What D7946 means

D7946 covers a LeFort I osteotomy (maxilla — total). "D" is dental, "79" is this oral surgery area, and "46" is this LeFort I total. The maxilla is the upper jaw. 'LeFort I' refers to a horizontal level of the maxilla (named from the classic LeFort fracture patterns) — the LeFort I level is a horizontal line above the tooth roots, below the cheekbones/nose, separating the tooth-bearing lower part of the maxilla from the rest. A LeFort I osteotomy cuts the maxilla at this level to free and reposition the whole upper jaw. '(maxilla — total)' indicates the entire maxilla is moved as one piece. So D7946 is the standard osteotomy to reposition the entire upper jaw.

So it's the surgery to cut and reposition the entire upper jaw — moving it to a corrected position to fix an upper-jaw deformity/bite problem.

The LeFort I osteotomy is the standard, workhorse procedure for repositioning the maxilla (upper jaw) in orthognathic surgery. The maxilla is cut horizontally at the LeFort I level, then 'down-fractured' (gently separated/freed so it can move), and repositioned to the correct position — it can be moved: up (impaction, to correct a long face / excessive gumminess / vertical excess); down (to lengthen a short face — often with grafting); forward (advancement, to correct a deficient/retruded maxilla — a midface that's set back); back (setback, less common); or rotated/leveled (to correct cant or asymmetry). It's then fixed in the new position (plates and screws). This corrects upper-jaw deformities and malocclusions (e.g., a midface deficiency, a vertical maxillary excess/'gummy smile', an open bite, or asymmetry), often as part of correcting the overall jaw relationship (frequently combined with a mandibular osteotomy in double-jaw surgery, and with orthodontics). The code includes the surgical exposure, the bone cuts, the down-fracture, the repositioning, the fixation, the routine wound closure, and the normal post-operative follow-up care. It's done under general anesthesia. It's performed by an oral and maxillofacial surgeon. These procedures are frequently medically necessary, so medical coverage often applies. This code is in the orthognathic surgery area (D7940-D7949). Documentation supports the claim.

When it's typically used

D7946 is reported for a LeFort I osteotomy of the maxilla (total) — cutting, down-fracturing, and repositioning the entire upper jaw — to correct an upper-jaw deformity/malocclusion (e.g., a midface deficiency, vertical maxillary excess/'gummy smile', open bite, or asymmetry). It moves the whole maxilla as one piece. The code includes the exposure, bone cuts, down-fracture, repositioning, fixation, closure, and routine post-op care.

How much does D7946 cost?

A LeFort I osteotomy is a major orthognathic surgery (under general anesthesia, in a surgical facility) — its cost is significant, often in the multiple-thousands range (and frequently part of a larger orthognathic surgery, possibly with a mandibular procedure too). Sample fee-schedule values are in the four-figure range (varying by region/case). As it's frequently medically necessary, medical coverage often applies. Verify your specific coverage.

Is D7946 covered by insurance?

A LeFort I osteotomy (orthognathic surgery) is frequently medically necessary — correcting functional upper-jaw deformities (the bite, chewing, sometimes breathing/airway) and significant skeletal/congenital deformities — so it's often covered under medical benefits (check both medical and dental plans; many have specific orthognathic-surgery medical-necessity criteria). Documentation of the deformity, the functional impairment, and the medical necessity is essential, and preauthorization is typically required. Verifying coverage and criteria helps.

Repositioning the whole upper jaw

The LeFort I frees and moves the entire maxilla, and understanding this clarifies the code.

Understanding the LeFort I procedure clarifies D7946. The maxilla (upper jaw) is the bone holding the upper teeth, forming the roof of the mouth and part of the midface. To reposition it, the LeFort I osteotomy cuts the maxilla horizontally at the 'LeFort I level' — a line running above the tooth roots, below the cheekbones and the floor of the nose, across the maxilla. This cut separates the lower, tooth-bearing portion of the maxilla from the upper part. The freed maxilla is then 'down-fractured' — gently and controlledly separated along the cut so it becomes mobile (a 'free' segment that can be moved while keeping its blood supply through the soft tissues).

Once mobilized, the whole maxilla can be repositioned — moved to the planned corrected position — and then fixed there (held with bone plates and screws) to heal. '(maxilla — total)' means the entire maxilla moves as a single unit. So the LeFort I frees the whole upper jaw and moves it to the correct position. It's the standard way to surgically reposition the maxilla. So the LeFort I repositions the whole upper jaw. Understanding this helps patients see that the maxilla (upper jaw) is the bone holding the upper teeth, forming the roof of the mouth and part of the midface, and to reposition it the LeFort I osteotomy cuts the maxilla horizontally at the 'LeFort I level' (a line running above the tooth roots, below the cheekbones and the floor of the nose, across the maxilla), separating the lower tooth-bearing portion from the upper part — the freed maxilla then 'down-fractured' (gently and controlledly separated along the cut so it becomes mobile, a 'free' segment that can be moved while keeping its blood supply through the soft tissues) — once mobilized, the whole maxilla repositioned (moved to the planned corrected position) and fixed there (held with bone plates and screws) to heal, with '(maxilla — total)' meaning the entire maxilla moves as a single unit, the standard way to surgically reposition the maxilla.

Which directions it moves the jaw

The maxilla can be moved in various directions to correct deformities, and understanding this clarifies the indications.

Understanding the directions of movement clarifies what D7946 corrects. Once the maxilla is freed (down-fractured), it can be repositioned in various directions to correct different deformities: up (impaction) — moving the maxilla upward, to correct vertical maxillary excess (a 'long face,' excessive tooth/gum show, a 'gummy smile') — impacting the maxilla shortens the lower face and reduces the gum show; down — moving it downward, to lengthen a deficient (short) midface (often requiring bone grafting to fill the gap created); forward (advancement) — moving it forward, to correct a deficient/retruded maxilla (a midface that's set back, often seen in midface hypoplasia) — advancing brings the upper jaw and midface forward; back (setback) — moving it backward (less common); and rotation/leveling — rotating or leveling the maxilla to correct a cant (a tilted bite plane) or asymmetry.

So the LeFort I is versatile — correcting vertical problems (long/short face, gummy smile, open bite), anteroposterior problems (midface deficiency/excess), and transverse/rotational problems (cant, asymmetry) — by moving the whole maxilla as planned. The specific movement is determined by the patient's deformity (worked out in the surgical planning). So the LeFort I moves the maxilla in the needed direction(s). Understanding this helps patients see that once the maxilla is freed (down-fractured) it can be repositioned in various directions to correct different deformities — up/impaction (moving the maxilla upward to correct vertical maxillary excess, a 'long face,' excessive tooth/gum show, a 'gummy smile' — impacting it shortening the lower face and reducing gum show), down (moving it downward to lengthen a deficient/short midface, often requiring bone grafting to fill the gap), forward/advancement (moving it forward to correct a deficient/retruded maxilla, a midface set back as in midface hypoplasia, advancing bringing the upper jaw and midface forward), back/setback (moving it backward, less common), and rotation/leveling (to correct a cant, a tilted bite plane, or asymmetry) — so the LeFort I is versatile (correcting vertical problems like long/short face, gummy smile, open bite; anteroposterior problems like midface deficiency/excess; and transverse/rotational problems like cant, asymmetry), the specific movement determined by the patient's deformity in the surgical planning.

Often part of double-jaw surgery

The maxilla and mandible are often corrected together, and understanding this clarifies the context.

Understanding how the LeFort I fits with mandibular surgery clarifies the context of D7946. Many jaw deformities involve both jaws, or are best corrected by moving both — so the LeFort I (maxilla) is frequently combined with a mandibular osteotomy (lower jaw, D7941) in a single operation — 'double-jaw surgery' (bimaxillary surgery). In double-jaw surgery, both the upper jaw (via the LeFort I) and the lower jaw (via the rami osteotomy) are repositioned to achieve the correct overall jaw relationship and bite — allowing comprehensive correction of complex deformities and optimal facial balance.

In such cases, both codes are reported (D7946 for the maxilla, D7941 for the mandible), reflecting the two-jaw surgery. (A genioplasty — chin repositioning — may also be added.) Alternatively, when only the upper jaw needs correction, the LeFort I is done alone (single-jaw). The surgical plan (single- or double-jaw) is determined by the deformity. So the LeFort I is often part of, or combined in, double-jaw surgery. So D7946 is frequently combined with a mandibular osteotomy. Understanding this helps patients see that many jaw deformities involve both jaws, or are best corrected by moving both, so the LeFort I (maxilla) is frequently combined with a mandibular osteotomy (lower jaw, D7941) in a single operation — 'double-jaw surgery' (bimaxillary surgery) — in which both the upper jaw (via the LeFort I) and the lower jaw (via the rami osteotomy) are repositioned to achieve the correct overall jaw relationship and bite (allowing comprehensive correction of complex deformities and optimal facial balance), both codes reported (D7946 for the maxilla, D7941 for the mandible), reflecting the two-jaw surgery (a genioplasty/chin repositioning may also be added), or alternatively when only the upper jaw needs correction the LeFort I done alone (single-jaw), the surgical plan determined by the deformity.

Where D7946 fits in the codes

D7946 is the standard maxillary osteotomy, and understanding this clarifies the coding.

Understanding where D7946 sits clarifies the coding. D7946 is among the orthognathic surgery codes (D7940-D7949) — specifically the maxillary (upper jaw) osteotomies, which are the LeFort codes: LeFort I (maxilla — total) (D7946, this code) — repositioning the whole maxilla as one piece (the standard, most common maxillary orthognathic procedure); LeFort I (maxilla — segmented) (D7947) — a LeFort I where the maxilla is also divided into segments (combining the down-fracture with segmentation); and LeFort II or LeFort III (D7948 without bone graft, D7949 with bone graft) — higher-level osteotomies of the midface (for midface hypoplasia/retrusion — more extensive, addressing more of the facial skeleton). The mandibular osteotomies are D7941-D7945.

D7946 specifically is the standard total LeFort I — the workhorse for repositioning the whole upper jaw. The surgeon codes D7946 for a total LeFort I (or D7947 if the maxilla is segmented, or D7948/D7949 for the higher LeFort levels), plus the mandibular code (D7941) if the lower jaw is also operated (double-jaw surgery). So D7946 is the standard maxillary osteotomy among the orthognathic codes. Understanding this helps patients see that D7946 is among the orthognathic surgery codes (D7940-D7949), specifically the maxillary osteotomies (the LeFort codes) — LeFort I (maxilla — total) (D7946, this code — repositioning the whole maxilla as one piece, the standard, most common maxillary orthognathic procedure), LeFort I (maxilla — segmented) (D7947 — a LeFort I where the maxilla is also divided into segments, combining the down-fracture with segmentation), and LeFort II or LeFort III (D7948 without bone graft, D7949 with bone graft — higher-level osteotomies of the midface for midface hypoplasia/retrusion, more extensive, addressing more of the facial skeleton) — with the mandibular osteotomies being D7941-D7945 — so D7946 specifically is the standard total LeFort I (the workhorse for repositioning the whole upper jaw), coded for a total LeFort I (or D7947 if the maxilla is segmented, or D7948/D7949 for the higher LeFort levels), plus the mandibular code (D7941) if the lower jaw is also operated (double-jaw surgery).

Frequently asked questions

What is the D7946 dental code?

It's a LeFort I osteotomy of the maxilla (total) — the standard surgery to reposition the entire upper jaw. The maxilla is cut horizontally (at the LeFort I level), 'down-fractured' (freed), and repositioned (moved up, down, forward, back, or rotated), then fixed. It corrects upper-jaw deformities/malocclusions. The code includes the exposure, bone cuts, down-fracture, repositioning, fixation, closure, and post-op care.

What does 'LeFort I' mean?

It refers to a horizontal level of the maxilla (named from the classic LeFort fracture patterns). The LeFort I level is a horizontal line above the tooth roots, below the cheekbones and nose, separating the tooth-bearing lower part of the maxilla from the rest. A LeFort I osteotomy cuts the maxilla at this level to free and reposition the whole upper jaw.

What is the 'down-fracture'?

After the horizontal cut, the freed maxilla is gently and controlledly separated along the cut — 'down-fractured' — so it becomes mobile (a free segment that can be moved, while keeping its blood supply through the soft tissues). Once mobilized, the whole maxilla can be repositioned to the planned corrected position and then fixed there.

Which directions can the jaw move?

Up (impaction — for vertical excess, a 'long face'/gummy smile), down (to lengthen a short midface, often with grafting), forward (advancement — for a deficient/retruded maxilla/midface), back (setback, less common), or rotated/leveled (to correct a cant or asymmetry). The LeFort I is versatile, correcting vertical, front-back, and rotational problems by moving the whole maxilla.

Is it combined with lower-jaw surgery?

Often — many deformities are best corrected by moving both jaws, so the LeFort I (upper jaw) is frequently combined with a mandibular osteotomy (lower jaw, D7941) in 'double-jaw surgery.' Both codes are reported. When only the upper jaw needs correction, the LeFort I is done alone. The plan depends on the deformity.

What does it cost, and is it covered?

It's a major orthognathic surgery (under general anesthesia, in a surgical facility) — cost is significant, often in the multiple-thousands range, and frequently part of a larger surgery. As it's frequently medically necessary (correcting functional jaw deformities), medical coverage often applies (check both plans; specific criteria and preauthorization typically apply). Verify your coverage.

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.