Dental sealants are one of the simplest, most effective preventive services you can offer—especially for kids and teens. But if you’ve ever submitted a sealant claim and gotten hit with a denial, you may be wondering:

Are sealants even covered by insurance?
And more importantly: How can I offer them consistently without running into coverage roadblocks?

Let’s break it down.

Are Sealants Covered by Dental Insurance?

Yes—but with strings attached.

Most dental insurance plans do cover sealants, but only under specific conditions. Typically, coverage includes:

• Permanent molars only (usually first and second molars),

• Patients under a certain age (commonly up to age 14 or 16),

• No existing restorations on the tooth,

• Once every 2 to 5 years, depending on the plan.

What this means is that:

• Primary teeth or premolars often aren’t covered.

• Adult patients? Almost never.

• If a tooth already has a filling or is not fully erupted? Likely denied.

So while sealants are technically covered in many cases, the narrow criteria make it easy to hit coverage limitations.

Why You Should Offer Sealants Anyway

Here’s the thing: sealants work. They’re a low-cost, non-invasive way to protect teeth from decay—especially in kids and teens with deep pits and fissures. They reduce risk and preserve tooth structure. That’s worth it, regardless of what insurance says.

Offering sealants consistently can:

• Prevent future restorative work, saving your patients money and discomfort.

• Position your practice as prevention-focused, which builds trust with families.

• Boost production with a service that’s quick to deliver and easy to explain.

How to Successfully Implement Sealants in Your Practice

1. Build Them Into Your Preventive Care Protocol

Train your hygiene team to:

• Identify eligible patients during cleanings,

• Educate parents on the long-term value of sealants,

• Recommend them routinely, not just “if covered.”

Make sealants part of your standard prevention conversation, not an optional afterthought.

2. Check Insurance, But Don’t Let It Decide

Yes, verify if a patient has sealant benefits—but avoid framing the conversation around insurance first.

Instead, focus on clinical need:

“Your child’s molars have deep grooves that are prone to cavities. We recommend sealing them now to prevent future decay.”

Then follow with:

“Some insurance plans help cover sealants—we can check yours. But even if it’s not covered, this is a valuable one-time preventive step.”

Let patients decide based on value, not just benefits.

3. Use Clear, Simple Language

Avoid jargon. Parents and patients are more likely to say yes when you explain:

• What a sealant is (“a protective coating”),

• Why it’s needed (“to prevent cavities in the chewing surface”),

• How quick and painless it is (“no shots, no drilling, done in minutes”).

The easier it is to understand, the easier it is to accept.

4. Price It Affordably

If insurance doesn’t cover it, have a clear, reasonable cash fee (e.g., $35–$60 per tooth) and communicate it upfront.

Consider offering:

• Bundled sealant packages for families,

• Membership plan discounts, or

• School-age special promos during back-to-school months.

Preventive services like sealants should never feel financially out of reach.

5. Document Thoroughly for Insurance

To improve your chances of getting sealants covered:

• Chart eruption status,

• Indicate tooth numbers,

• Include age and diagnostic justification (e.g., “deep pits and fissures, no existing restoration”).

Attach intraoral photos if needed, especially if the tooth doesn't look "decay-prone" to the payer.

Final Thoughts

Insurance coverage for sealants is limited, but their clinical value is not.

By shifting the focus from “Will insurance pay for this?” to “Is this the right preventive care for the patient?”, you can build trust, protect teeth, and grow your practice with a service that truly makes a difference.

Make sealants a standard, not a suggestion—and educate, not apologize, when insurance doesn’t cooperate.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com