CurrentColorado Rocky Mountain Health PlansPolicy DCP032.14

Oral Surgery: Orthodontic Related Procedures

Defines indications, contraindications, and coverage considerations for orthodontic-related oral surgery procedures including surgical placement/removal of temporary anchorage devices (TADs), surgical access/exposure of unerupted teeth, placement of devices to facilitate eruption, corticotomy, and mobilization of ankylosed teeth; includes applicable CDT procedure codes and supporting evidence/references. Applies to UnitedHealthcare dental and Medicare Advantage dental plans; member benefit documents govern final coverage.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyOral Surgery: Orthodontic Related Procedures

Policy CodePolicy DCP032.14

Change TypeRevised (supporting information)

Effective DateSep 1, 2025

Next Review Date

Key ActionDocument that patient is age 12 or older and the clinical indication for TAD placement and confirm no listed contraindications are present.

SourceLink

POLICY UPDATE CHANGES

Updated Description of Services, Clinical Evidence, and References sections to reflect most current information.

12+Policy applies to TADs age threshold

3Primary covered procedures described

1Procedure considered unproven (Corticotomy)

Coverage Summary

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This policy (Policy Number DCP032.14, effective 2025-09-01) provides coverage criteria for oral surgical procedures related to orthodontic treatment, including surgical placement and removal of temporary anchorage devices (TADs), surgical access/exposure of unerupted teeth, placement of devices to facilitate eruption, corticotomy, and mobilization of ankylosed teeth. The scope applies to UnitedHealthcare dental and Medicare Advantage dental plans, with member-specific benefit documents governing final coverage determinations. The overall coverage stance is mixed: specific indications and contraindications are defined for procedures such as TAD placement, while certain procedures (notably corticotomy/PAOO/SAOO outside specified indications) are considered unproven or not established as standard/medically necessary.

Display thresholds and quick facts

Minimum patient age for TADs (FDA informational)>= 12 years

Gingival cuff after eruption for labially impacted teeth2-3 mm

Policy applies to TADs age threshold (stat)Policy notes FDA approval for patients aged 12 and older

Coding

Applicable CDT procedure codes (reference only)mixed

D7280	Exposure of an unerupted tooth.
D7282	Mobilization of erupted or malpositioned tooth to aid eruption.
D7283	Placement of device to facilitate eruption of impacted tooth.
D7292	Placement of temporary anchorage device (screw retained plate) requiring flap.
D7293	Placement of temporary anchorage device requiring flap.
D7294	Placement of temporary anchorage device without flap.
D7296	Corticotomy - one to three teeth or tooth spaces, per quadrant.
D7297	Corticotomy - four or more teeth or tooth spaces, per quadrant.
D7298	Removal of temporary anchorage device [screw retained plate], requiring flap.
D7299	Removal of temporary anchorage device, requiring flap.

1–10 of 12

1/2

Provider Actions

Documentation Required

Document indication and age for TAD placement

Document that patient is age 12 or older and clinical indication (e.g., intrusion, molar distalization, canine retraction, correction of open bite/deep overbite, canted occlusal plane) and that no listed contraindications are present.

D7292
D7293
D7294

Documentation Required

Document surgical access justification

For surgical exposure (D7280), document that a normally developing permanent tooth is unable to erupt into a functional position and, for labial impactions, that 2-3 mm gingival cuff will be present after eruption.

D7280
D7283

Documentation Required

Document ankylosis for mobilization

For mobilization of erupted/malpositioned tooth to aid eruption (D7282), document ankylosis diagnosis and clinical rationale.

D7282

Billing Rule

Code reporting for TAD removal

Use the specific removal codes corresponding to whether a flap was required when removing a temporary anchorage device.

D7298
D7299
D7300

Background & Evidence

Temporary anchorage devices (TADs) are intraoral anchorage implants used adjunctively with orthodontic therapy to improve anchorage; the policy notes the FDA approves TADs for use in patients aged 12 years and older and describes common clinical uses (e.g., intrusion, molar distalization, canine retraction, correction of open bite/deep overbite, correction of a canted occlusal plane).

Corticotomy (also called periodontally accelerated osteogenic orthodontics [PAOO] or surgically assisted osteogenic orthodontics [SAOO]) involves intentional cuts to cortical bone to accelerate tooth movement; multiple systematic reviews and meta-analyses report temporary acceleration of tooth movement but overall low-to-moderate quality evidence, heterogeneity among studies, and unclear long-term effects, and the policy characterizes corticotomy (when not related to distraction osteogenesis or orthognathic surgery) as unproven due to insufficient evidence of efficacy and/or safety.

When TADs are used for distraction osteogenesis of the mandible or in the context of orthognathic procedures, that use is considered medical in nature and is typically covered under the member's medical plan rather than the dental plan.

Key Evidence

Definitions

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyOral Surgery: Orthodontic Related Procedures

Policy CodePolicy DCP032.14

Change TypeRevised (supporting information)

Effective DateSep 1, 2025

Next Review Date

Key ActionDocument that patient is age 12 or older and the clinical indication for TAD placement and confirm no listed contraindications are present.

SourceLink

On This Page

OpenPayer

Oral Surgery: Orthodontic Related Procedures

Coverage Summary

Medical-Necessity Criteria

Coding

Provider Actions

Background & Evidence

Revision History