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

Description

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.

Policy/criteria

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.

Codes

CDT - D3000-D3999 - see above.

Disclaimer

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