Coding with Kyle: Apicoectomy codes

March 17, 2023
An apicoectomy is a minor surgical procedure that removes the apex, or very tip, of the tooth's root. This month, OM Kyle Summerford covers the related codes.
Kyle L. Summerford, Editorial Director

D3410: Apicoectomy, anterior

D3421: Apicoectomy, premolar (first root)

D3425: Apicoectomy, molar (first root)

D3426: Apicoectomy, each additional root

D3430: Retrograde filling, per root

Purpose: To access the root of the tooth through gum tissue and remove the infected root end in hopes of alleviating infection of a tooth that has had prior root canal therapy fail.

More "Coding with Kyle":

D3430: Retrograde filling, per root

Purpose: A filling placed upon completion of the apicoectomy procedure.

Retrograde filling should be billed separately per tooth.

Below are a few variables involved when it comes to dental insurance coverage and reimbursement:

  • Most insurance plans will pay for a root canal once in a lifetime and deny payment for an apicoectomy.
  • PPO plans may place a time limit from the time of completion of the root canal to when the apicoectomy has been performed.
  • Submitting a clear written narrative explaining the reason for the apicoectomy to be performed and long term prognosis can help facilitate approval in most cases.
  • If reporting a buildup or resin composite on the same tooth at the same visit, insurance plan will deny.
  • Providing x-rays, narrative, recent periodontal charting, and photographs will ensure a smooth claim approval or denial and alleviate the need to submit additional information to the insurance company later.