GUIDELINE NOTE 34, EXTRACTION OF IMPACTED WISDOM TEETH
GUIDELINE NOTE 34, EXTRACTION OF IMPACTED WISDOM TEETHLine 341Extraction of impacted wisdom teeth (D7220, D7230, D7240, D7241, D7250) is only included on this line when there is Evidence of pathology. Such pathology includes unrestorable caries, non-treatable pulpal and/or periapical pathology, cellulitis, abscess and osteomyelitis, internal/external resorption of the tooth or adjacent teeth, fracture of tooth, disease of follicle including cyst/tumor, tooth/teeth impeding surgery or reconstructive jaw surgery, and when a tooth is involved in or within the field of tumor resection ORTwo or more episodes of pericoronitis ORSevere pain directly related to the impacted tooth that does not respond to conservative treatment. (Extraction for pain or discomfort related to normal tooth eruption or for non-specific symptoms such as “headaches” or “jaw pain” is not considered medically or dentally necessary for treatment.) ................
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