Billing Guide for D3330 ENDODONTIC THERAPY, MOLAR 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
D3330 - ENDODONTIC THERAPY, MOLAR 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 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 procedure on the start date, the third party payors often may require that the root canal be submitted using the completion date.
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. The molar root canal would be completed on a subsequent visit.
3. If an endodontic access opening is done through an intact 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. This code requires the relief of acute pain.
COMMENTS
1. Report a root amputation (D3450) or hemisection (D3920) separately.
2. Report D3330 for all molar root canals, regardless of the number of canals. Note: Some dentists charge an additional $100-$200 for a four canal molar vs. a three canal molar.
3. D3330 may be used to report a root canal completed on a first or second primary molar tooth when the corresponding permanent tooth is not present. In this case the canals must be obturated and filled with a non-resorbable, gutta-percha like material.
4. An oral evaluation and diagnostic radiograph(s) for initial diagnosis should be reported separately from the root canal. An oral evaluation would not be reported if the need for root canal had been previously diagnosed. Only the initial diagnostic radiograph(s) can be reported, not working radiographs. If multiple visits are necessary, the diagnostic test(s) should be reported on the first visit and the root canal procedure upon completion, at the last visit.
5. 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 as 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 denied and 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, but never completed, is considered overbilling and is subject to adjustment by the third party payor. A refund may be requested 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 of 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 exisitng 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 reports endodontic access hole closure for an intact crown, not crown repair. However, some payors 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 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 procedure on the start date, the third party payors often may require that the root canal be submitted using the completion date.
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. The molar root canal would be completed on a subsequent visit.
3. If an endodontic access opening is done through an intact 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. This code requires the relief of acute pain.
COMMENTS
1. Report a root amputation (D3450) or hemisection (D3920) separately.
2. Report D3330 for all molar root canals, regardless of the number of canals. Note: Some dentists charge an additional $100-$200 for a four canal molar vs. a three canal molar.
3. D3330 may be used to report a root canal completed on a first or second primary molar tooth when the corresponding permanent tooth is not present. In this case the canals must be obturated and filled with a non-resorbable, gutta-percha like material.
4. An oral evaluation and diagnostic radiograph(s) for initial diagnosis should be reported separately from the root canal. An oral evaluation would not be reported if the need for root canal had been previously diagnosed. Only the initial diagnostic radiograph(s) can be reported, not working radiographs. If multiple visits are necessary, the diagnostic test(s) should be reported on the first visit and the root canal procedure upon completion, at the last visit.
5. 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 as 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 denied and 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, but never completed, is considered overbilling and is subject to adjustment by the third party payor. A refund may be requested 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 of 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 exisitng 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 reports endodontic access hole closure for an intact crown, not crown repair. However, some payors 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.
