D7240Removal of Impacted Tooth, Completely Bony

What This Code Covers

D7240 is used for the removal of a tooth that is completely encased in bone. No portion of the tooth crown is visible above the bony ridge, and extensive bone removal is required to uncover and extract the tooth. This is the most complex of the standard impaction codes and carries the highest reimbursement. It most commonly applies to wisdom teeth that never erupted and remain fully buried in the jaw. The procedure typically involves a mucoperiosteal flap, significant bone removal with a handpiece, and often sectioning of the tooth.

Billing Guide

Bill this code when:

• The tooth is completely surrounded by bone with no portion of the crown above the bone line
• Extensive bone removal is required to uncover and extract the tooth
• The pre-operative radiograph confirms a complete bony impaction
• A mucoperiosteal flap, bone removal, and likely tooth sectioning are all performed

Do not bill this code when:

• Any portion of the crown is visible above the bone line, so use D7230 (partial bony impaction)
• The tooth is covered by soft tissue only with no bone involvement, so use D7220
• The impaction involves unusual complications such as aberrant position or unusually difficult bone removal, so use D7241
• The tooth has erupted into the mouth, regardless of how difficult the extraction is, so use D7140 or D7210

Insurance and Denial Prevention

Key Payer Rules:

• Most plans reimburse D7240 at 50-80% under major or surgical services, and it typically has the highest reimbursement of the standard impaction codes
• A panoramic radiograph is almost always required by payers to verify the complete bony classification
• Pre-authorization is strongly recommended given the higher cost of this procedure
• Some medical insurance plans may cover D7240 when performed in a hospital or surgical center, especially with general anesthesia, so always check medical benefits for cross-coding opportunities

Common Denials and How to Respond:

• Downgraded to D7230 (partial bony impaction) → Appeal with an annotated panoramic radiograph demonstrating that the entire crown was below the bone line. Include the operative note with detailed measurements or descriptions of bone removal. Reference the CDT definition stating "most or all of the crown covered by bone" for D7240.
• Denied as not medically necessary (asymptomatic impaction) → Appeal with documentation of the clinical rationale for removal. Cite risk factors such as cyst or tumor development, resorption of adjacent teeth, or orthodontic treatment planning. Reference published guidelines from the ADA or AAOMS supporting prophylactic removal when risk factors are present.
• Coordination of benefits delay (dental and medical both involved) → Submit to the primary payer first, then send the explanation of benefits along with the claim to the secondary payer. If medical insurance is involved, use the appropriate medical diagnosis code (such as K01.1 for impacted teeth) alongside the CDT procedure code.