Delta considers all applications of direct pulp capping to be part of the restoration. The initial opening into the canal, sealing of the access opening and routine post-operative visits are considered part of, and included in the fee for, the completed endodontic treatment. When root canal therapy is performed without the use of a solid core material, the root canal procedure and the subsequent restoration are not payable by Delta or the patient.
Delta considers all applications of direct pulp capping to be part of the restoration. The initial opening into the canal, sealing of the access opening and routine post-operative visits are considered part of, and included in the fee for, the completed endodontic treatment. When root canal therapy is performed without the use of a solid core material, the root canal procedure and the subsequent restoration are not payable by Delta or the patient.
Delta considers all applications of direct pulp capping to be part of the restoration. The initial opening into the canal, sealing of the access opening and routine post-operative visits are considered part of, and included in the fee for, the completed endodontic treatment. When root canal therapy is performed without the use of a solid core material, the root canal procedure and the subsequent restoration are not payable by Delta or the patient.
Delta considers all applications of direct pulp capping to be part of the restoration. The initial opening into the canal, sealing of the access opening and routine post-operative visits are considered part of, and included in the fee for, the completed endodontic treatment. When root canal therapy is performed without the use of a solid core material, the root canal procedure and the subsequent restoration are not payable by Delta or the patient.
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ENDODONTICS (D3000 — D3999)
PULP CAPPING ENDODONTIC THERAPY ON 3. Under Delta’s processing
PRIMARY TEETH policies, the initial opening into the PROCEDURE D3110 canal, sealing of the access Pulp cap — direct (excluding final PROCEDURE D3230 opening and routine post-operative restoration). Pulpal therapy (resorbable filling) — visits are considered part of, and 1. Delta considers all applications anterior, primary tooth (excluding included in the fee for, completed of direct pulp capping to be part of, final restoration). endodontic treatment. and included in the fee for, the 4. Incomplete endodontic PROCEDURE D3240 restoration. treatment is not a benefit of Delta Pulpal therapy (resorbable filling) — programs. In the date of service 2. Delta considers cement bases to posterior, primary tooth (excluding be included in the fee for column of the claim form, please final restoration). restorations. indicate the date that the ENDODONTIC THERAPY endodontic treatment was PROCEDURE D3120 (INCLUDING TREATMENT completed. Pulp cap — indirect (excluding final PLAN, CLINICAL 5. When endodontic therapy is restoration). PROCEDURES AND FOLLOW- provided in conjunction with Delta considers all applications of UP CARE) — GENERAL overdentures (complete or partial), indirect pulp capping to be part of, GUIDELINES the treatment is the financial and included in the fee for, the 1. Delta considers test films taken responsibility of the patient. restoration. as part of root canal therapy to be 6. When root canal procedures are part of, and included in the fee for, performed on primary teeth that PULPOTOMY have a permanent successor, a the complete endodontic procedure. This does not apply to a member of Delta’s consultant staff PROCEDURE D3220 diagnostic film taken to ascertain will determine the appropriate Therapeutic pulpotomy (excluding the presence of pathology. allowance which will generally be final restoration) — removal of pulp based on the dentist’s fee for coronal to the dentinocemental 2. Although submission of x-ray documentation is not generally pulpotomy. junction and application of medicament. required in conjunction with root 7. When root canal therapy is canal therapy, any exceptional performed without the use of a 1. This procedure is covered under circumstances (such as unusual solid core material (often referred to Delta programs for primary teeth. difficulty or retreatment) should be as the Sargenti method), the root 2. Delta considers this procedure to thoroughly documented. canal procedure and the be part of, and included in the fee subsequent restoration are not for the complete endodontic payable by Delta or the patient. treatment. DOTTIE 8. Delta considers endodontic PROCEDURE D3221 retreatment by the same Pulpal debridement, primary and dentist/dental office within two permanent teeth. years to be included in the cost of the initial root canal. Delta considers this procedure to be the equivalent of palliative treatment, procedure D9110. Under Delta’s processing policies, procedure D3221 is not considered a separate procedure when performed by the same provider or the same dental office on the same day that the root canal is completed. “Come on, Joey. That’s the maintenance man, not the dentist.”
1/05 ENDODONTICS (D3000 — D3999) 2.23
PROCEDURE D3310 ENDODONTIC RETREATMENT APEXIFICATION/ Anterior (excluding final restoration). — GENERAL GUIDELINE RECALIFICATION Delta considers endodontic PROCEDURES PROCEDURE D3320 retreatment procedures to include Bicuspid (excluding final restoration). the removal of posts, silver point PROCEDURE D3351 and old root canal filling material, Apexification/recalcification — initial PROCEDURE D3330 and any procedures necessary to visit (apical closure/calcific repair of Molar (excluding final restoration). prepare the canals and place the perforations, root resorption, etc.) canal filling, as well as the root PROCEDURE D3331 canal therapy. Claims for additional PROCEDURE D3352 Treatment of root canal obstruction; allowances due to extraordinary Apexification/recalcification — non-surgical access. circumstances will be individually interim medication replacement Please describe the nature and evaluated by Delta’s consultant (apical closure/calcific repair of duration of the treatment. staff. The consultant will base his perforations, root resorption, etc.) or her determination on the written PROCEDURE D3332 report and radiographs submitted PROCEDURE D3353 Incomplete endodontic therapy; with the claim. Apexification/recalcification — final inoperable, unrestorable or fractured visit (includes completed root canal tooth. PROCEDURE D3346 therapy — apical closure/calcific Retreatment of previous root canal repair of perforations, root Delta considers procedure D3332 therapy — anterior. resorption, etc.). to be the equivalent of procedure D9110. Claims for additional APICOECTOMY/ allowances due to extraordinary PROCEDURE D3347 PERIRADICULAR SERVICES circumstances will be individually Retreatment of previous root canal evaluated by Delta’s consultant therapy — bicuspid. PROCEDURE D3410 staff. The consultant will base his or Apicoectomy/periradicular surgery her determination on the PROCEDURE D3348 — anterior. documentation submitted with the Retreatment of previous root canal claim. 1. Delta defines this service as the therapy — molar. excision of the apical portion of the PROCEDURE D3333 root of a previously endodontically Internal root repair of perforation treated anterior tooth to remove defects. diseased periapical tissue. Delta considers procedure D3333 to 2. For retrograde filling, see be the equivalent of procedure procedure D3430. D3351. PROCEDURE D3421 Apicoectomy/periradicular surgery — bicuspid (first root). 1. Delta defines this service as the excision of the apical portion of the root of a previously endodontically treated bicuspid to remove diseased periapical tissue. 2. For retrograde filling, see procedure D3430. 3. For additional roots, see procedure D3426.
X-rays required
2.24 ENDODONTICS (D3000 — D3999) 1/05
PROCEDURE D3425 OTHER ENDODONTIC PROCEDURE D3460 Apicoectomy/periradicular surgery PROCEDURES Endodontic endosseous implant. — molar (first root). 1. Please submit x-rays. PROCEDURE D3910 1. Delta defines this service as the excision of the apical portion of the 2. Procedure D3460 describes a Surgical procedure for isolation of root of a previously endodontically smooth and/or threaded pin implant tooth with rubber dam. treated molar to remove diseased which extends through the root Delta considers this procedure to periapical tissue. canal into periapical bone to be part of, and included in the fees stabilize a mobile tooth. for, the related services provided 2. For retrograde filling, see procedure D3430. 3. See “Implants — General on the same date. Guidelines” in this section, 3. For additional roots, see PROCEDURE D3920 immediately preceding procedure procedure D3426. D6010. Hemisection (including any root removal), not including root canal PROCEDURE D3426 PROCEDURE D3470 therapy. Apicoectomy/periradicular surgery Intentional reimplantation (including (each additional root). PROCEDURE D3950 necessary splinting). 1. Please submit an operative Canal preparation and fitting of This service is not a benefit of most report. The consultant staff will preformed dowel or post. Delta programs. determine Delta’s allowance. Delta considers this service to be 2. When more than one additional part of, and included in the fee for, root is involved, please use a completed endodontic therapy separate line for each additional and/or placement of the post. root, and indicate the tooth number. PROCEDURE D3999 Unspecified endodontic procedure, PROCEDURE D3430 by report. Retrograde filling — per root. Please enter a complete description When more than one root is of service and clinical reason. involved, please submit an x-ray for review by Delta’s consultant staff, and use a separate line for each root.