If your child has a loose baby tooth that just won’t fall out, you might have seen the code D7111 on a treatment plan. While dental codes can look like a confusing alphabet soup, understanding them is the secret to saving money on your family’s dental bills.
Here is the plain-English breakdown of what D7111 means, how much it costs, and which insurance plans actually cover it without making you wait.
What is the D7111 Dental Code?
The CDT code D7111 stands for the “extraction of coronal remnants – primary tooth.”
In simple terms, this isn’t a complex surgery. It usually happens when a baby tooth (primary tooth) is held in place only by soft tissue because the root has already dissolved. The dentist simply removes this “remnant” to make way for the permanent tooth or to stop gum irritation. It is less invasive—and typically cheaper—than a full surgical extraction (which would be code D7210).
Does Insurance Cover D7111?
The good news: Yes, most dental insurance plans cover D7111. Because it involves a child, pediatric dental care is often categorized as an essential health benefit under the Affordable Care Act (ACA). However, how much they pay depends entirely on your plan’s fine print.
Here is what you need to watch out for when reviewing your policy:
1. The “Waiting Period” Trap Many standard insurance policies require you to wait 6 to 12 months before they cover any extractions. If your child is in pain today, this is a problem.
• The Fix: Look for plans specifically marketed as “No Waiting Period.” For instance, Spirit Dental offers plans where coverage for preventive and basic services begins immediately—no waiting required,.
• Humana: Their “Preventive Plus” plan is popular, but be aware that while preventive care is usually immediate, some basic services might still have waiting periods depending on your state.
2. Deductibles Matter Before the insurance pays a dime for a D7111 extraction, you usually have to meet an annual deductible.
• Providers like Cigna offer low-deductible plans (sometimes ranging from $0 to $50), which is ideal if this is the only procedure your child needs this year.
• Spirit Dental offers a unique structure with a $100 lifetime deductible in some plans, meaning once you pay it, you never pay it again.
How Much Does D7111 Cost?
Since we are not a dental office, we can’t give an exact price, but we can tell you how to find it. The cost varies significantly based on whether you go to an in-network or out-of-network dentist.
• Use Tech to Predict Costs: Don’t guess. Major carriers like Delta Dental provide a “Dental Care Cost Estimator” tool. You can enter your ZIP code and the D7111 code to see the estimated price range in your area,.
• Ask for the Cash Price: If you are uninsured, ask the dentist for a cash discount. Since D7111 is a quick procedure, some clinics offer reduced rates for direct payment.
What If You Don’t Have Insurance?
If you are staring at a bill for a D7111 procedure and don’t have coverage, you still have options:
1. Dental Savings Plans: These are not insurance but membership cards that give you 10-60% off. They are great for immediate needs because they activate instantly.
2. State Programs: In states like Iowa, programs like the Dental Wellness Plan Kids or Hawki (CHIP) provide comprehensive coverage for eligible children,.
3. Dental Schools: Students supervised by experienced professors often perform simple procedures like D7111 for a fraction of the cost.
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Frequently Asked Questions (FAQ)
Is D7111 considered a surgical extraction? No. D7111 is the removal of a “coronal remnant” (soft tissue extraction of a loose baby tooth). It is distinct from code D7210, which is a surgical extraction requiring the elevation of a flap or removal of bone.
Does Medicaid cover D7111? Generally, yes. Medicaid and CHIP programs are required to provide dental benefits to children, which typically includes necessary extractions like D7111 to prevent pain or infection.
Is there a waiting period for D7111? It depends on your plan. Traditional plans often have a 6-month wait for basic services. However, carriers like Spirit Dental and specific Anthem family plans offer no waiting periods for diagnostic and preventive care, and sometimes basic services as well,.
How much does a D7111 extraction cost without insurance? Prices vary by ZIP code. To get an accurate number, we recommend using the Delta Dental Cost Estimator tool or calling your local dental school for their rates.
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> Disclaimer: This article is for informational purposes only and does not constitute medical or financial advice. We are not dentists or insurance agents. Coverage details, deductibles, and plan availability vary by state and provider. Always verify benefits with your insurance carrier and consult a licensed dentist for treatment.
