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Dentovio public answer
Surgical-extraction downcoding is the recurring denial here, and the published rules agree on the reason.
Surgical-extraction downcoding is the recurring denial here, and the published rules agree on the reason. Aetna defines surgical removal as cutting the gingiva for flap design and removing bone for access to non-diseased tooth structure, and gives no surgical benefit for periodontally involved teeth with excessive bone loss or exposed roots — the downcode targets are D7140 or D7111, applied after review rather than automatically. Guardian states that coding for impacted teeth follows the anatomic position of the tooth, not the technique used, and may limit a surgical extraction to the D7140 benefit when performed with another surgical procedure in the same site. United Concordia re-benefits impactions by bone coverage: partially bony above 50% of the anatomical crown, completely bony above 75%. Delta Dental Insurance requires periapical or panoramic radiographs and tooth-specific chart notes from D7210 upward, with no submission requirement for a simple D7140. Aetna's third-molar bulletin puts the prudent removal window before age 25 and rejects anterior crowding as an indication.
Dentovio is an independent publisher — not a dental payer, the ADA, or any state dental board. These summaries describe the payers' published clinical-review and documentation criteria as addressed to dentists — what a reviewer looks for on a claim, never what a patient's plan pays. Individual plan contracts govern: every payer document here states that the member's plan documents control coverage, frequencies and exclusions where they conflict with the policy, and payers revise policy documents on their own schedules. Where a record's reach is narrower than the payer — one plan line, one federal program, one state Medicaid program — or where a figure comes from a plan-sponsor or federal-program document rather than the payer's own policy manual, the record says so. Educational billing reference only, not billing, legal, or clinical advice. CDT codes are referenced by number only; CDT is the American Dental Association's copyrighted code set and this page does not reproduce ADA descriptors.
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