The short version
# D7240 Dental Code: Removal of a Completely Bony Impacted Tooth
D7240 reports surgical removal of an impacted tooth whose crown is completely covered by bone. The preoperative anatomy, not procedure time or perceived difficulty, selects the impacted-tooth code. A payer needs a current image and tooth-specific operative note to verify that coverage.
- Bill D7240 when the impacted tooth is completely encased in bone before removal.
- Use D7220 when only soft tissue covers the occlusal surface and D7230 when bone partially covers it.
- D7210 is for an erupted tooth that requires bone removal or sectioning. It isn't an impacted-tooth code.
- The ADA says impacted extraction codes follow anatomical presentation, not difficulty.
- Delta requests a current periapical or panoramic image plus tooth-specific clinical notes for D7240.
- In a worked claim, an $800 office fee becomes a $550 allowable. The plan pays $440 at 80%, the patient owes $110, and the office adjusts $250.
What is D7240?
D7240 is the completely bony impacted-tooth removal code. The tooth is unerupted and its crown is fully covered by bone.
| Fact | D7240 |
|---|---|
| CDT category | Oral surgery |
| Tooth status | Impacted |
| Defining anatomy | Crown completely covered by bone |
| Reported by | Tooth number |
| Public fee references | Oregon Medicaid: $349.13; Washington Medicaid: $164.37 or $193.20 by program in 2025 |
When do you bill D7240?
Use D7240 when the preoperative condition and completed surgery support complete bony impaction.
- Identify the tooth and reason for removal.
- Retain a current image showing the entire tooth and bony coverage.
- Record the impaction classification before surgery.
- Describe flap, bone removal, sectioning, delivery, and socket care.
- Note relevant anatomical relationships and complications.
- Document closure, instructions, and follow-up.
D7240 vs D7220, D7230, and D7210
Start with erupted versus impacted.
| D7220 | D7230 | D7240 | D7210 | |
|---|---|---|---|---|
| Tooth status | Impacted | Impacted | Impacted | Erupted |
| Occlusal coverage | Soft tissue only | Partly covered by bone | Completely covered by bone | Not the deciding feature |
| Difficulty decides | No | No | No | No |
| Oregon Medicaid example | $221.45 | $293.20 | $349.13 | $194.97 |
What does insurance actually do with D7240?
Delta's oral-surgery guidance requires a current periapical or panoramic image for D7210 through D7241 plus the indication and surgical complexity.
- Office fee: $800
- Contracted allowable: $550
- Contractual adjustment: $250
- Plan payment at 80%: $440
- Patient balance: $110
Why does D7240 get denied?
- The image doesn't show complete bone coverage.
- The payer doesn't find complete bony coverage.
- The plan doesn't cover the service under its age or coordination rules.
What documentation gets D7240 paid?
- Don't omit the tooth number, diagnosis, or removal reason.
- Attach a current image showing the whole tooth and complete bony coverage.
- Record the preoperative impaction classification.
- Describe flap access, bone removal, sectioning, and delivery.
- Note proximity to relevant structures and any complication.
- Record socket management, closure, and postoperative instructions.
- Retain authorization and benefit verification.
For a downcode appeal, point directly to the image anatomy and matching operative note.
Common questions about D7240
Is D7240 always a wisdom-tooth code?
No. D7240 applies to any completely bony impacted tooth that meets the procedure, regardless of whether it's a third molar. The preoperative image and note must support complete bone coverage of the crown. Don't select it from tooth type or expected difficulty alone.
What is the difference between D7230 and D7240?
D7230 describes partial bone coverage of the impacted crown. D7240 requires complete bony coverage. Use the preoperative anatomy shown in the image and clinical record, not the time or effort required during removal, to separate the two claim codes properly.
Does difficult removal make a D7230 into D7240?
No. ADA guidance says impaction codes aren't based on difficulty. A difficult partial-bony removal remains tied to the partial-bony anatomy, while D7240 requires complete bony coverage before surgery. Document complications separately, but don't upgrade the impaction category because the case took longer.
Can anesthesia be billed with D7240?
Anesthesia is separately coded when delivered and supported under the applicable anesthesia procedure. Coverage can require authorization, provider qualifications, and complete time and monitoring records. Don't assume the surgical extraction benefit automatically includes or excludes anesthesia; verify the member's plan and document the service delivered.
Prove the anatomy before submission
Before filing, match the image and note to complete bony coverage.
Sources
- ADA, Guide to Extractions: Tooth and Remnants
- ADA News, tips to avoid common coding mistakes
- ADA, Glossary of Dental Terms
- Delta Dental, X-ray claim guidelines for oral surgery
- Delta Dental, common claim documentation gaps
- Washington Medicaid, July 2025 dental fee schedule
- Oregon Medicaid, June 2025 fee schedule
- ADA, acute dental pain management guideline
CDT codes and nomenclature are copyright © American Dental Association. This guide explains the code in plain language; the current CDT manual is the authoritative source.
