Insurance · Updated 2026-09-08 · 5 min read

Which teeth are covered for sealants?

Most plans pay sealants on permanent first and second molars only. Some name the eight teeth outright, and one carrier pays only on the four first molars.

A premolar sealant is usually denied because the plan pays sealants only on permanent molars, not because of the patient's age. The commercial default across the carriers in this evidence is unrestored permanent first and second molars — teeth 2, 3, 14, 15, 18, 19, 30 and 31 — with bicuspids excluded by name in the plan's exclusion list. One further tooth rule catches offices out: some plans narrow the list to the four first permanent molars, so half the teeth a hygienist would seal on a 12-year-old sit outside the benefit even though the child is well inside the age. As of September 2026, only 5.5% of Cigna's D1351 lines and 0.5% of Guardian's were denied for age — the tooth is the more common refusal, and it does not appear in the age numbers at all.

What we measured

Every remittance line billed under D1351 to that carrier, all dates, with the share paying $0 for an age-limitation reason. Measured September 2026 across 37 practices and more than 170 payers; Delta Dental member companies are pooled. These are age denials only. A sealant refused because the tooth is a premolar is classified under a different denial reason and is not counted here, so nothing in this table sizes the tooth problem.

What the carriers' own policies say

The Alabama Medicaid provider manual, chapter 13 (dentist), January 2026, names the teeth outright:

"D1351 Sealant, per tooth — Only covered for teeth: 02, 03, 14, 15, 18, 19, 30, 31, on children aged 5 through 14 years. For procedure D1351, teeth to be sealed must be free of caries and restorations."

Blue Cross Blue Shield of Alabama's carrier-wide dental policy narrows it further, to first permanent molars only: sealants on teeth #3, #14, #19 and #30, one per tooth per 48 months, a $20 maximum payment per tooth, for children through age 13.

Delta Dental states the tooth rule across the federation as an exclusion — sealants on bicuspids or premolars are not covered, permanent molars only — and its own public article on sealants puts the clinical window beside it:

"Children and teenagers ages six to 15 are the best candidates for sealants."

That window and the plan's tooth list are two different tests, and a sealant has to pass both.

The UnitedHealthcare FEDVIP dental plan's network policy states the exclusion as a general exclusion rather than a limitation:

"Sealants for teeth other than permanent molars are not covered"

Pennsylvania's Department of Human Services Medical Assistance bulletin of June 5, 2024 is one of the programs that goes the other way:

"D1351 Sealant - per tooth … 1 application per indicated 1st and 2nd premolars – 1 application per permanent 1st and 2nd molars per lifetime (Under 21 years of age only)"

Why it depends on the plan

Three separate rules decide whether a sealant is paid, and a plan can fail you on any one of them.

The tooth. Molars only is the default: Delta Dental's federation-wide exclusion, Aetna's carrier-wide restriction to first and second permanent molars, and named exclusions at Blue Cross Blue Shield of Illinois and of Texas. Cigna is the main commercial exception, paying on unrestored permanent bicuspid or molar teeth on most plans. Guardian's pediatric essential health benefit rule covers premolars and permanent molars to 19. Delta Dental of Arizona covers bicuspids at ages 13 to 19 on most of its plans.

The surface and the condition of the tooth. Ameritas pays on the occlusal surface only. Alabama Medicaid requires the tooth to be free of caries and restorations. Physicians Mutual limits coverage to the occlusal surface of permanent molar teeth for persons age 16 and under. A restored tooth is not an unrestored tooth, and "unrestored" appears in the MetLife, UnitedHealthcare, BCBS FEP Dental and Guardian sealant rules.

The age, which travels with the tooth list rather than apart from it. Alabama Medicaid pays its eight named teeth only for children aged 5 through 14; Blue Cross Blue Shield of Alabama pays four teeth through 13; Pennsylvania pays molars and premolars under 21. An age quoted without the tooth list answers half the question.

What to do

• Ask the payer for the covered tooth numbers, not just "are sealants covered". A yes that means molars only reads exactly like a yes that includes premolars.
• Ask whether the plan pays on both first and second permanent molars or only the firsts, and record the tooth numbers next to the age.
• Check whether the plan requires the tooth to be unrestored and the surface to be occlusal before you seal a tooth with an existing restoration.
• Where a premolar sealant is clinically indicated and the plan excludes it, quote it to the patient as a non-covered charge before the appointment.
• On state Medicaid, read the tooth list on the fee schedule. Programs differ in both directions — one names eight teeth and ages 5 through 14, another pays premolars that most commercial plans never will.

Numbers last refreshed September 2026.

All articles · Kaylie