D7220 - Extract Impacted S
Removal of impacted tooth – soft tissue.
- Procedure Code
- D7220
- Category
- Oral Surgery
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
Required Claim Attachments & Pre-Submission Checklist
- Diagnostic pre-operative radiograph showing affected tooth/area
- Post-operative radiograph or surgical operative report
Bill When (Allowable Clinical Criteria)
- Indicated for non-restorable caries, severe periodontal disease, orthodontic necessity, or symptomatic impaction.
Restrictions & Clinical Exclusions
- General Policy Biopsies are done to obtain a sample of diseased tissue for laboratory examination. The pathology report is sufficient evidence that a biopsy has been done and submitted for examination. A separate laboratory fee is not a benefit.
- The fee for all oral and maxillofacial surgery includes local anesthesia and suturing on the same date of service as the oral and maxillofacial surgery, and routine postoperative care 30 days following surgery. Separate fees for these procedures by the same dentist/dental office are not billable to the patient and are denied if done by another dentist/dental office.
- Infection control is included in the fee for the dental services provided. Separate fees are not billable to the patient.
- The fees for exploratory surgery or unsuccessful attempts at extractions are not billable to the patient.
- All services and treatment provided remotely via tele-health modalities, be they synchronous or asynchronous, must be performed by a licensed dentist or their supervised staff, acting within the scope of applicable law. Services and treatment delivered virtually are only a benefit when the elements included in the descriptor of the CDT procedure code are completed and only when they meet generally accepted clinical guidelines.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
ICD-10 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K01.1 | Impacted teeth | Embedded and impacted teeth | Yes (Primary) | BOTH | removal of impacted tooth – soft tissue indicated for Impacted teeth |
| K00.1 | Supernumerary teeth | Disorders of tooth development and eruption | Secondary | BOTH | removal of impacted tooth – soft tissue indicated for Supernumerary teeth |
| K00.6 | Disturbances in tooth eruption | Disorders of tooth development and eruption | Secondary | BOTH | removal of impacted tooth – soft tissue indicated for Disturbances in tooth eruption |
| K01.0 | Embedded teeth | Embedded and impacted teeth | Secondary | BOTH | removal of impacted tooth – soft tissue indicated for Embedded teeth |
| K09.0 | Developmental odontogenic cysts | Cysts of oral region | Secondary | BOTH | removal of impacted tooth – soft tissue indicated for Developmental odontogenic cysts |