D7210 - Extract Surgical
Surgical removal of erupted tooth.
- Procedure Code
- D7210
- Category
- Oral Surgery
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental National / PPO Standard
- Frequency Limitation
- Once per tooth per lifetime (LIFETIME)
- Age Limitation
- All ages covered.
Required Claim Attachments & Pre-Submission Checklist
- Operative clinical notes detailing mucoperiosteal flap, bone guttering, or tooth sectioning
- Pre-operative radiograph showing root curvature, impaction, or extensive breakdown
Bill When (Allowable Clinical Criteria)
- Surgical removal of erupted tooth requiring mucoperiosteal flap, bone removal, and/or tooth sectioning
Restrictions & Clinical Exclusions
- Do NOT bill if tooth was removed with forceps/elevators alone without bone removal or sectioning
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-50 | Downgraded to routine extraction D7140 due to lack of surgical narrative | Submit detailed surgical operative note explicitly describing flap reflection and bone removal. |
ICD-10 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K04.02 | Irreversible pulpitis | Diseases of pulp and periapical tissues | Yes (Primary) | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Irreversible pulpitis |
| K02.53 | Dental caries on pit and fissure surface penetrating into pulp | Dental caries | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Dental caries on pit and fissure surface penetrating into pulp |
| K02.63 | Dental caries on smooth surface penetrating into pulp | Dental caries | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Dental caries on smooth surface penetrating into pulp |
| K04.01 | Reversible pulpitis | Diseases of pulp and periapical tissues | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Reversible pulpitis |
| K04.1 | Necrosis of the pulp | Diseases of pulp and periapical tissues | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Necrosis of the pulp |
| K04.5 | Chronic apical periodontitis | Diseases of pulp and periapical tissues | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Chronic apical periodontitis |
| K04.6 | Periapical abscess with sinus | Diseases of pulp and periapical tissues | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Periapical abscess with sinus |
| K04.7 | Periapical abscess without sinus | Diseases of pulp and periapical tissues | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Periapical abscess without sinus |
| K04.8 | Radicular cyst | Diseases of pulp and periapical tissues | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Radicular cyst |
| K05.211 | Aggressive periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Aggressive periodontitis, localized, slight |
| K05.212 | Aggressive periodontitis, localized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Aggressive periodontitis, localized, moderate |
| K05.213 | Aggressive periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Aggressive periodontitis, localized, severe |
| K05.219 | Aggressive periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Aggressive periodontitis, localized, unspecified severity |
| K05.3 | Chronic periodontitis | Gingivitis and periodontal diseases | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Chronic periodontitis |
| K05.311 | Chronic periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Chronic periodontitis, localized, slight |
| K05.312 | Chronic periodontitis, localized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Chronic periodontitis, localized, moderate |
| K05.313 | Chronic periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Chronic periodontitis, localized, severe |
| K05.319 | Chronic periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Chronic periodontitis, localized, unspecified severity |
| K08.439 | Partial loss of teeth due to caries, unspecified class | Other disorders of teeth and supporting structures | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Partial loss of teeth due to caries, unspecified class |
| K09.0 | Developmental odontogenic cysts | Cysts of oral region | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Developmental odontogenic cysts |
| L02.91 | Cutaneous abscess, unspecified | Infections of the skin and subcutaneous tissue | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Cutaneous abscess, unspecified |
| L03.90 | Cellulitis, unspecified | Infections of the skin and subcutaneous tissue | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Cellulitis, unspecified |
| L03.91 | Acute lymphangitis, unspecified | Infections of the skin and subcutaneous tissue | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Acute lymphangitis, unspecified |
| R44.8 | Other symptoms and signs involving general sensations and perceptions | General symptoms and signs | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Other symptoms and signs involving general sensations and perceptions |
| R44.9 | Unspecified symptoms and signs involving general sensations and perceptions | General symptoms and signs | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Unspecified symptoms and signs involving general sensations and perceptions |
| R69 | Illness, unspecified | General symptoms and signs | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Illness, unspecified |
| S02.5XXA | Fracture of tooth (traumatic), initial encounter for closed fracture | Fracture of skull and facial bones | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Fracture of tooth (traumatic), initial encounter for closed fracture |
| S02.5XXB | Fracture of tooth (traumatic), initial encounter for open fracture | Fracture of skull and facial bones | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Fracture of tooth (traumatic), initial encounter for open fracture |
| S03.2XXA | Dislocation of tooth, initial encounter | Dislocation and sprain of joints and ligaments of head | Secondary | BOTH | extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated indicated for Dislocation of tooth, initial encounter |