D1352Preventive Resin Restoration in a Moderate to High Caries Risk Patient - Permanent Tooth

What This Code Covers

D1352 covers a preventive resin restoration (PRR) on a permanent tooth for a patient assessed as moderate to high caries risk. A PRR is a conservative approach where minimal decay in the pit or groove of a tooth is removed and filled with flowable composite, then the remaining pits and fissures are sealed. It is a hybrid between a sealant and a filling, used when decay is too advanced for just a sealant but not extensive enough for a full restoration.

Billing Guide

Bill this code when:

• Minimal pit and fissure decay is present on a permanent tooth
• The decay is limited to enamel or barely into dentin
• The tooth is treated with both a small resin restoration and a sealant over the remaining grooves
• The patient is assessed as moderate to high caries risk

Do not bill this code when:

• No decay is present and only a sealant is needed. Use D1351
• The decay extends significantly into dentin requiring a full restoration. Use D2391 or D2330
• The tooth is a primary (baby) tooth
• The patient is low caries risk and the decay warrants monitoring rather than treatment

Insurance and Denial Prevention

Key Payer Rules:

• Some payers cover D1352, while others do not recognize the code and require billing as either a sealant or a restoration
• When covered, D1352 may be reimbursed at a rate between a sealant (D1351) and a one-surface filling (D2391)
• Some payers require documentation of the caries risk assessment to justify D1352
• If the payer does not recognize D1352, bill the procedure as a one-surface restoration with a narrative

Common Denials and How to Respond:

• Code not recognized → Some payers do not have D1352 in their fee schedule. Contact the payer to determine the alternate code they prefer (usually D1351 or D2391).
• No caries risk assessment → Include documentation of the patient's caries risk level to support the use of this code.
• Downgraded to sealant → Appeal with clinical documentation showing that decay was present and a restoration was placed, not just a sealant.