D7220Removal of Impacted Tooth, Soft Tissue

What This Code Covers

D7220 is used for the removal of a tooth that is impacted within the soft tissue (gum) but not embedded in bone. The tooth has not fully erupted through the gum line and requires an incision through the overlying soft tissue to access and remove it. This code most commonly applies to partially erupted wisdom teeth that are blocked by a flap of gum tissue. The key distinction is that bone removal is not necessary to extract the tooth.

Billing Guide

Bill this code when:

• The tooth is covered by soft tissue and requires an incision through the gum to access it
• No bone removal is needed to extract the tooth
• A mucoperiosteal flap is raised but only soft tissue is reflected, not bone
• Radiographs confirm the tooth is impacted in soft tissue only, with the crown above the bone line

Do not bill this code when:

• Any amount of bone must be removed to free the tooth, so use D7230 (partial bony) or D7240 (complete bony)
• The tooth has fully erupted and is visible in the mouth, so use D7140 or D7210
• The tooth is partially erupted but can be removed without an incision or flap, so use D7140 or D7210
• The impaction is radiographically confirmed as partially or completely bony

Insurance and Denial Prevention

Key Payer Rules:

• Most plans cover impacted tooth removal under major services at 50-80%, though some plans cover wisdom tooth extractions at a higher percentage
• Many payers require a panoramic radiograph (D0330) to verify the level of impaction before approving the claim
• Some plans have age limitations or require pre-authorization for impacted tooth removal
• Medicaid coverage for impacted teeth varies significantly by state and may require prior authorization

Common Denials and How to Respond:

• Downgraded to D7140 or D7210 → Appeal with the panoramic radiograph showing the tooth impacted beneath soft tissue. Include operative notes describing the incision and flap required to access the tooth. Highlight that the tooth was not visible in the mouth before the procedure.
• Level of impaction disputed (payer says partial bony, not soft tissue) → Review the radiograph carefully. If the impaction classification is accurate, appeal with a written explanation and annotated radiograph. If the payer is correct that bone was involved, recode to D7230.
• Pre-authorization required but not obtained → Submit a retroactive authorization request with the radiograph and operative note. Emphasize medical necessity such as infection, pain, or damage to adjacent teeth. Many payers will approve retroactively for urgent extractions.