Billing Guide for D3320 ENDODONTIC THERAPY, PREMOLAR TOOTH (EXCLUDING FINAL RESTORATION)
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Description
This is an optional lesson that covers advanced billing guidelines. It is not required but may be helpful for further learning.
May 06, 2025
D3320 - ENDODONTIC THERAPY, PREMOLAR TOOTH (EXCLUDING FINAL RESTORATION)
1. It is inappropriate to report pulpal debridement (D3221) or palliative (D9110) at the initial, regularly scheduled root canal visit to receive a higher overall reimbursement. These codes require the relief of acute pain. If a root canal is initiated (the length determined and the regularly scheduled instrumentation of the canal begun), the root canal codes (D3310, D3320, or D3330) should be used to report the service. Although the terminology used on the current ADA claim form permits reporting of the root canal on the start date, most third party payors often require the root canal be submitted using the completion date. However, the ADA Policy Eligibility and Payment Dates for Endodontic Treatment (1994:674) encourages the completion date as the date of service.
2. For treatment to alleviate acute pain at an emergency visit by debriding and removing all the pulpal tissue, consider the pulpal debridement (D3221) code to describe this emergency procedure. Also see palliative (D9110) in situations where only part of the pulpal tissue is removed. However, the root canal would be completed on a subsequent visit.
3. If an endontic access opening is done through a crown which is already permanently cemented/bonded, it is inappropriate to report restoration of the endodontic access opening as a core buildup (D2950). The purpose of a core buildup, reported as D2950 is for retention of the crown. Report a one surface amalgam or composite (see comments below, Limitation #5) to describe the access opening hole closure restorative procedure.
4. A root canal procedure performed to allow the placement of an overdenture attachment in the tooth is an 'elective" procedure. An "elective" root canal procedure completed to aid in the delivery of another more "specialized" procedure, like an overdenture, should be submitted, but is generally not reimbursed.
5. For a routine, regularly scheduled visit, do not report pulpal debridement (D3221) at the first visit of a scheduled two appointment visit technique. These codes require the relief of acute pain.
WARNING
The determination of the endodontic code that describes the endodontic procedure provided is based on the tooth type rather than the number of canals treated. Report D3320 to describe a root canal provided to a premolar, regardless of the number of canals treated.
COMMENTS
1. Report the root amputation (D3450) or hemisection (D3920) separately.
2. Report D3320 for root canals performed on premolars, regardless of the number of canals. Fees vary and dentists may charge an additional $100-$200 fee for a two or three canal premolar, vs. a one canal premolar.
3. An oral evaluation and diagnostic radiograph(s) for initial diagnosis should be reported separately from the root canal procedure. An evaluation would not be reported if the need for root canal treatment had been previously diagnosed. The initial diagnostic radiograph(s) should be reported, not working radiographs. Working and intraoperative radiographs are considered part of the endodontic procedure. If multiple visits are necessary, the diagnostic test(s) should be reported prior to, or on the first visit date.
4. Enter the tooth number being treated in Box 27 of the 2024 ADA Dental Claim Form.
LIMITATIONS
1. "Working" or intraoperative radiographs and post-treatment images (within thirty days of treatment) are considered a part of the root canal global fee. Note: Diagnostic images done prior to initiation of endodontic treatment are considered a separate diagnostic procedure and may be reimbursed. An oral evaluation may be submitted at the diagnostic appointment; however, plan limitations may limit reimbursement.
2. Reimbursement for an under filled or over filled root canal may be disallowed by a payor.
3. A pulpal debridement (D3221) procedure may be reported when performed to relieve acute pain. "Starting" an endodontic procedure involves establishing working length and beginning the use of a sequence of files to instrument and enlarge the canal. This is permitted at the emergency visit. Some payors may "re-map" D3221 to a pulpotomy (D3220) or palliative (D9110) for reimbursement. Also see D9110.
4. A root canal submitted for reimbursement and paid based on the start date that is never completed is considered overbilling and is subject to adjustment by the third party payor. A refund may be requested by the payor for all or part of the fee. Any cancellations and attempts to reschedule the patient for completion of treatment must be noted in the clinical record. Notify the payor that the root canal was not completed. Submit a request for the alternate benefit D3999, unspecified procedure, by report, to recoup for the time and materials used. The ADA recommends the root canal completion date be used when reporting endodontic therapy; however, state law and/or contract language could indicate or require otherwise. PPOs typically require the completion date by contract.
5. The closure of an endodontic access hole is reported as a separate procedure. Use codes such as a one surface amalgam or composite to report the restoration for access hole closure if the crown is intact and in place. Restorations to seal the access opening are generally reimbursed at 80% of the payor's fee. Some third party contracts include access closure in the global fee for the endodontic procedure. It is recommended that a brief narrative be included with the claim that describes the restoration technique used and reason for the procedure. "An occlusal composite was placed for access hole closure." The payor may have tracked the tooth with a crown and may reject the composite restoration without a narrative.
6. If the crown comes off or is removed, then a core buildup (D2950) or pre-fabricated post and core (D2954) could be reported, if performed. The existing or new crown would be placed subsequently.
7. The D2980 crown repair code now reports "necessitated by restorative failure" in its nomenclature so now either a one surface amalgam or composite is the code to use to report endodontic access hole closure, not crown repair. However, some payor's continue to reimburse endodontic access closure with D2980.
NARRATIVES
1. If documentation is requested: "See attached pre- and post-op radiographic images."
2. If diagnostic radiographic images are denied, submit a narrative stating they were taken prior to initiation of endodontic therapy and are not "working" or intraoperative radiographs.
1. It is inappropriate to report pulpal debridement (D3221) or palliative (D9110) at the initial, regularly scheduled root canal visit to receive a higher overall reimbursement. These codes require the relief of acute pain. If a root canal is initiated (the length determined and the regularly scheduled instrumentation of the canal begun), the root canal codes (D3310, D3320, or D3330) should be used to report the service. Although the terminology used on the current ADA claim form permits reporting of the root canal on the start date, most third party payors often require the root canal be submitted using the completion date. However, the ADA Policy Eligibility and Payment Dates for Endodontic Treatment (1994:674) encourages the completion date as the date of service.
2. For treatment to alleviate acute pain at an emergency visit by debriding and removing all the pulpal tissue, consider the pulpal debridement (D3221) code to describe this emergency procedure. Also see palliative (D9110) in situations where only part of the pulpal tissue is removed. However, the root canal would be completed on a subsequent visit.
3. If an endontic access opening is done through a crown which is already permanently cemented/bonded, it is inappropriate to report restoration of the endodontic access opening as a core buildup (D2950). The purpose of a core buildup, reported as D2950 is for retention of the crown. Report a one surface amalgam or composite (see comments below, Limitation #5) to describe the access opening hole closure restorative procedure.
4. A root canal procedure performed to allow the placement of an overdenture attachment in the tooth is an 'elective" procedure. An "elective" root canal procedure completed to aid in the delivery of another more "specialized" procedure, like an overdenture, should be submitted, but is generally not reimbursed.
5. For a routine, regularly scheduled visit, do not report pulpal debridement (D3221) at the first visit of a scheduled two appointment visit technique. These codes require the relief of acute pain.
WARNING
The determination of the endodontic code that describes the endodontic procedure provided is based on the tooth type rather than the number of canals treated. Report D3320 to describe a root canal provided to a premolar, regardless of the number of canals treated.
COMMENTS
1. Report the root amputation (D3450) or hemisection (D3920) separately.
2. Report D3320 for root canals performed on premolars, regardless of the number of canals. Fees vary and dentists may charge an additional $100-$200 fee for a two or three canal premolar, vs. a one canal premolar.
3. An oral evaluation and diagnostic radiograph(s) for initial diagnosis should be reported separately from the root canal procedure. An evaluation would not be reported if the need for root canal treatment had been previously diagnosed. The initial diagnostic radiograph(s) should be reported, not working radiographs. Working and intraoperative radiographs are considered part of the endodontic procedure. If multiple visits are necessary, the diagnostic test(s) should be reported prior to, or on the first visit date.
4. Enter the tooth number being treated in Box 27 of the 2024 ADA Dental Claim Form.
LIMITATIONS
1. "Working" or intraoperative radiographs and post-treatment images (within thirty days of treatment) are considered a part of the root canal global fee. Note: Diagnostic images done prior to initiation of endodontic treatment are considered a separate diagnostic procedure and may be reimbursed. An oral evaluation may be submitted at the diagnostic appointment; however, plan limitations may limit reimbursement.
2. Reimbursement for an under filled or over filled root canal may be disallowed by a payor.
3. A pulpal debridement (D3221) procedure may be reported when performed to relieve acute pain. "Starting" an endodontic procedure involves establishing working length and beginning the use of a sequence of files to instrument and enlarge the canal. This is permitted at the emergency visit. Some payors may "re-map" D3221 to a pulpotomy (D3220) or palliative (D9110) for reimbursement. Also see D9110.
4. A root canal submitted for reimbursement and paid based on the start date that is never completed is considered overbilling and is subject to adjustment by the third party payor. A refund may be requested by the payor for all or part of the fee. Any cancellations and attempts to reschedule the patient for completion of treatment must be noted in the clinical record. Notify the payor that the root canal was not completed. Submit a request for the alternate benefit D3999, unspecified procedure, by report, to recoup for the time and materials used. The ADA recommends the root canal completion date be used when reporting endodontic therapy; however, state law and/or contract language could indicate or require otherwise. PPOs typically require the completion date by contract.
5. The closure of an endodontic access hole is reported as a separate procedure. Use codes such as a one surface amalgam or composite to report the restoration for access hole closure if the crown is intact and in place. Restorations to seal the access opening are generally reimbursed at 80% of the payor's fee. Some third party contracts include access closure in the global fee for the endodontic procedure. It is recommended that a brief narrative be included with the claim that describes the restoration technique used and reason for the procedure. "An occlusal composite was placed for access hole closure." The payor may have tracked the tooth with a crown and may reject the composite restoration without a narrative.
6. If the crown comes off or is removed, then a core buildup (D2950) or pre-fabricated post and core (D2954) could be reported, if performed. The existing or new crown would be placed subsequently.
7. The D2980 crown repair code now reports "necessitated by restorative failure" in its nomenclature so now either a one surface amalgam or composite is the code to use to report endodontic access hole closure, not crown repair. However, some payor's continue to reimburse endodontic access closure with D2980.
NARRATIVES
1. If documentation is requested: "See attached pre- and post-op radiographic images."
2. If diagnostic radiographic images are denied, submit a narrative stating they were taken prior to initiation of endodontic therapy and are not "working" or intraoperative radiographs.
