D3410 is the CDT code for an apicoectomy performed on an anterior tooth. It describes the surgical procedure of removing the root tip of an incisor or canine to address persistent periapical pathology that has not resolved following conventional root canal therapy. This is a periradicular surgical procedure, distinct from routine root canal treatment.
Last updated June 2026 ยท Reviewed by the PracticeAlpha billing team
Get help with D3410 claims →Use D3410 when surgically removing the apex of an anterior tooth to treat periapical pathology that has not resolved with conventional root canal therapy. The procedure involves raising a mucoperiosteal flap, resecting the root tip (typically 2-3 mm), curettage of the periapical lesion, and closure. An anterior tooth is any incisor or canine: teeth 6-11 and 22-27 in the Universal Numbering System.
Common clinical scenarios: Persistent periapical lesion on a previously root-canal-treated anterior tooth that has not healed after an appropriate observation period. Fractured root tip preventing conventional re-treatment. Irretrievable broken instrument at the apex making conventional re-treatment impractical. Calcified canals in an anterior tooth with apical pathology where conventional access is not feasible. Biopsy of a periapical lesion coinciding with the apicoectomy.
Do NOT use D3410 for: Apicoectomy on a premolar tooth (use D3421). Apicoectomy on a molar tooth (use D3426). Conventional root canal re-treatment on an anterior tooth (use D3346). Incision and drainage of a periapical abscess without surgical root resection (separate code). Retrograde filling only without apical resection (the apical resection is what defines an apicoectomy).
Most plans require evidence of prior conventional endodontic treatment before approving a surgical apicoectomy. If the original root canal was performed at another office or was not submitted to the patient's current plan, the payer may have no record of it. Submit the prior root canal date and any available radiographs alongside the D3410 claim. If the original root canal predates the patient's current coverage, a narrative explaining the treatment history is essential.
Surgical endodontic procedures almost always require pre-authorization. Submitting a claim without prior approval is a common cause of denial. Obtain pre-auth with a narrative, periapical radiographs showing the periapical pathology, and documentation of prior endodontic treatment on the tooth. Wait for approval before scheduling the surgery.
The periapical radiograph must clearly show ongoing apical pathology. A lesion that appears to be healing or a tooth with no clear radiographic pathology weakens the medical necessity argument. When radiographic findings are subtle, include a narrative explaining the clinical symptoms and any CBCT findings if available.
Using D3410 when the tooth is a premolar or molar results in an immediate coding error and potential denial. The tooth number on the claim must correspond to an incisor or canine. D3421 applies to premolars and D3426 applies to molars. Verify the tooth number before submitting.
Current periapical x-ray showing the periapical pathology. The radiograph must demonstrate a clear apical lesion or other pathologic finding justifying surgical intervention. Compare with any available prior films to document persistence or progression.
Records showing the original root canal was performed. Include the date of the prior root canal, the treating provider, and the outcome. If the prior root canal is not in the current practice's records, obtain copies or document the treatment history in the narrative.
A written narrative is usually required for surgical endodontic procedures. Explain why conventional re-treatment is not feasible or was unsuccessful, describe the clinical findings, and state why apicoectomy is the appropriate intervention. Reference the radiographic findings specifically.
Document the surgical procedure in detail: flap design, extent of root resection, curettage findings, any retrograde preparation and fill, closure technique, and materials used. Note any biopsy submission if a tissue specimen was sent for pathologic evaluation.
Include the authorization number on the claim if pre-auth was obtained. Document authorization in the patient record. Some payers also require post-operative documentation submitted with the claim, so review the plan requirements before submitting.
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Learn about our billing servicesD3410 is the CDT code for an apicoectomy on an anterior tooth. It describes the surgical removal of the root tip of an incisor or canine to treat persistent periapical pathology that has not resolved following conventional root canal therapy.
D3410 covers anterior teeth only: incisors and canines. In the Universal Numbering System, these are teeth 6-11 (maxillary) and 22-27 (mandibular). For premolars use D3421, for molars use D3426.
In most clinical situations and per most plan policies, yes. An apicoectomy is typically a secondary procedure following failed conventional root canal therapy. Most payers require evidence of prior endodontic treatment and a documented period of observation before approving surgical intervention.
Common reasons: no prior root canal on record, missing pre-authorization, insufficient radiographic evidence of persistent pathology, tooth number on the claim not matching an anterior tooth, or the payer determining re-treatment rather than surgery should be attempted first.
Yes. If a retrograde root-end preparation and fill is performed during the apicoectomy, it can be billed separately using D3430. Some plans bundle it into D3410, so verify the patient's plan. Document the retrograde fill material and procedure in operative notes.
D3410 is for apicoectomy on an anterior tooth (incisors and canines). D3421 is for apicoectomy on a premolar (bicuspid). The tooth type determines which code applies. Using D3410 for a premolar tooth is a coding error that can result in denial.
Search all 206 CDT codes in our dental coding guide.