What D7490 means

D7490 covers the radical resection of the maxilla or mandible. "D" is dental, "74" is this oral surgery group, and "90" is this radical jaw resection. 'Radical resection' means removing a large/major portion — so D7490 is for surgically removing a significant segment of the jaw bone: the maxilla (upper jaw) or the mandible (lower jaw). Unlike removing a localized lesion or a small piece of bone, a radical resection removes a major portion of the jaw (a large segment of bone, along with the involved tissue). This is the most extensive of the oral/maxillofacial bone-removal procedures. It's used for aggressive or extensive conditions that require removing a large portion of the jaw — most commonly: a malignant tumor (a cancer involving the jaw bone — where removing the cancer requires resecting a large segment of the jaw, the primary scenario), but also extensive osteomyelitis (a severe bone infection that has destroyed a large area of bone), or severe trauma/destruction (in some cases). The resection may be done with or without immediate reconstruction (rebuilding the resected jaw).

So it's removing a large segment of the upper or lower jaw — the most extensive jaw surgery — usually for cancer (or extensive infection/destruction), often with reconstruction.

A radical resection of the jaw is major surgery, done by an oral and maxillofacial or head-and-neck surgeon, in a hospital/surgical setting under general anesthesia. For the common scenario (a malignant jaw tumor), it's part of comprehensive cancer care — the resection removes the cancer (the involved jaw segment) with margins, and is accompanied by staging, pathology, evaluation for spread, and often additional treatment (radiation, chemotherapy) and reconstruction (rebuilding the jaw — e.g., with bone grafts or flaps — to restore form and function). The recovery and rehabilitation can be significant (restoring chewing, speaking, appearance). D7490 is the radical resection itself; reconstruction and other care involve additional codes/procedures. Compared to the other cancer-surgery codes (the lesion excisions D7413-D7415 and tumor excisions D7440/D7441), D7490 is the most extensive (a major jaw resection, vs excising a lesion/tumor). It typically involves medical insurance (a major medical/cancer matter), usually with preauthorization. This is a serious, sensitive topic — anyone facing such surgery should work closely with their care team.

When it's typically used

D7490 is reported for a radical resection of the maxilla or mandible — surgically removing a large segment of the upper or lower jaw, with or without reconstruction. It's used for aggressive/extensive conditions, most commonly a malignant tumor involving the jaw (also extensive osteomyelitis or severe destruction). It's the most extensive jaw surgery, part of comprehensive (often cancer) care, distinct from the lesion/tumor excision codes.

How much does D7490 cost?

A radical resection of the jaw is major surgery with a substantial cost — the procedure itself can run several thousand to well over ten thousand USD (nationwide charges for the resection are often around 10,000 USD, and fee schedules vary widely), and the overall care (hospital, anesthesia, reconstruction, pathology, and — for cancer — staging and additional treatment) is far greater. Medical insurance is typically the primary coverage (usually with preauthorization). This is a serious, sensitive topic — anyone facing such surgery should work closely with their care team.

Is D7490 covered by insurance?

Typically involves medical insurance (a major medical/cancer matter, usually covered primarily by medical rather than dental insurance), and usually requires preauthorization (with supporting documentation — the diagnosis, imaging like CT scans, the operative plan, pathology). Thorough documentation of the medical necessity (the malignant tumor, extensive infection, or severe destruction) and the extent of the resection supports the claim. It's distinguished from the less extensive excision codes (D7413-D7415, D7440/D7441). Reconstruction and other care involve additional codes. Coordination with the care team and the medical insurer is essential.

What a radical resection is

A radical resection removes a major portion of the jaw, and understanding this clarifies the code.

A radical resection of the maxilla or mandible (D7490) is the surgical removal of a large/major segment of the jaw bone — and understanding this clarifies the code. 'Radical' (in surgery) refers to an extensive procedure aimed at thoroughly removing a disease (often used for cancer surgery, removing the disease along with surrounding tissue). 'Resection' means surgically removing (cutting out) part of an organ/structure. So a radical resection of the jaw removes a major portion of the maxilla (upper jaw) or mandible (lower jaw) — a large segment of bone, along with the involved/surrounding tissue. This is fundamentally different from the more localized procedures: removing a localized lesion/cyst/tumor (the excision/removal codes) takes out the lesion (and a margin), whereas a radical resection removes a major segment of the jaw itself (e.g., a section of the mandible). It's the most extensive jaw bone removal.

This extent is warranted when the condition requires removing a large portion of the jaw — most often when a cancer (malignant tumor) has involved the jaw bone such that removing it requires resecting a large segment (to remove all the cancer with adequate margins), or when another extensive condition (severe infection/destruction) necessitates it. So a radical resection is reserved for these extensive situations (it's not done for a small, localized lesion — that would be a lesser procedure). D7490 reports this major resection. The oral/maxillofacial or head-and-neck surgeon performs it. For patients, understanding what a radical resection is — removing a major portion of the jaw — clarifies the code. It's a major jaw removal. The surgeon performs it. Understanding this helps patients see that a radical resection of the maxilla or mandible (D7490) is the surgical removal of a large/major segment of the jaw bone (the upper or lower jaw) — 'radical' indicating an extensive procedure to thoroughly remove a disease, and 'resection' meaning surgically removing part of the structure — fundamentally more extensive than removing a localized lesion/cyst/tumor (which the excision codes cover), reserved for conditions requiring removal of a large portion of the jaw (most often a malignant tumor involving the bone, also extensive infection or destruction), and reported with D7490 as the most extensive jaw bone removal.

When a radical resection is needed

A radical resection is needed for extensive conditions, and understanding them clarifies the indications.

A radical resection of the jaw (D7490) is needed for aggressive or extensive conditions requiring removal of a large portion of the jaw — and understanding them clarifies the indications. The main scenarios: a malignant tumor (the primary indication) — a cancer (malignant tumor) involving the jaw bone, where removing the cancer adequately (with margins, to remove all of it) requires resecting a large segment of the jaw — this is the most common reason (e.g., an oral cancer that has invaded the mandible or maxilla, or an aggressive malignant jaw tumor); extensive osteomyelitis — a severe bone infection (osteomyelitis) that has destroyed a large area of the jaw bone, where removing the extensively infected/destroyed bone (when it can't be managed more conservatively) requires a resection; severe trauma/destruction — in some cases, severe trauma or other destruction of a large jaw segment; and other aggressive pathology — occasionally, an aggressive (even if benign) tumor that has extensively involved the jaw such that a resection is the appropriate treatment (e.g., a large, aggressive ameloblastoma sometimes requires resection). So the common thread is an extensive condition requiring removal of a major jaw portion.

The decision for a radical resection is made carefully, based on the diagnosis, imaging (CT scans showing the extent), and (for cancer) staging and multidisciplinary consultation — it's a major undertaking, chosen when the condition warrants it. For the common cancer scenario, the resection is part of the comprehensive cancer treatment plan. So a radical resection is needed for these extensive situations. The care team determines the need. For patients, understanding when a radical resection is needed — for extensive conditions like a malignant jaw tumor — clarifies the indications. It's for extensive conditions. The team determines it. Understanding this helps patients see that a radical resection (D7490) is needed for aggressive or extensive conditions requiring removal of a large portion of the jaw — most commonly a malignant tumor involving the jaw bone (where adequate cancer removal requires resecting a large segment), also extensive osteomyelitis (severe bone infection destroying a large area), severe trauma/destruction, or occasionally an aggressively-involving tumor — with the decision made carefully based on the diagnosis, imaging (CT scans), and (for cancer) staging and multidisciplinary consultation, as a major undertaking chosen when the condition warrants it.

The surgery, reconstruction, and recovery

A radical resection involves major surgery, reconstruction, and recovery, and understanding this clarifies what's involved.

A radical resection of the jaw (D7490) involves major surgery, often reconstruction, and a significant recovery — and understanding this clarifies what's involved. The surgery: it's a major operation, done by an oral/maxillofacial or head-and-neck surgeon (often with a surgical team) in a hospital setting under general anesthesia — removing the large jaw segment (with margins, for cancer), which may also involve removing other affected tissue and (for cancer) addressing lymph nodes (a neck dissection) as part of the cancer surgery. Reconstruction: the resection (with or without immediate reconstruction, per the code) often requires reconstruction to restore the jaw — rebuilding the removed segment, which can involve bone grafts or flaps (e.g., a free flap — transferring bone and tissue, such as from the leg/fibula, to reconstruct the jaw) — a significant reconstructive effort (sometimes done immediately, sometimes later); this reconstruction involves additional procedures/codes. Recovery and rehabilitation: the recovery from such major surgery (and reconstruction) is significant — a hospital stay, healing, and rehabilitation to restore function (chewing, speaking, swallowing) and appearance (which the reconstruction addresses), often with a team (including speech/swallowing therapy, nutrition, and dental rehabilitation/prosthetics to restore the dentition). So a radical resection is a major surgery with reconstruction and substantial recovery.

For the common cancer scenario, all of this is part of comprehensive cancer care — alongside the resection, there's the staging, pathology, possible additional treatment (radiation, chemotherapy), and ongoing care. The overall journey is extensive. So a radical resection involves major surgery, reconstruction, and recovery, within comprehensive care. The care team manages the whole process. For patients, understanding that a radical resection involves major surgery, reconstruction, and recovery clarifies what's involved. It's major surgery with reconstruction and recovery. The team manages it. Understanding this helps patients see that a radical resection of the jaw (D7490) involves major surgery (removing the large jaw segment with margins, by an oral/maxillofacial or head-and-neck surgeon in a hospital under general anesthesia, possibly with a neck dissection for cancer), often significant reconstruction (rebuilding the jaw with bone grafts or flaps, e.g., a free flap from the fibula — involving additional procedures), and a substantial recovery and rehabilitation (a hospital stay, healing, and restoring chewing/speaking/appearance with a multidisciplinary team) — all part of comprehensive (often cancer) care that also includes staging, pathology, and possible additional treatment, with the care team managing the extensive overall journey.

The most extensive cancer-surgery code

D7490 is the most extensive cancer-surgery code, and understanding this clarifies the coding.

D7490 is the most extensive of the oral cancer-surgery (and lesion/tumor-removal) codes — and understanding where it fits clarifies the coding. The relevant codes, by increasing extent: malignant lesion excisions (D7413/D7414/D7415) — removing more superficial malignant lesions (e.g., of the soft tissue), by size and complexity; malignant tumor excisions (D7440/D7441) — removing more substantial malignant tumors (possibly involving some bone), by size; and radical resection (D7490) — removing a large segment of the jaw (the most extensive — this code). So D7490 sits at the top of this progression: from excising a lesion (D7413-D7415), to excising a tumor (D7440/D7441), to resecting a major portion of the jaw (D7490). The distinction is the extent — D7490 is for removing a large jaw segment (not just excising a lesion/tumor).

The coding reflects the extent of the cancer surgery: a more superficial lesion → the lesion codes; a more substantial tumor (excised) → the tumor codes; a cancer requiring removal of a large jaw segment → D7490 (radical resection). So the surgeon/cancer team codes D7490 when the surgery is a radical resection of the jaw (the most extensive). D7490 is also used for the non-cancer extensive scenarios (extensive osteomyelitis, severe destruction) requiring a jaw resection. Reconstruction (often needed after a resection) and other care involve additional codes (D7490 being the resection itself). So D7490 is the most extensive code — the radical jaw resection. The team codes by the extent. For patients, understanding that D7490 is the most extensive cancer-surgery code clarifies the coding. It's the most extensive (a major jaw resection). The team codes by the extent. Understanding this helps patients see that D7490 is the most extensive of the oral cancer-surgery and lesion/tumor-removal codes — sitting at the top of a progression from excising a malignant lesion (D7413-D7415, more superficial), to excising a malignant tumor (D7440/D7441, more substantial), to resecting a large segment of the jaw (D7490, the most extensive) — distinguished by the extent (removing a major jaw portion, not just a lesion/tumor), used for cancer requiring such a resection (and also for extensive non-cancer conditions like severe osteomyelitis), with reconstruction and other care involving additional codes, so the team codes D7490 for a radical jaw resection (the most extensive procedure).

Frequently asked questions

What is the D7490 dental code?

It's the radical resection of the maxilla or mandible — surgically removing a large segment of the upper or lower jaw (with or without reconstruction). It's the most extensive jaw surgery, used for aggressive/extensive conditions — most commonly a malignant tumor involving the jaw (also extensive infection or severe destruction).

When is a radical resection needed?

For conditions requiring removal of a large portion of the jaw — most commonly a malignant tumor involving the jaw bone (where adequate cancer removal requires resecting a large segment), but also extensive osteomyelitis (a severe bone infection), severe trauma/destruction, or occasionally an aggressively-involving tumor. The decision is made carefully based on the diagnosis, imaging, and (for cancer) staging.

How is it different from excising a lesion or tumor?

Excising a lesion (D7413-D7415) or tumor (D7440/D7441) removes the localized growth (with a margin). A radical resection (D7490) removes a major segment of the jaw bone itself — far more extensive. D7490 is the most extensive of these procedures, used when a large portion of the jaw must be removed.

What does the surgery and recovery involve?

Major surgery by an oral/maxillofacial or head-and-neck surgeon in a hospital under general anesthesia (removing the large jaw segment with margins, possibly with a neck dissection for cancer), often significant reconstruction (rebuilding the jaw with bone grafts or flaps), and a substantial recovery and rehabilitation (restoring chewing, speaking, and appearance with a multidisciplinary team).

How much does it cost, and what insurance applies?

It's major surgery with a substantial cost — the resection itself can run several thousand to well over ten thousand USD, and the overall care (hospital, reconstruction, and — for cancer — staging and additional treatment) is far greater. Medical insurance is typically the primary coverage, usually with preauthorization. Work closely with your care team and medical insurer.

Is reconstruction included?

The code is for the resection itself (with or without immediate reconstruction). Reconstruction (rebuilding the jaw — e.g., with bone grafts or flaps) is often needed and typically involves additional procedures/codes. The overall treatment — resection, reconstruction, and (for cancer) comprehensive care — is managed by the care team.

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.