Fee Schedule Changes for Sealants and Preventive Resin Restorations
Posted 10/19/11
Effective for charges incurred on or after April 1, 2012, the Allowed Charges for sealant – one tooth (D1351) and preventive resin restoration (D1352) will be revised as indicated below:
| CDT Code | Description | Allowable Charge |
| D1351 | Sealant – per tooth | $31.00 |
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Preventive resin restoration in a moderate to high caries risk patient-permanent tooth | $46.00 |
Additionally, coverage for preventive resin restoration will be restricted to only permanent teeth; however, there will be no restrictions regarding the age of the patient.
Please email questions to HealthChoice Provider Relations at oseegibproviderrelations@sib.ok.gov or contact a Provider Relations specialist at 1-405-717-8790 or toll-free 1-800-543-6044.
Last Modified on 10/19/2011