Billing Guide for D1208 (Topical Application of Fluoride - Excluding Varnish)
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Description
Billing Guidelines, Tips and Reminders for D1208 (Topical Application of Fluoride - Excluding Varnish)
February 03, 2025
WARNING
1. Some practices erroneously report fluoride application when the prophylaxis is provided using a paste containing fluoride. For proper reporting, fluoride must be applied to the teeth in a separate procedure afterward, apart from the prophylaxis paste.
2. Fluoride preparations dispensed for home use should not be reported as D1208. See D9630 for take home fluoride application and D1999 for fluoride toothpaste, toothbrushes, etc.
3. D1208 should not be used to report desensitization. See D9910 to report desensitizing.
4. D1208 should not report a caries preventive medicament application - per tooth. See D1355 for remineralization.
5. D1208 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 (D1208). See D9910, D4999, D1999, D6199 for other situations where Cervitec® Gel may be reported.
6. D1208 should not be used to report the application of silver diamine fluoride. See D1354.
7. D1208 should not be reported for application of hydoxyapatite regeneration medicament, such as Curodont Repair. See D2991.
WATCH
The D1208 code does not specify the specific type of fluoride formulation or technique used for the topical application, but it does exclude fluoride varnish. For fluoride varnish, see D1206 to report topical application of fluoride varnish for either the child or adult.
COMMENTS
1. Topical application of fluoride - excluding varnish (D1208) reports any fluoride application using prescription strength swish, trays, isolate and paint-on. The specific delivery mechanism is not important. The topical application of fluoride must be applied as a separate procedure apart from the prophylaxis. The fluoride formulation and application technique is not specified in this code description but it is assumed that the fluoride utilized must be prescription strength. However, note that the nomenclature of D1208 specifically excludes fluoride varnish.
2. If therapeutic topical fluoride varnish is applied, report D1206 for either the child or adult.
3. Enter "00" for the entire area of the oral cavity in Box 25 of the 2024 ADA Dental Claim Form.
LIMITATIONS
1. Fluoride 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. D1206 may be reimbursed at a higher fee than D1208 with some plans. D1206 might be covered for certain plans whereas D1208 is not. On the other hand, D1208 might be covered for certain plans whereas D1206 is not. See D1206, as the overall reporting of this code is often superior.
3. D1206 is recommended for under six years of age by the ADA/AAPD. Certain payors will not reimburse D1208 for children under age six.
4. D1206 may be required specifically for adult coverage, if reimbursed. See D1206.
1. Some practices erroneously report fluoride application when the prophylaxis is provided using a paste containing fluoride. For proper reporting, fluoride must be applied to the teeth in a separate procedure afterward, apart from the prophylaxis paste.
2. Fluoride preparations dispensed for home use should not be reported as D1208. See D9630 for take home fluoride application and D1999 for fluoride toothpaste, toothbrushes, etc.
3. D1208 should not be used to report desensitization. See D9910 to report desensitizing.
4. D1208 should not report a caries preventive medicament application - per tooth. See D1355 for remineralization.
5. D1208 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 (D1208). See D9910, D4999, D1999, D6199 for other situations where Cervitec® Gel may be reported.
6. D1208 should not be used to report the application of silver diamine fluoride. See D1354.
7. D1208 should not be reported for application of hydoxyapatite regeneration medicament, such as Curodont Repair. See D2991.
WATCH
The D1208 code does not specify the specific type of fluoride formulation or technique used for the topical application, but it does exclude fluoride varnish. For fluoride varnish, see D1206 to report topical application of fluoride varnish for either the child or adult.
COMMENTS
1. Topical application of fluoride - excluding varnish (D1208) reports any fluoride application using prescription strength swish, trays, isolate and paint-on. The specific delivery mechanism is not important. The topical application of fluoride must be applied as a separate procedure apart from the prophylaxis. The fluoride formulation and application technique is not specified in this code description but it is assumed that the fluoride utilized must be prescription strength. However, note that the nomenclature of D1208 specifically excludes fluoride varnish.
2. If therapeutic topical fluoride varnish is applied, report D1206 for either the child or adult.
3. Enter "00" for the entire area of the oral cavity in Box 25 of the 2024 ADA Dental Claim Form.
LIMITATIONS
1. Fluoride 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. D1206 may be reimbursed at a higher fee than D1208 with some plans. D1206 might be covered for certain plans whereas D1208 is not. On the other hand, D1208 might be covered for certain plans whereas D1206 is not. See D1206, as the overall reporting of this code is often superior.
3. D1206 is recommended for under six years of age by the ADA/AAPD. Certain payors will not reimburse D1208 for children under age six.
4. D1206 may be required specifically for adult coverage, if reimbursed. See D1206.
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