D7230 Dental Code: Extraction of Erupted Tooth Requiring Removal of Bone

Tooth extraction is a common dental procedure, but not all extractions are the same. While simple extractions (coded under D7140) involve removing visibly accessible teeth, more complex cases require surgical intervention. The D7230 dental code is specifically used when an erupted tooth must be extracted with additional steps such as bone removal or tooth sectioning.

This article provides an in-depth exploration of the D7230 code, covering its clinical applications, procedural details, billing considerations, and potential complications. Whether you’re a dental professional, student, or patient seeking clarity, this guide will serve as a definitive resource.

2. Understanding the D7230 Dental Code

Definition and Scope

The D7230 code, as defined by the American Dental Association (ADA), refers to:

“Extraction of an erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated.”

Unlike a simple extraction (D7140), D7230 involves:

• Osteotomy (Bone Removal): When the tooth is partially covered by bone.

• Tooth Sectioning: Dividing the tooth into smaller pieces for easier removal.

• Flap Elevation: Reflecting gum tissue to access the surgical site.

When is D7230 Used?

This code applies to cases where:
✔ The tooth is fully erupted but has dense surrounding bone.
✔ The tooth has divergent or curved roots making elevation difficult.
✔ The patient has ankylosis (fusion of tooth to bone).

3. Clinical Indications for D7230

Complex Tooth Extractions

Common scenarios requiring D7230 include:

• Molars with Hypercementosis (excessive cementum buildup).

• Teeth with Prior Root Canal Treatment (more brittle).

• Teeth Near Anatomical Structures (e.g., inferior alveolar nerve).

Impacted vs. Erupted Teeth

4. Step-by-Step Procedure for D7230

Pre-Extraction Evaluation

• Radiographic Analysis (X-rays/CBCT to assess bone density and root morphology).

• Medical History Review (bleeding disorders, bisphosphonate use).

Surgical Technique

1. Local Anesthesia (lidocaine with epinephrine).

2. Mucoperiosteal Flap Elevation (if needed).

3. Bone Removal (using a surgical bur or osteotome).

4. Tooth Sectioning (if roots are fused or divergent).

5. Tooth Elevation & Extraction (using periotomes and forceps).

6. Socket Debridement & Suturing (to promote healing).

Post-Extraction Care

• Pain Management (NSAIDs or prescribed analgesics).

• Antibiotics (if infection risk is high).

• Avoid Smoking & Straws (to prevent dry socket).

5. Differences Between D7210 and D7230

6. Common Challenges and Complications

• Nerve Injury (lingual or inferior alveolar nerve damage).

• Bone Fractures (mandibular weakening).

• Dry Socket (Alveolar Osteitis) (5% risk, higher in smokers).

7. Billing and Insurance Considerations

• Documentation Needed: X-rays, clinical notes justifying complexity.

• Reimbursement Issues: Some insurers downgrade to D7140 if notes are insufficient.

8. Case Studies

Case 1: A 45-year-old male required D7230 for a fractured first molar with curved roots. Bone removal was necessary, and healing was uneventful.

Case 2: A 60-year-old female with osteoporosis needed careful bone removal to avoid jaw fracture.

9. FAQs

Q1: Does D7230 require sedation?
A: Not always, but oral sedation or IV sedation may be used for anxious patients.

Q2: How long does healing take after D7230?
A: Initial healing takes 1-2 weeks, but bone remodeling may take 3-6 months.

Q3: Can D7230 be billed with other codes?
A: Yes, if additional procedures (e.g., socket preservation D7953) are performed.

10. Conclusion

The D7230 dental code is essential for complex extractions requiring bone removal or tooth sectioning. Proper technique, documentation, and post-op care ensure successful outcomes. Dentists must accurately document cases to justify insurance claims, while patients should follow post-operative instructions to avoid complications.