So you've just started working in dental billing at an endodontic office — welcome! Endodontics is a specialty focused primarily on root canals, surgical endodontic procedures, and diagnosis of tooth pain, and billing in this setting has a different rhythm and set of challenges than in general dentistry.

If you’re feeling overwhelmed, don’t worry — you’re not alone. This guide will walk you through the essentials you need to know as a beginner in endodontic billing, so you can confidently support your team and get paid accurately and on time.

1. Understand the Core Procedures You’ll Be Billing

Unlike general dental offices that deal with a wide variety of procedures, endodontic practices focus on a narrower set of high-value, medically complex treatments. The most common codes you’ll see include:

• D0140 – Limited exam (problem-focused)

• D0220/D0230 – Periapical X-rays (first and additional)

• D3310 – Root canal (anterior)

• D3320 – Root canal (bicuspid)

• D3330 – Root canal (molar)

• D3331 – Incomplete endo (started but not completed)

• D3332 – Incomplete endo, not restorable

• D3351–D3353 – Apexification

• D3410 – Apicoectomy (anterior)

• D3421/D3425 – Apicoectomy (bicuspid/molar)

Pro tip: Root canals are often reported by tooth number, and payers will require the correct tooth to be listed on the claim.

2. Be Proactive with Insurance Verification

Before the patient walks in the door, you should:

• Verify dental benefits, including:

  • Root canal coverage

  • Endodontic frequency limits

  • Waiting periods

  • Missing tooth clause

• Ask if there’s secondary insurance, and verify coordination of benefits (COB).

• Determine if a prior authorization is required (less common for endo, but still happens).

3. Medical vs. Dental Billing – Know When It Applies

While most endodontic procedures are billed to dental insurance, there are occasional situations where medical billing may apply, especially if:

• The patient presents with trauma or infection that affects overall health.

• Treatment is being done in conjunction with a hospital/surgical setting.

• The patient does not have dental insurance but needs urgent care.

If medical billing is needed:

• Use appropriate diagnosis codes (ICD-10) and CPT procedure codes.

• You may need to submit narratives, clinical notes, and X-rays with the claim.

4. Expect Emergency Visits and Same-Day Treatment

Endodontic practices see a high volume of emergency patients — people in pain who need relief fast. Often, they’ll be referred by a general dentist and may not fully understand their insurance situation.

• Be ready to verify insurance quickly, even on the same day.

• Educate patients on financial responsibility if insurance info is incomplete or out-of-network.

• If treatment is started but not completed (e.g., pulpectomy only or patient referred back), use codes like D3221 (pulpal debridement) or D3331.

5. Use Narratives and X-rays Strategically

Insurance companies sometimes flag root canal procedures for review, especially if:

• It's a second treatment on the same tooth.

• The provider is out-of-network.

• There's a high frequency of endodontic claims.

To support your claims:

• Always attach diagnostic X-rays and chart notes.

• Write brief narratives that explain symptoms, diagnosis, and reason for treatment.

Example:

“Tooth #30 diagnosed with irreversible pulpitis and periapical radiolucency. Patient presented with spontaneous pain and swelling. Root canal therapy initiated to resolve infection.”

6. Track Tooth Numbers Carefully

Almost every endodontic procedure must include the correct tooth number, or the claim will be denied or delayed. Double-check:

• That the doctor documented it correctly.

• That it’s listed on the claim form (Box 27 on ADA claim).

• That it matches what's in the treatment plan and ledger.

7. Coordinate with Referring Offices

Endodontists often rely on referrals from general dentists. That means:

• You may receive incomplete insurance info, and need to follow up directly with patients.

• You’ll often need to share treatment notes and post-op instructions back to the referring provider.

• If the patient is returning to the general dentist for restoration, coordinate on what was billed vs. what’s planned.

8. Collect Payment Strategically

Because root canals are high-cost procedures, it’s important to:

• Collect estimated co-pays or down payments upfront, especially for out-of-network patients.

• Be clear about insurance estimates vs. actual coverage.

• Have a plan in place for patients who want to delay treatment due to costs — offering financing or payment plans may help.

Final Thoughts

Endodontic billing is a blend of urgency, precision, and high-value procedures, which makes your role extremely important in helping the practice run smoothly and patients get the care they need. Focus on mastering your core procedure codes, verifying insurance quickly, tracking tooth numbers accurately, and staying organized with documentation.

Once you’ve got the rhythm, you’ll find endodontic billing is fast-paced but very rewarding — and your expertise will have a direct impact on patient care and practice success.