Indication: Tooth extraction is indicated for conditions such as pain, dental caries, periodontal disease, periapical pathology, split/cracked tooth, tooth mobility, internal or external root resorption, infection, severe anomaly of the crown or root precluding prosthetic/restorative treatment, traumatic injuries, loss of pulp vitality (often secondary to infection), ectopic position causing damage to other teeth, teeth in the line of fracture, prophylactic removal related to organ transplant/chemotherapy/radiation/prosthetic heart valve or joint replacement, or for orthodontic purposes.
From Clinical Indications (policy).
Imaging: Current (within 12 months), dated, diagnostic pretreatment periapical or panoramic images must be provided for all extractions.
Imaging requirement for benefit determination (Criteria #1).
Coding and procedure documentation: Code selection must reflect actual tooth position and the surgical technique performed (e.g., erupted vs. surgical removal; soft tissue, partially bony, or completely bony impaction). Erupted extractions use D7140 or D7210 as appropriate; impacted removals use D7220, D7230, D7240, or D7241 as appropriate; D7250 and D7251 apply to residual roots or coronectomy respectively.
See CDT code descriptions and coding guidance in Criteria.
Impacted tooth pathology: An impacted tooth (one that cannot fully erupt due to abnormal position or impingement of anatomic structures) will be benefited only when associated pathology or clinical indications are present; asymptomatic, nonpathologic impactions generally are not automatically benefited unless plan design permits (see plan-specific rules).
Impaction definition and benefit condition (Criteria #4 and policy text).
Documentation for complex completely bony impactions (D7241): For D7241 (removal of completely bony impacted tooth with unusual surgical complications), submit clinical notes and/or narrative documenting specific complicating features such as intimate involvement with the mandibular canal, involvement with adjacent tooth roots, obstructing mandibular ramus, unusually low tooth position, access/angulation that risks injury to adjacent teeth, or (for maxillary teeth) proximity to the maxillary sinus or location above adjacent roots.
Special documentation requirement to consider D7241 (Criteria and illustrative features).
Primary tooth billing: Extraction of fully erupted primary teeth must be billed with D7111 or D7140; if not submitted with those codes, supporting documentation is required for benefit determination.
Primary tooth documentation requirement (policy note).