D7220 is the CDT code for the removal of a soft-tissue impacted tooth — one whose occlusal surface is covered by soft tissue, requiring a mucoperiosteal flap to be raised for removal. It is the least complex of the impaction codes, with no bone removal involved.
Informational only — confirm the official CDT descriptor and your payers' rules independently. This is general guidance, not billing, coding, or clinical advice.
When to Use the D7220 Code
Report D7220 when an impacted tooth is covered by soft tissue only and the gingiva must be incised and reflected (a mucoperiosteal flap raised) to access and remove it — but no bone removal is required. It commonly applies to partially erupted wisdom teeth where gum tissue, not bone, blocks the occlusal surface.
The impaction codes step up by depth, so code by what covers the tooth:
- D7220 — soft tissue over the tooth, flap only, no bone removal.
- D7230 — partially bony: part of the crown is covered by bone, requiring bone removal.
- D7240 — completely bony: most or all of the crown is covered by bone.
If the tooth is erupted and merely needs surgical access, that is D7210, not an impaction code.
Documentation & Clinical Scenarios
Payers scrutinize impaction level, so documentation should justify the soft-tissue classification:
- Tooth number (often #1, #16, #17, or #32 for third molars) and the indication for removal.
- A radiograph (often a panoramic film) showing the tooth covered by soft tissue and not bone.
- An operative narrative documenting that a flap was raised and the tooth removed without bone removal, with closure.
- Any symptoms — pericoronitis, recurrent infection, or pain — supporting medical necessity.
If bone had to be removed, the case is no longer D7220 and should be coded to the appropriate higher impaction level.
Insurance & Billing Tips
- Verify benefits first. Confirm coverage for impacted-tooth removal, any waiting period, and the remaining annual maximum.
- Match the code to the impaction depth. D7220 is soft-tissue only; bone involvement moves the claim to D7230 or D7240. The radiograph and narrative establish the level.
- Expect imaging requirements. Many payers require a panoramic or periapical film to confirm the impaction class before paying.
- Bill sedation and grafts separately. They are distinct codes, not part of D7220.
- Read the EOB and appeal. If down-coded, resubmit with the film and narrative supporting the soft-tissue classification.
Example Case
A 19-year-old presents with recurring soreness around a partially erupted lower wisdom tooth. The panoramic film shows tooth #17 with its crown covered by a flap of gum tissue but no overlying bone. The dentist incises and reflects the soft tissue, removes the tooth without taking any bone, and sutures the site — reported as D7220 with the panoramic film and an operative narrative noting no bone removal. Because the soft-tissue level was documented and benefits verified, the claim is paid at the soft-tissue impaction level.
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Frequently Asked Questions
What is the difference between D7220, D7230, and D7240?
All three remove an impacted tooth; the difference is what covers it. D7220 is a soft-tissue impaction — gum tissue only, flap raised, no bone removed. D7230 is partially bony — part of the crown is covered by bone, so some bone is removed. D7240 is completely bony — most or all of the crown is covered by bone. The radiograph and operative narrative document which level applies, and coding above or below the true depth is a common denial trigger.
Does D7220 include the X-rays, sedation, or grafts?
No. D7220 covers the surgical removal and closure. The diagnostic radiograph, any sedation, and any socket preservation graft or membrane are separate procedures with their own CDT codes. Billing them on the extraction line causes bundling denials, so each is reported on its own line with its own documentation.
How do I know it's soft tissue and not partially bony?
The classification depends on what covers the tooth at the time of removal. If only soft tissue (gingiva) covers the occlusal surface and no bone must be removed, it is D7220. If part of the crown is covered by bone and bone removal is required, it becomes D7230. The pre-operative radiograph and the operative note together establish the level, which is why payers usually require the film to confirm a soft-tissue impaction.
Does D7220 require pre-authorization?
Many payers recommend or require a pre-treatment estimate for impacted-tooth removal and often request a panoramic or periapical film to confirm the impaction class. Verify benefits, confirm any waiting period and remaining maximum, and submit the radiograph with the request when possible. Establishing the soft-tissue level up front reduces the chance of a denial or a down-code after the procedure.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.