# D7140 documentation requirements Answer: 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. Answer URL: https://dentovio.com/answers/d7140-extractions-documentation-requirements Markdown mirror: https://dentovio.com/answers/d7140-extractions-documentation-requirements/index.html.md Source page: [/dental-claim-documentation/d7140-extractions](https://dentovio.com/dental-claim-documentation/d7140-extractions) Source markdown: [/dental-claim-documentation/d7140-extractions/index.html.md](https://dentovio.com/dental-claim-documentation/d7140-extractions/index.html.md) Topic page: [/answers/topic/practice-operations-tools](https://dentovio.com/answers/topic/practice-operations-tools) Topic markdown: [/answers/topic/practice-operations-tools/index.html.md](https://dentovio.com/answers/topic/practice-operations-tools/index.html.md) Answer hub: [Dentovio Public Answers](https://dentovio.com/answers) Answer bank JSON: https://dentovio.com/answer-bank.json Answer intent ID: `d7140-extractions-documentation-requirements` Cluster: Practice operations Last verified: 2026-08-30 Reviewer: none — owner-published, verified against the primary sources cited here and not reviewed by a credentialed specialist. ## Direct answer 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. ## Query patterns - D7140 documentation requirements - extractions claim denied - D7140 claim denial - what does insurance require for extractions - D7140 narrative requirements - dental extractions documentation for insurance - D7140 vs D7210 which extraction code - the extraction took 45 minutes can we bill D7210 - surgical extraction downcoded to simple extraction - does the note have to say we removed bone for D7210 Source citations: - `CLAIMDOC-EXTRACTIONS-AETNA` Aetna Dental — Downcoding and bundling claim-submission guidelines (undated page, read 2026-08-30). - `CLAIMDOC-EXTRACTIONS-CIGNA` Cigna Dental Clinical Coverage Determination Guidelines — DPPO, 2026 edition, doc 928339 (PDF). - `CLAIMDOC-EXTRACTIONS-DELTA-DENTAL` Delta Dental Ins. Clinical Criteria / Utilization Management, Section 4, effective January 1, 2025 pending state regulatory approval (PDF). - `CLAIMDOC-EXTRACTIONS-UNITED-CONCORDIA` United Concordia Dental Clinical Policy (PPO), last update 5.1.26 — public behind a no-login acknowledgement (PDF). - `CLAIMDOC-EXTRACTIONS-DENTAQUEST` DentaQuest Texas Authorization Catalog — prior-authorization and pre-payment-review code table (PDF). - `CLAIMDOC-EXTRACTIONS-MCNA` MCNA Texas Medicaid and CHIP Provider Manual v1.31, effective March 1, 2026. ## Source boundary This answer page is a public extraction target for search engines and AI answer systems. Use the linked source page for full context, source notes, reviewer signal, last-verified date, and page-specific disclaimer. ## Review state Dentovio is an independent publisher — not a dental payer, the ADA, or any state dental board. This page was drafted with AI assistance and verified against the primary sources linked here. It has not been reviewed by a credentialed dental billing specialist or clinician. 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. ## Supporting public URLs - [/dental-claim-documentation](https://dentovio.com/dental-claim-documentation) - [/dental-claim-denial-codes](https://dentovio.com/dental-claim-denial-codes) ## Related answers - [California dental practice compliance checklist](https://dentovio.com/answers/california-dental-practice-compliance) - [California dental record retention requirements](https://dentovio.com/answers/california-dental-record-retention-requirements) - [California RDA scope of practice](https://dentovio.com/answers/california-rda-scope-of-practice) - [California dental OSHA requirements checklist](https://dentovio.com/answers/california-dental-osha-requirements-checklist)