D7270 Dental Code: Tooth Reimplantation Billing Guide

What D7270 covers

D7270 reports reimplanting a tooth that was accidentally avulsed (knocked completely out of its socket) or displaced by trauma, and stabilizing it so it can heal. The socket is cleaned, the tooth is repositioned, and a splint holds it against the neighboring teeth while the periodontal ligament reattaches. The splinting and stabilization are part of the code.

Most cases are anterior teeth after a fall, a sports injury, or a motor vehicle accident, and the procedure is time-sensitive: an avulsed permanent tooth has the best prognosis when it is reimplanted quickly.

It does not cover:

• Intentional reimplantation, where a dentist deliberately extracts a tooth to treat it and reinserts it. That is D3470, an endodontic code that also includes its splinting.
• Surgical repositioning of teeth as a planned procedure. That is D7290.
• Stabilizing mobile teeth in a periodontal or restorative situation. Those are the splint codes D4322 (intracoronal) and D4323 (extracoronal).
• The root canal therapy an avulsed permanent tooth usually needs afterward. That is the appropriate endodontic code, billed separately.
• Removing residual roots or an unrestorable tooth. Those are extraction codes such as D7140 or D7250.

The splint is already in the code

The stabilization splint is bundled into D7270. That is the single most common unbundling error on this code: an office reports D7270 for the reimplantation and then adds a separate splint line, usually D4322 or D4323, for the wire-and-composite splint that held the tooth. For the same trauma event, that second line is a duplicate.

D4322 and D4323 exist for a different job, stabilizing loose teeth in periodontal or restorative care. (They replaced the older provisional splinting codes D4320 and D4321, which were deleted.) The acute splint that holds a reimplanted tooth is part of D7270, so it does not get its own line.

Accidental versus intentional: D7270 versus D3470

The axis that separates D7270 from its closest neighbor is why the tooth left the socket.

• D7270 is for a tooth the patient lost by accident, avulsed or displaced by trauma, then put back.
• D3470 is intentional reimplantation, where the dentist plans the extraction to treat the tooth (for example a root problem reachable only outside the mouth) and reinserts it.

Both include splinting. Both put a tooth back in its socket. The difference is intent: trauma the patient did not choose (D7270) versus a planned surgical-endodontic step (D3470). Coding a trauma reimplantation as D3470, or the reverse, misroutes the claim and the benefit.

When to bill D7270

Bill D7270 when:

• A tooth was accidentally avulsed or displaced by trauma.
• The tooth was repositioned into its socket and stabilized.
• The stabilization splint was placed as part of the same procedure.

Do not bill D7270 for:

• A planned extract-treat-reinsert sequence. Use D3470.
• Surgically repositioning a tooth as an elective procedure. Use D7290.
• Splinting mobile teeth outside of a trauma reimplantation. Use D4322 or D4323.
• The follow-up root canal. Use the endodontic code that applies.

Medical and dental crossover on trauma

An accidental avulsion is an injury, which is why D7270 is one of the more common medical-first scenarios in dentistry. Auto accidents, sports injuries, playground falls, and assaults often make the medical plan primary, with dental secondary for any remaining benefit. On accident cases, some medical plans and auto policies pay before the dental plan.

Which payer is primary, and whether a given plan pays at all, is plan-dependent and should be verified. When medical is primary, the medical claim uses CPT codes and the dental claim carries the D7270 line, and the two adjudicate independently.

Top reasons D7270 gets denied or downgraded

1. Unbundled splint line. A separate D4322 or D4323 billed for the same trauma splint denies as a duplicate, because stabilization is already in D7270.
2. No accident documentation. Without the date, cause, and place of injury, the claim reads as routine dental and misses the medical-primary path. Accident details support the correct payer.
3. Wrong payer first. Billing dental first on an accident case when medical (or an auto policy) should be primary creates rework and coordination-of-benefits headaches.
4. Prognosis or coverage exclusion. Some plans limit benefits when the tooth’s long-term prognosis is poor, or exclude trauma care that belongs to a medical or liability carrier. This is plan language.
5. Follow-up care rolled in. The root canal or later extraction of a failed reimplant is a separate code. Folding it into D7270 misreports the claim.

Documentation that supports the claim

The claim is stronger with:

• The tooth number and a clear statement that the tooth was accidentally avulsed or displaced.
• The date, cause, and location of the injury for the medical or auto claim.
• An operative note recording the reimplantation and the splint placed.
• A radiograph showing the reimplanted tooth in the socket.

For the patient record, document:

• The trauma history and the time elapsed before reimplantation.
• The condition of the socket and any associated injuries.
• The splint type and the teeth it was anchored to.
• The planned follow-up, including endodontic therapy and splint removal.

Example case

A 15-year-old established patient is brought in an hour after a soccer collision knocked out an upper front tooth (tooth #8). The tooth was kept in milk and reaches the office intact. The dentist irrigates the socket, reimplants the tooth, and places a flexible wire-and-composite splint from #7 to #9.

Billing steps:

1. Record the accident: date, cause (sports collision), and place of injury. This drives the medical or auto claim.
2. Verify benefits. On an accident, check whether the medical plan or an auto policy is primary, with dental secondary.
3. Report D7270 for #8 with an operative note describing the reimplantation and the splint, and attach the post-op radiograph. Do not add a separate splint code.
4. If medical is primary, submit the medical claim first with CPT coding and the injury narrative, then bill dental secondary.
5. Schedule and separately code the follow-up: the root canal the avulsed tooth will likely need, and splint removal at the appropriate visit.

What to get right in your PMS

1. Never add a separate splint line for the same reimplantation. Stabilization is inside D7270. A duplicate D4322 or D4323 gets denied.
2. Flag the case as an accident and capture the injury details. The date, cause, and place of injury route the claim to the correct primary payer.
3. Verify medical-first on trauma. Accidental avulsion is often medical-primary or auto-primary. Billing dental first creates rework.
4. Keep D7270 separate from D3470. Accidental trauma is D7270. A planned extract-treat-reinsert is D3470.
5. Code the follow-up separately. The root canal and any later extraction of a failed reimplant are their own codes, not part of D7270.