D7953 - Bone Repl Graft
Bone replacement graft for ridge preservation.
- Procedure Code
- D7953
- 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
Bill When (Allowable Clinical Criteria)
- Benefits are limited to one per extraction site.
- D7953 is only a benefit when done on the same site and on the same date of service as an extraction (D7140, D7210, D7220, D7230, D7240, D7241, D7250) or removal of an implant (D6100 and D6105).
Restrictions & Clinical Exclusions
- All procedures are by report and are subject to coverage under medical. This procedure is not billable to the patient by the same dentist/dental office when billed in conjunction with any surgical procedure not in conjunction with fractures for which splinting, wiring or banding is considered part of the complete procedure (e.g., D7270, D7272).
- Fees for D7953 are not billable to the patient on an edentulous ridge or on the same date of service as implant placement.
- Benefits for D7953 are denied when performed on third molars.
- 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.
- 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 |
|---|---|---|---|---|---|
| K04.02 | Irreversible pulpitis | Diseases of pulp and periapical tissues | Yes (Primary) | BOTH | bone replacement graft for ridge preservation – per site indicated for Irreversible pulpitis |
| K02.53 | Dental caries on pit and fissure surface penetrating into pulp | Dental caries | Secondary | BOTH | bone replacement graft for ridge preservation – per site 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 | bone replacement graft for ridge preservation – per site indicated for Dental caries on smooth surface penetrating into pulp |
| K04.01 | Reversible pulpitis | Diseases of pulp and periapical tissues | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Reversible pulpitis |
| K04.1 | Necrosis of the pulp | Diseases of pulp and periapical tissues | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Necrosis of the pulp |
| K04.5 | Chronic apical periodontitis | Diseases of pulp and periapical tissues | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic apical periodontitis |
| K04.6 | Periapical abscess with sinus | Diseases of pulp and periapical tissues | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Periapical abscess with sinus |
| K04.7 | Periapical abscess without sinus | Diseases of pulp and periapical tissues | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Periapical abscess without sinus |
| K04.8 | Radicular cyst | Diseases of pulp and periapical tissues | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Radicular cyst |
| K05.211 | Aggressive periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Aggressive periodontitis, localized, slight |
| K05.212 | Aggressive periodontitis, localized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Aggressive periodontitis, localized, moderate |
| K05.213 | Aggressive periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Aggressive periodontitis, localized, severe |
| K05.219 | Aggressive periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Aggressive periodontitis, localized, unspecified severity |
| K05.30 | Chronic periodontitis, unspecified | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic periodontitis, unspecified |
| K05.311 | Chronic periodontitis, localized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic periodontitis, localized, slight |
| K05.312 | Chronic periodontitis, localized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic periodontitis, localized, moderate |
| K05.313 | Chronic periodontitis, localized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic periodontitis, localized, severe |
| K05.319 | Chronic periodontitis, localized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic periodontitis, localized, unspecified severity |
| K05.321 | Chronic periodontitis, generalized, slight | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic periodontitis, generalized, slight |
| K05.322 | Chronic periodontitis, generalized, moderate | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic periodontitis, generalized, moderate |
| K05.323 | Chronic periodontitis, generalized, severe | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic periodontitis, generalized, severe |
| K05.329 | Chronic periodontitis, generalized, unspecified severity | Gingivitis and periodontal diseases | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Chronic periodontitis, generalized, unspecified severity |
| K09.0 | Developmental odontogenic cysts | Cysts of oral region | Secondary | BOTH | bone replacement graft for ridge preservation – per site indicated for Developmental odontogenic cysts |
| S02.5XXA | Fracture of tooth (traumatic), initial encounter for closed fracture | Fracture of skull and facial bones | Secondary | BOTH | bone replacement graft for ridge preservation – per site 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 | bone replacement graft for ridge preservation – per site 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 | bone replacement graft for ridge preservation – per site indicated for Dislocation of tooth, initial encounter |