Diagnosis: Dental Disorder.
Treatment: Apicoectomy and retrograde filling for tooth #3.

The insurer denied the Apicoectomy and retrograde filling for tooth #3. The determination is overturned.

The patient presented with an existing root canal on tooth number (#) 3 that had a recurrent periapical infection on the mesial root. Apicoectomy and retrograde filling are being requested at this time. At issue is the medical necessity of the apicoectomy and retrograde filling.
The requested health service treatment of apicoectomy and retrograde filling for tooth #3 is medically necessary.
The submitted radiograph shows tooth #3 with an existing root canal that has a recurrent periapical infection on the mesial root. Apicoectomy is considered a standard oral surgical procedure that is used as a last resort to surgically maintain a tooth with a periapical lesion that cannot be managed with conventional endodontic re-treatment. Because the periapical infection is minimal and the tooth appears to have a good prognosis, it is important to save the tooth and maintain the space to prevent the adjacent teeth from collapsing in and causing unnecessary occlusal problems. In addition, losing a tooth will lead to the bone level in that area receding, which will affect the adjacent teeth as well. Therefore, an apicoectomy and retrograde filling is medically necessary for tooth #3.