Extractions (D7111-D7250):
- The extraction of asymptomatic teeth is not a benefit. The following conditions shall be considered symptomatic and shall be a benefit:
- full bony impacted supernumerary teeth, mesiodens or teeth unerupted because of lack of alveolar ridge length,
- teeth which are involved with a cyst, tumor or other neoplasm,
- unerupted teeth which are distorting the normal alignment of erupted teeth or causing the resorption of the roots of other teeth,
- the extraction of all remaining teeth in preparation for a full prosthesis,
- malaligned teeth which cause intermittent gingival inflammation,
- extraction of primary teeth required to minimize malocclusion or malalignment when there is adequate space to allow normal eruption of succedaneous teeth,
- perceptible radiologic pathology that fails to elicit symptoms, extractions that are required to complete orthodontic dental services






