Understanding Dental Code D3352

When to Use D3352 dental code

The D3352 dental code refers to "Apexification/recalcification – interim medication replacement." This CDT code is specifically used during endodontic procedures when a dentist places or replaces an interim medication in the root canal to encourage continued root development or closure of the root apex. D3352 is appropriate when a patient, often a child or adolescent, presents with an incompletely developed root due to trauma or necrosis, and the provider is managing the case with staged medication changes before final obturation. It is not used for the initial placement of medication (see D3351) nor for the final root canal filling (D3331), but specifically for subsequent interim medication replacements during the apexification process.

Documentation and Clinical Scenarios

Proper documentation is essential for successful billing and clinical justification of D3352. Dental teams should include:

• Detailed clinical notes describing the diagnosis (e.g., non-vital immature tooth), treatment plan, and rationale for ongoing apexification.
• Radiographs showing the open apex and progress over time.
• Dates and types of interim medication placed or replaced (e.g., calcium hydroxide, MTA).
• Patient’s response and any complications or changes in the treatment plan.

Common clinical scenarios include young patients with traumatic dental injuries or necrotic immature teeth where root development is incomplete. D3352 is billed each time the interim medication is replaced, which may occur over several months as the apexification process is monitored.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D3352:

• Verify coverage before treatment by checking the patient’s dental benefits for endodontic and apexification procedures.
• Submit comprehensive documentation with the claim, including clinical notes, radiographs, and a narrative explaining the necessity for repeated interim medication changes.
• Use correct CDT code sequencing: D3351 for the initial visit, D3352 for each interim medication replacement, and D3353 for the final obturation, if applicable.
• Track EOBs (Explanation of Benefits) and follow up promptly on any denials or requests for additional information.
• Appeal denied claims with additional documentation, emphasizing the staged nature of apexification and the medical necessity for each D3352 charge.

Example Case for D3352

Consider a 10-year-old patient who suffered a traumatic injury to a maxillary incisor, resulting in pulp necrosis and an open apex. The endodontist initiates apexification with calcium hydroxide (billed as D3351). Over the next six months, the patient returns every 6–8 weeks for evaluation and medication replacement, each visit billed as D3352. Radiographs document progressive root closure. Once the apex is closed, the provider completes the root canal with obturation (D3353), concluding the staged treatment.

This approach ensures accurate billing, supports clinical best practices, and provides a clear record for insurance review, ultimately supporting both patient care and practice revenue cycle management.