Is a fully impacted wisdom tooth covered by insurance?
It depends on the plan. Many dental plans pay it as basic at 70 to 80%, others file it under major at 50%, and some send it to medical insurance first. A full bony impaction (code D7240) is a tooth, usually a wisdom tooth, that never came in and sits entirely under bone, so reaching it means opening the gum and removing bone. Billed per tooth.
50 to 80%
Basic or major, plan by plan
Dental or medical
Some plans make medical insurance primary for bony impactions. File the wrong payer first and both claims stall while the patient holds the bill.
Pano on file
Payers expect a panoramic X-ray (D0330) or a 3D scan (D0367) showing the tooth under bone. No image, no D7240, whatever the note says.
4 teeth, 1 max
Four wisdom teeth in one visit can run past the annual maximum on its own. Whatever is left over lands on the patient, at 100%.
Sedation separate
IV sedation (D9222) is a separate line that many plans exclude or cap. Run the code check on both before the consult, not after the surgery.
What would a real check show for this patient's D7240?
Pick a sample plan and type your per-tooth fee. This is the visibility a real-time check gives the desk for every actual patient, in under a second.
Eligibility readout · D7240
Sample- Coverage
- Active, D7240 covered at 80%
- Frequency
- Per tooth, imaging required with the claim
- Patient share
- Type your fee to see it
Estimate from a sample plan. A real check reads the actual plan in under a second.
When D7240 is the right code
- Tooth never came through the gum
- Crown of the tooth is fully covered by bone on X-ray
- Bone had to be removed to reach the tooth
- Tooth usually sectioned to get it out
- Imaging on file showing the bone over the tooth
Documentation payers expect
A panoramic X-ray or 3D scan dated before surgery, tooth numbers, and an operative note describing the bone removed. Plans that route to medical want the same packet plus a diagnosis code.
Why impacted wisdom tooth claims get denied
What happens after impacted wisdom teeth come out
On plans where medical is primary, the dental claim sits until the medical explanation of benefits arrives, and the patient gets a statement in the meantime. On plans where dental pays, four teeth against one annual maximum can leave the last tooth or two on the patient, and the crown or filling they need later that year (D2740, D2392) becomes cash. A desk that checked the percentage, waiting period and remaining maximum before the consult, and confirmed which payer goes first, sends one estimate and no apology.
D7240, quick answers
Does dental insurance cover impacted wisdom teeth?
Most dental plans cover D7240, some as basic at 70 to 80% and some as major at 50%. A few plans route bony impactions to medical insurance first.
Should I bill medical or dental for a bony impaction?
It depends on the plan language. Confirm which payer is primary before the surgery date; filing the wrong one first delays both.
What imaging does the payer want?
A panoramic X-ray (D0330) or 3D scan (D0367) taken before surgery that shows the tooth fully under bone. Without it, the claim usually downgrades or denies.
Is the sedation covered too?
Not automatically. IV sedation (D9222) is its own line, and many plans cap it or exclude it. Check that code against the plan alongside D7240.
Does D7240 need prior authorization?
Often, yes, especially on plans that treat impactions as major or route to medical. The real-time check shows the category, waiting period and remaining maximum so the request goes out early.
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Related: D7230 · D7210 · D0330
CDT is maintained by the American Dental Association. This page is Valian's own plain-English summary for front-desk teams, not official CDT descriptor text, and is not billing or clinical advice. Coverage patterns are common plan behaviors; every plan differs. Verify benefits before treatment.