Endodontics Section - Pulp Capping, Direct
| Topic: Pulp Capping,
Direct |
Last Reviewed Date:
01/2003 |
| Section: Endodontics |
Policy No: 22 |
| Revised/Effective Date: 01/2003
|
Next Review Date: 01/2005 |
IMPORTANT INFORMATION
This Dental Policy has been developed through consideration of
generally accepted standards of dental practice, review of dental literature,
dental necessity, and as appropriate, government approval.
Benefit determinations should be based
in all cases on the applicable contract language.
To the extent there are any conflicts between these guidelines and the
contract language, the contract language will control.
The purpose of dental policy is to provide a guide to coverage. Dental
policy is not intended to dictate to providers how to practice dentistry.
Providers are expected to exercise their clinical judgment in providing
the most appropriate care.
|
Description
Pulp cap – direct (excluding final restoration)
(D3110):
Procedure in which the exposed pulp is covered with
a dressing or cement that protects the pulp and promotes
healing and repair.
Policy/Criteria
Procedures are in accordance with generally accepted
standards of dental practice.
Bases billed as pulp caps are not covered.
Administrative Guidelines
Process to contract benefits.
Direct pulp cap (D3110) --allow at the same time as
the placement of the restoration. Subject to review
with supporting documentation and radiographs showing
pulpal encroachment.
Bases billed as a pulp cap are not covered.
| Codes |
Number |
Description |
| CDT |
D3000-D3999 |
See above |
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