What should SDF cost, and will insurance pay?
The short answer
SDF is billed per tooth and usually costs far less than a filling. Coverage varies a lot: some plans cover it, sometimes only for children or with a limit on how often, and some don't cover it at all.
What drives the price
We don't list prices here, because they vary too much to be useful. If your dentist is in network with your plan, the fee is set by your plan's contract with the dentist. If they're out of network, they set their own fee. The best way to know your cost is to ask the office for it in writing before treatment. If the cost is higher than you expected, it's reasonable to ask why, or to get a quote from another office.
- How many teeth: D1354 is charged per tooth.
- How many applications: each reapplication is usually charged again.
- Where you live.
The full bill
- An exam and X-rays
- SDF, per tooth
- Sometimes fluoride varnish on the other teeth
- Later, a filling on many treated teeth. See Will the tooth need a filling later?
Will insurance pay?
Coverage for SDF varies from plan to plan:
- Some plans cover it as a preventive or basic service.
- Some cover it only up to a certain age.
- Many limit how often they'll pay for it on the same tooth. See Insurance says I had this done too recently.
- Some plans don't pay for SDF and a filling on the same tooth on the same day.
- Some don't cover it at all.
Medicaid programs in many states cover SDF for children. Check your plan's summary of benefits, or ask member services how your plan handles D1354.
If your dentist is out of network, they can charge their own fee and bill you for whatever the plan doesn't pay. Out-of-network offices often collect the full fee up front, and the plan pays you back whatever benefits it covers.
Ways to manage the cost
- Ask for a predetermination if many teeth are being treated.
- Ask which treated teeth are likely to need a filling later, so you can plan for it.
- Ask whether the office offers a payment plan.
Questions to ask
- How many teeth are you treating, and what's the total?
- Will the reapplications be charged separately?
- Does my plan cover SDF, and how often?
- Which teeth will likely need fillings later?
- Before we schedule, can I get my cost in writing? (A predetermination if I'm using insurance, or a good faith estimate if I'm paying myself.)
When a second opinion makes sense
Not usually needed for cost alone, since SDF is one of the less expensive treatments.