Pulp Capping, Indirect

Policy No: 22A
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


Pulp cap – indirect (excluding final restoration) (D3120)
Procedure in which the nearly exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair via formation of secondary dentin.


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

Bases billed as a pulp cap are not covered when placed on the same date of service as the restorative procedure.

Administrative guidelines

Process to contract benefits.


CDT - D3000-D3999 - see above.


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