Gross Pulpal Debridement

Policy No: 22C
Originally Created: 01/01/2011
Section: Endodontics
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Approved: 01/01/2018
Effective: 01/01/2018

Description

Gross pulpal debridement, primary and permanent teeth (D3221)
Gross pulpal debridement for the relief of acute pain prior to conventional root canal therapy (not to be used when endodontic treatment is completed on the same day.)

Policy/criteria

Procedures are in accordance with generally accepted standards of dental practice.

Procedure is considered inclusive of the completed root canal therapy when completed by the same provider.

Administrative guidelines

Process to contract benefits.

Not to be used by provider completing endodontic treatment.

Note: Also considered "open and broach".

Codes

CDT - D3000-D3999 - see above.

Disclaimer

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