D3220 - Pulpotomy
Therapeutic pulpotomy (excluding restoration).
- Procedure Code
- D3220
- Category
- Endodontics
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
Required Claim Attachments & Pre-Submission Checklist
- Standard ADA claim form with CDT procedure code and date of service
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- If provided on permanent teeth, D3220 is processed as palliative treatment (D9110) and any fees in excess of D9110 are not billable to the patient.
- When done in conjunction with a root canal procedure (D3310-D3330) the fees for D3220 are not billable to the patient.
- For benefit purposes, anesthesia is an integral part of the procedures being performed and additional fees are not billable to the patient.
- All services and treatment provided remotely via tele-health modalities, be they synchronous or asynchronous, must be performed by a licensed dentist or their supervised staff, acting within the scope of applicable law. Services and treatment delivered virtually are only a benefit when the elements included in the descriptor of the CDT procedure code are completed and only when they meet generally accepted clinical guidelines.
- Benefits for restorations for altering occlusion, adjusting vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion, abfraction, corrosion, TMD, or for periodontal, orthodontic, or other splinting are denied, unless covered by group contract.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
ICD-10 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K04.0 | Pulpitis | Diseases of pulp and periapical tissues | Yes (Primary) | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Pulpitis |
| K02.53 | Dental caries on pit and fissure surface penetrating into pulp | Dental caries | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Dental caries on pit and fissure surface penetrating into pulp |
| K02.63 | Dental caries on smooth surface penetrating into pulp | Dental caries | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Dental caries on smooth surface penetrating into pulp |
| K03.81 | Cracked tooth | Other diseases of hard tissues of teeth | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Cracked tooth |
| K03.89 | Other specified diseases of hard tissues of teeth | Other diseases of hard tissues of teeth | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Other specified diseases of hard tissues of teeth |
| K04.1 | Necrosis of the pulp | Diseases of pulp and periapical tissues | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Necrosis of the pulp |
| K04.5 | Chronic apical periodontitis | Diseases of pulp and periapical tissues | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Chronic apical periodontitis |
| K04.6 | Periapical abscess with sinus | Diseases of pulp and periapical tissues | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Periapical abscess with sinus |
| K04.7 | Periapical abscess without sinus | Diseases of pulp and periapical tissues | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Periapical abscess without sinus |
| K04.8 | Radicular cyst | Diseases of pulp and periapical tissues | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Radicular cyst |
| K04.90 | Unspecified diseases of pulp and periapical tissues | Diseases of pulp and periapical tissues | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Unspecified diseases of pulp and periapical tissues |
| K04.99 | Other diseases of pulp and periapical tissues | Diseases of pulp and periapical tissues | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Other diseases of pulp and periapical tissues |
| K05.5 | Other periodontal diseases | Gingivitis and periodontal diseases | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Other periodontal diseases |
| K08.8 | Other specified disorders of teeth and supporting structures | Other disorders of teeth and supporting structures | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Other specified disorders of teeth and supporting structures |
| K08.81 | Primary occlusal trauma | Other disorders of teeth and supporting structures | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Primary occlusal trauma |
| K08.82 | Secondary occlusal trauma | Other disorders of teeth and supporting structures | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Secondary occlusal trauma |
| K08.89 | Other specified disorders of teeth and supporting structures | Other disorders of teeth and supporting structures | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Other specified disorders of teeth and supporting structures |
| S02.5XXA | Fracture of tooth (traumatic), initial encounter for closed fracture | Fracture of skull and facial bones | Secondary | BOTH | therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament indicated for Fracture of tooth (traumatic), initial encounter for closed fracture |