ADA Code for Extracting an Implant: D6110 and D6111

Let’s be honest for a moment. In the world of dentistry, few things feel more frustrating than dealing with a failed dental implant. You’ve invested time, skill, and resources into placing it, or perhaps you are inheriting a case from another practitioner where things just didn’t go as planned.

When that implant has to come out, a new challenge arises: How do you bill for it?

You can’t just use a standard tooth extraction code. An implant is not a tooth. It is a prosthetic device integrated into the bone. Removing it requires a different skill set, different instruments (like trephine burs or high-torque ratchets), and a different approach to coding.

If you use the wrong code, you are essentially leaving money on the table—or worse, inviting a nasty audit down the line.

In this guide, we are going to break down everything you need to know about the specific ADA (American Dental Association) codes for extracting an implant. We will focus on the nuances of D6110 and D6111, explore when to use them, and discuss the documentation required to get paid fairly for this complex procedure.

Let’s dive in.

What is an Implant Extraction?

Before we talk about codes, we need to understand what we are actually doing when we remove an implant. It is crucial to distinguish this from a standard exodontia procedure.

When we extract a natural tooth, we are typically dealing with a periodontal ligament. That ligament provides a slight cushion and allows for expansion of the socket. When we apply forceps, the ligament gives way, and the tooth releases.

An implant is different. It is rigidly locked into the bone through a process called osseointegration. There is no ligament. It is essentially a titanium screw fused to the living bone.

Methods of Implant Removal

There are generally three ways to remove a failed implant. The method you choose often dictates the complexity and, subsequently, the coding nuances.

1. The Reverse Torque Method: If the implant is mobile due to loss of osseointegration but the bone structure is relatively intact, you might simply use a ratchet to unscrew it. This is the least invasive.

2. Trephination (Surgical Extraction): This is the most common method. You use a trephine bur—a hollow, tube-like drill—that fits over the implant. You drill around the implant to cut a core of bone, allowing you to remove the implant along with a small plug of bone.

3. Laser or Piezoelectric Surgery: In advanced cases, clinicians use piezosurgery to selectively cut bone away from the implant without damaging soft tissue or adjacent nerves.

Because this is a surgical procedure that involves cutting bone (in most cases), it requires a specific surgical code, not a routine extraction code.

The Core Codes: D6110 vs. D6111

In the ADA’s Current Dental Terminology (CDT), there are two specific codes designed for this scenario. You will not find a code called “implant removal” under the extraction section (D7111, D7140, D7210). Instead, these codes live under the “Implant Services” section.

Here are the two codes you need to know:

Wait—why do both say “by report”?

This is the most critical part of understanding these codes. Unlike a standard extraction (D7140) which has a set fee schedule in most insurance plans, D6110 and D6111 do not have a predefined value.

The descriptor “by report” means that the insurance company will not pay a standard rate. Instead, the dentist must submit a detailed narrative (a report) explaining the complexity, the time involved, the anatomy affected, and the reason for failure. The payer then determines the reimbursement based on that specific scenario.

The Difference Between D6110 and D6111

Many dentists get confused about which code to pick. The difference hinges on bone coverage.

• D6110: The implant is partially or fully exposed (non-submerged). You can see the top of the implant or the healing abutment. The procedure does not necessarily require raising a full-thickness flap to access the implant body, though it often does.

  • Example: A patient comes in with a crown that has loosened. You take an x-ray and discover the implant has fractured or lost integration. The top of the implant is at the bone level but visible after removing the crown.

• D6111: The implant is completely covered by bone and soft tissue (submerged). This is a buried implant. You must incise the tissue, reflect a flap, and remove bone to access the implant body before you can even begin to unscrew or trephine it.

  • Example: An implant was placed and buried for future restoration, but it failed during the healing phase. The cover screw is sitting 2mm below the crestal bone. You have to cut through mucosa and bone to get to it.

In essence, D6111 represents a higher level of surgical difficulty than D6110.

Why You Cannot Use Extraction Codes (D7140 or D7210)

It might be tempting to bill a surgical extraction code (D7210) when you remove an implant. After all, you are surgically removing something from the alveolar bone, right?

Do not do this.

Here is why using extraction codes for implant removal is a bad idea:

1. It is Code Misrepresentation: The ADA CDT manual specifies that extraction codes are for the removal of erupted teeth or residual roots. An implant is neither. It is a manufactured medical device. If an auditor reviews your charts and sees a D7210 for a case where the notes clearly state “removed #30 implant,” you will likely face a clawback (repayment) and potential fraud allegations.

2. It Undervalues the Service: Insurance companies are sophisticated. When they see an extraction code submitted by a general dentist or specialist for a site that clearly had an implant (visible on the x-ray), they often deny it as “not a covered service under this code,” or they pay the lower extraction rate, which does not reflect the time and risk of implant removal.

3. Medical Necessity: To justify implant removal to a medical insurer (if the patient has medical coverage for surgical procedures), you need to identify the device as an implant. Using a tooth code obscures the medical nature of the procedure.

Important Note: If the implant is so mobile that you can pull it out with your fingers without any incision or bone removal, some offices bill a “limited oral evaluation” or simply include it in the appointment fee. However, technically, if the device is removed, even if it’s mobile, the proper code is still D6110 if you intend to bill for the removal as a separate procedure.

Documentation: The Key to Getting Paid

Since D6110 and D6111 are “by report” codes, your narrative is your invoice. If you simply submit the code with an x-ray, you will likely get a denial stating: “This code requires a narrative. Please submit documentation.”

To avoid delays, submit a comprehensive report with your initial claim. Here is what your narrative should include:

1. The Reason for Removal

Insurance companies want to know why the implant failed. Was it peri-implantitis (bone loss due to infection)? Was it a mechanical failure (fracture of the implant body)? Was it failure to osseointegrate? Be specific.

*“The patient presented with a fractured implant fixture at site #19. Radiographic evaluation reveals a horizontal fracture of the titanium body at the mid-root level. The implant is non-restorable and is a source of chronic inflammation.”*

2. Surgical Complexity

Describe what you did. Did you use a trephine? Did you have to remove bone? How many sutures?

*“Following administration of local anesthetic, a full-thickness mucoperiosteal flap was reflected. A trephine bur was used under copious irrigation to circumscribe the implant body to a depth of 10mm. The implant was luxated and removed in one piece. The defect was debrided, and primary closure was achieved with 4-0 vicryl sutures.”*

3. Time

Include the surgical time. “By report” codes often rely on the concept of “time spent.” If it took you 45 minutes to remove a deeply submerged implant, that justifies a higher fee than a 10-minute unscrewing of a loose implant.

“Total surgical time: 47 minutes.”

4. Anatomical Considerations

Were there nerves involved? Was it near the sinus?

“Care was taken to avoid the inferior alveolar nerve canal, which was in close proximity to the apical third of the implant.”

Billing Scenarios: Real-World Examples

To make this clearer, let’s look at three typical scenarios you might face in practice.

Scenario 1: The Loose Crown

The Case: A patient returns for a routine recall. You notice the implant crown on #8 is mobile. You take a periapical x-ray and see significant bone loss around the implant (peri-implantitis). The implant is clinically mobile. You explain to the patient that the implant has failed and must be removed.
The Procedure: You unscrew the crown, use a ratchet to apply reverse torque, and the implant unscrews with minimal resistance. You curette the soft tissue lining the socket and place a few sutures.
The Code: D6110. The implant was exposed. No bone removal was necessary.
The Narrative: *“Removal of failed endosteal implant #8 due to advanced peri-implantitis and clinical mobility. Following removal of the abutment, reverse torque was applied. The implant fixture was removed with minimal surgical intervention.”*

Scenario 2: The Submerged Failure

The Case: A patient is referred to you. Six months ago, another dentist placed an implant in the #30 region but never restored it because the patient moved. The patient now reports pain. Your x-ray shows the implant is sitting below the bone level and is surrounded by a radiolucency (dark area) indicating failed integration.
The Procedure: You reflect a flap, expose the cover screw, and attempt to unscrew it, but the implant is locked in. You use a trephine bur to drill around the implant to a depth of 12mm to free it. You then remove the implant and graft the socket with allograft.
The Code: D6111. The implant was completely submerged under bone. A flap and osteotomy were required.
The Narrative: *“Full-thickness flap reflection was performed to access a submerged, non-integrated implant #30. A trephine bur was utilized to perform a 12mm osteotomy circumferentially around the implant body. The implant was removed en bloc with a core of bone. The site was thoroughly debrided.”*

Scenario 3: The Fractured Abutment Screw

The Case: A patient presents with a broken abutment screw. The screw is fractured inside the implant body. You cannot simply “unscrew” the implant because the implant is integrated.
The Procedure: You try to retrieve the screw but fail. You explain to the patient that the only way to fix the restoration is to remove the integrated implant. You use a trephine bur to remove the implant.
The Code: D6110 (if the implant body was at bone level) or D6111 (if the implant body was buried).
The Narrative: *“Removal of integrated implant #14 due to non-restorable abutment screw fracture. Following flap reflection, a trephine bur was utilized to separate the implant from the surrounding bone. The implant was removed, preserving adjacent anatomy.”*

Medical vs. Dental Insurance

One of the biggest debates in implant dentistry revolves around whether to bill dental insurance or medical insurance for implant removal.

While dental insurance is the primary pathway for code D6110/6111, there are times when medical insurance may be a viable secondary or primary payer.

• Trauma: If the implant was placed due to a medical condition (e.g., post-traumatic reconstruction) and removal is necessary due to pathology (infection), medical may cover it.

• CPT Codes: If you are billing medical insurance, you will not use ADA codes. You would use Current Procedural Terminology (CPT) codes, such as:

  • 41899: Unspecified procedure, dentoalveolar structures (used as a “by report” code similar to D6110).

  • 21040: Excision of benign tumor or cyst, mandible (if the implant removal involves significant pathology/bone removal).

Disclaimer: Medical billing for dental procedures is complex and varies by carrier. Always verify medical necessity and pre-authorization before proceeding.

Setting Your Fee: What is Fair?

Since these are “by report” codes, there is no standard fee. Your fee should reflect:

1. Overhead: The cost of sterilization, instruments (trephine burs are expensive), and staff time.

2. Expertise: This is a surgical procedure requiring advanced training.

3. Risk: The risk of complications such as jaw fracture, nerve paresthesia, or sinus perforation.

In general, across the United States, fees for D6110 range from $250 to $600, while D6111 (the more complex submerged removal) ranges from $450 to $900+, depending on the geographic location and whether a bone graft is placed at the same time.

What About Bone Grafting?

If you remove an implant and place a bone graft to prepare the site for a future implant (or simply to heal the defect), you should bill for that separately.

• D4266: Guided tissue regeneration – resorbable barrier, per site.

• D7953: Bone replacement graft – retained natural bone – first site in quadrant.

Do not bundle the graft into your D6110 narrative. Bill for the removal and the graft separately.

FAQ: ADA Code for Extracting an Implant

1. Can I use D7140 (extraction, erupted tooth) to remove an implant?

No. This is incorrect coding. Implants are not teeth. Using D7140 for implant removal can be considered fraud upon audit. Always use D6110 or D6111.

2. What if the implant is mobile and falls out on its own?

If the implant exfoliates (falls out) before the procedure, you did not perform a surgical removal. You should not bill a removal code. Instead, you may bill for the evaluation (D0120 or D0140) and any necessary debridement (D4355) if you had to clean the site.

3. Do I need a separate narrative for D6110 and D6111?

Yes. Because both are “by report” codes, you must include a narrative description of the procedure, the complexity, the time, and the reason for removal. If you submit electronically without a narrative attachment, the claim will almost certainly be denied or pended.

4. What if I have to remove the implant and place a new one on the same day?

This is a complex ethical and coding scenario. Typically, you would bill for the removal (D6110 or D6111) and the new implant placement (D6010 or D6011). However, many insurance plans have a “same-day” service limitation or will downgrade the second service. Be sure to check the patient’s plan limitations before doing this to avoid writing off a large portion of your fee.

5. Is the removal of a mini-implant coded differently?

Mini-implants (often used for denture stabilization) fall under the same coding logic. Since there isn’t a specific code for mini-implant removal, you would still use D6110 if it is a surgical removal. If the mini-implant is broken and you are simply fishing out a fragment with a hemostat without flap elevation, you might consider billing a foreign body removal, but D6110 remains the safest bet for documentation.

6. Does medical insurance ever cover implant removal?

Yes. If the implant is causing a pathological condition (infection, nerve impingement) or if it was placed as part of a medical reconstruction (e.g., post-oncology), medical insurance may cover the removal. You would use CPT codes rather than ADA codes in that scenario.

Additional Resource

Navigating the nuances of dental coding can be challenging, especially with surgical procedures like implant removal. For the most up-to-date information on CDT codes and coding guidelines, I highly recommend utilizing the following resource:

• American Dental Association (ADA) Coding Resources: The ADA publishes the CDT (Current Dental Terminology) manual annually. This is the definitive guide for dental coding. You can access it directly through the ADA store. It provides the exact verbiage and guidelines for codes D6110 and D6111.

  • Link: https://www.ada.org/en/publications/cdt

Conclusion

In summary, extracting a dental implant is a distinct surgical procedure that requires specific coding to ensure proper reimbursement and legal compliance. Avoid the trap of using standard extraction codes. Instead, master the use of D6110 for exposed or partially integrated implants and D6111 for fully submerged, bone-covered implants. Remember that both codes operate on a “by report” basis, meaning the quality of your narrative—detailing surgical complexity, time, and medical necessity—is just as important as the code itself.

FAQ Recap:

• Q: What is the ADA code for extracting an implant?
  A: D6110 (implant removal, by report) for exposed implants, and D6111 (implant removal, by report) for submerged implants.

• Q: Why can’t I just use D7210?
  A: Because D7210 is for surgical extraction of a natural tooth, not a titanium medical device. Using it misrepresents the service.

• Q: Do I need a narrative?
  A: Yes. Both D6110 and D6111 require a detailed narrative to justify the procedure and the fee.

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Additional Resource
For official guidance and the most current coding definitions, always refer to the American Dental Association’s CDT Codebook.
Link to ADA CDT Codebook