What D7240 means

D7240 covers the removal of an impacted tooth — completely bony. "D" is dental, "72" is the surgical-extractions group of oral surgery, and "40" is this completely-bony impaction. An impacted tooth hasn't fully erupted (it's stuck below the gum and/or bone, commonly a wisdom tooth). The impacted-tooth removal codes are tiered by the degree of impaction. A completely bony impaction (D7240) is when most or all of the crown is covered by bone — the tooth essentially encased in bone (the most deeply impacted of the standard degrees). Removing it requires raising a mucoperiosteal flap (lifting the gum) and removing more extensive bone (the bone encasing the crown) to access and remove the tooth (usually with sectioning).

So it's removing an impacted tooth that's mostly or fully encased in bone — requiring a flap and more extensive bone removal.

D7240 is the most complex of the standard impaction tiers: soft tissue (D7220, gum only), partially bony (D7230, part of crown covered by bone), completely bony (D7240, this code — most or all of crown covered by bone), with completely bony plus unusual complications (D7241) being a further tier. The ADA's guidance interprets 'most or all of the crown' (completely bony) as at least about half the crown covered by bone, versus 'part of the crown' (partially bony) as less than about half. So D7240 is for an impacted tooth where bone covers most or all of the crown — the most involved standard impaction removal (more bone removal, more time, more difficulty). It's commonly used for deeply-impacted wisdom teeth. Importantly, documentation of the bone removal (the completely-bony nature) is essential — insurers may downgrade to a lower impaction code without it. Coverage is under oral surgery benefits.

When it's typically used

D7240 is reported for the removal of a completely bony impacted tooth — extracting an impacted tooth where most or all of the crown is covered by bone (encased in bone), requiring raising a soft-tissue flap and removing more extensive bone to access and remove it. It's the most complex standard impaction removal (above soft-tissue D7220 and partially-bony D7230), commonly for deeply-impacted wisdom teeth.

How much does D7240 cost?

Removing a completely bony impacted tooth is a significant fee, often roughly 350 to 700 USD per tooth depending on region — the highest of the standard impaction codes (the extensive bone removal adding complexity, time, and difficulty). For multiple impacted wisdom teeth, the cost multiplies (each coded). Sedation/anesthesia, if used, is typically separate.

Is D7240 covered by insurance?

Covered under oral surgery benefits as an impacted-tooth removal, typically the highest-reimbursed standard impaction code (reflecting the complexity). Documentation of the completely-bony nature (most or all of the crown covered by bone, requiring extensive bone removal) is essential — the operative report should explicitly mention the bone removal/ostectomy, as insurers may otherwise downgrade to a lower impaction code. A panoramic or CBCT X-ray supports the claim. Sedation, if used, may be coded separately. Verifying coverage helps.

What a completely bony impaction is

A completely bony impaction has the crown encased in bone, and understanding this clarifies this most-impacted type.

Impacted teeth are classified by how deeply they're impacted — what covers the tooth. A completely bony impaction (D7240) is when most or all of the crown is covered by bone — the tooth essentially encased in bone, the most deeply impacted of the standard degrees. So unlike a soft-tissue impaction (covered by gum only) or a partially bony impaction (part of the crown covered by bone), a completely bony impaction has most or all of the crown encased in bone — the tooth deeply embedded in the jawbone. To remove it, the dentist raises a mucoperiosteal flap (lifts the gum) and removes more extensive bone (the bone encasing the crown) to uncover and free the tooth, then removes it (usually with sectioning). So a completely bony impaction requires the most bone removal of the standard impactions, making it the most involved.

The ADA's guidance helps interpret 'completely bony': the 'crown' is the anatomical crown (above the cemento-enamel junction), and 'most or all of the crown' covered by bone is interpreted as at least about half the crown covered by bone — versus a partially bony impaction (less than about half). So a completely bony impaction has bone over most or all (at least ~half) of the crown — the tooth deeply impacted in bone. This is common for deeply-impacted wisdom teeth (fully embedded in the jaw). The dentist assesses the degree (from the X-ray and clinically) and codes a completely bony impaction when most/all of the crown is covered by bone. For patients, understanding what a completely bony impaction is — an impacted tooth with most or all of its crown encased in bone, the most deeply impacted standard degree — clarifies this type. The tooth is embedded in bone. The dentist removes the bone and the tooth. Understanding this helps patients see that a completely bony impaction (D7240) is an impacted tooth with most or all of its crown covered by bone (at least about half) — the most deeply impacted of the standard degrees — requiring raising a flap and removing more extensive bone to access and remove the deeply-embedded tooth, the most involved standard impaction removal, commonly seen with deeply-impacted wisdom teeth.

The most involved standard impaction

A completely bony impaction is the most involved standard impaction, and understanding why clarifies its complexity.

A completely bony impaction (D7240) is the most involved of the standard impaction removals because the tooth is the most deeply embedded in bone — requiring the most bone removal and surgical effort. The procedure involves: anesthesia (often with sedation, given the complexity); raising a flap (lifting the gum to expose the area); removing extensive bone — removing the bone encasing most or all of the crown, more than for a partially bony impaction (to uncover and free the deeply-embedded tooth); sectioning the tooth — cutting the tooth into pieces (commonly necessary to remove a deeply-embedded tooth through the available space); removing the tooth (or its pieces); and closing the site (smoothing bone, suturing the flap). The extensive bone removal and the depth of the tooth make this the most time-consuming and difficult of the standard impactions.

This greater complexity is reflected in the code (D7240, the highest standard impaction tier) and the fee/reimbursement (the highest of the standard impactions). A completely bony impaction takes more time, skill, and surgical effort (the deeply-embedded tooth, the extensive bone removal) than a soft-tissue or partially bony impaction. Because of this, completely bony impactions (and the complex ones) are often handled by oral surgeons. The depth and the bone removal also mean the recovery may be somewhat more involved (more swelling/discomfort initially) than less-impacted teeth. The dentist/oral surgeon performs this more involved procedure. For patients, understanding that a completely bony impaction is the most involved standard impaction — the most deeply embedded tooth, requiring the most bone removal — clarifies its complexity. It's the most involved standard impaction removal. The oral surgeon often handles it. Understanding this helps patients see that a completely bony impaction (D7240) is the most involved standard impaction removal — the deeply-embedded tooth (most or all of the crown in bone) requiring extensive bone removal, sectioning, more time, and more surgical skill — the highest standard impaction tier (and fee), often handled by oral surgeons, with a somewhat more involved recovery, reflecting the greater complexity of removing a deeply-impacted tooth.

Documentation and avoiding downcoding

Documentation is important for a completely bony impaction, and understanding why clarifies the billing.

For a completely bony impaction (D7240), documentation of the bone removal is especially important — to support the code and avoid 'downcoding' (the insurer reducing it to a lower, lower-paying impaction code). Because D7240 is the highest standard impaction code (reflecting the extensive bone removal), insurers scrutinize these claims and may downcode them to a partially bony (D7230) or even soft-tissue (D7220) impaction if the documentation doesn't clearly establish the completely-bony nature. The key is the operative report explicitly documenting the bone removal — describing that bone was removed (ostectomy) to access the deeply-embedded tooth, and the degree of bony coverage. Without explicit mention of the bone removal, the payer may downcode the claim (paying a lower rate) regardless of what the X-ray shows.

Supporting documentation includes: the operative report (clearly describing the flap, the bone removal, the sectioning, and the completely-bony nature); the radiograph — a panoramic X-ray (standard) or a CBCT (3D imaging, increasingly used, especially to show the bony encasement and any complications) demonstrating the tooth's deep impaction in bone; and the clinical narrative. So thorough documentation (operative notes plus imaging) establishes the completely-bony nature and supports appropriate coding and reimbursement. The dentist's office documents the procedure thoroughly. For patients, understanding that documentation is important for a completely bony impaction — to support the code and avoid downcoding — clarifies the billing. The bone removal must be documented. The office documents it thoroughly. Understanding this helps patients see that for a completely bony impaction (D7240), thorough documentation (an operative report explicitly noting the bone removal, plus a panoramic or CBCT X-ray showing the bony encasement) is important — to establish the completely-bony nature and support appropriate coding and reimbursement, since insurers may otherwise downcode the claim to a lower impaction code (paying less) without clear evidence of the bone removal.

Completely bony impacted wisdom teeth

Completely bony impactions are common with wisdom teeth, and understanding this clarifies a common context.

The most common context for a completely bony impaction is wisdom teeth (third molars). Wisdom teeth often become impacted, and some are deeply impacted — fully or mostly embedded in the jawbone (a completely bony impaction). Such deeply-impacted wisdom teeth may be entirely below the bone (not visible in the mouth), discovered on X-rays. They're removed for problems (e.g., associated infection, cysts, damage to adjacent teeth, or pain) or preventively (to avoid anticipated problems, especially if monitoring shows risk). A completely bony impacted wisdom tooth is the most involved degree to remove (the extensive bone removal for the deeply-embedded tooth).

Removing completely bony impacted wisdom teeth is commonly done by oral surgeons (given the complexity), often with sedation. Multiple wisdom teeth may be removed together (each coded by its degree — and a person's four wisdom teeth can be at different degrees of impaction). For deeply-impacted lower wisdom teeth, the roots' proximity to the nerve (the inferior alveolar nerve) is an important consideration (sometimes leading to extra imaging like CBCT, or alternative approaches like coronectomy in select cases). After removal, aftercare and healing follow (managing the surgical sites, which may have somewhat more swelling given the bone removal). The oral surgeon removes completely bony impacted wisdom teeth when warranted. For patients, understanding that completely bony impactions are common with wisdom teeth — deeply embedded in the jaw, removed for problems or preventively — clarifies a common context. Wisdom teeth can be deeply impacted in bone. The oral surgeon removes them when warranted. Understanding this helps patients see that this code (D7240) is commonly used for completely bony impacted wisdom teeth — deeply embedded in the jawbone (most or all of the crown in bone), removed for problems (infection, cysts, damage to other teeth) or preventively — the most involved degree of wisdom-tooth impaction, often handled by oral surgeons (sometimes with extra imaging for deeply-positioned teeth near the nerve), with multiple wisdom teeth potentially removed together (each coded by its degree).

Frequently asked questions

What is the D7240 dental code?

It's the removal of a completely bony impacted tooth — extracting an impacted tooth where most or all of the crown is covered by bone (encased in bone), requiring raising a soft-tissue flap and removing more extensive bone to access and remove it. It's the most complex standard impaction removal, commonly for deeply-impacted wisdom teeth.

What is a completely bony impaction?

An impacted tooth where most or all of the crown (interpreted as at least about half) is covered by bone — the tooth essentially encased in bone, the most deeply impacted standard degree. Removing it requires a flap and extensive bone removal (plus usually sectioning the tooth).

How is it different from a partially bony impaction?

A partially bony impaction (D7230) has part of the crown (less than ~half) covered by bone. A completely bony impaction (D7240) has most or all of the crown (at least ~half) covered by bone — requiring more extensive bone removal, making it the most involved standard impaction (and highest-fee).

Why is documentation important?

Because D7240 is the highest standard impaction code, insurers may downcode it to a lower (lower-paying) impaction code without clear evidence of the bone removal. The operative report should explicitly note the bone removal (ostectomy), with a panoramic or CBCT X-ray showing the bony encasement, to support the code.

How much does it cost?

Often around 350 to 700 USD per tooth — the highest of the standard impaction codes (the extensive bone removal adding complexity, time, and difficulty). For multiple impacted wisdom teeth, the cost multiplies (each coded), and sedation is typically separate.

Is this used for wisdom teeth?

Yes, commonly — wisdom teeth can be deeply impacted (fully or mostly embedded in the jawbone), a completely bony impaction. They're removed for problems (infection, cysts, damage to other teeth) or preventively. These are often handled by oral surgeons, sometimes with extra imaging for teeth near the nerve.

This page is an independent, plain-language explanation for general information only. It is not billing, coding, or clinical advice. For the official CDT descriptor and current-year wording, refer to the American Dental Association.