach to maximize reimbursement and minimize denials. Here are best practices:

• Verify coverage: Not all dental plans cover D1352. Check eligibility and frequency limitations before treatment.
• Submit supporting documentation: Always include the caries risk assessment and clinical notes with your claim. Attach images or radiographs if possible.
• Use accurate CDT codes: Do not confuse D1352 with D1351 (sealant) or restorative codes. D1352 is for preventive resin restorations in at-risk patients.
• Appeal denials: If a claim is denied, review the EOB for the reason, supplement with additional documentation, and submit a timely appeal. Reference the patient’s risk status and the preventive intent of the procedure.

Consistent use of these steps can help reduce accounts receivable (AR) days and improve cash flow.

Example Case for D1352

Consider a 16-year-old patient with a history of multiple carious lesions and poor oral hygiene. During a recall exam, the dentist notes deep, stained fissures on the occlusal surface of tooth #19, with no radiographic evidence of cavitation. The patient is assessed as high caries risk. The provider documents the risk assessment, takes an intraoral photo, and applies a flowable resin to seal and protect the surface. The procedure is billed as D1352, with supporting documentation attached to the claim. The insurance company initially denies the claim, but after submitting an appeal with additional clinical notes and risk assessment details, the claim is approved and paid in full.