D7250 Dental Code: Surgical Removal of Impacted Tooth – Partial Bony
Dental extractions are among the most common oral surgical procedures, but not all extractions are the same. The D7250 dental code specifically refers to the surgical removal of an impacted tooth with partial bony retention, a procedure that requires precision, skill, and a thorough understanding of oral anatomy.
Unlike simple extractions (D7140) or fully bony impactions (D7241), D7250 involves teeth that are partially embedded in bone, necessitating flap elevation, bone removal, and sometimes tooth sectioning. This article provides an in-depth, guide covering everything from diagnosis to billing, ensuring dental professionals and patients alike understand this critical procedure.
2. Understanding the D7250 Dental Code
Definition and Scope
The Current Dental Terminology (CDT) defines D7250 as:
“Surgical removal of impacted tooth – partial bony.”
This means the tooth is partially covered by bone but may also have soft tissue involvement. Common examples include:
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Partially erupted mandibular third molars (wisdom teeth)
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Maxillary canines stuck in bone
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Impacted premolars preventing orthodontic treatment
When is D7250 Used?
This code applies when:
✅ The tooth is not fully erupted and partially encased in bone.
✅ A mucoperiosteal flap is required for access.
✅ Bone removal or tooth sectioning is necessary.
Example: A wisdom tooth with its crown visible but roots trapped in bone would qualify for D7250.
3. Types of Tooth Impactions and Classifications
Soft Tissue vs. Partial Bony vs. Complete Bony Impaction
| Type | Description | Applicable CDT Code |
|---|---|---|
| Soft Tissue Impaction | Tooth blocked by gum tissue only | D7240 |
| Partial Bony Impaction | Tooth partially trapped in bone (D7250) | D7250 |
| Complete Bony Impaction | Tooth fully encased in bone (D7241) | D7241 |
Angulation Classifications (Pell & Gregory, Winter’s Classification)
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Vertical Impaction – Tooth is upright but stuck.
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Horizontal Impaction – Tooth lies sideways.
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Mesioangular Impaction – Tilted toward the front of the mouth.
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Distoangular Impaction – Tilted toward the back of the mouth.
4. Clinical Indications for D7250
Patients may need a D7250 extraction if they experience:
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Recurrent pericoronitis (infection around the tooth)
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Cyst or tumor formation
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Orthodontic crowding
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Risk of adjacent tooth damage
Diagnostic Tools:
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Periapical X-rays – Initial assessment.
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Panoramic Radiograph (OPG) – Full jaw view.
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Cone Beam CT (CBCT) – 3D imaging for complex cases.
5. Step-by-Step Surgical Procedure for D7250
1. Preoperative Assessment
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Review medical history (bleeding disorders, diabetes, etc.).
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Obtain informed consent.
2. Anesthesia Options
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Local anesthesia (Lidocaine with Epinephrine)
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Sedation (Nitrous Oxide, IV Sedation, General Anesthesia for complex cases)
3. Incision and Flap Design
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Envelope flap or triangular flap for access.
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Care to avoid nerve injury (especially in mandibular extractions).
4. Bone Removal and Tooth Sectioning
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Use a surgical handpiece or osteotome to remove bone.
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Section the tooth if needed (common in multi-rooted teeth).
5. Extraction and Debridement
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Elevators and forceps used to mobilize the tooth.
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Irrigation to remove debris.
6. Suturing and Postoperative Care
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Resorbable or non-resorbable sutures.
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Post-op instructions: Ice pack, soft diet, no smoking.
6. Complications and Risk Management
| Complication | Prevention/Treatment |
|---|---|
| Dry Socket (Alveolar Osteitis) | Avoid smoking, proper clot formation. |
| Nerve Injury (Inferior Alveolar Nerve) | CBCT planning, careful technique. |
| Infection | Antibiotics if needed, proper oral hygiene. |
7. Postoperative Care and Recovery
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First 24 Hours: Bite on gauze, avoid rinsing.
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Pain Management: NSAIDs (Ibuprofen 600mg).
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Diet: Soft foods (yogurt, mashed potatoes).
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Follow-up: 7-day suture removal if non-resorbable.
8. D7250 vs. Other Extraction Codes
| Code | Description | Key Difference |
|---|---|---|
| D7140 | Simple extraction (fully erupted) | No flap or bone removal. |
| D7240 | Soft tissue impaction | Only gum tissue covering. |
| D7241 | Complete bony impaction | Fully encased in bone. |
9. Insurance and Billing Considerations
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Documentation must include:
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Radiographic evidence.
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Clinical justification.
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Common Denials:
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Lack of medical necessity.
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Incorrect coding (e.g., using D7240 instead of D7250).
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10. FAQs About D7250
Q1: Does D7250 require sedation?
A: Not always, but sedation options (nitrous oxide, IV) are available for anxious patients.
Q2: How long does healing take after D7250?
A: Initial healing: 1-2 weeks. Full bone remodeling: 3-6 months.
Q3: Can a general dentist perform D7250?
A: Yes, if trained in oral surgery. Complex cases may require an oral surgeon.
11. Conclusion
The D7250 dental code is essential for partially bony impacted teeth, requiring surgical skill and precise documentation. Proper diagnosis, technique, and postoperative care ensure successful outcomes. By understanding coding, procedures, and potential complications, dental professionals can optimize patient care and insurance reimbursement.
