D7241 is the CDT code for surgical removal of a completely bony impacted tooth that presents unusual surgical complications. The tooth is fully encased in bone and factors such as nerve proximity, aberrant position, dense bone, or divergent roots push the difficulty beyond a routine complete bony extraction. D7240 is the routine version of the same impaction.
Last updated June 2026 · Reviewed by the PracticeAlpha billing team
Use D7241 when removing a fully bony-impacted tooth that presents documented unusual surgical complications. The tooth must be completely encased in bone, with most or all of the crown covered, and there must be a complicating factor that materially raises the difficulty. Aberrant tooth position, proximity to the inferior alveolar nerve, unusually dense bone, and dilacerated or divergent roots are the typical examples.
This is the most complex tier on the impaction ladder. The progression runs D7220 for a soft tissue impaction, D7230 for a partial bony impaction, D7240 for a routine complete bony impaction, and D7241 for that same complete bony case once unusual complications are present. The code climbs as the tooth gets harder to reach and harder to remove.
Do NOT use D7241 for: a routine complete bony extraction with no unusual complications (use D7240). A partial bony impaction (use D7230). A soft tissue impaction (use D7220). A surgical removal of an erupted tooth (use D7210). The unusual complications are what move the case from D7240 to D7241, so they have to be real and documented.
Click any code to see the difference.
Tooth fully encased in bone plus unusual complications such as nerve proximity, aberrant position, dense bone, or divergent roots. The most difficult of the impaction tiers.
The same fully bony impaction without unusual complications. Difficult, but a standard complete bony extraction. This is the baseline that D7241 builds on.
Billing tip: This is the pair payers scrutinize most. D7241 requires an operative report describing the specific unusual complications. If the report does not name them, the payer downgrades the claim to D7240 reimbursement. The documentation is what carries the higher code.
This is the most common outcome for a D7241 claim. The payer accepts the complete bony impaction but reads the case as routine because the record does not document the unusual complications. The claim is not denied outright. It is paid at the D7240 rate. To hold the higher code, the operative report has to name the specific complicating factors and tie them to the added difficulty.
D7241 is built on the surgical narrative. Without an operative report describing what made the case unusual, there is nothing for the reviewer to evaluate. The report should describe the aberrant position, the nerve proximity, the dense bone, the divergent or dilacerated roots, or whatever factor applied, in clinical detail rather than a single label.
A panoramic film or CBCT showing the impaction is a baseline requirement. The imaging needs to show the tooth position and, where relevant, the relationship to the inferior alveolar nerve. If the complication being claimed is nerve proximity or aberrant position, the radiograph is the evidence that supports it. A claim with no supporting image invites a downgrade.
Some surgical extractions route to medical coverage rather than dental. When the case is tied to pathology, trauma, or another medical indication, the claim may belong with the medical payer. Submitting to the wrong payer or with the wrong format leads to a denial. Verify the routing before submission so the claim and its documentation reach the right place.
Imaging showing the tooth fully encased in bone and its position. Where nerve proximity is the complication, the film should show the relationship to the inferior alveolar nerve. The radiograph is the primary support for the impaction depth.
A detailed surgical narrative describing the procedure. This is the document that distinguishes D7241 from D7240, so it has to read like a complex case, not a routine one.
Spell out the specific unusual complications: aberrant position, nerve proximity, unusually dense bone, dilacerated or divergent roots, or the like. Naming them is what justifies the higher tier over a routine complete bony extraction.
Record the tooth number and confirm the impaction is completely bony. The note and the radiograph should agree that most or all of the crown is covered by bone.
Check whether the case belongs to the medical or dental payer before submission. Document the routing decision and any pre-authorization number, and include it on the claim.
Surgical extraction claims getting downgraded? We fix the coding, documentation, and follow-up patterns that cause it.
Learn about our billing servicesD7241 is the CDT code for surgical removal of a completely bony impacted tooth that presents unusual surgical complications. The tooth is fully encased in bone and complicating factors such as nerve proximity, aberrant position, dense bone, or divergent roots materially increase the difficulty beyond a routine complete bony extraction.
Both involve a completely bony impacted tooth. D7240 is the routine complete bony extraction. D7241 adds unusual surgical complications such as nerve proximity, aberrant tooth position, unusually dense bone, or dilacerated roots. Without documented complications, the payer reads the case as D7240.
D7241 is for a tooth completely encased in bone with unusual complications. D7230 is for a partially bony impaction, where part of the crown is covered by bone and part by soft tissue. The amount of bone covering the tooth is what separates the two codes.
The most common outcome is a downgrade to D7240 because the operative report did not document the specific unusual complications. Other reasons include missing panoramic or CBCT radiographs showing position and nerve proximity, and medical versus dental routing confusion.
An operative report naming the specific complicating factors, a panoramic or CBCT radiograph showing the impaction and nerve relationship, and a narrative connecting the imaging to the added surgical difficulty. The complications must be described, not just implied.
It can be either depending on the plan. Some surgical extractions route to medical coverage, especially when tied to pathology or trauma. Verify medical versus dental routing before submission so the claim goes to the correct payer with the right supporting documentation.
Search all 206 CDT codes in our dental coding guide.