The short version
# D1354 Dental Code: Caries-Arresting Medicament per Tooth
D1354 reports conservative treatment of an active, non-symptomatic cavitated carious lesion with a topical arresting or inhibiting medicament. It's reported once for each treated tooth, not once for each lesion and not once for the whole mouth. Silver diamine fluoride is common, but the code isn't limited to one product.
- Bill one D1354 unit for each tooth treated with a medicament to arrest or inhibit an active, non-symptomatic cavitated lesion.
- Count teeth, not lesions. Two treated lesions on one tooth still produce one D1354 line for that tooth on that date.
- The ADA says D1354 isn't restricted to SDF or to primary teeth.
- D1206 is a full-mouth fluoride-varnish service for prevention. D1351 is a sealant on a qualifying surface. Neither replaces D1354.
- A public Delta plan limits D1354 to once every six months. CDT itself doesn't set a reapplication schedule.
- In a four-tooth example, four $50 charges total $200. A $30-per-tooth allowable totals $120; the plan pays $96, the patient owes $24, and the adjustment is $80.
What is D1354?
D1354 is a per-tooth caries-control procedure. The dentist applies a topical medicament to an active lesion without mechanically removing sound tooth structure.
| Fact | D1354 |
|---|---|
| CDT category | Other preventive services |
| Unit | Per treated tooth |
| Target | Active, non-symptomatic cavitated lesion |
| Common medicament | Silver diamine fluoride, but not limited to SDF |
| Public fee references | Oregon Medicaid: $22.39; Georgia Medicaid: published D1354 rate in 2025 material |
When do you bill D1354?
Use D1354 when the treatment purpose and lesion status match caries arrest.
- Diagnose and chart the active lesion and affected tooth.
- Confirm the lesion is non-symptomatic for this procedure.
- Select the medicament and record why nonrestorative arrest is appropriate.
- Obtain consent that covers expected appearance and follow-up.
- Apply the product without removing sound tooth structure.
- Schedule monitoring, reapplication, or definitive treatment from clinical need.
D1354 vs D1206, D1351, and D1355
The treatment goal separates these procedures more reliably than the product name.
| D1206 | D1351 | D1354 | D1355 | |
|---|---|---|---|---|
| Purpose | Full-mouth fluoride prevention | Seal pits and fissures | Arrest active cavitated caries | Prevent or remineralize a non-cavitated site |
| Unit | Full mouth | Per tooth | Per tooth | Per tooth |
| Existing cavitation required | No | No | Yes | No |
| Code follows | Varnish application | Sealant placement | Arresting intent | Preventive or remineralizing intent |
What does insurance actually do with D1354?
One published Delta California plan limits D1354 to once every six months. The ADA guide says CDT doesn't set an application protocol and reapplication can occur when the dentist finds a clinical need. Coverage and clinical timing are therefore separate questions.
- Four teeth at a $50 office fee: $200
- Four teeth at a $30 allowable: $120
- Contractual adjustment: $200 minus $120, or $80
- Plan payment at 80%: $96
- Patient balance at 20%: $24
Why does D1354 get denied?
- Tooth numbers are missing or the quantity doesn't match them.
- The treated tooth received D1354 within the payer's reapplication limit.
- The note describes prevention, varnish, or a non-cavitated site instead of active lesion arrest.
- The lesion was symptomatic, but the record doesn't explain the broader treatment decision.
What documentation gets D1354 paid?
- Chart each treated tooth and lesion surface.
- Record activity, cavitation, symptoms, and diagnosis.
- Name the medicament and the arresting purpose.
- Document consent, including expected staining when applicable.
- State that sound tooth structure wasn't mechanically removed.
- Record monitoring, repeat-application, or definitive-care plans.
- Check prior D1354 dates tooth by tooth.
Common questions about D1354
Is D1354 only for silver diamine fluoride?
No. The ADA says the code covers an appropriate caries-arresting or inhibiting medicament selected by the dentist. Silver diamine fluoride is one possible material, not a requirement. Record the product, concentration, tooth, lesion, treatment goal, informed-consent discussion, and follow-up plan.
How many D1354 units are billed for two lesions on one tooth?
One. D1354 is reported per tooth on the date of service. The unit follows the tooth, not each lesion or surface. Document both lesions and every treated surface in the note, but don't submit two units only because one tooth has two sites.
Can D1354 be used on permanent teeth?
Yes. The ADA guide doesn't limit it to primary dentition. The procedure can apply to a qualifying active cavitated lesion on a primary or permanent tooth. Document the diagnosis, tooth, surface, material, treatment goal, and follow-up plan for that lesion.
Is D1354 the same as fluoride varnish?
No. D1354 is lesion-directed treatment intended to arrest or inhibit active caries. The D1206 guide covers a preventive full-mouth varnish application. Record the diagnosis, material, and purpose so the claim doesn't make the two services look interchangeable on that date.
Reconcile every treated tooth
Don't post D1354 until you've matched every unit to a tooth and active cavitated lesion.
Sources
- ADA, Guide to Reporting D1354
- ADA, Silver Diamine Fluoride
- ADA, caries risk assessment and management
- ADA, nonrestorative caries treatment guideline
- ADA, Guide to Reporting D1355
- Delta Dental, California D1354 frequency
- Oregon Medicaid, June 2025 fee schedule
- Georgia Medicaid, 2025 dental manual and fee material
CDT codes and nomenclature are copyright © American Dental Association. This guide explains the code in plain language; the current CDT manual is the authoritative source.
