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Impacted Tooth Removal – Soft Tissue Only

Wyoming rates for HCPCS D7220

Surgical removal of a tooth that has not fully erupted but is covered only by gum tissue, not by bone. The gum is opened to expose and remove the tooth, without needing to remove any surrounding jawbone. This is the least involved category of impacted-tooth surgery, though it is still more than a simple extraction of a fully erupted tooth.

Rates data updated October 2026.

How much rates vary

Facilitymedian $138 · 10th to 90th $138 to $138Professionalmedian $295 · 10th to 90th $138 to $295
$200facility $138professional $295

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Aetna
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
BCBS Wyoming
Setting
Professional
Modifier
None
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
BCBS Wyoming
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$208.93
Median
$208.93
Typical High
$208.93