D3222 - Partial Pulpotomy
Partial pulpotomy for apexogenesis.
- Procedure Code
- D3222
- Clinical Category
- Endodontics
- Primary ICD-10 Justification
- See mapped diagnoses below
- Reference Fee & Claim Types
- DENTAL
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D3222.
- 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)
- Benefits are determined by group/individual contract.
Restrictions & Clinical Exclusions
- Fees for D3222 are not billable to the patient when performed within 30 days on same tooth by the same dentist/dental office as root canal therapy (D3230–D3333) or codes D3351- D3353. construed as the first stage of root canal therapy.
- The fees for D9110 in conjunction with D3222 are not billable to the patient by the same dentist/dental office.
- 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-CM Justification & Crosswalk Mappings for D3222 (0)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
No direct ICD-10 mappings recorded for D3222.
Frequently Asked Questions — D3222 (Partial Pulpotomy)
Quick answers for dental billers and treatment coordinators submitting claims for D3222.
What ICD-10 diagnosis codes link to dental procedure D3222?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D3222.
Can CDT code D3222 be billed to medical insurance?▾
Billing CDT D3222 (Partial Pulpotomy) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: DENTAL.
What attachments and documentation are required for billing CDT D3222?▾
Required claim attachments for CDT D3222 (Partial Pulpotomy) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D3222?▾
Standard commercial insurance frequency for D3222: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D3222?▾
Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.