D7220 Dental Code: Extraction of Erupted Tooth Requiring Removal of Bone and/or Sectioning of Tooth
Tooth extraction is a common dental procedure, but not all extractions are the same. The D7220 dental code refers to the extraction of an erupted tooth requiring the removal of bone and/or sectioning of the tooth. Unlike simple extractions (D7140), this procedure involves surgical intervention due to complex tooth anatomy, dense bone, or other complicating factors.
This article provides an in-dept hguide on D7220, covering its clinical applications, procedural steps, billing considerations, and patient management. Whether you’re a dentist, dental student, or patient seeking clarity, this guide offers exclusive, well-researched insights not found on other websites.
2. Understanding the D7220 Dental Code
Definition and Scope
The D7220 code, as defined by the American Dental Association (ADA), applies to the extraction of an erupted tooth that cannot be removed with simple forceps due to:
-
Bone removal (osteotomy) needed to access the tooth.
-
Tooth sectioning (dividing the tooth into smaller pieces for easier removal).
This code is not used for:
-
Impacted teeth (D7240, D7250).
-
Simple extractions (D7140).
When Is D7220 Used?
Common cases include:
✔ Broken teeth with roots fused to bone.
✔ Multi-rooted molars with divergent roots.
✔ Teeth with hypercementosis (excessive cementum buildup).
✔ Teeth near vital structures (e.g., sinus, nerve) requiring careful bone removal.
3. Clinical Indications for D7220
Impacted vs. Erupted Teeth
| Feature | Erupted Tooth (D7220) | Impacted Tooth (D7240/D7250) |
|---|---|---|
| Visibility | Fully or partially visible in the mouth | Completely below the gumline |
| Bone Removal | Sometimes required | Almost always required |
| Sectioning | Often needed | Typically needed |
Common Scenarios Requiring D7220
-
Fractured molars with deep subgingival caries.
-
Ankylosed teeth (fused to bone).
-
Teeth with curved roots preventing easy elevation.
4. Step-by-Step Procedure for D7220
Preoperative Assessment
-
Radiographic evaluation (X-ray or CBCT to assess root morphology).
-
Medical history review (bleeding disorders, bisphosphonate use).
Surgical Technique
-
Local anesthesia (lidocaine with epinephrine).
-
Mucoperiosteal flap elevation.
-
Bone removal with a surgical bur.
-
Tooth sectioning (if needed).
-
Tooth elevation and extraction.
-
Socket debridement and suturing.
Postoperative Care
-
Pain management (NSAIDs, opioids if necessary).
-
Antibiotics (if infection risk is high).
-
Follow-up in 7–10 days for suture removal.
5. Differences Between D7210 and D7220
| Code | Description | Bone Removal | Tooth Sectioning |
|---|---|---|---|
| D7210 | Extraction of erupted tooth using forceps/elevator only | No | No |
| D7220 | Extraction requiring bone removal and/or sectioning | Yes | Yes |
6. Common Challenges and Complications
-
Root fracture (retained fragments may require additional surgery).
-
Nerve injury (lingual or inferior alveolar nerve damage).
-
Dry socket (alveolar osteitis due to poor clot formation).
7. Billing and Insurance Considerations
-
Documentation is key: Include preoperative X-rays, surgical notes, and justification for bone removal.
-
Insurance denials: Some insurers may downgrade D7220 to D7140—appeal with proper documentation.
8. Patient Education and Informed Consent
-
Explain why surgical extraction is necessary.
-
Discuss risks (nerve injury, prolonged healing).
-
Provide written aftercare instructions.
9. Advances in Surgical Extraction Techniques
-
Piezoelectric surgery (reduces bone trauma).
-
Laser-assisted extraction (minimizes bleeding).
-
3D-guided surgery (improves precision).
10. FAQs About D7220
Q: Is D7220 more painful than a simple extraction?
A: Local anesthesia ensures minimal pain during the procedure, but postoperative discomfort may be higher due to bone removal.
Q: How long does healing take after D7220?
A: Initial healing takes 1–2 weeks, but complete bone remodeling may take 3–6 months.
Q: Can D7220 be billed with other codes?
A: Yes, if additional procedures (e.g., bone grafting D7953) are performed.
11. Conclusion
The D7220 dental code applies to complex extractions requiring bone removal or tooth sectioning. Proper technique, documentation, and patient communication are essential for successful outcomes. Advances in surgical methods continue to improve patient comfort and recovery.
12. Additional Resources
-
ADA CDT 2024 Code Manual (ADA Website)
-
AAOMS Surgical Extraction Guidelines (AAOMS)
-
Journal of Oral Surgery Research Papers (PubMed)
