Policy No: 53
Originally Created: 03/01/1997
Section: Oral and Maxillofacial Surgery
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Approved: 01/01/2018
Effective: 01/01/2018


Frenulectomy (frenectomy or frenotomy) - separate procedure (D7960)
The frenum may be excised when the tongue has limited mobility; for large diastemas between teeth; or when the frenum interferes with a prosthetic appliance; or when it is the etiology of periodontal tissue disease


Procedure is in accordance with generally accepted standards of dental practice.

Administrative guidelines

Process to contract benefits.

Considered dental for the upper and lower lip, except considered medical for infants less than 12 months of age with feeding problems.

Considered medical for the tongue.


CDT - D7000-D7999 -see above


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