D1354 is the CDT code for the interim application of a caries-arresting medicament, reported per tooth — the conservative, non-surgical treatment of an active cavity by painting on a medicament (most commonly silver diamine fluoride) to stop or slow the decay without drilling away tooth structure.
Informational only — confirm the official CDT descriptor and your payers' rules independently. This is general guidance, not billing, coding, or clinical advice.
When to Use the D1354 Code
Report D1354 when a caries-arresting medicament such as silver diamine fluoride (SDF) is applied to an active, non-symptomatic carious lesion to arrest it — without mechanical removal of sound tooth structure — with one unit reported per tooth treated.
Keep it distinct from preventive fluoride. D1354 treats active decay; the preventive fluoride codes D1206 (varnish) and D1208 (gel/foam/rinse) are for caries prevention, not arrest, and should not be substituted for D1354. A D1354 application is also an interim measure, not a definitive restoration — if the tooth is later restored, the filling or crown is reported under its own restorative code.
Documentation & Clinical Scenarios
Because D1354 is per tooth and treats active decay, the chart should support both the diagnosis and the tooth:
- The specific tooth number(s) treated — each is a separate D1354 line.
- The diagnosis — an active, non-symptomatic carious lesion appropriate for arrest.
- The medicament used (e.g., silver diamine fluoride) and that no tooth structure was removed.
- Patient consent for staining, since SDF darkens arrested decay — and any plan for definitive restoration later, billed separately.
Clear per-tooth notes and the active-caries diagnosis are what support the line and distinguish it from preventive fluoride.
Insurance & Billing Tips
- Verify the benefit. Coverage for D1354 varies widely; some plans (especially pediatric Medicaid) cover it, while others consider it inclusive or non-covered.
- List each tooth. D1354 is per tooth — report a separate line per treated tooth with the tooth number; bundling can cause denials.
- Distinguish from fluoride. Don't bill D1354 as preventive fluoride or vice versa; the diagnosis (active caries) drives the code.
- Watch frequency rules. Plans that cover D1354 may limit applications per tooth or per period; re-applications can be denied beyond the limit.
- Document consent and diagnosis. A noted active-caries diagnosis and staining consent support the claim and any appeal.
Example Case
A 4-year-old established patient has an active cavity on a primary molar, but is too young to tolerate a conventional filling. To arrest the lesion in the interim, the dentist applies silver diamine fluoride to the tooth, with the parent's consent to the expected staining. The visit is coded D1354 for the single treated tooth, with the tooth number, the active-caries diagnosis, and the medicament documented. Because the office confirmed the child's plan covered caries-arrest applications, the line processes cleanly, and a definitive restoration is planned later under its own code.
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Frequently Asked Questions
How is D1354 different from fluoride codes D1206 and D1208?
D1354 treats active decay — it's a caries-arresting medicament (commonly SDF) applied to stop an existing lesion — while D1206 (varnish) and D1208 (gel/foam/rinse) are preventive fluoride applications for caries prevention. The driving difference is the diagnosis: an active carious lesion supports D1354, while a preventive treatment on sound enamel supports a fluoride code. Substituting one for the other is a common error that can trigger a denial.
Is D1354 billed per tooth or per visit?
Per tooth. D1354 represents a caries-arresting application on a single tooth, so treating three teeth at one visit is three separate D1354 lines, each with its own tooth number. Reporting them as one unit can lead to denials or underpayment, and the per-tooth structure lets the plan apply any per-tooth frequency limit correctly. Always note the specific teeth treated on the claim.
Will insurance cover D1354?
Coverage varies widely. Many pediatric Medicaid programs cover D1354, and some commercial plans do, but others consider it inclusive of other services or non-covered, and frequency may be limited per tooth or per period. Because policies differ so much, verifying the specific benefit before treatment — and documenting the active-caries diagnosis — is the best way to avoid a surprise denial or out-of-pocket charge.
Does D1354 need a pre-authorization, and is consent required?
A formal pre-authorization usually isn't required, but verifying the benefit is important because coverage is inconsistent. Clinically, informed consent for the expected staining of arrested decay is standard, since SDF darkens the treated lesion, and that consent should be noted in the chart. Documenting the diagnosis, the medicament, and the patient's consent supports the claim and any appeal if the line is denied.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.