Implementation Tips

  • Educate all staff, including front desk personnel, on caries risk assessment and the value of fluoride varnish.
  • Train all clinicians on application procedures.
  • Identify a varnish champion who answers questions, understands billing issues, assigns tasks, orders the varnish, and maintains supplies.
  • Divide tasks among staff to avoid time burdens for one person.
  • Store supplies in exam rooms or in a portable kit.
  • CPT code effective January 2015 for fluoride varnish application is 99188. It is suggested to append a Z modifier for preventive services (e.g. Prophylactic fluoride administration Z29.3).
  • Update billing forms with varnish code(s).
  • Have copies of educational handouts preprinted to give to parents.


Lewis C, Lynch H, Richardson L. Fluoride Varnish Use in Primary Care: What Do Providers Think? Pediatrics 2005;115:e69–e76. URL:

Slade GD, Rozier RG, Zeldin LP, Margolis PA. Training pediatric health care providers in prevention of dental decay: results from a randomized controlled trial. BMC Health Services Research 2007, 7:176. View site here.