Understanding Dental Code D3472

When to Use D3472 dental code

The D3472 dental code is designated for the surgical repair of root resorption in premolars. Dental practices should use this CDT code when addressing internal or external resorption that compromises the structural integrity of a premolar tooth and requires surgical intervention. This code is not to be used for routine endodontic procedures or for teeth other than premolars. Correct code selection is critical for accurate claim submission and reimbursement.

Documentation and Clinical Scenarios

Proper documentation is essential when billing for D3472. Ensure the patient’s chart includes:

• Detailed clinical notes describing the extent and location of the resorption
• Pre-operative radiographs or CBCT images demonstrating the defect
• Diagnosis and rationale for surgical intervention
• Step-by-step surgical procedure notes
• Post-operative findings and follow-up recommendations

Common clinical scenarios include trauma-induced resorption, orthodontic-related resorption, or idiopathic cases where the premolar’s root structure is at risk. Always differentiate from other procedures, such as apicoectomy or pulpal debridement, by clearly stating the surgical repair of resorption as the primary service.

Insurance Billing Tips

To maximize reimbursement and reduce denials for D3472, follow these best practices:

• Insurance Verification: Confirm the patient’s benefits and any plan exclusions for surgical endodontic procedures before treatment.
• Pre-Authorization: Submit a pre-treatment estimate with supporting documentation (radiographs, clinical notes) to the payer when required.
• Claim Submission: Use the D3472 code with a detailed narrative describing the necessity of surgical repair. Attach all supporting images and documentation.
• Explanation of Benefits (EOB) Review: Carefully review EOBs for payment accuracy. If underpaid or denied, reference your documentation and submit a claim appeal with additional clinical justification.
• Accounts Receivable (AR) Follow-Up: Track outstanding claims and follow up promptly with payers to resolve delays or denials.

Example Case for D3472

Consider a patient presenting with pain and radiographic evidence of external root resorption on the maxillary first premolar. The dentist determines that non-surgical management is insufficient, and surgical repair is indicated to preserve the tooth. The dental team documents the findings, obtains pre-authorization, and performs the procedure. The claim is submitted with D3472, including pre- and post-op radiographs and a detailed narrative. The insurance carrier approves the claim, and payment is received without delay, thanks to thorough documentation and proactive communication.

By understanding when and how to use the D3472 dental code, dental practices can ensure accurate billing, minimize claim denials, and support optimal patient care outcomes.