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Pulp Capping

Pulp Capping

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Published by: porsche_cruise on Aug 06, 2008
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10/24/2011

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PULP CAPPING
PROCEDURE D3110
Pulp cap —direct (excluding final restoration).
1.
Delta considers all applicationsof direct pulp capping to be part of,and included in the fee for, therestoration.
2.
Delta considers cement bases tobe included in the fee forrestorations.
PROCEDURE D3120
Pulp cap —indirect (excluding final restoration).
Delta considers all applications ofindirect pulp capping to be part of,and included in the fee for, therestoration.
PULPOTOMY
PROCEDURE D3220
Therapeutic pulpotomy (excluding final restoration) —removal of pulp coronal to the dentinocemental  junction and application of medicament.
1.
This procedure is covered underDelta programs for primary teeth.
2.
Delta considers this procedure tobe part of, and included in the feefor the complete endodontictreatment.
PROCEDURE D3221
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
PROCEDURE D3230
Pulpal therapy (resorbable filling) — anterior, primary tooth (excluding final restoration).
PROCEDURE D3240
Pulpal therapy (resorbable filling) — posterior, primary tooth (excluding final restoration).
ENDODONTIC THERAPY(INCLUDING TREATMENTPLAN, CLINICALPROCEDURES AND FOLLOW-UP CARE) — GENERALGUIDELINES
1.
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.
2.
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.”
DOTTIE1/05
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.
4.
Incomplete endodontictreatment is not a benefit of Deltaprograms. In the date of servicecolumn of the claim form, pleaseindicate the date that theendodontic treatment wascompleted.
5.
When endodontic therapy isprovided in conjunction withoverdentures (complete or partial),the treatment is the financialresponsibility of the patient.
6.
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.
7.
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.
8.
Delta considers endodonticretreatment by the samedentist/dental office within twoyears to be included in the cost ofthe initial root canal.
 
PROCEDURE D3310
Anterior (excluding final restoration).
PROCEDURE D3320
Bicuspid (excluding final restoration).
PROCEDURE D3330
Molar (excluding final restoration).
PROCEDURE D3331
Treatment of root canal obstruction; non-surgical access.
Please describe the nature andduration of the treatment.
PROCEDURE D3332
Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth.
Delta considers procedure D3332to be the equivalent of procedureD9110. Claims for additionalallowances due to extraordinarycircumstances will be individuallyevaluated by Delta’s consultantstaff. The consultant will base his orher determination on thedocumentation submitted with theclaim.
PROCEDURE D3333
Internal root repair of perforationdefects.
Delta considers procedure D3333 tobe the equivalent of procedureD3351.
ENDODONTIC RETREATMENTGENERAL GUIDELINE
Delta considers endodonticretreatment procedures to includethe removal of posts, silver pointand old root canal filling material,and any procedures necessary toprepare the canals and place thecanal filling, as well as the rootcanal therapy. Claims for additionalallowances due to extraordinarycircumstances will be individuallyevaluated by Delta’s consultantstaff. The consultant will base hisor her determination on the writtenreport and radiographs submittedwith the claim.
PROCEDURE D3346
Retreatment of previous root canal therapy —anterior.
PROCEDURE D3347
Retreatment of previous root canal therapy —bicuspid.
PROCEDURE D3348
Retreatment of previous root canal therapy molar.
ENDODONTICS (D3000 — D3999)2.24
1/05
X-rays required
APEXIFICATION/RECALIFICATIONPROCEDURES
PROCEDURE D3351
Apexification/recalcification initial visit (apical closure/calcific repair of perforations, root resorption, etc.) 
PROCEDURE D3352
Apexification/recalcification — interim medication replacement (apical closure/calcific repair of perforations, root resorption, etc.) 
PROCEDURE D3353
Apexification/recalcification final visit (includes completed root canal therapy —apical closure/calcific repair of perforations, root resorption, etc.).
APICOECTOMY/PERIRADICULAR SERVICES
PROCEDURE D3410
Apicoectomy/periradicular surgery anterior.
1.
Delta defines this service as theexcision of the apical portion of theroot of a previously endodonticallytreated anterior tooth to removediseased periapical tissue.
2.
For retrograde filling, seeprocedure D3430.
PROCEDURE D3421
Apicoectomy/periradicular surgery bicuspid (first root).
1.
Delta defines this service as theexcision of the apical portion of theroot of a previously endodonticallytreated bicuspid to removediseased periapical tissue.
2.
For retrograde filling, seeprocedure D3430.
3.
For additional roots, seeprocedure D3426.

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