Understanding Dental Code D7995

When to Use D7995 dental code

The D7995 dental code is designated for a synthetic graft procedure, specifically for bone replacement in oral and maxillofacial surgery. This CDT code is used when a dentist or oral surgeon places a synthetic material to augment or replace bone, typically in preparation for dental implants, ridge preservation, or after tooth extractions where bone loss is anticipated. The code is not used for autogenous (patient’s own bone) or allogenic (donor bone) grafts, but strictly for synthetic materials such as hydroxyapatite or other biocompatible substances. Proper use of D7995 ensures accurate reporting and reimbursement for these advanced procedures.

Documentation and Clinical Scenarios

Accurate documentation is critical when billing for D7995. Clinical notes should clearly indicate:

 
• The reason for the synthetic graft (e.g., site preservation, implant preparation)
 
• The location and extent of the graft
 
• The type and brand of synthetic material used
 
• Any related procedures performed at the same visit (such as extractions or membrane placement)

Common clinical scenarios include:

 
• Socket preservation after extraction to maintain bone volume
 
• Augmentation of a deficient alveolar ridge prior to implant placement
 
• Repair of bony defects due to trauma or pathology

Be sure to include pre- and post-operative radiographs, consent forms, and detailed progress notes to support the claim. This level of documentation reduces the risk of denials and supports appeals if necessary.

Insurance Billing Tips

Billing D7995 successfully requires attention to payer-specific policies. Here are key steps:

 
1. Verify coverage: Before treatment, confirm with the patient’s insurance whether synthetic grafts are a covered benefit. Many dental plans have limitations or require pre-authorization.
 
2. Submit comprehensive documentation: Attach clinical notes, radiographs, and material invoices with the claim. Clearly state the medical necessity for the graft.
 
3. Use correct CDT codes: If additional procedures are performed (e.g., extractions, membrane placement), use the appropriate codes and ensure they are not bundled incorrectly.
 
4. Monitor EOBs and AR: Review Explanation of Benefits (EOBs) promptly for denials or underpayments. Track outstanding Accounts Receivable (AR) and follow up on unpaid claims within 30 days.
 
5. Appeal when necessary: If a claim is denied, submit a detailed appeal with additional documentation, emphasizing the clinical need and referencing insurance policy language when possible.

Example Case for D7995

Case: A 52-year-old patient requires extraction of tooth #30 due to severe decay. To preserve the site for a future implant, the dentist places a synthetic bone graft (hydroxyapatite) immediately after extraction.

Billing steps:

 
• Document the extraction and rationale for grafting in the clinical notes.
 
• Record the type and amount of synthetic material used.
 
• Take pre- and post-op radiographs and include them in the patient’s chart.
 
• Submit a claim using D7995 for the synthetic graft and the appropriate extraction code (e.g., D7140 for a simple extraction).
 
• Attach all supporting documentation to the claim.
 
• Follow up with the insurance company to ensure timely payment.

This approach maximizes the likelihood of reimbursement and demonstrates compliance with industry standards.