Pulp cap —direct (excluding final restoration).
Delta considers all applicationsof direct pulp capping to be part of,and included in the fee for, therestoration.
Delta considers cement bases tobe included in the fee forrestorations.
Pulp cap —indirect (excluding final restoration).
Delta considers all applications ofindirect pulp capping to be part of,and included in the fee for, therestoration.
Therapeutic pulpotomy (excluding final restoration) —removal of pulp coronal to the dentinocemental junction and application of medicament.
This procedure is covered underDelta programs for primary teeth.
Delta considers this procedure tobe part of, and included in the feefor the complete endodontictreatment.
Pulpal debridement, primary and permanent teeth.
Delta considers this procedure tobe the equivalent of palliativetreatment, procedure D9110.Under Delta’s processing policies,procedure D3221 is not considereda separate procedure whenperformed by the same provider orthe same dental office on the sameday that the root canal is completed.
ENDODONTIC THERAPY ONPRIMARY TEETH
Pulpal therapy (resorbable filling) — anterior, primary tooth (excluding final restoration).
Pulpal therapy (resorbable filling) — posterior, primary tooth (excluding final restoration).
ENDODONTIC THERAPY(INCLUDING TREATMENTPLAN, CLINICALPROCEDURES AND FOLLOW-UP CARE) — GENERALGUIDELINES
Delta considers test films takenas part of root canal therapy to bepart of, and included in the fee for,the complete endodonticprocedure. This does not apply to adiagnostic film taken to ascertainthe presence of pathology.
Although submission of x-raydocumentation is not generallyrequired in conjunction with rootcanal therapy, any exceptionalcircumstances (such as unusualdifficulty or retreatment) should bethoroughly documented.
ENDODONTICS (D3000 —D3999)
“Come on, Joey. That’s the maintenanceman, not the dentist.”
2.23ENDODONTICS (D3000 — D3999)3.
Under Delta’s processingpolicies, the initial opening into thecanal, sealing of the accessopening and routine post-operativevisits are considered part of, andincluded in the fee for, completedendodontic treatment.
Incomplete endodontictreatment is not a benefit of Deltaprograms. In the date of servicecolumn of the claim form, pleaseindicate the date that theendodontic treatment wascompleted.
When endodontic therapy isprovided in conjunction withoverdentures (complete or partial),the treatment is the financialresponsibility of the patient.
When root canal procedures areperformed on primary teeth thathave a permanent successor, amember of Delta’s consultant staffwill determine the appropriateallowance which will generally bebased on the dentist’s fee forpulpotomy.
When root canal therapy isperformed without the use of asolid core material (often referred toas the Sargenti method), the rootcanal procedure and thesubsequent restoration are notpayable by Delta or the patient.
Delta considers endodonticretreatment by the samedentist/dental office within twoyears to be included in the cost ofthe initial root canal.