Avoid CDT coding errors and protect your practice

During our ongoing review of clinical documentation and claims activity, we have noticed recurring patterns in CDT code usage that suggest potential misuse or misinterpretation. In some cases, submissions lack adequate support from clinical findings or radiographic evidence. These issues can lead to compliance risks and even jeopardize payment recoupment. Listed below are typical examples of improper CDT code usage, along with practical tips to help avoid common coding mistakes.

D3331: Treatment of root canal obstruction; non-surgical access

This code is being routinely submitted with root canal therapy, including situations where clinical indicators make its use highly unlikely (for example, anterior teeth in young patients). D3331 is not a routine component of endodontic therapy. Its use should be reserved for specific clinical situations, such as:

• A nonnegotiable canal that requires special access to achieve an apical seal

• An obstruction caused by separated instruments, fractured posts, or significant canal calcification (≥50%)

Current documentation and radiographs often do not substantiate the presence of these conditions when this code is billed. If it’s being used regularly in your practice, it’s time to reassess.

D4212: Gingivectomy or gingivoplasty for restorative access, per tooth

We are seeing instances where D4212 is billed for each crown preparation, even when clinical records do not demonstrate that a gingivectomy or gingivoplasty was performed. If the only intervention documented is cord packing or tissue displacement, D4212 is not supported. Of note:

• Cord packing is considered a routine part of the impression and restorative process.

• It is not separately billable to members.

Clinical documentation must support that the actual removal or recontouring of gingival tissue was necessary to gain restorative access — not simply to improve visibility or margin capture.

D7210: Surgical extraction of an erupted tooth

We have found instances where D7210 has been used for all extractions, including full-mouth extraction cases where teeth already exhibit advanced periodontal bone loss. Not every extraction is surgical. Each tooth must be coded based on the procedure actually performed, not the overall complexity of the case or the patient’s periodontal status.

Code differentiation for tooth extractions

CDT codes for tooth extractions range from simple to complex surgical removals. The specific code depends on whether the tooth is erupted or requires bone removal or sectioning:

• D7140: Extraction of an erupted tooth or exposed root using elevation and/or forceps (includes minor bone smoothing and closure)

• D7210: Extraction requiring bone removal and/or tooth sectioning, with mucoperiosteal flap elevation as indicated

D7310 should not be used for routine bone smoothing that is already included in extraction codes.

If D7210 is your default extraction code, then you’re consistently coding for complex removals. When bone removal is not indicated, then D7140 may be the appropriate code to use.

Presubmission checklist

Before submitting claims, ask yourself:

• Does the documentation clearly justify the code?

• Would radiographs, photos, and clinical notes support it on external review?

• Am I using this code because it’s appropriate, or because it’s habitual?

Accurate coding matters. It ensures each claim reflects the actual clinical circumstances for every patient and every tooth. This not only safeguards your practice but also supports providing the best care for your patients.