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Central accessory cusp in primary molars is an extremely rare condition which is due to abnormal proliferation and folding of inner enamel epithelium during morphodifferentiation stage of tooth development. The extension of the pulp in the cuspal area is often the reason for early involvement of pulp by the caries process. Therefore, early diagnosis and treatment planning is necessary to maintain the integrity of primary dental arch. This article reports such a case of central accessory cusps involving maxillary second primary molars. How to cite this article: Chandra B, Das M. Accessory Central Cusp in the Maxillary Second Primary Molars: A Rare Entity among the Rare. Int J Clin Pediatr Dent 2014;7(3):202-205.