Endodontics Section - Endodontic Therapy,
Therapy, Root Canal
||Date of Origin: January 2011
||Policy No: 26
|Last Reviewed: January 2015
|Approved: January 2015
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.
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.
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
Process to contract benefits.
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