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Understanding dental billing codes helps your practice submit accurate claims and receive proper reimbursement. D7230 represents a specific surgical extraction procedure that requires careful documentation and coding precision. This guide clarifies when to use D7230, what documentation supports proper billing, and how to avoid common mistakes that delay payment.
Nov 1, 2025
What is Dental Code D7230?
D7230 describes the surgical removal of a partially bony impacted tooth. The procedure applies when part of the tooth's crown is covered by bone and requires both mucoperiosteal flap elevation and bone removal to extract the tooth. This code sits between simpler soft tissue impactions and more complex completely bony impactions.
The anatomical crown refers to the portion of the tooth above the cemento-enamel junction. For D7230, less than 50% of the entire crown is covered by bone. The procedure cannot be completed through simple extraction methods and demands surgical intervention with bone removal.
Common Terminology
D7230 billing requires familiarity with specific clinical and anatomical terms. These terms appear in documentation, insurance requirements, and procedural narratives.
Mucoperiosteal flap: A surgical flap that includes both the mucosa and periosteum, reflected to expose the underlying bone and impacted tooth
Partial bony impaction: A tooth where less than half of the anatomical crown is covered by bone, preventing normal eruption or simple extraction
Cemento-enamel junction (CEJ): The boundary line where the tooth's enamel meets the cementum, used as the reference point for determining crown coverage
Surgical extraction: A procedure requiring incision, bone removal, possible tooth sectioning, and suturing beyond the scope of routine forceps extraction
When is D7230 Used?
D7230 applies to surgical extractions where the tooth cannot be removed through simple elevation techniques. The code requires both soft tissue incision and bone removal to access and extract the impacted tooth. Clinical examination and radiographic imaging determine whether the impaction meets the criteria for D7230.
Common Clinical Scenarios
D7230 most frequently applies to wisdom teeth and other impacted teeth with partial bony coverage. The specific clinical presentations guide proper code selection.
Partially erupted third molars: Wisdom teeth that have broken through the gum line but remain partially trapped beneath bone, causing pain, infection, or crowding
Pre-orthodontic extractions: Removal of impacted canines or premolars before orthodontic treatment when part of the crown remains under bone
Teeth with pathology: Impacted teeth associated with cysts, infections, or damage to adjacent teeth requiring surgical intervention with bone removal
Failed eruption cases: Teeth that stopped erupting partway, leaving part of the crown beneath bone and creating oral health complications
When D7230 is NOT Appropriate
Proper code selection requires understanding when D7230 does not accurately describe the procedure. Using the wrong code leads to claim denials and reimbursement delays.
Soft tissue impactions only: Teeth covered entirely by soft tissue without bony obstruction should be coded as D7220, not D7230
Completely bony impactions: Teeth with more than 50% of the crown covered by bone require D7240, which reflects the increased complexity
Simple extractions: Fully erupted teeth or those removed without bone removal fall under codes D7140 or D7210, depending on circumstances
Unusual surgical complications: Cases requiring nerve dissection, sinus closure, or management of aberrant tooth position warrant D7241 instead of D7230
Billing and Insurance Considerations
Accurate billing for D7230 starts with thorough documentation and proper insurance verification. Most dental plans cover surgical extractions, but coverage levels and preauthorization requirements vary widely between carriers and plans.
Documentation Requirements
Insurance carriers scrutinize surgical extraction claims and frequently request supporting documentation. Complete records prevent delays and denials.
Clinical examination findings: Detailed notes describing the tooth position, impaction level, symptoms, and clinical necessity for surgical removal
Surgical procedure details: Documentation of the flap design, bone removal technique, sectioning approach if used, and closure method
Tooth identification: Clear notation of which specific tooth was removed using standard numbering systems
Radiographic documentation: Pre-operative X-rays showing the impaction level, bone coverage, and relationship to adjacent structures like nerves or sinuses
Narrative description: Written explanation distinguishing why simple extraction was not possible and why D7230 specifically applies to this case
Insurance Coverage
Coverage for D7230 varies based on the patient's specific dental plan and the medical necessity of the extraction. Understanding these patterns helps set realistic payment expectations.
Medical vs. dental claims: Impacted teeth causing infection, pain, cyst formation, or damage to adjacent teeth may qualify for medical insurance coverage, requiring CPT code conversion
Age restrictions: Some plans limit coverage for third molar extractions to patients under specific ages, typically 25 or younger
Frequency limitations: Most plans do not impose frequency limits on D7230 since each tooth is billed separately and extractions are typically one-time procedures
Preauthorization requirements: Many carriers require predetermination for surgical extractions, especially when multiple teeth are involved or when patients have specific plan limitations
Common Billing Mistakes
Small errors in coding or documentation cause unnecessary claim denials and payment delays. Avoiding these patterns improves first-pass acceptance rates.
Confusing D7230 with D7240: Misidentifying the percentage of crown covered by bone leads to incorrect code selection and potential downcoding by insurance reviewers
Insufficient radiographic evidence: Submitting claims without clear X-rays showing partial bony impaction results in requests for additional information or outright denials
Missing procedure narratives: Failing to explain why surgical intervention was necessary rather than simple extraction leaves carriers questioning the appropriateness of D7230
Incorrect tooth numbering: Using inconsistent or incorrect tooth identification between the radiographs, clinical notes, and claim form triggers processing holds
Submitting dental codes to medical insurance: Billing D7230 directly to medical carriers without proper CPT conversion causes immediate claim rejection
Common Questions
How often can D7230 be billed? D7230 can be billed once per tooth. There are no frequency limitations because each tooth requires a separate surgical procedure. You can bill multiple D7230 codes on the same date if removing multiple partially bony impacted teeth.
Do I need preauthorization for D7230? Preauthorization requirements depend on the patient's insurance plan. Many carriers require predetermination for surgical extractions, especially for third molars or when multiple teeth are involved. Verify coverage and authorization requirements before scheduling the procedure.
What if the impaction turns out to be more complex than expected? Document the actual surgical findings and code accordingly. If you discover during surgery that the tooth requires more extensive bone removal than anticipated, D7240 may be more appropriate. Include a narrative explaining the intraoperative findings that necessitated the more complex approach.
Can D7230 be billed to medical insurance? Medically necessary impacted tooth extractions may qualify for medical insurance coverage. You must convert D7230 to the appropriate CPT code (typically 41899 for unlisted dentoalveolar procedures) and submit with proper diagnosis codes, documentation, and operative notes justifying medical necessity.
What is the difference between D7230 and D7210? D7210 applies to erupted teeth requiring surgical soft tissue elevation for removal but no bone removal. D7230 requires actual bone removal to access and extract the tooth. The key difference is bone coverage and the need for osteotomy.
How long is the global period for D7230? Most plans include routine postoperative care in the D7230 fee. This typically covers normal follow-up visits within 10-14 days after surgery. Complications requiring additional treatment beyond normal healing may be separately billable.
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