Few oral surgery appointments create as much anxiety as being told you need an impacted tooth removed. Patients immediately think about pain, swelling, missing work, and whether they’ll need sedation. Meanwhile, the dental team is thinking about something entirely different: selecting the correct procedure code and documenting the surgery well enough to support reimbursement. This guide explains how to report D7240, the CDT code for removal of an impacted tooth that is completely bony, and how it differs from other impaction codes.
The ADA defines an impacted tooth as an unerupted or partially erupted tooth that is positioned against another tooth, bone, or soft tissue so that complete eruption is unlikely. While impacted third molars are among the most common oral surgery procedures, not every impacted tooth is the same. Impacted wisdom teeth are often divided into mesial impactions (most common), distal impactions, vertical impactions, or horizontal impactions, depending on how the tooth is positioned in the jaw and what is preventing eruption. In addition to the orientation, the amount of soft tissue or bone covering the tooth directly affects the complexity of the procedure, the documentation required, and ultimately the code selection.
What Is CDT Code D7240?
Although “completely bony” sounds like the tooth must be 100% encased in bone, D7240 actually applies to any routine impacted tooth removal where 50% or more of the clinical crown is covered by bone. A mucoperiosteal flap is elevated and pericoronal bone removed in order to access the tooth for extraction.
This procedure is more complex than a soft tissue impaction because surgical access requires substantial removal of bone in addition to soft tissue management. The level of surgical difficulty, instruments used, and postoperative care typically increase accordingly.
Accurate documentation should clearly describe the clinical findings (including whether it is a mesial, distal, vertical, or horizontal impaction), anesthesia or sedation required, the surgical approach and procedure performed, and why the tooth meets the definition of a completely bony impaction.
How Does D7240 Differ From Other Impacted Tooth Codes?
Choosing the correct CDT code begins with understanding the clinical presentation. The table below compares the four impacted tooth removal codes.
| Code | Impaction type | Crown coverage | Surgical requirement |
|---|---|---|---|
| D7220 | Soft tissue | Covered by soft tissue only | Flap elevation |
| D7230 | Partial bony | Part of the crown covered by bone | Flap elevation and bone removal |
| D7240 | Completely bony | Most or all of the crown covered by bone | Flap elevation and bone removal |
| D7241 | Completely bony with unusual surgical complications | Most or all of the crown covered by bone | Added difficulty, such as nerve dissection, sinus closure, or aberrant tooth position |
Soft Tissue Impaction (D7220)
A soft tissue impaction occurs when the tooth has erupted enough that the clinical crown is covered only by gingival tissue. These cases are often less surgically complex than bony impactions, but they still require a much more technical approach than a D7140 or D7210. Soft tissue impactions are reported using D7220.
Documentation should note that the tooth was impacted and describe its clinical presentation, including orientation, and that the clinical crown was covered by soft tissues only. Include a description of the procedure performed.
Partial Bony Impaction (D7230)
A partial bony impaction is reported using D7230.
This type of impaction has bone surrounding some of the clinical crown, but coverage is less than 50%.
Clinical documentation should include details such as:
- The orientation of the impacted tooth
- The portion of the crown covered by bone
- Bone removal performed during surgery (location and extent)
- Surgical flap design when applicable
- Tooth sectioning if necessary
- Anesthesia and/or sedation required
- Any radiographic findings supporting the diagnosis of the impaction type
This level of detail helps support the selected procedure code and demonstrates medical necessity for the surgical approach.
Completely Bony With Unusual Surgical Complications (D7241)
Some completely bony impactions require a more complex procedure for removal due to unusual circumstances. This may be due to a nerve bundle that must be moved to avoid damage, a sinus perforation, or extreme tooth position. In these cases, the completely bony impaction should be reported using D7241, which includes these additional necessary procedures.
What Documentation Supports a D7240 Claim?
Claims are supported by documentation—not assumptions. When documentation clearly explains the amount of soft tissue or bone involved and describes the surgical procedure performed, the claim has a much stronger foundation.
Documentation supporting D7240 should typically include:
- Clinical description of the impaction (including orientation)
- Diagnostic radiographs
- Operative report describing flap design
- Bone removal performed (extent and location)
- Tooth sectioning, when applicable
- Surgical complications, if any
- Anesthesia and/or sedation required
- Final postoperative prognosis and directions given
The more complete the record, the easier it is to support the procedure code selected.
Some oral surgery procedures may also be billed to a medical plan. To learn more, download The Medical-Dental Billing Playbook.
How Does Sedation Coding Affect Impacted Tooth Claims?
Oral surgery often brings another concern for patients—fear.
For many people, the anticipation of having an impacted tooth removed creates more anxiety than the procedure itself. Fear of pain, difficulty hearing stories from friends or family, or uncertainty about recovery can cause patients to delay treatment for months—or even years.
When sedation becomes part of treatment, practices should be especially attentive to current CDT guidance and payor requirements. Recent significant updates to sedation-related coding and documentation expectations have reinforced the importance of accurately recording the type of sedation provided, the time involved when applicable, appropriate monitoring, and the clinical necessity supporting the service.
Rather than assuming coverage or relying on previous habits, practices should verify that documentation aligns with the most current CDT coding and individual payor policies. Careful documentation helps reduce confusion, supports compliant billing, and creates a clearer clinical record.
For patients, properly documented sedation represents something even more meaningful—it reflects that their anxiety was recognized and that their comfort mattered during what can be a stressful experience.
Frequently Asked Questions
D7240 is the CDT code for removal of an impacted tooth, completely bony. It is reported when most or all of the clinical crown is covered by bone and the surgery requires a flap and bone removal to reach the tooth.
The difference is how much of the crown is covered by bone. D7230 applies when only part of the crown is covered, and D7240 applies when most or all of it is. Radiographs and the operative report should show which applies.
D7241 is used for completely bony impactions with unusual surgical complications, such as nerve dissection, separate sinus closure, or an aberrant tooth position. The complication should be described in the operative report.
Yes. Report each impacted tooth removed with its own tooth number, and document each tooth’s impaction type and surgical approach separately.
Sedation and anesthesia have their own CDT codes and documentation requirements, separate from the extraction code. Payor policies on sedation vary, so verify requirements before the appointment.
Need Help With Oral Surgery Billing?
Accurately coding impacted tooth removals and documenting each surgery for payors takes time and attention your team may not always have. If you are struggling to keep up, consider partnering with eAssist for OMS specialty billing services. Our dental billing specialists understand oral surgery coding and documentation and work to get your claims paid. To learn more, schedule a free consultation.
Disclaimer: Insurance administration and dental billing recommendations, as well as interpretations of the CDT codes, represent the opinions of our experts. For the latest CDT codes and official interpretations, contact the American Dental Association or visit ADA.org. You are responsible for your own use of the CDT Codes, insurance administration, and dental billing.
