D7140 Extraction Erupted Tooth Template (Simple Extraction)

The template

Pick your PMS to format the placeholders, then copy.

PMS format

[Prompt:"name"]

Extraction - erupted tooth or exposed root.

RMH: Medical history reviewed/updates
Vitals: BP/pulse; other vitals if indicated

Tooth: #Tooth number(s)
Indication: Indication/diagnosis
Radiographs/images: Radiographs/images reviewed/taken and findings

Consent: Consent/PARQ reviewed; signed/verbally obtained

Anesthesia: Anesthetic used
Carps: Carpules/amount

Surgical elements: None or describe flap/bone removal/sectioning if performed

Extraction code support: Elevation/forceps removal; closure if performed; no bone removal/sectioning unless documented
Dressings/packing: Dressings, packing, hemostatic agents, or none

Procedure:
Tooth elevated and luxated.
Tooth extracted with forceps.
Socket examined and debrided.
Tooth delivered intact.
Hemostasis achieved with gauze pressure.

Complications: None or describe.

Patient tolerance: Tolerance/response.

Post-op instructions: Instructions reviewed.
Rx: Prescription or none

NV: Next visit

Field glossary

What each placeholder represents.

Medical history reviewed/updates
Note that medical history was reviewed and any changes since last visit — meds (especially anticoagulants, bisphosphonates, immunosuppressants), allergies, premed status, ASA, MRONJ risk. Write "no changes" rather than leaving blank.
BP/pulse; other vitals if indicated
Pre-op blood pressure and pulse, plus any additional vitals (SpO2, respiratory rate) if sedation or medical complexity warrants. Standard of care for surgical procedures and required by most state boards on extraction visits.
Tooth number(s)
Universal numbering for the tooth or teeth being extracted. List each tooth separately — D7140 is reported per tooth.
Indication/diagnosis
Clinical reason for extraction — caries, fracture, periodontal, orthodontic, prosthetic, failed RCT, retained root, trauma. Tie the indication to objective findings (e.g., "non-restorable gross distal caries to alveolar crest" not just "non-restorable").
Radiographs/images reviewed/taken and findings
Pre-op PA, BW, or pano taken today (or recent and relevant); diagnostic-quality status; one-line interpretation noting tooth condition, root morphology, periapical pathology, bone levels, and proximity to sinus / IAN / adjacent structures.
Consent/PARQ reviewed; signed/verbally obtained
Risks discussed and accepted: pain, swelling, bleeding, infection, dry socket, adjacent tooth/restoration damage, root fracture, sinus communication (maxillary posteriors), nerve paresthesia (mandibular posteriors), surgical conversion, replacement options. Signed or verbal-with-witness, dated.
Anesthetic used
Agent, concentration, vasoconstrictor ratio, and technique (infiltration, IAN block, PSA, etc.). Example: "2% Lidocaine with 1:100,000 epi, IAN block + long buccal infiltration."
Carpules/amount
Number of carpules and total volume in mL. Required for any sedation case and standard of care for any extraction.
None or describe flap/bone removal/sectioning if performed
The single most important line for D7140 audit defense — explicitly state "no flap, no bone removal, no sectioning" when those weren't performed. If any surgical element was used, the case is D7210, not D7140.
Elevation/forceps removal; closure if performed; no bone removal/sectioning unless documented
Brief technique narrative supporting the D7140 code: instruments used (periotome, elevators, forceps), whether tooth came out intact, sutures placed (if any) for tissue approximation. Closure is included in the D7140 descriptor; sutures alone do not upgrade to D7210.
Dressings, packing, hemostatic agents, or none
Hemostatic measures used — gauze, Surgicel, Gelfoam, collagen plug — or "none." Note time to hemostasis if relevant.
None or describe
Intraoperative complications — root fracture, soft-tissue tear, oroantral communication, prolonged bleeding, broken instrument — or "none." Be specific; "none" copy-pasted across every chart is an audit pattern.
Tolerance/response
Patient response — vitals trend, anxiety management, dismissal status, escort. Patient-specific, not a default phrase.
Instructions reviewed
Verbal and written post-op instructions covered with patient and escort: bite on gauze, no smoking/straws/spitting, soft diet, ice protocol, OHI for site, when to call office. Both verbal *and* written delivery is the documentation standard.
Prescription or none
Analgesic plan (OTC vs scheduled), antibiotics if indicated (not routine for uncomplicated D7140), CHX rinse if used. Or "none." Document patient acknowledgment.
Next visit
Post-op check (typically 1 week if sutures placed), recall, ridge-preservation visit, prosthetic next steps, or implant consult timing. "PRN" only when clinically appropriate.

Documentation requirements

D7140 is one of the three extraction codes carriers actively police (D7140, D7210, D7250 per ), and the chart-note will be the deciding evidence in any utilization review. The two failure modes are opposite: notes that read "surgical" trigger an upcode-to-D7210 audit, and notes that read like a routine D7140 when the procedure was actually surgical leave money on the table and create a paper trail of inconsistent coding.

Tooth number — by Universal numbering. If multiple, list each separately; D7140 is reported per tooth.
Indication / diagnosis — caries, fracture, perio, ortho, prosthetic, failed RCT, retained root. The diagnosis must support extraction as the chosen treatment. "Patient wants tooth out" alone is weak; pair with the underlying clinical reason.
Pre-op radiograph — diagnostic-quality PA, BW, or pano dated for this visit (or recent enough to be relevant). Note tooth condition, root morphology, proximity to sinus / IAN / adjacent structures, periapical pathology, bone levels. Carriers routinely request the pre-op image on appeal.
Medical history reviewed — current meds (especially anticoagulants, bisphosphonates / anti-resorptives, immunosuppressants), allergies, premed status, ASA. MRONJ risk and antithrombotic considerations belong in the note when relevant.
Vitals — BP and pulse pre-op are standard of care for any surgical procedure, mandatory for sedation cases, and required by most state boards on extraction visits.
Consent / PARQ — risks discussed and accepted: pain, swelling, bleeding, infection, dry socket, adjacent tooth/restoration damage, root fracture, sinus communication (maxillary posteriors), nerve paresthesia (mandibular posteriors), need for further surgery if complications arise. Signed or verbal-with-witness, dated.
Anesthesia — agent, concentration, vasoconstrictor ratio, number of carpules (typically 1.7 mL each), technique (infiltration / IAN / PSA / etc.).
Surgical elements section — explicitly state "no flap, no bone removal, no sectioning" when those weren't performed. This single line is the most effective audit defense for D7140: it pre-empts the auditor's question and pairs the descriptor language with the actual technique.
Technique narrative — elevation and luxation, forceps delivery, socket inspection, curettage / debridement of any granulation tissue, irrigation. Note whether the tooth came out intact or fragmented, and whether any retained root tip required additional management (and whether that additional management qualified as D7210).
Closure — sutures or none. Closure when needed is included in D7140 per the descriptor; placing a suture by itself does not upgrade the case to D7210. Document suture type and count if placed.
Hemostasis — method (gauze pressure, hemostatic agent, surgicel, gelfoam) and time to achieve hemostasis if relevant.
Complications — root fracture, oroantral communication, soft-tissue tear, prolonged bleeding, broken instrument, adjacent tooth mobility — or "none." A root fracture managed during the same visit by additional bone removal / sectioning to retrieve the apex moves the procedure to D7210, not D7140 + D7250.
Patient tolerance — vitals trend if relevant, anxiety management, dismissal status.
Post-op instructions — verbal and written, given to patient and any escort. Bite on gauze, no smoking / straws / spitting, soft diet, ice, OHI for site, when to call.
Rx — analgesic plan (OTC vs scheduled), antibiotics if indicated (not routine for an uncomplicated D7140), CHX rinse if used. Or "none."
Follow-up / next visit — recall, post-op check, ridge preservation visit, prosthetic next steps. Note "PRN" only when clinically appropriate.

Two universal pitfalls:

Templated language that says "flap reflected" or "tooth sectioned" on a D7140 chart. Macro residue from a D7210 template is the single fastest way to get a D7140 claim recoded — auditors read the note language literally.
Default-normal vitals or "no complications" copy-pasted across every patient. Document what you actually saw. Auditors compare a sample of charts and flag the office when every chart reads identical.

Common denial reasons

The most frequent reasons D7140 is denied, downgraded, or recouped:

Chart describes flap, bone removal, or sectioning while billing D7140. This is the inverse of the more famous D7210-downgrade audit: when the operative note language matches the D7210 descriptor but the claim is D7140, carriers either deny (mismatched code-to-documentation) or, more often, leave the lower payment in place and flag the office for utilization review. Either way the inconsistency is now in the carrier's record.
Chart is silent on flap / bone / sectioning altogether, billed as D7210. Mirror image of the above — when D7210 is billed but the note doesn't affirm the surgical elements, carriers auto-recode to D7140 and pay the lower fee. Most major dental payors run this rule programmatically. Appeals require the original PA, an operative narrative referencing the descriptor language, and ideally an intraoral photo of the sectioned tooth.
Pre-op radiograph not submitted or not diagnostic-quality. Many carriers require the pre-op image with any extraction claim above an established fee threshold or for any extraction in the posterior. A non-diagnostic image is treated as no image submitted.
Tooth previously billed extracted. A duplicate D7140 on a tooth number already shown extracted in carrier history denies as "service previously rendered." Common when a patient transfers offices or a chart contains a transcription error in tooth numbering.
Frequency / annual max exhausted. Late-year extractions in patients who have used their annual maximum get applied to next plan year or denied as patient responsibility.
Waiting period not met. Typical for new enrollees in the first 6-12 months on a plan; extractions billed before the waiting period clears come back as not-covered-yet.
Elective extraction without medical necessity. Bicuspid extractions for ortho on a plan without ortho coverage; healthy-tooth extractions for prosthetic preference. Document the specific clinical justification.
D7250 billed same DOS as D7140 on the same tooth. Most payors hard-block this pairing because D7250 is for residual root removal at a subsequent visit. A root that fractures during a D7140 and is retrieved the same visit by surgical means is D7210, not D7140 + D7250.
Missing operator / provider signature or auxiliary initials. State boards and many payors will reject a surgical-procedure chart without a closed signature and time stamp.
Default-normal templating. "No complications" + "patient tolerated well" + "vitals stable" copy-pasted on every extraction chart, with no patient-specific findings, draws audit attention because the chart pattern is identical across patients.
Coding asymmetry. Offices whose D7140-to-D7210 ratio sits far outside specialty norms (either direction) are flagged for audit. If 90%+ of your extractions are D7210, expect scrutiny; same for offices that bill D7140 on cases that should clearly be D7210.