Blue Cross Blue Shield FEP Dental
Class C Major

D3310 Endodontic therapy, anterior tooth (excluding final restoration)

D3320 Endodontic therapy, premolar tooth (excluding final restoration)

D3330 Endodontic therapy, molar tooth (excluding final restoration)

D3346 Retreatment of previous root canal therapy – anterior

D3347 Retreatment of previous root canal therapy – premolar

D3348 Retreatment of previous root canal therapy – molar

D3351 Apexification/recalcification – initial visit (apical closure/calcific repair of perforations, root resorption, etc.)

D3352 Apexification/recalcification – interim medication replacement

D3353 Apexification/recalcification – final visit (includes completed root canal therapy - apical closure/calcific repair of perforations, root resorption, etc.)

D3410 Apicoectomy – anterior

D3421 Apicoectomy – premolar (first root)

D3425 Apicoectomy – molar (first root)

D3426 Apicoectomy (each additional root)

D3430 Retrograde filling – per root

D3450 Root amputation – per root

D3471 Surgical repair of root resorption – anterior

D3472 Surgical repair of root resorption – premolar

D3473 Surgical repair of root resorption – molar

D3501 Surgical exposure of root surface without apicoectomy or repair of root resorption – anterior

D3502 Surgical exposure of root surface without apicoectomy or repair of root resorption – premolar

D3503 Surgical exposure of root surface without apicoectomy or repair of root resorption – molar

D3920 Hemisection (including any root removal), not including root canal therapy

D3921 Decoronation or submergence of an erupted tooth