CommercialAdministrativeLow impact
04.00.05d, Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth
Independence Blue Cross·Dentistry, Oral & Maxillofacial Surgery·Medical Policy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 04.00.05d to reaffirm its continuing position on extraction of bony impacted teeth (covered) versus exposure of impacted teeth (not covered). No substantive coverage changes were made; this is a routine policy maintenance reissue. Billing teams should verify individual member benefits, as some group contracts exclude bony impacted tooth extraction coverage entirely.
Action Required
No immediate action required. This is a reissue with no substantive changes to coverage or billing rules. Billing team should: (1) Ensure claims for bony impacted tooth extraction (D7230, D7240, D7241) are submitted only after verifying member eligibility, as some group contracts exclude this benefit; (2) Deny or do not submit claims for exposure-only procedures (D7280, D7283) for all Independence Blue Cross members, as these remain non-covered; (3) Maintain current documentation practices requiring medical necessity in member records for all impacted tooth claims.