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When a tooth crown breaks off and leaves roots embedded in bone, surgical intervention becomes necessary to remove the remaining fragments. Dental code D7250 covers the surgical removal of residual roots that require more than routine extraction technique. This article explains when D7250 applies, how it differs from routine extractions, and what documentation justifies surgical root removal billing.
Nov 1, 2025
What is Dental Code D7250?
D7250 describes the surgical removal of residual tooth roots when the clinical crown is absent or severely damaged. The procedure involves incising tissue, reflecting a flap, removing bone, and extracting root fragments that cannot be removed with routine forceps technique. You use this code when roots have fractured during previous extraction attempts, when only roots remain after crown loss, or when root anatomy makes simple elevation impossible.
D7250 is billed per root or root fragment removed and represents a more complex procedure than routine surgical extractions covered by D7210. The code applies when surgical access and bone removal are necessary to retrieve residual roots.
Common Terminology
Understanding surgical extraction terminology helps you differentiate between routine and surgical root removal procedures in your documentation.
Residual roots: Root fragments or portions remaining after crown loss or incomplete extraction attempts
Surgical flap: Incision and reflection of gingival tissue to expose underlying bone for surgical access
Bone removal: Use of surgical burs or chisels to remove bone covering or surrounding root fragments
Root tip retrieval: Surgical technique to locate and remove small root fragments embedded in alveolar bone
When is D7250 Used?
Residual root removal becomes necessary when roots cannot be extracted using routine technique due to fracture, position, or lack of coronal structure for forceps placement. Surgical access provides visibility and control for safe root retrieval.
Your clinical assessment should determine whether roots can be elevated through the socket or require surgical flap and bone removal for proper access.
Common Clinical Scenarios
You'll encounter several situations where surgical technique is required to remove roots that remain after crown loss or fracture.
Previous extraction attempts: When roots fractured during earlier extraction efforts and remain embedded in the socket
Fractured endodontically treated teeth: When brittle root canal-treated teeth break during extraction leaving roots below the gumline
Severely decayed teeth: When extensive decay destroys the crown entirely and only root structure remains in bone
Hypercementosis: When excessive cementum buildup makes roots bulbous and impossible to remove without bone removal
Curved or dilacerated roots: When root anatomy includes severe curves or bends preventing routine elevation through the socket
When D7250 is NOT Appropriate
Knowing when simpler extraction codes apply helps you avoid upcoding and ensures accurate procedure documentation.
Routine extractions with forceps: When you can grasp and remove the entire tooth including roots using forceps, use D7140 for routine extraction
Surgical extractions with crown present: When removing intact teeth that require surgical technique, use D7210 for surgical removal of erupted tooth
Simple root elevation: When roots can be elevated through the socket without flap or bone removal, use D7140 instead
Root fragments left intentionally: When small root tips are left in place because removal risks exceed benefits, document the decision but don't bill D7250
Failed extraction billing: When roots break during your extraction attempt, you bill for the procedure performed, not separately for removing the fragments you created
Billing and Insurance Considerations
Documentation demonstrates that surgical intervention was necessary rather than routine extraction technique. Insurance companies scrutinize D7250 claims to ensure the procedure required true surgical access and bone removal.
Your records should describe the surgical approach, why routine technique was inadequate, and the complexity of root retrieval.
Documentation Requirements
Your clinical records must show that residual roots required surgical intervention beyond what's included in routine extraction codes. Detailed operative notes support the higher-level procedure code.
Pre-operative assessment: Document that only roots remain or that previous extraction attempts left root fragments in place
Reason for surgical approach: Note why routine elevation was impossible such as root position, fracture pattern, or lack of coronal structure
Surgical technique used: Describe flap design, amount of bone removed, instruments used, and method of root retrieval
Root characteristics: Record root anatomy factors that complicated removal such as curves, hypercementosis, or ankylosis
Post-operative radiograph: Include radiograph confirming complete root removal or documenting any fragments intentionally retained
Insurance Coverage
Coverage for D7250 falls under oral surgery benefits with reimbursement rates typically higher than routine extractions. Most plans cover surgical root removal when documentation supports medical necessity.
Surgical procedure classification: Plans categorize D7250 as oral surgery covered at 50-80% under major services after deductible
Documentation requirements: Carriers often request operative notes to verify that surgical technique was actually necessary
Pre-existing condition clauses: Some plans question coverage if roots resulted from previous failed extraction attempts by the same provider
Comparative fee structures: D7250 fees are typically 1.5 to 2 times higher than routine extraction fees to reflect increased complexity
Multiple root billing: You can bill D7250 for each residual root removed when multiple fragments require separate surgical retrieval
Common Billing Mistakes
Errors in coding D7250 typically involve confusion about when surgical root removal qualifies versus routine extraction or surgical extraction of intact teeth.
Upcoding routine extractions: Billing D7250 when roots could have been removed with forceps or simple elevators without surgical access
Wrong code for intact teeth: Using D7250 for surgical removal of teeth with crowns present, which should be coded as D7210 or D7140
Self-created fragments: Billing D7250 separately when roots broke during your own extraction attempt in the same appointment
Inadequate operative notes: Submitting claims without detailed descriptions of surgical flap, bone removal, and root retrieval technique
Missing radiographic documentation: Failing to include pre-operative and post-operative radiographs showing residual roots and complete removal
Common Questions About D7250
Can I bill D7250 if the tooth breaks during my extraction attempt?
No, you should not bill D7250 separately when a tooth breaks during your own extraction procedure in the same appointment. If you begin removing a tooth using D7140 (routine extraction) technique and the crown breaks off, you continue with whatever technique is necessary to complete the extraction, including surgical approach if needed. Bill only one extraction code for the entire procedure. However, if a patient returns after a previous dentist's failed extraction attempt with residual roots remaining, then D7250 is appropriate for the surgical root removal.
What's the difference between D7210 and D7250?
D7210 covers surgical removal of erupted teeth requiring flap elevation and bone removal when the tooth structure is still largely intact. D7250 specifically applies to removing residual roots when the crown is missing or severely damaged. If you're surgically extracting a tooth with a visible crown using flap and bone removal technique, use D7210. If only roots remain and you need surgical access to retrieve them, use D7250. The key distinction is whether coronal tooth structure is present for initial engagement with instruments.
How many units of D7250 can I bill for one tooth?
You can bill D7250 per root or root fragment that requires separate surgical retrieval. A molar with three roots where all three require individual surgical removal could justify three units of D7250 if each root demanded distinct surgical effort. However, most insurance companies expect one unit per tooth unless your documentation clearly shows that multiple roots required separate flap designs, bone removal episodes, or significantly increased surgical time. Be conservative and document thoroughly when billing multiple units for roots from the same tooth.
Do I need to take a post-operative radiograph for D7250?
Yes, post-operative radiographs are essential documentation for D7250 claims. These images confirm that you successfully removed the residual roots and that no significant fragments remain. Insurance auditors commonly request post-operative radiographs to verify that surgical root removal was completed. The radiograph also protects you medico-legally by documenting complete removal or showing any small fragments you intentionally left due to anatomical risk factors. Take and save post-operative images for every D7250 procedure.
Can I bill D7250 for roots I intentionally leave in place?
No, you cannot bill D7250 for roots or root fragments you decide not to remove. The code describes the surgical removal procedure, not the assessment or decision to leave roots in place. When small root tips are in close proximity to vital structures like the inferior alveolar nerve or maxillary sinus, leaving them may be the safest option. Document your clinical reasoning thoroughly, inform the patient, and monitor the site, but only bill for procedures you actually perform. You might bill an appropriate office visit or consultation code for the evaluation, but not the surgical removal code.
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