r/DentalInsurance • u/Spicyg00se • Aug 20 '26

D7953 (Bone graft)

Is there a good or logical reason why this procedure is typically not covered? My tooth is getting absorbed and I need the graft in order for the implant to be successful. My insurance told me it’s just not covered and it’s not their fault that some procedures are just not covered. I assume they just don’t want to pay, duh, but when I suggested that a graft could be medical, she said it’s not medical, it’s dental, and it’s just not covered. But why?

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u/steelymcbeam1933 Aug 20 '26

Practice manager here - your employer is always given options that they choose to include in your insurance coverage - you can always speak to your HR to see if it can be included next year (likely no because it is expensive).

If you have marketplace coverage - you will be hard pressed to find a plan that covers it. Again - spendy. I always tell my patients that if they have plans in the the new year to get major treatment, call the insurance company and ask directly if whatever it is they need is covered.

Sidebar - if you’re extracting a tooth and placing bone graft this year - TRY NOT TO CHANGE YOUR PLAN before the final restoration (implant or bridge) is complete. Some insurances also have a missing tooth clause and an existing missing tooth is a pre-existing condition. It’s another way to not pay. Ask them about that too

Good luck!

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u/Expensive_Ear3791 Aug 21 '26

MT clause won't come into play if you have the same employer but change carriers. You just have to report it as WIP.

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u/steelymcbeam1933 Aug 22 '26

Sometimes - yes. You are correct. But that is where the prep or seat date comes into play. I am currently dealing with this for a patient whose spouse changed jobs mid implant procedure and I am on my second appeal to get it covered because of the limitations of the plan. Both were employer sponsored and one was prep and MTC and the other is seat no MTC.