Removal of Teeth (dental extractions)
Clinical policy describing indications, documentation, coding, and coverage considerations for surgical and non-surgical removal of primary, erupted, and impacted permanent teeth for Anthem dental plans. Applies to providers submitting claims for dental extractions; member benefits remain subject to individual contract language.
Minor editorial refinements to description, clinical indications, criteria (added line #17), and reference; intent unchanged.
Line #17 added specifying requirement for documentation for extraction of fully erupted primary teeth when not submitted with codes D7111 or D7140.
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