WARNING

1. Some practices erroneously report fluoride application when the prophylaxis paste contains fluoride. For proper reporting, fluoride varnish application must be applied separately from the prophylaxis paste.

2. Fluoride dispensed for home use should not be reported as D1206. See D9630 to report certain take-home products and see D1999 for an unspecified preventive procedure.

3. D1206 should not report desensitization. It is for caries prevention. See D9910 for a
desensitization procedure.

4. D1206 should not report a caries preventive medicament application - per tooth. See D1355
for remineralization.

5. D1206 should not be used to report the application of Cervitec® Gel. Fluoride is not listed as a component of Cervitec Gel, therefore it cannot be reported as Fluoride varnish (D1206). See D9910, D4999, D1999, D6199, for other situations where Cervitec Gel may be reported.

6. D1206 should not be used to report the application of silver diamine fluoride. See D1354.

7. D1206 should not be reported for application of hydoxyapatite regeneration medicament, such as Curodont Repair. See D2991.

COMMENTS

1. D1206 reports the application of topical fluoride varnish.

2. D1206 reports the therapeutic application of topical fluoride varnish delivered throughout the entire oral cavity in a single visit. The technique used for application is not specified, but fluoride varnish application is required to report D1206.

3. The fluoride varnish procedure may be reported in addition to a related prophylaxis (child or adult) or on a stand-alone basis. Fluoride varnish (D1206) may be applied and reported without having provided a prophylaxis. This is typically in a school setting.

4. D1206 is applicable to both children and adults. D1206 is specifically recommended for children under age six by the ADA/AAPD. Some payors will not reimburse D1208 under age six, only D1206.

5. Enter "00" for the entire area of the oral cavity in Box 25 of the 2024 ADA Dental Claim Form.

LIMITATIONS

1. Fluoride varnish application, if a covered benefit, is often reimbursed twice per year; however, the reimbursement trend is once per year. Patients age 16 and older are generally not covered. In some cases, the limitation begins at 15 years.

2. In the past D1206 required that the patient have a moderate to high risk for caries. The D1206 code has been revised and a specific caries risk status is no longer required. However, some payors require a moderate to high caries risk to reimburse for adult varnish application. For caries risk assessment, demonstrating increased risk, if appropriate, see D0602 and D0603.

3. D1206 may be reimbursed at a higher fee than D1208 with some plans.

NARRATIVE 

Some contracts may reimburse fluoride varnish (D1206) specifically for ages above 18, particularly if the patient is moderate or high caries risk. Be sure to note that "moderate caries risk" or "high caries risk" in the remarks section of the claim form for adults. Confirm that a caries risk assessment has been done and is part of the patient's chart, and report D0602 or D0603 risk assessment code on the claim form. The D0602 or D0603 caries assessment code may be "no charge to the patient" and reported as no charge on the claim form. There is no "special" narrative to gain adult fluoride coverage. Adult fluoride application is either covered or not in the plan document (covered about 10% of time).