Endodontics Section - Gross Pulpal Debridement
| Topic: Gross Pulpal
Debridement |
Last Reviewed Date:
01/2003 |
| Section: Endodontics |
Policy No: 22C |
| 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
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 |
Number |
Description |
| CDT |
D3000-D3999 |
See above |
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|
