An apicoectomy is minor surgery on the tip of a tooth root. The provider opens the gum, removes the infected tissue and the end of the root, seals the canal from below and closes the site. It is usually considered when a root canal has failed and retreatment would not solve the problem or is not practical. The cost depends on the tooth, since front teeth are simpler than molars near the sinus or a nerve, and on the provider, the imaging and the sedation. Endodontists perform most of them, often with a surgical microscope. Plans usually classify it as surgery and may pay a share, and some route parts through a medical policy. Ask whether the fee includes the imaging, the sedation and a follow-up visit, and who bills each of them, because those are usually separate lines.
Published fees for the coded services
| Service | Delta Dental of Washington plan, 2023 | Maryland Medicaid, 2025 |
|---|---|---|
| Apicoectomy, anterior (D3410) | $412 | $504 |
| Apicoectomy, premolar, first root (D3421) | $362 | $570 |
| Apicoectomy, molar, first root (D3425) | $393 | $659 |
| Each additional root (D3426) | $144 | $217 |
Private offices can charge more, and fees differ by region and case. Sources: the Delta Dental of Washington fee schedule (as of June 8, 2023) and the Maryland Healthy Smiles 2025 fee schedule. For a fee lookup by ZIP code, see FAIR Health Consumer.
What moves the number
What drives the cost of an apicoectomy
| Factor | Detail |
|---|---|
| Which tooth | Front teeth usually have one root. Molars have several and may sit near a nerve or the sinus. |
| Number of roots | Treating more than one root takes longer and costs more. |
| Provider and equipment | Endodontists commonly perform it, often with a microscope. Find out whether the fee reflects that. |
| Imaging | Three-dimensional scans help plan the surgery. Find out whether one is included. |
| Filling material | The root end is sealed with a material chosen by the provider. |
| Sedation | Usually separate from the surgical fee. |
Complete cost
What belongs in an apicoectomy estimate
Examination, X-rays and any three-dimensional scan
The surgery, by tooth or by root
Anesthetic and any sedation
Sutures and post-operative visits
Medication prescribed afterwards
A follow-up X-ray to check healing
The crown or restoration, if it is affected
Ask for a written estimate and confirm who bills each item.
Where surprises come from
Things people do not expect
Finding a crack during surgery that makes the tooth unsavable
Needing a second procedure if the first does not resolve the infection
A plan that classifies the surgery differently from what the office expected
A separate bill from a specialist or an anesthesia provider
Follow-up imaging that was not in the quote
Compare like for like
Questions that make two quotes comparable
- Why is surgery proposed instead of retreatment, and what would retreatment involve?
- Who performs it, and do they use a microscope?
- Is the fee per tooth or per root, and does it include imaging and follow-up?
- What is the outlook for the tooth, and what would change the plan?
- What happens if the surgery does not resolve the problem?
- How do the costs compare with extraction and a replacement?
Insurance
How dental plans usually treat an apicoectomy
Plans usually classify an apicoectomy as oral surgery, and Cigna lists oral surgery as major care. That generally means a smaller plan share, a possible waiting period and a draw on the annual maximum. Some plans handle certain surgical procedures under a medical policy, and others have frequency limits. If retreatment was done first, ask whether the plan links the two. A written pretreatment estimate and a call to the plan with the exact procedure code settle most questions before the day of surgery.
Check both your dental plan and any medical plan, since they may treat the same service differently.
Lowering the bill
Ways to reduce cost without lowering the standard
Call a dental school or advanced endodontic program to find out whether it performs apicoectomies and how fees are set
Ask whether the specialist is in your plan's network
Get a second opinion on whether retreatment, surgery or extraction is best
Ask what the plan pays under dental and medical benefits
Ask what the tooth's outlook is, so you can weigh saving it against replacement
Questions people ask
Common questions
01What is an apicoectomy?
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It is minor surgery on the tip of a root. The provider opens the gum, removes the infected tissue and the end of the root, seals the canal from below and closes the site. It is usually considered when a root canal has failed and retreatment is not enough or is not practical. Find out why it is proposed for your tooth.
02Does insurance cover an apicoectomy?
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Often in part. Plans usually classify it as oral surgery, and Cigna lists oral surgery as major care. Some plans process certain surgical procedures under a medical policy. Ask for a pretreatment estimate and the plan's written position on the exact code before you schedule.
03Is an apicoectomy cheaper than an implant?
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It can be, and it is not a like-for-like choice. Saving a tooth with surgery avoids the replacement question, and the outlook depends on the tooth. An extraction and implant has its own cost and timeline. Request the complete estimate for each path and the provider's view of the outlook.
04Who performs an apicoectomy?
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Endodontists perform most of them, often with a surgical microscope, and oral and maxillofacial surgeons and some general dentists do as well. Find out about the provider's experience with your kind of tooth, and whether they are in your plan's network. See the endodontist guide for what the specialty covers.
05Is an apicoectomy painful?
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It is done under local anesthetic, sometimes with sedation, and you may have swelling and tenderness afterwards. Your provider will give instructions and medication. Ask what to expect for your tooth and what signs mean you should call. Most people manage recovery at home.
06What if the apicoectomy does not work?
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Sometimes the infection returns or a crack is found, and the tooth may need to be extracted. Check what the outlook is for your tooth, what the follow-up schedule is and what the plan would be if the problem persists. Find out whether any fee is refunded or credited in that case.
07Should I try retreatment first?
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Often retreatment is considered first, since it does not involve cutting the gum, but there are cases where surgery is the better choice, for example when a crown and post would be lost or when the anatomy blocks access. Ask your provider to explain why each option is or is not suited.
08Can I get an apicoectomy at lower cost?
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Some dental schools and advanced endodontic programs treat patients at reduced fees under close supervision, according to the National Institute of Dental and Craniofacial Research. Scope and waits vary. Check what the program offers and who supervises, and do not delay care for a painful or infected tooth.
09How long does an apicoectomy take?
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Usually a visit of less than a few hours, depending on the tooth and the number of roots. Ask how long yours is expected to take, what anesthesia is used and how quickly you can return to work. Recovery is often managed at home.
10Will I need sutures after an apicoectomy?
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Usually, since the gum is opened and closed. Ask whether they dissolve or need removal, and whether the follow-up visit is in the fee. Your provider will give instructions on cleaning and eating.
11Can an apicoectomy be done on any tooth?
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Not always. Location, root shape, nearby nerves and the sinus all affect whether surgery is a good option. Ask your endodontist whether your tooth is a candidate, what the risks are and what the alternatives would cost.
12What follow-up is needed after an apicoectomy?
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Usually a review and an X-ray after a period of healing to see whether the area is settling. Ask when the check happens, whether it is in the fee and what would be done if healing is slow.
Related glossary terms
Sources
- Oral Health TopicsAmerican Dental AssociationAccessed 2026-08-17
- Medicare Dental CoverageCenters for Medicare & Medicaid ServicesAccessed 2026-08-17
- Dental HMO vs. PPO PlansCigna HealthcareAccessed 2026-09-24
- Finding Dental CareNational Institute of Dental and Craniofacial ResearchAccessed 2026-09-23