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Lost teeth create functional and aesthetic gaps that can impact your patients' confidence and oral health. When partial dentures become the treatment of choice, proper coding determines whether your practice gets paid correctly for the work you've done. This article breaks down dental code D5213, explaining when to use it, what documentation you need, and how to avoid common billing mistakes that delay reimbursement.
Nov 1, 2025
What is Dental Code D5213?
D5213 covers maxillary partial dentures with a cast metal framework and resin denture bases. This code applies when you fabricate a removable prosthetic device that replaces one or more missing teeth in the upper arch using a metal framework for structural support and acrylic resin bases that hold the replacement teeth.
The cast metal framework provides strength and retention through clasps that engage the remaining natural teeth. The resin bases support artificial teeth and rest on the residual ridge tissue, restoring both function and appearance for patients with partial tooth loss.
Common Terminology
Understanding the components of a cast metal partial denture helps clarify what D5213 actually covers. Each element plays a specific role in the prosthesis's function and retention.
Cast metal framework: A custom-fabricated metal structure, typically chrome-cobalt alloy, that provides the primary support and retention for the partial denture
Resin denture base: Acrylic material that holds the artificial teeth and rests against the oral tissues
Clasps: Metal components that wrap around natural teeth to stabilize the partial denture
Rests: Metal extensions that sit on prepared tooth surfaces to prevent tissue displacement
Major connectors: Large metal components that join the right and left sides of the partial denture framework
When is D5213 Used?
Code D5213 applies when fabricating a new maxillary partial denture with specific material characteristics. The presence of both a cast metal framework and resin bases distinguishes this code from alternative partial denture options that use different materials or designs.
Common Clinical Scenarios
Several patient presentations make D5213 the appropriate billing code for maxillary prosthetic treatment. These situations share the common requirement for a metal framework combined with acrylic resin bases.
Patients missing multiple maxillary teeth who have sufficient remaining natural teeth to support clasps and provide retention
Cases where metal framework strength is needed due to long edentulous spans or heavy occlusal forces
Treatment plans requiring precision attachments or complex clasp designs that demand cast metal construction
Situations where tissue coverage needs to be minimized through metal major connectors rather than full acrylic coverage
Patients who have failed with all-acrylic partial dentures due to breakage or inadequate retention
When D5213 is NOT Appropriate
Certain clinical situations require different codes even though they involve maxillary partial dentures. Recognizing these exceptions prevents billing errors and claim denials.
Immediate partial dentures placed at the time of extraction (use D5820 instead)
All-acrylic or flexible resin partial dentures without cast metal frameworks (use D5211 or D5214)
Interim partial dentures intended as temporary appliances (use D5820 or D5821)
Partial dentures with metal bases rather than resin bases
Repairs, adjustments, or relines of existing partial dentures (use appropriate adjustment or repair codes)
Mandibular partial dentures (use D5223 for the lower arch equivalent)
Billing and Insurance Considerations
Insurance carriers scrutinize partial denture claims closely, often requiring specific documentation before authorizing payment. Missing records or incomplete treatment notes create the most common reason for claim denials, forcing your office to resubmit documentation and extending payment timelines unnecessarily.
Documentation Requirements
Complete records demonstrate medical necessity and support claim approval from the first submission. Gathering these materials before submitting claims reduces back-and-forth with insurance carriers.
Comprehensive periodontal charting showing the condition of abutment teeth and supporting structures
Complete tooth-by-tooth charting identifying which teeth are missing and which remain
Narrative justifying medical necessity, especially for patients under typical coverage age limits
Progress notes documenting impressions, bite registrations, try-in appointments, and final delivery
Radiographs showing the condition of abutment teeth and surrounding bone (panoramic or periapical series)
Photographs of the edentulous areas and remaining dentition when coverage is questionable
Insurance Coverage
Plan benefits for partial dentures vary widely across carriers and specific policies. Understanding typical coverage patterns helps set realistic patient expectations during treatment planning.
Most plans cover one maxillary partial denture every five to seven years per arch
Replacement before the waiting period typically requires documentation of irreparable damage or significant changes in the oral condition
Some carriers require prior authorization with full documentation before beginning fabrication
Age restrictions may apply, with some plans covering partial dentures only for patients over specific ages
Coordination of benefits becomes necessary when patients have dual coverage to maximize reimbursement
Common Billing Mistakes
Small coding errors create significant payment delays when insurance carriers reject claims. Avoiding these frequent mistakes keeps revenue flowing smoothly.
Billing D5213 for immediate partial dentures instead of using the correct interim code
Failing to wait for prior authorization before starting treatment, leading to denied claims
Submitting claims without required radiographs or treatment notes
Using the maxillary code (D5213) when treating the mandibular arch (should be D5223)
Not documenting medical necessity for early replacement when billing before the waiting period expires
Confusing this code with all-acrylic partials or flexible framework partials that use different codes
Common Questions
How often can D5213 be billed?
Most insurance plans allow one maxillary partial denture per five to seven years. Billing for early replacement requires documentation showing the existing prosthesis cannot be repaired or that significant oral changes make it non-functional.
Can I bill for a partial denture if the patient already has one?
You can bill for a replacement partial denture, but coverage depends on how long ago the previous one was delivered. If the replacement falls within the plan's waiting period, you'll need to document why early replacement is medically necessary, such as irreparable breakage or tooth loss that makes the existing partial unusable.
What's the difference between D5213 and D5214?
D5213 covers maxillary partials with cast metal frameworks and resin bases. D5214 applies to maxillary partials made entirely of flexible thermoplastic materials without metal frameworks. The material composition determines which code to use.
Do I need prior authorization before fabricating the partial?
Many insurance carriers require prior authorization for partial dentures. Check the patient's specific plan benefits before beginning treatment, as starting without authorization may result in payment denial even if the treatment was clinically appropriate.
Can I bill D5213 for a partial denture with metal bases?
No. D5213 specifically requires resin denture bases. If the partial denture uses cast metal bases, you would use a different code (D5225 for maxillary partials with both framework and bases made of metal).
How long do I have to submit the claim after delivery?
Filing deadlines vary by carrier, but most require submission within 90 days to one year from the date of service. Submit claims promptly after delivery to avoid crossing filing deadline thresholds that result in automatic denials.
Get Your Office Fully Staffed for Complex Restorative Cases
Complex partial denture cases require experienced hygienists and assistants who understand multi-appointment restorative workflows. When team members call out sick or leave unexpectedly, treatment delays frustrate patients and create revenue gaps.
Teero connects your practice with qualified dental professionals who can jump in and keep your restorative schedule moving. Post shifts in minutes, review profiles, and fill staffing gaps before your next partial denture delivery appointment. Sign up for Teero today and prevent staffing shortages from disrupting patient care.