Blue Cross Blue Shield FEP Dental
Class B Intermediate
Class B Intermediate
Endodontic Services
D3110 Pulp cap - direct (excluding final restoration)
D3120 Pulp cap - indirect (excluding final restoration)
D3220 Therapeutic pulpotomy (excluding final restoration) - Primary teeth only, 1 per lifetime
D3221 Pulpal debridement, primary and permanent teeth
D3222 Partial pulpotomy for apexogenesis – permanent tooth with incomplete root development - 1 per lifetime
D3230 Pulpal therapy (resorbable filling) – anterior, primary tooth (excluding final restoration) - 1 per lifetime
D3240 Pulpal therapy (resorbable filling) – posterior, primary tooth (excluding final restoration) - 1 per lifetime
D3355 Pulpal regeneration initial visit
D3356 Pulpal regeneration interim medication replacement
D3357 Pulpal regeneration completion of treatment
D3120 Pulp cap - indirect (excluding final restoration)
D3220 Therapeutic pulpotomy (excluding final restoration) - Primary teeth only, 1 per lifetime
D3221 Pulpal debridement, primary and permanent teeth
D3222 Partial pulpotomy for apexogenesis – permanent tooth with incomplete root development - 1 per lifetime
D3230 Pulpal therapy (resorbable filling) – anterior, primary tooth (excluding final restoration) - 1 per lifetime
D3240 Pulpal therapy (resorbable filling) – posterior, primary tooth (excluding final restoration) - 1 per lifetime
D3355 Pulpal regeneration initial visit
D3356 Pulpal regeneration interim medication replacement
D3357 Pulpal regeneration completion of treatment