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Missing teeth in the lower jaw can affect how you speak, eat, and smile. When bridgework isn't an option, partial dentures offer a reliable solution. Dental code D5214 covers a specific type of lower partial denture that combines durability with functionality. This article explains when to use D5214, how to document the procedure correctly, and what dental teams need to know to bill this code without delays or denials.
Nov 1, 2025
What is Dental Code D5214?
D5214 is the CDT code for a mandibular partial denture with a cast metal framework and resin denture bases. This removable prosthesis replaces some, but not all, missing teeth in the lower arch. The cast metal framework provides strength and stability, while the resin base supports the artificial teeth. The code also includes retentive or clasping materials, rests, and the replacement teeth themselves.
This code applies when a patient has remaining natural teeth in the mandibular arch that can support a partial denture. It's distinct from D5212, which covers a mandibular partial denture with a resin base only (no metal framework), and from D5213, which applies to the upper arch. Selecting the correct code prevents billing errors and claim denials.
Common Terminology
Understanding the terminology related to D5214 helps dental teams communicate clearly with labs, insurance carriers, and patients.
Cast metal framework: A precision-made metal structure that distributes chewing forces across the remaining natural teeth and provides stability to the partial denture.
Resin denture base: The pink, gum-colored material that rests on the gum tissue and holds the replacement teeth.
Retentive/clasping materials: Metal or plastic components that grip the natural teeth to keep the partial denture in place.
Rests: Small metal extensions that sit on prepared surfaces of natural teeth to provide support and prevent the partial from sinking into soft tissue.
Abutment teeth: Natural teeth that support and stabilize the partial denture.
Edentulous area: The section of the jaw where teeth are missing.
When is D5214 Used?
D5214 should be used when a patient requires a mandibular partial denture with a cast metal framework to restore function, aesthetics, and oral health. The partial denture must be removable and designed to replace multiple missing teeth in the lower arch while preserving the remaining natural teeth.
Common Clinical Scenarios
Code D5214 applies in several situations where patients need lower partial dentures but still have natural teeth that can support the prosthesis.
A patient has lost multiple mandibular molars and premolars due to advanced periodontal disease. Fixed bridgework isn't possible because the remaining abutment teeth lack sufficient support. A cast metal partial denture provides a durable, functional solution.
A patient experiences tooth loss from decay or trauma in the lower arch. The remaining teeth are stable, but the edentulous areas need restoration. A partial denture with a metal framework offers long-term stability and better chewing function than a resin-only option.
A patient cannot afford or isn't a candidate for dental implants. The cast metal partial denture serves as a practical alternative, restoring both appearance and bite function.
A patient has bilateral missing teeth in the mandibular arch, requiring a prosthesis that distributes forces evenly across the remaining dentition.
When D5214 is NOT Appropriate
Selecting the wrong code can lead to claim denials and delayed reimbursements. Avoid using D5214 in situations where other codes or treatments are more appropriate.
The partial denture is for the upper arch, not the lower arch. Use D5213 for maxillary partial dentures with cast metal frameworks.
The partial denture is fabricated with a resin base only, without a cast metal framework. Use D5212 for mandibular partial dentures with resin bases.
The partial denture is delivered immediately after extractions on the same day. Use D5222 for immediate mandibular partial dentures.
The patient requires a complete denture to replace all teeth in the lower arch. Use D5120 for complete mandibular dentures.
The prosthesis is a flexible base partial denture. Use D5226 for mandibular partial dentures with flexible bases.
The patient needs a temporary or provisional partial denture. Use D5820 for interim partial dentures.
Billing and Insurance Considerations
Billing D5214 correctly requires careful attention to documentation, insurance verification, and claim submission protocols. Proper preparation reduces denials and improves reimbursement speed.
Documentation Requirements
Insurance carriers expect thorough clinical documentation to justify the use of D5214 and support the claim. Missing or incomplete records are common reasons for denials.
Detailed chart notes describing the edentulous areas, the condition of the remaining natural teeth, and the clinical rationale for a mandibular partial denture with a cast metal framework.
Pre-operative radiographs showing the bone structure, remaining teeth, and any pathology that supports the need for a partial denture.
Diagnostic casts and impressions documenting the current state of the mandibular arch before fabrication.
A written treatment plan that outlines the prosthetic design, materials used, and the expected restoration outcome.
Photos of the patient's dentition, if available, to provide visual evidence of the edentulous areas and the need for prosthetic intervention.
A clinical narrative explaining why a partial denture is the most appropriate treatment option, especially if alternative treatments like bridges or implants were considered and ruled out.
Insurance Coverage
Coverage for D5214 varies widely by plan, and understanding a patient's benefits before treatment prevents surprises and payment delays.
Many dental insurance plans cover partial dentures as a major restorative service, typically reimbursing 50% to 80% of the allowed amount after the patient meets their annual deductible.
Plans often have frequency limitations, restricting replacements to once every five to ten years. Verify the patient's history to determine if they've received a partial denture recently and whether a replacement is covered.
Some plans require pre-authorization before fabricating the partial denture. Submitting a pre-treatment estimate with supporting documentation reduces the risk of denial after the prosthesis is delivered.
Missing tooth clauses may apply, meaning some plans won't cover teeth that were missing before the patient's coverage began. Confirm eligibility for each edentulous area.
Waiting periods for major services are common, ranging from six months to two years. Check whether the patient has satisfied any waiting period requirements.
Alternative benefit provisions may allow the carrier to reimburse for a less expensive option, such as a resin-base partial instead of a cast metal framework. Discuss out-of-pocket costs with the patient upfront.
Common Billing Mistakes
Even experienced dental teams can make errors when billing D5214. Avoiding these mistakes improves claim acceptance rates and reduces administrative burdens.
Confusing D5214 with D5213. D5214 is for the lower arch only. Using the wrong code for the wrong arch results in automatic denials.
Billing D5214 when the prosthesis is delivered immediately after extractions. Immediate partial dentures require different codes: D5222 for mandibular or D5223 for maxillary.
Submitting claims without adequate documentation. Missing radiographs, clinical notes, or narratives lead to requests for additional information or outright denials.
Failing to verify insurance benefits before treatment. Frequency limitations, waiting periods, and missing tooth clauses can all affect coverage. Verify benefits upfront to avoid unexpected out-of-pocket costs for the patient.
Billing for diagnostic casts separately. Most insurance plans consider diagnostic casts (D0470) part of the global fee for partial dentures and won't reimburse separately.
Using D5214 for resin-base partials without metal frameworks. A cast metal framework must be part of the prosthesis to use this code.
Not submitting pre-authorization when required. Some plans deny claims outright if pre-authorization wasn't obtained, even if the treatment was medically necessary.
Common Questions
How often can D5214 be billed for the same patient?
Most dental insurance plans limit partial denture replacements to once every five to ten years. Some plans may allow more frequent replacements if the existing prosthesis is damaged beyond repair or if there have been significant changes to the patient's oral structure. Always verify the patient's plan-specific frequency limitations before beginning treatment. If a replacement is needed sooner than the plan allows, provide detailed clinical justification and supporting documentation to request an exception.
Does D5214 cover adjustments after delivery?
No. D5214 covers the fabrication and initial delivery of the mandibular partial denture. Adjustments made after delivery are typically billed separately using code D5511 for repair of a broken clasp or D5650 for adding a tooth to an existing partial. Minor adjustments immediately following delivery are usually included in the global fee, but significant modifications require separate billing.
Can D5214 be billed on the same day as extractions?
No. D5214 is for conventional partial dentures delivered after the extraction sites have healed. If the partial denture is fabricated before extractions and delivered immediately after tooth removal on the same day, use code D5222 for an immediate mandibular partial denture instead.
What if the patient has both upper and lower partial dentures?
Bill each arch separately using the appropriate code. For the lower arch, use D5214. For the upper arch, use D5213. Each code represents a distinct prosthesis and should be billed on separate claim lines with corresponding documentation for each arch.
Does insurance cover partial dentures for patients with implants?
It depends on the patient's plan. Some plans cover partial dentures regardless of whether the patient has implants. Others may consider a partial denture unnecessary if implants are present. Review the patient's benefits and obtain pre-authorization if the plan has specific restrictions related to implant coverage.
What happens if the patient's plan denies the claim due to frequency limitations?
Review the Explanation of Benefits (EOB) carefully to understand the denial reason. If the denial is due to frequency limitations, check whether the patient had a previous partial denture placed within the restricted timeframe. If replacement is medically necessary due to damage, disease, or significant oral changes, submit an appeal with a detailed clinical narrative, photos, and supporting documentation explaining why the replacement cannot wait.
Can D5214 be used for unilateral partial dentures?
No. D5214 is for bilateral partial dentures that replace teeth on both sides of the mandibular arch. For unilateral partial dentures, use D5282 for a removable unilateral partial denture with a one-piece cast metal design or D5283 for a one-piece resin design.
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