CDT code D7111 causes a lot of confusion for dental professionals, but we’re here to clear it up. Accurate CDT coding is crucial for prompt dental insurance claim reimbursement, which means staying up to date on CDT code guidelines and revisions has a huge impact on your cash flow — and your bottom line.
It’s not a new challenge in dental billing: CDT codes and all the confusion that comes with them. Not to mention, they’re updated and revised annually. But CDT coding knowledge necessary if you want your dental insurance claims paid promptly for the full amount you’re owed, so we’re here to help you better understand them.
DCS is a full-service revenue cycle management company that prides itself on the pool of dental insurance billing experts we call our DCS Knowledge Network. A claims topic they excel at helping dental teams with is CDT coding.
Specifically, CDT code D7111 can be difficult, as it relates to the extraction of a primary tooth, but there are two CDT codes that apply to the extraction of deciduous or primary teeth. Which one should you be using?
Let’s dig into those details and answer the most common questions…
Key takeaways on CDT code D7111:
- D7111 is not a catch-all CDT code for all extractions
- Your fee will largely depend on what kind of tooth it is
- Always report the charged fee on the insurance claim, not the contracted fee
What is CDT Code D7111?
CDT code D7111 is defined as follows:
D7111 extraction, coronal remnants – primary tooth
Removal of soft tissue – retained coronal remnants.
The nomenclature language stating “coronal remnants” is often overlooked, and it’s assumed that D7111 is used for all primary teeth — but that is not the case.
When it is time to lose a primary tooth to make room for the eruption of a permanent successor tooth, the primary tooth begins to be naturally resorbed by the body, beginning at the tooth roots.
Once the tooth roots are reabsorbed back into the body, only the crown of the tooth remains — its coronal remnant. From that point, the coronal remnant of the primary tooth is retained in the mouth by soft tissue only.
There are various reasons a child or their parents can’t remove their primary tooth, such as multiple roots and tooth positioning. If there’s any difficulty, the tooth should be removed by their dentist.
As the dentist removing a coronal remnant, you’ll report CDT code D7111.
But, how do I code for the removal of a primary tooth retained by remaining roots?
The removal of a primary tooth retained by roots is appropriately documented and reported using CDT code D7140. It’s defined as:
D7140 extraction, erupted tooth or exposed root (elevation and/or forceps removal)
Includes removal of tooth structure, minor smoothing of socket bone, and closure, as necessary.
This is not specific to whether it’s a permanent or primary tooth extraction. So, it’s appropriate to use code D7140 to document the extraction of a primary tooth retained by tooth roots.
Related: What is the missing tooth clause? 4 questions answered for dentists
How much should I charge for D7140 primary tooth extractions with roots?
Some practices struggle with what fee to charge for the removal of a root-retained primary tooth.
Usually, this is a simple procedure that does not require a lot of the doctor’s time. Also, you may choose to charge a different fee for the extraction of a primary tooth with roots than you would for the extraction of a permanent tooth, which can be more difficult and take much longer to perform.
You can charge different fees for D7140 as long as all patients with similar circumstances are treated the same way.
For example, you can have a standard fee of $50 for all permanent tooth extractions, and a $25 standard fee for primary tooth extractions, as long as you routinely charge $50 for permanent teeth and $25 for primary teeth. To remain compliant and avoid claim denials, be consistent.
And as always, if you’re in network, be aware of fee capping laws in your state.
The code reported on the claim will still be the standard D7140, but by using the in-office identifying code of D7140A or D7140B, the appropriate fee will be documented on the ledger and reported on the claim.
These differentiating codes aren’t included in your software by default. Software instructions on how to create these internal identifiers and enter different fees for the same CDT code will vary. Reach out to your software support team to learn how best to do this.
For example, for the removal of a primary tooth retained by roots, you would report $25 as the actual fee charged for that line item on the claim form. If the contracted fee for D7140 was $80, and the plan pays 100% of the contracted fee, the plan will pay $25, not $80.
If submitting accurate insurance claims is a struggle for your team, our DCS Knowledge Network can help. Their vast array of knowledge covers CDT coding, insurance regulations and rules, and insider tricks to appealing denied claims.
You’ll partner with and have full access to our Knowledge Network when you use our DCS Insurance Billing services.