Policy No: 26
Originally Created: 01/01/2011
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Endodontic Therapy (including treatment plan, clinical procedures and follow-up care)
- Includes primary teeth without succedaneous teeth and permanent teeth. Complete root canal therapy. Pulpectomy is part of root canal therapy. Includes appointments necessary to complete treatment; also includes intra-operative radiographs. Does not include diagnostic evaluation and necessary radiographs/diagnostic images. CDT codes: D3310-D3330.
- Treatment of root canal obstruction; non-surgical access (D3331) is not inclusive of endondontic therapy retreatment when performed by a provider that was not the original treating dentist.
Procedures are in accordance with generally accepted standards of dental practice.
Canal preparation and fitting of preformed dowel or post is included in the placement of cast or prefabricated post and core. No additional reimbursement is available.
Process to contract benefits.
CDT - D3000-D3999 - see above.