MedicaidCoverageMedium impact
Provider Letter 2025-11: RE: Differentiation for D1354
Oklahoma SoonerCare·OK · Dentistry·Coding
Effective date
Apr 10, 2025
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid has clarified strict criteria for billing D1354 (caries arresting medicament) - it's only for silver diamine fluoride on active decay when patients can't receive typical restorative care, limited to once every 6 months with maximum 2 treatments per tooth lifetime. High concentration fluoride and preventive treatments should not be billed as D1354.
Action Required
Immediately: Review all D1354 claims to ensure they meet the strict criteria - patient unable to receive typical restorative care, active decay into dentin, no restorative care for 3 months after treatment. Update billing system to limit D1354 to once every 6 months with lifetime maximum of 2 per tooth. Train billing team to use D1208 for high concentration fluoride treatments instead of D1354.