D7240 is the CDT code for the removal of a completely bony impacted tooth — one where most or all of the crown is covered by bone, requiring a mucoperiosteal flap and significant bone removal for delivery. It is the most complex of the standard impaction codes.
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 D7240 Code
Report D7240 when most or all of the crown of an impacted tooth is covered by bone, requiring the dentist to raise a flap and remove substantial bone — usually with sectioning of the tooth — to deliver it. It commonly applies to deeply impacted third molars fully encased in bone.
Code by how much bone covers the crown:
- D7220 — soft tissue only; no bone removed.
- D7230 — partially bony; part of the crown under bone.
- D7240 — completely bony; most or all of the crown under bone.
When a completely bony case involves unusual surgical complications — such as nerve dissection, sinus exposure requiring separate closure, or aberrant tooth position — the appropriate code is D7241, not D7240.
Documentation & Clinical Scenarios
The completely bony level is closely reviewed, so documentation must support it:
- Tooth number (typically third molars) and the indication for removal.
- A radiograph (usually panoramic, sometimes CBCT) showing most or all of the crown encased in bone.
- An operative narrative documenting flap elevation, significant bone removal, sectioning, and closure.
- Symptoms or pathology — cyst, recurrent infection, pressure on adjacent teeth — supporting medical necessity.
If unusual complications occurred, document them specifically so the claim can correctly move to D7241 rather than D7240.
Insurance & Billing Tips
- Verify benefits first. Confirm impacted-tooth coverage, any waiting period, and the remaining annual maximum.
- Document the bone encasement. D7240 requires most or all of the crown covered by bone; the radiograph and narrative prevent a down-code to D7230.
- Expect imaging requirements. Many payers require a panoramic film or CBCT to confirm the completely bony classification.
- Bill add-ons separately. Sedation, bone grafts, and membranes are distinct codes, not part of D7240.
- Read the EOB and appeal. If down-coded, resubmit with the film and operative note documenting the bone removal.
Example Case
A 23-year-old is referred for a deeply impacted lower third molar found on a routine panoramic film. The image shows tooth #17 fully encased in bone, with the entire crown covered. The surgeon raises a flap, removes the overlying bone, sections the tooth into segments, delivers it, and sutures the site — reported as D7240 with the panoramic film and an operative narrative documenting the significant bone removal and sectioning. Because the completely bony level was clearly supported, the claim is paid at the D7240 level.
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Frequently Asked Questions
What is the difference between D7230 and D7240?
Both are bony impactions; the difference is how much of the crown the bone covers. D7230 is partially bony — part of the crown is covered by bone and some bone is removed. D7240 is completely bony — most or all of the crown is encased in bone, requiring more extensive bone removal. The pre-operative radiograph and operative narrative establish the level, and coding a partially bony case as completely bony (or the reverse) is a frequent cause of denials and payment adjustments.
When does the case become D7241 instead of D7240?
D7240 is a completely bony impaction without unusual difficulty. D7241 is reserved for a completely bony impaction with unusual surgical complications — for example, nerve dissection, a maxillary sinus exposure requiring separate closure, or an aberrant tooth position. The documentation must specifically describe the complication to justify D7241; without it, the case remains D7240. Reporting D7241 routinely, without a documented complication, invites denials.
Does D7240 include X-rays, sedation, or bone grafts?
No. D7240 covers the surgical removal and closure of the completely bony impacted tooth. The diagnostic imaging, any sedation, and any socket preservation graft or membrane are separate procedures with their own CDT codes. Reporting them on the extraction line causes bundling denials, so each is billed on its own line with its own supporting documentation.
Does D7240 require pre-authorization?
Many payers recommend or require a pre-treatment estimate for completely bony impactions and commonly request a panoramic film or CBCT to confirm the classification. Verify benefits, confirm any waiting period and remaining maximum, and submit the imaging with the request. Establishing the completely bony level up front reduces the chance of a denial or a down-code to D7230 after the procedure.
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