MEDICAID DENTISTS: Please take our confidential and anonymous five-question survey about D1352. It is basically a simple Yes-No questionnaire. It takes less than a minute. SURVEY IS NOW CLOSED.
Back in late 2011, the ADA added several new codes to the CDT (Current Dental Terminology) manual. One of these codes was D1352 which is defined as a “conservative restoration of an active cavitated lesion in a pit or fissure that does not extend into dentin; includes placement of a sealant in any radiating non-carious fissures or pits.” Casually, it is called a shallow filling.
Used in Texas since 2012
This new code was added to the December 2012 Texas Medicaid providers manual as a line item. There was no announcement about its inclusion, but it marked a change in that a Medicaid dentist could no longer remove the decay, place composite on the tooth, and always consider it a D23xx filling for billing purposes. Dentists who finished dental school prior to 2012 were immediately at an educational disadvantage about this new code.
Lack of use causing audits and recoupments
TDMR has learned that some dentists have recently come under investigation by Texas HHS-OIG and DMOs for not using this D1352 code but instead billing for a regular filling using D2391.
Dentists not familiar with it
Some of the dentists apparently have reported that they didn’t know anything about this newer code.
Regardless, this incorrect billing is triggering audits and recoupments.
We just wanted to let the Medicaid dental community know about this.