Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.31
    OpenPayerPolicy UpdatesDental/Oral & MaxillofacialDelta Dental Ohio Alveoloplasty Coverage | OpenPay…
    Ask Trek AI about this page
    CurrentDelta Dental of OhioPolicy 282.26.v2

    Clinical Criteria for Alveoloplasty

    Customize your policy alerts

    Sign up for deltadentalofohio Policy 282.26.v2 alerts

    Get alerted when Policy 282.26.v2 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Establishes clinical criteria for determining the medical necessity and clinical appropriateness of alveoloplasty when benefit payment requires utilization management review for Delta Dental of Ohio members, subject to applicable dental plan provisions and laws or regulations.

    Policy Summary
    PayerDelta Dental of Ohio
    PolicyClinical Criteria for Alveoloplasty
    Policy CodePolicy 282.26.v2
    Change TypeNo material change
    Effective DateJune 21, 2025
    Next Review DateN/A
    Key ActionSubmit diagnostic-quality radiographic or intraoral photographic images documenting the alveolar bone condition.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    4Applicable CDT procedure codes
    1 per quadrantFrequency limit
    4+D7310 or D7320 threshold
    3 or fewerD7311 or D7321 threshold
    Consultant review

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    D7310 review requirement

    Medical Necessity and Coverage Criteria

    Generally accepted indications

    Generally accepted indications for alveoloplasty include any of the following.

    Accepted indications

    • Indication: Irregularities in alveolar bone require surgical recontouring in preparation for prosthetic rehabilitation.
    • Indication: Irregularities in alveolar bone require surgical recontouring in preparation for medical procedures such as radiation therapy, chemotherapy, or transplant surgery.
    • Indication: A pathological condition requires surgical removal of alveolar bone.

    Not medically necessary, inadvisable, or deficient care

    The procedure may be considered not medically necessary, inadvisable, or deficient in clinical quality when any of the following apply.

    Adverse clinical circumstances

    • No preventive or therapeutic indication: There is no preventive or therapeutic indication for surgical recontouring, including only minor smoothing of socket bone included in an extraction procedure.
    • Risk to vital structures: Soft tissue incision or bone recontouring could damage adjacent vital structures.
    • Insufficient bone volume: The surgical site has inadequate bone volume to allow osseous recontouring.
    • Compromised systemic status: The patient's compromised systemic status makes alveoloplasty a serious health risk.
    • Incomplete recontouring: Incomplete alveolar ridge recontouring leaves bony irregularities likely to compromise the outcome of prosthetic rehabilitation.

    Code-specific clinical and anatomical requirements

    Code-specific coverage consideration requires all applicable elements below.

    Code-specific requirements

    • Clinical necessity: Documentation supports that the procedure was clinically required.
    • Separate procedure: The alveoloplasty was performed as a separate procedure.

    • Applicable code configuration

      • D7310: Alveoloplasty was performed in conjunction with extractions over an anatomical area of bone encompassing four or more teeth or tooth spaces per quadrant.
      • D7311:

    Appendix A benefit criteria

    Appendix A establishes additional benefit criteria.

    • Prosthodontic construction: The alveoloplasty is provided in conjunction with construction of a prosthodontic appliance.
    • Frequency: No more than one alveoloplasty is performed per quadrant.1 per quadrant
    • Consultant review: When D7310 is performed in conjunction with four or more extractions in the same quadrant, the service is subject to consultant review.

      Applies to D7310 submissions with four or more extractions in the same quadrant.

    Alveoloplasty is generally not considered for benefits when submitted for minor smoothing and contouring of alveolar ridges performed in conjunction with tooth extraction or for placement of a single implant fixture.

    Alveoloplasty is generally not considered for benefits when performed in the same surgical area on the same date of service as another surgical procedure involving excision of bone, such as removal of a lateral exostosis.

    Benefits may be disapproved when there is no preventive or therapeutic indication for surgical recontouring of alveolar bone, including minor smoothing of socket bone that is included in an extraction procedure.

    Alveoloplasty may be considered not medically necessary or clinically inappropriate when soft-tissue incision or bone recontouring could damage adjacent vital structures, when the surgical site has inadequate bone volume for osseous recontouring, or when the patient's compromised systemic status makes the procedure a serious health risk.

    Benefits may be disapproved when alveolar ridge recontouring is incomplete and leaves bony irregularities likely to compromise prosthetic rehabilitation, or when improper technique damages adjacent soft or hard tissues or neurovascular structures.

    Procedure Codes and Benefit Limits

    Applicable Dental Procedure CodesCDT
    D7310alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant
    D7311alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quadrant
    D7320alveoloplasty not in conjunction with extractions - four or more teeth or tooth spaces, per quadrant
    D7321alveoloplasty not in conjunction with extractions - one to three teeth or tooth spaces, per quadrant
    Alveoloplasty with extractions — four or more teeth or tooth spaces
    CDT codeD7310
    Procedure contextAlveoloplasty in conjunction with extractions
    QuantityFour or more teeth or tooth spaces per quadrant
    Alveoloplasty with extractions — one to three teeth or tooth spaces
    CDT codeD7311
    Procedure contextAlveoloplasty in conjunction with extractions
    Quantity

    Documentation and Submission Requirements

    Documentation Required

    Document the Preoperative Diagnostic Rationale

    Submit documentation from the patient’s dental record explaining the preoperative diagnostic rationale for performing alveoloplasty. The record should reflect a thorough clinical and radiographic examination and include supporting information from the patient’s dental and medical histories, as applicable.

    Documentation Required

    Include Referrals and Relevant Clinical Sources

    Submit supporting information from referrals or other relevant clinical sources when it helps establish the need for alveoloplasty. For patients who do not meet published qualifying criteria, relevant clinician documentation may explain why coverage is necessary for the patient’s condition.

    Documentation Required

    Provide Radiographic and Photographic Evidence

    Submit diagnostic-quality evidence documenting the condition of the alveolar bone. Delta Dental of Ohio may require both preoperative and postoperative evidence for review.

    Clinical Background

    Alveoloplasty is the surgical recontouring of significant irregularities in alveolar bone. It may be performed as an ancillary procedure at the time of tooth extraction or as a standalone procedure in an edentulous area after the extraction site has healed. The procedure is commonly used to prepare an alveolar ridge for a removable prosthesis and may also support preparation for implants, radiation therapy, chemotherapy, or transplant surgery.

    Definition

    Alveoloplasty
    ProcedureSurgical procedure to recontour significant irregularities in alveolar bone
    Ancillary useMay be performed as a separate ancillary procedure at the time of tooth extraction
    Standalone useMay be performed as a standalone procedure in an edentulous area after healing from tooth extraction
    Policy Summary
    PayerDelta Dental of Ohio
    PolicyClinical Criteria for Alveoloplasty
    Policy CodePolicy 282.26.v2
    Change TypeNo material change
    Effective DateJune 21, 2025
    Next Review DateN/A
    Key ActionSubmit diagnostic-quality radiographic or intraoral photographic images documenting the alveolar bone condition.
    SourceLink
    On This Page
    Medical Necessity and Coverage CriteriaProcedure Codes and Benefit LimitsDocumentation and Submission RequirementsClinical BackgroundDefinition
  1. Improper technique: Improper alveoloplasty technique causes damage to adjacent soft or hard tissues or neurovascular structures.
    2. Alveoloplasty was performed in conjunction with extractions over an anatomical area of bone encompassing one to three teeth or tooth spaces per quadrant.
  2. D7320: Alveoloplasty was performed not in conjunction with extractions over an anatomical area of bone encompassing four or more teeth or tooth spaces per quadrant.
  3. D7321: Alveoloplasty was performed not in conjunction with extractions over an anatomical area of bone encompassing one to three teeth or tooth spaces per quadrant.
    4. One to three teeth or tooth spaces per quadrant
    Alveoloplasty without extractions — four or more teeth or tooth spaces
    CDT codeD7320
    Procedure contextAlveoloplasty not in conjunction with extractions
    QuantityFour or more teeth or tooth spaces per quadrant
    Alveoloplasty without extractions — one to three teeth or tooth spaces
    CDT codeD7321
    Procedure contextAlveoloplasty not in conjunction with extractions
    QuantityOne to three teeth or tooth spaces per quadrant
    Alveoloplasty frequency
    Frequency limitOne alveoloplasty per quadrant
    Benefit conditionProvided in conjunction with construction of a prosthodontic appliance
    Additional reviewD7310 with four or more extractions in the same quadrant is subject to consultant review
    • Diagnostic-quality radiographic images
    • Diagnostic-quality intraoral photographic images
    • Preoperative and postoperative images when required for review
    Documentation Required

    Submit a Detailed Clinical Narrative When Needed

    When the available clinical documentation does not conclusively support the need for alveoloplasty, submit a detailed narrative describing the clinical condition found in the specific area requiring the intervention and explaining why the procedure is medically necessary.

    Note

    Respond to Additional Information Requests

    Delta Dental of Ohio may request additional clinical information relevant to the patient’s care when necessary to determine medical necessity or clinical appropriateness. Failure to provide applicable required documentation may result in disapproval of benefit payment.

    Denial Risk

    No Therapeutic or Preventive Indication

    Benefits may be disapproved when alveoloplasty has no preventive or therapeutic indication, including surgical recontouring that is unnecessary or minor smoothing of socket bone included in an extraction procedure.

    • No preventive or therapeutic indication for surgical recontouring
    • Minor smoothing or contouring of socket bone performed as part of tooth extraction
    Denial Risk

    Unsafe Clinical Circumstances

    Alveoloplasty may be considered not medically necessary, inadvisable, or clinically inappropriate when the surgical circumstances create unacceptable risk or do not permit effective recontouring.

    • Soft-tissue incision or bone recontouring could damage adjacent vital structures
    • Insufficient bone volume exists at the surgical site for osseous recontouring
    • The patient’s compromised systemic status creates a serious health risk
    Denial Risk

    Use Complete and Proper Technique

    Benefits may be disapproved when the procedure is incomplete or performed with improper technique, including inadequate ridge recontouring or damage to surrounding tissues or neurovascular structures.

    • Bony irregularities remain that are likely to compromise prosthetic rehabilitation
    • Improper technique damages adjacent soft or hard tissues
    • Adjacent neurovascular structures are damaged
    Billing Rule

    Clinically Required and Separately Performed

    Coverage requires documentation that alveoloplasty was clinically required and performed as a separate procedure. The applicable code and extraction relationship must also match the anatomical area treated.

    • D7310: separate alveoloplasty with extractions over an area encompassing four or more teeth or tooth spaces
    • D7311: separate alveoloplasty with extractions over an area encompassing one to three teeth or tooth spaces
    • D7320: separate alveoloplasty not in conjunction with extractions over an area encompassing four or more teeth or tooth spaces
    • D7321: separate alveoloplasty not in conjunction with extractions over an area encompassing one to three teeth or tooth spaces
    • Generally not covered for minor ridge smoothing with extraction, placement of a single implant fixture, or the same surgical area and date as another bone-excision procedure such as lateral exostosis removal
    • Apply any program-specific criteria established by the dental benefit program
    Billing Rule

    Prosthodontic Appliance and Quadrant Limits

    Alveoloplasty is covered only when provided in conjunction with construction of a prosthodontic appliance and is limited to one procedure per quadrant. D7310 performed with four or more extractions in the same quadrant is subject to consultant review.

    • A prosthodontic appliance must be constructed in conjunction with the service
    • Limit: one alveoloplasty per quadrant
    • D7310 with four or more extractions in the same quadrant is subject to consultant review