D3425 is the CDT code for surgically removing the tip of one molar root and cleaning out the infected tissue around it.
- When to use: Apical surgery on a molar, billed once for the first root, with each additional root at the same surgery added as D3426.
- When not to use: Removing a whole root is D3450, sectioning the tooth through the crown is D3920, and nonsurgical molar retreatment is D3348.
- Billing note: Name every root resected and sealed in the operative note, and bill D3430 once per root sealed so no units are dropped.
What D3425 covers
D3425 reports an apicoectomy on one root of a molar: surgical flap, access through bone to the root end, resection of the apex, removal of the periapical lesion, and closure. Cleaning and irrigating the bony defect is part of the surgery, with no separate code. The line pays for the first root only. Each additional root treated at the same surgery is D3426.
Separately reportable: the root-end filling (D3430, per root), bone graft material at the periradicular site (D3428, plus D3429 per additional contiguous tooth), a resorbable barrier (D3432), or biologic material (D3431). Root canal therapy on the molar at a different visit is D3330; non-surgical retreatment is D3348.
The unit math on a molar
Upper molars usually have three roots, lower molars two. Build the claim root by root:
| Case | Claim lines |
|---|---|
| One root resected, no seal | D3425 |
| Two roots resected, both sealed | D3425, D3426 ×1, D3430 ×2 |
| Three roots resected, all sealed | D3425, D3426 ×2, D3430 ×3 |
The AAE’s coding scenario for an upper first molar shows how D3430 is counted: tooth #3 was treated on two roots, and the retrograde filling was reported twice, once per root sealed. D3430 counts roots sealed, not fillings placed. Two fillings in one root are not two units; the codebook routes that case to D3999 with a description. The root canal dental codes guide shows how the apicoectomy codes fit with retreatment and the rest of the endodontic family.
The alternatives question is different on a molar
On an anterior tooth or premolar, the reviewer asks why the root was resected rather than retreated. A molar has roots to spare, so two more surgical options are available:
- D3450, root amputation, per root: an entire root removed from the multi-rooted tooth, with the crown left intact and supported by the remaining roots.
- D3920, hemisection: the tooth sectioned through the furcation into segments that each carry a root and the crown above it, with one or more segments removed. The codebook’s boundary: if the crown is sectioned, it is hemisection, not amputation. Root canal therapy is not included in D3920.
Neither is an apicoectomy; the difference is how much of the tooth comes out. This matters on the claim in two ways. The operative note must make clear that only the apical portion of the root was removed, or a reviewer can recharacterize the procedure. And when one root of a molar is failing badly, some plans’ clinical criteria ask why the root tip was resected rather than the root amputated. Answer that in the narrative up front rather than on appeal.
Non-surgical retreatment is still the first alternative a reviewer considers. UnitedHealthcare’s surgical endodontics policy lists failed retreatment first among its apicoectomy indications, alongside an apex blocked by calcification, a suspected fracture or perforation requiring visualization, persistent symptoms needing diagnosis, and overextended fill.
The same policy names contraindications that fall mostly on molars: root and bone configurations that prevent surgical access, and nearby neurovascular structures, such as the maxillary sinus above the upper molars and the mandibular canal below the lowers. A molar narrative should answer why not D3348, and why access and anatomy permit surgery on this tooth. That policy is one carrier’s; other plans ask the same kind of question with their own specifics.
Frequency windows and repeat surgery
Plans that publish guidelines for this family tend to limit repeat surgery rather than first-time coverage. Hawaii Dental Service’s endodontic guidelines are one published example. A repeat apicoectomy on the tooth by the same dentist or office within 24 months of the initial surgery is not billable to the patient, the retrograde filling is limited to once per 24 months, and pre-operative and post-operative radiographs are required with the claim.
Other carriers use different windows, route a repeat through clinical review instead of a hard limit, or fold a same-day, same-site biopsy into the surgical fee. All of it is plan-dependent. Ask the frequency and attachment questions during verification with the original root canal date in hand, because timing rules are measured from it.
Documentation that carries the claim
- Pre-operative radiograph showing the periapical lesion, and a post-op image where the plan requires one.
- The tooth number and a named list of roots resected: mesiobuccal, distobuccal, palatal, not “the roots.” The add-on units depend on this list.
- The endodontic history with dates: original root canal, any retreatment, any prior surgery. Frequency windows are computed from these.
- The reason retreatment was not chosen, and on a single-root failure, why apicoectomy rather than amputation or hemisection.
- Roots sealed, matching the D3430 unit count, plus any graft or membrane material with quantity.
Setting up the PMS for molar cases
- Let D3426 and D3430 take multiple units. A system that defaults every procedure to quantity one undercounts every molar apicoectomy.
- Tie the add-on to a base code. If the system supports dependent procedures, require D3421 or D3425 on the same date and tooth before D3426 posts.
- Keep D3430 out of the surgical fee. The codebook separates the seal from the surgery, and a bundled fee schedule loses the line on every case.
- Store the original endo date on the tooth where the biller sees it at claim time, since frequency windows are measured from it.
- Label the family by tooth type: anterior D3410, premolar D3421, molar D3425. The tooth number picks the base code, and the root count only adds units.
For line-by-line form mechanics, see the ADA dental claim form guide.
FAQs
- How do I bill an apicoectomy on all three roots of an upper molar?
- D3425 for the first root plus two units of D3426, one for each additional root treated at the same surgery. If each root also received a root-end filling, add three units of D3430, since that code counts per root sealed. The AAE's coding scenario for tooth #3 uses this structure: base code, add-on, and D3430 once per sealed root. The operative note must name each root resected, because the add-on units are what a carrier audits.
- Is the retrograde filling part of D3425?
- No. Every code in the apicoectomy family, including the add-on, excludes retrograde filling material. The filling is D3430, one unit per root sealed. If more than one filling goes into a single root, the codebook directs that to D3999 with a description rather than a repeated D3430.
- When is D3450 or D3920 the right code instead of D3425?
- When more than the root tip comes out. An apicoectomy removes only the apical portion of the root. Root amputation, D3450, removes an entire root from a multi-rooted tooth while the crown stays whole, and is reported per root. Hemisection, D3920, sections the tooth through the furcation into root-and-crown segments and may remove one or more of them; the codebook draws the line at whether the crown is cut. The operative note has to state exactly what was removed.
- Why was my molar apicoectomy claim sent for review?
- Because surgical endodontics is adjudicated on clinical criteria, and the molar is the expensive version of the claim. Reviewers typically want the periapical lesion on a pre-op radiograph, the tooth's endodontic history with dates, and the reason non-surgical retreatment (D3348 on a molar) was not chosen. UnitedHealthcare's surgical endodontics policy lists failed retreatment first among its indications and names cases where an apicoectomy is not indicated, including root or bone anatomy that blocks surgical access and involvement of neurovascular structures. Requirements differ by plan, so treat a pend as a documentation request rather than a denial.
- Does the number of roots change what the plan pays?
- Yes, through the add-on units, but how much is plan-dependent. Many fee schedules price D3426 well below D3425, so the second and third roots pay a fraction of the first even though the surgical field is the same. Some plans also apply frequency rules to the family: Hawaii Dental Service's published endodontic guidelines make a repeat apicoectomy by the same office within 24 months not billable to the patient, and limit D3430 to once per 24 months. Verify the plan's surgical endodontic benefit and any per-tooth frequency window before scheduling.
Related codes
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CDT codes are maintained by the American Dental Association. This page is an editorial billing guide, not the official ADA code descriptor. Verify current coverage policies with each carrier before submitting claims.