D3450 is the CDT code for root amputation. It describes the surgical removal of one root from a multi-rooted tooth, leaving the remaining roots and the crown in place. The code is billed per root removed, so amputating two roots from a molar means billing D3450 twice. This is a tooth-saving procedure when one root is compromised but the rest of the tooth is restorable.
Last updated June 2026 ยท Reviewed by the PracticeAlpha billing team
Get help with D3450 claims →Use D3450 when surgically removing one or more roots from a multi-rooted tooth while retaining the crown and the remaining roots. The procedure involves raising a mucoperiosteal flap, sectioning the compromised root at its furcation junction, extracting the root, and closing the site. The retained roots and crown remain functional. Bill one unit of D3450 per root amputated.
Common clinical scenarios: Maxillary molar with one root showing severe periodontal bone loss isolated to that root while the other two roots have adequate support. Furcation defect confined to one root making it non-maintainable but the rest of the tooth is periodontally sound. Root fracture limited to one root of a multi-rooted tooth. Perforation or resorption on a single root that cannot be repaired and where extraction of the full tooth is not preferred. Endodontic failure on one root of a molar when retreatment is not technically feasible on that root alone.
Do NOT use D3450 for: Single-rooted teeth (there is no remaining root to retain). Surgical removal of the root tip only, not the full root (use D3410, D3421, or D3426 for apicoectomy). Full extraction of the tooth (use D7140 or D7210). Hemisection of a mandibular molar where both halves are separated and one half is retained as a separate unit (some plans treat hemisection differently; verify the payer's policy and whether D3450 or a different code is expected). Resection performed solely for periodontal reasons without endodontic involvement, which some plans classify differently.
Root amputation is a surgical procedure and most dental plans require pre-authorization before treatment. Submitting a D3450 claim without prior approval is one of the most common reasons for denial. Obtain pre-auth with periapical and full-mouth radiographs, a narrative explaining why the root is non-salvageable, and documentation of endodontic treatment on the retained roots. Wait for the authorization number before scheduling surgery.
Payers typically expect evidence that the retained roots have been root canal treated before approving a root amputation. If the prior root canal was performed at a different office or under a previous insurance plan, the payer may have no record of it. Submit the root canal date, treating provider, and supporting radiographs with the D3450 claim. A narrative explaining the full treatment history is often required when the prior endodontic treatment is not in the current plan's records.
The claim must demonstrate that the amputated root was non-salvageable and that removing it preserves a functional tooth. A periapical radiograph alone is rarely enough. The narrative should describe the specific pathology on the target root (isolated bone loss, fracture, perforation), confirm adequate periodontal support on the retained roots, and explain why extraction of the full tooth was not the preferred option. Without this, payers often deny the procedure as not medically necessary.
D3450 is only appropriate for multi-rooted teeth. Billing it for a single-rooted tooth is a coding error that results in an immediate denial. Verify the tooth anatomy before submitting. Upper molars (three roots), lower molars (two roots), and some upper premolars (two roots) are the eligible candidates. Single-rooted upper premolars, canines, and incisors do not qualify.
Current periapical x-ray clearly showing the pathology on the root being amputated. Ideally compare with prior radiographs to demonstrate progression or chronicity. The radiograph needs to show why that specific root cannot be retained.
Records confirming endodontic therapy has been completed on the retained roots, and ideally on the amputated root prior to surgery if clinically indicated. Include the date, treating provider, and any relevant post-operative radiographs confirming obturation.
A written narrative stating why the amputated root is non-salvageable, why the remaining tooth structure is restorable and has sufficient periodontal support, and why full extraction was not chosen. Payers need to understand the clinical logic for preserving the tooth.
Document the flap design, the root(s) amputated, the furcation anatomy, any bone grafting performed, closure materials, and post-operative instructions given. If two roots were amputated, document each individually. Note the condition of the retained roots and the crown.
Record the authorization number in the patient chart and include it on the claim. Some payers also require post-operative radiographs submitted with or shortly after the claim. Review the specific plan requirements before submitting to avoid unnecessary delay.
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Learn about our billing servicesD3450 is the CDT code for root amputation, billed per root. It covers the surgical removal of one root from a multi-rooted tooth while preserving the remaining roots and crown. It is used when a single root is non-salvageable but the rest of the tooth can be retained.
D3450 removes an entire root from a multi-rooted tooth down to the furcation. D3410 removes only the apex (root tip) of an anterior single-rooted tooth. They are different procedures on different tooth types. D3450 is a root amputation; D3410 is an apicoectomy.
Yes. D3450 is billed per root. If two roots are amputated from the same molar, bill D3450 twice with the same tooth number. Document each root individually in operative notes and verify the payer's billing rules for multiple units on one tooth.
Common reasons include missing pre-authorization, no documented prior root canal treatment on the retained roots, insufficient clinical narrative justifying tooth retention, and billing D3450 for a single-rooted tooth, which is ineligible for root amputation.
In most clinical cases and per most payer policies, yes. Endodontic therapy on the retained roots is expected before or concurrent with D3450. Without documentation of prior root canal treatment, most plans will deny the procedure as not medically necessary or premature.
D3450 applies only to multi-rooted teeth. Upper molars (three roots), lower molars (two roots), and some upper premolars (two roots) are the most common candidates. Single-rooted teeth cannot have one root amputated while retaining the rest, so D3450 does not apply to them.
Search all 206 CDT codes in our dental coding guide.