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The Regence Group Dental Policy
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Endodontics Section - Endodontic Therapy, Root Canal

Topic: Endodontic Therapy, Root Canal Date of Origin: January 2011
Section: Endodontics Policy No: 26
Last Reviewed: January 2014 Last Revised: January 2014
Approved: January 2014  

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
Endodontic Therapy (including treatment plan, clinical procedures and follow-up care):

Includes primary teeth without succedaneous teeth and permanent teeth.  Complete root canal therapy.  Pulpectomy is part of root canal therapy.  Includes appointments necessary to complete treatment; also includes intra-operative radiographs.  Does not include diagnostic evaluation and necessary radiographs/diagnostic images.  CDT-2 codes:  D3310-D3330.

Treatment of root canal obstruction; non-surgical access (D3331) is not inclusive of endondontic therapy retreatment when performed by a provider that was not the  original treating dentist. 

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

Canal preparation and fitting of preformed dowel or post is included in the placement of cast or prefabricated post and core.  No additional reimbursement is available.

Administrative Guidelines
Process to contract benefits.

Codes Number Description
CDT
D3000-D3999 See above

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