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  • Pulp Capping

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    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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    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.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    858 views3 pages

    Pulp Capping

    Uploaded by

    porsche_cruise
    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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    of 3

    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.

    PROCEDURE D3450
    Root amputation — per root.

    By report
    X-rays required

    1/05 ENDODONTICS (D3000 — D3999) 2.25

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