The following information is a reminder of our reimbursement policies concerning impacted teeth removal procedures and erupted teeth/exposed root removal procedures.
D7230 and D7240 – Guidance on Reimbursement for Impacted Teeth Removal Procedures
Delta Dental of Missouri’s policy on reimbursement for D7230 and D7240 has not changed as a result of the ADA’s recently published guidance on this topic. Our policy is simple: in order for the extraction of an impacted tooth to be reimbursed as a D7240 (removal of impacted tooth – completely bony), all surfaces of the coronal portion of the tooth (including the occlusal surface) must at least be partially covered by bone. The CDT guidebook contains the following statement in acknowledgement of differing interpretation of procedures based on the individual policies of the dental benefits company: If there is more than one code in this edition that consists of a procedure and a dentist submits a claim under one of these codes, the payor may process the claim under any of these codes that is consistent with the payor’s reimbursement policy.
D7140 and D7210 – Guidance on Reimbursement for Erupted Teeth/Exposed Root Removal Procedures
Delta Dental of Missouri’s policy for reimbursement of D7140 and D7240 is determined based upon the images submitted to support the procedure. Claims for the extraction of intact periodontally-involved teeth or third molars with conical, fused roots that have erupted into the plain of occlusion are submitted as D7210. The images of these teeth clearly show no need for the removal of bone or sectioning to facilitate extraction. In these situations, the service will be re-coded more appropriately to D7140. The removal of bone and/or sectioning of the tooth must be REQUIRED rather than the individual dentist’s preference or practice. The CDT guidebook contains the following statement in acknowledgement of differing interpretation of procedures based on the individual policies of the dental benefits company: If there is more than one code in this edition that consists of a procedure and a dentist submits a claim under one of these codes, the payor may process the claim under any of these codes that is consistent with the payor’s reimbursement policy.
