Removal of a tooth that is completely covered by bone, requiring mucoperiosteal flap elevation, bone removal, and possibly tooth sectioning.
Get help with D7240 claims →Third molars completely encased in bone with no eruption pathway visible.
Teeth impacted in unusual positions (horizontal, inverted) requiring significant bone removal.
Impacted teeth in close proximity to the inferior alveolar nerve or maxillary sinus.
These are the denial reasons we see most often for D7240. Each one is preventable with proper documentation.
Most common denial. Payer reviews radiograph and determines the tooth is only partially bony, not completely bony.
Asymptomatic impacted teeth may be denied as not medically necessary by some plans.
Some plans require pre-authorization for complete bony impaction removal.
Full view showing the tooth completely encased in bone.
Document that bone covers the tooth on all surfaces.
Note relationship to inferior alveolar nerve, maxillary sinus, or adjacent tooth roots.
Record tooth sectioning, amount of bone removal, and nerve proximity.
D7240 requires that bone covers the ENTIRE crown of the tooth. If any portion of the crown is visible through bone (even if gum tissue covers it), the correct classification is D7230 (partial bony). The distinction is based on the radiographic appearance, not the surgical difficulty.
Some cases are genuinely difficult to classify. A tooth that appears completely bony on the panoramic may have a thin layer of bone that was already eroding. In these borderline cases, take a CBCT if available to better document the bone coverage, and describe the bone removal in detail in your surgical notes.
D7241 is for complete bony impaction with "unusual surgical complications." This applies when the surgery involves significant additional difficulty: unusually dense bone, aberrant tooth morphology (dilacerated roots, hypercementosis), ankylosis, or proximity to vital structures requiring special techniques. Document the specific complication and the additional surgical steps required. Without documentation of the unusual complication, D7241 will be downgraded to D7240.
Our team handles D7240 billing daily. We know the denial patterns, documentation requirements, and appeal strategies that get claims paid.
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