D3333 - Internal Root Repair
Internal repair of perforation defects.
- Procedure Code
- D3333
- Category
- Endodontics
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- Frequency Limitation
- 1 per tooth per lifetime (retreatment eligible after 24 months) (per_tooth_lifetime)
Required Claim Attachments & Pre-Submission Checklist
- Diagnostic pre-operative radiograph showing affected tooth/area
Bill When (Allowable Clinical Criteria)
- Internal root repair is only a benefit on permanent teeth with incomplete root development or for repair of a perforation.
Restrictions & Clinical Exclusions
- Benefits for techniques, e.g. ultrasonic cleaning, or instrumentation are considered to be part of the procedure and not billable to the patient.
- The fee for a root canal includes treatment, working and final fill radiographic images, and temporary restorations. Fees for radiographic images and temporary restorations in the course of endodontic treatment are not billable to the patient.
- When radiograph indicates obturation of an endodontically treated tooth has been performed without the use of a solid core material, fees for the endodontic therapy and/or restoration of the tooth are not billable to the patient.
- A diagnostic film taken to ascertain the presence of pathology is a separate benefit. The initial opening into the canal and routine postoperative visits are considered part of and included in the fee for completed endodontic treatment. Separate fees are not billable to the patient.
- Incompletely filled root canals are not a benefit. Fees for the endodontic therapy are not billable to the patient.
- Root canal therapy is not a benefit in conjunction with overdentures(D5863-D5866) and benefits are denied.
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 |
|---|