D1354 is the CDT code for interim caries arresting medicament application, per tooth. It is the code practices use to report silver diamine fluoride, or SDF, applied to arrest an active carious lesion. Use of SDF has grown quickly as a minimally invasive way to stop decay without drilling, especially for children, older adults, and patients who cannot tolerate traditional restorative care.
Last updated June 2026 · Reviewed by the PracticeAlpha billing team
Get help with D1354 claims →Use D1354 when applying a caries arresting medicament, such as silver diamine fluoride, to a tooth with an active carious lesion. The code is reported per tooth, so each treated tooth gets its own line with its tooth number. The goal of the procedure is to arrest the progression of decay, not to restore the tooth.
Common clinical scenarios: Young children with early childhood caries who cannot tolerate a drill. Older adults with root caries and limited dexterity. Patients with special health care needs. High caries risk patients where decay is being managed medically while definitive treatment is sequenced or deferred.
Do NOT use D1354 for: Routine preventive fluoride varnish on sound teeth (use D1206 or D1208). Application of a sealant to a pit or fissure (use D1351). Any definitive restoration that rebuilds tooth structure (use the appropriate restorative code). A tooth with no active lesion present.
Silver diamine fluoride is reported with D1354 in these common cases.
A tooth has an active carious lesion and the goal is to stop it from progressing. SDF is applied directly to the lesion. Reported once for that tooth.
Young children, older adults, or patients with special needs who cannot tolerate conventional restorative care. SDF manages the decay non-invasively.
High caries risk patients where lesions are arrested medically while restorative treatment is sequenced over time. Each treated tooth is reported separately.
Some plans still do not list D1354 as a covered procedure. Coverage has expanded as silver diamine fluoride has become more widely used, but it is not universal. Verify the benefit before treatment so the patient understands whether it is covered or an out of pocket cost. Do not assume coverage based on another plan.
Several plans only cover D1354 for pediatric patients up to a stated age. An adult claim under those plans gets denied as a non-covered age. Check the age rules in the patient's specific plan before applying SDF, and set patient expectations accordingly.
SDF often needs reapplication, but plans that cover D1354 may limit how often it is payable per tooth. A second application within the plan window can be denied even when it is clinically appropriate. Track prior applications per tooth and submit a narrative when reapplication is needed.
Because D1354 is per tooth, a claim without a tooth number gets rejected. The documentation should also show an active carious lesion was present and treated. "Applied SDF" with no tooth number and no lesion description is not enough. Record the tooth, the surface involved, and the lesion.
Because D1354 is reported per tooth, every claim line needs the specific tooth number. Note the surface involved so the lesion location is clear in the record.
The note should describe the active carious lesion being treated. The procedure arrests decay, so the record must show decay was present, not a sound tooth.
Record that silver diamine fluoride was the medicament applied. The material is included in the procedure and is not billed under a separate code.
Silver diamine fluoride darkens the arrested lesion. Document that the patient or guardian was informed of the expected black staining and consented before application.
Note any prior SDF applications on the same tooth and verify the plan's age and frequency rules before treatment. Keep the verification in the record.
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Learn about our billing servicesD1354 is the CDT code for interim caries arresting medicament application, per tooth. In practice it is used to report the application of silver diamine fluoride (SDF) to arrest an active carious lesion. It is reported once per treated tooth.
D1354 is reported per tooth. If silver diamine fluoride is applied to four teeth at one visit, the code is reported four times with the corresponding tooth numbers, not once for the whole visit.
D1354 is the application of a caries arresting medicament such as silver diamine fluoride to a specific tooth with an active lesion. D1206 is a topical fluoride varnish applied for prevention across the dentition. One arrests existing decay, the other prevents it.
Common reasons include the plan not covering the code, age limitations, frequency limits per tooth, missing tooth number or surface, and documentation that does not show an active carious lesion was present and treated.
Yes. D1354 reports the procedure of applying the caries arresting medicament, and the material cost is considered part of that procedure. The medicament is not billed separately under a different code.
No. Silver diamine fluoride is an interim, non-restorative treatment that arrests the progression of decay. It does not rebuild tooth structure. The tooth may still need a definitive restoration later, which is reported with its own code.
Search all 206 CDT codes in our dental coding guide.