D3333 is the CDT code for the internal root repair of perforation defects. It covers the non-surgical, intracanal sealing of a perforation in the root using a biocompatible repair material. Perforations may be iatrogenic (caused during access or instrumentation) or may result from internal resorption. The procedure is performed through the coronal access, not through a surgical flap.
Get help with D3333 claims →Last updated June 2026 · Reviewed by the PracticeAlpha billing team
D3333 is appropriate when a perforation is created during root canal access or canal preparation and is repaired internally without surgical intervention. The repair involves placing a calcium silicate-based material at the perforation site through the canal and sealing it before continuing with or completing the root canal procedure.
Internal resorption that perforates the root wall can sometimes be managed with internal repair using biocompatible materials. When the perforation is accessible from inside the canal and does not require surgical access, D3333 covers the repair procedure.
If the perforation repair is performed at the same appointment as the root canal treatment, D3333 can be billed alongside the root canal code. The clinical note must describe the perforation as a separate finding from the routine canal preparation and document the specific repair procedure performed.
Many plans consider all intracanal procedures part of the root canal fee. Billing D3333 alongside a root canal code requires a narrative explaining the perforation repair as a distinct additional procedure that required separate time and materials beyond the routine endodontic procedure.
The perforation must be identifiable on a periapical radiograph, ideally with a file or cone placed at the perforation site. Without radiographic evidence, the payer cannot verify that a perforation existed and was repaired.
D3333 is for internal (non-surgical) repair only. If the repair required a surgical flap, D3333 does not apply. Ensure the code matches the actual approach documented in the clinical notes.
Some plans bundle endodontic complications into the root canal fee regardless of the code used. Verify coverage before the procedure and set patient expectations if the plan may not pay D3333 separately.
Note how the perforation was discovered: during access, during instrumentation, or identified on pre-operative imaging. Specify the location within the canal system.
A periapical radiograph showing the perforation location, ideally with a file or material in place to confirm the site, is essential for supporting the claim.
Record the specific biocompatible repair material used (e.g., MTA, bioceramic cement), the method of placement, and the estimated set time if relevant.
Confirm in the clinical notes that the repair was performed through the coronal access without any surgical flap or external root access.
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Learn about our billing servicesD3333 is the CDT code for the internal root repair of perforation defects. It covers non-surgical, intracanal sealing of a root perforation using a biocompatible repair material, typically a calcium silicate-based cement.
D3333 covers iatrogenic perforations created during canal access or instrumentation and perforations caused by internal resorption, when repaired through a non-surgical, intracanal approach.
D3333 is for internal, non-surgical repair through the coronal access. Surgical repair involving a flap and external root access falls under a different code in the surgical endodontic category.
Yes, when the perforation repair is a distinct additional procedure at the same appointment. Attach a clinical narrative describing the perforation as a separate finding and the repair as a separate service from routine canal preparation.
Common reasons: bundled into the root canal fee, perforation not documented with a radiograph, code applied to a surgical approach, or the plan does not cover repair separately from the root canal fee.
Biocompatible calcium silicate-based cements such as MTA or similar bioceramic materials are standard for internal perforation repair. Document the specific material used in the clinical notes.
Search all CDT codes in our dental coding guide.