Fee Schedule Changes for Sealants and Preventive Resin Restorations
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:
||Sealant – per tooth
|Preventive resin restoration in a moderate to high caries risk patient-permanent tooth
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 firstname.lastname@example.org or contact a Provider Relations specialist at 1-405-717-8790 or toll-free 1-800-543-6044.