D7230Removal of Impacted Tooth, Partially Bony

What This Code Covers

D7230 is used for the removal of a tooth that is partially embedded in bone, with a portion of the crown still visible through or just beneath the soft tissue. The procedure requires a gum incision, elevation of a mucoperiosteal flap, and removal of bone overlying a portion of the tooth. This is one of the most commonly billed impacted tooth codes, especially for wisdom teeth. It sits between D7220 (soft tissue only) and D7240 (completely bony) in terms of complexity and reimbursement.

Billing Guide

Bill this code when:

• The tooth is partially covered by bone, with part of the crown visible through or just below the gum line
• A mucoperiosteal flap is raised and some bone is removed to access and extract the tooth
• The radiograph confirms the tooth is partially embedded in bone but not completely covered by bone
• The tooth may also need to be sectioned in addition to bone removal

Do not bill this code when:

• The tooth is impacted in soft tissue only with no bone covering any part of the crown, so use D7220
• The tooth is completely encased in bone with no portion visible above the bone line, so use D7240
• The tooth has fully erupted and is visible in the mouth, even if surgical extraction is needed, so use D7210
• The impaction involves unusual complications such as an aberrant tooth position requiring extensive bone removal, so consider D7241

Insurance and Denial Prevention

Key Payer Rules:

• Most dental plans cover D7230 under major services at 50-80%, with oral surgeons often reimbursed at a slightly higher rate than general dentists
• Payers almost always require a panoramic radiograph to verify the level of impaction
• Pre-authorization is strongly recommended, especially for plans with low annual maximums or waiting periods on surgical services
• Some plans bundle all four wisdom teeth into a single authorization, so submit all teeth at once when possible

Common Denials and How to Respond:

• Downgraded to D7220 (soft tissue impaction) → Appeal with an annotated panoramic radiograph clearly showing bone overlying a portion of the crown. Include the operative note describing the specific bone removal performed. Reference the CDT definition that distinguishes partial bony from soft tissue impaction.
• Upgraded by the payer to D7240 (payer says completely bony) → This is unusual but does happen. Review the radiograph to confirm your classification is accurate. If the tooth was truly partially bony, respond with a detailed explanation and annotated image. Overcoding can trigger audit flags, so accuracy matters.
• Claim denied for lack of medical necessity → Appeal with documentation of symptoms such as pain, infection, pericoronitis, cyst formation, or damage to the adjacent tooth. Include clinical photos if available and reference the ADA guidelines on third molar removal when appropriate.