When is D5222 used?
The D5222 dental code applies to an immediate mandibular partial denture—a resin-based prosthetic (including standard clasps, rests, and teeth) placed the same day as tooth extractions in the lower jaw. This CDT code is appropriate when patients need replacement of several, but not all, lower teeth immediately after extractions, ensuring they have a working prosthesis before leaving the appointment. This code does not apply to complete dentures or prosthetics delivered after a healing period. Choosing the correct code helps ensure proper billing and reduces claim rejections.
D5222 Charting and Clinical Use
Proper documentation is crucial when using D5222. Clinical records must clearly show:
Which teeth will be removed and the planned immediate partial prosthetic
Pre-treatment impressions or digital images used for construction
Same-day placement of the appliance after extractions
Patient agreement and comprehension of the immediate denture procedure
Typical clinical situations involve patients with severe gum disease, injury, or teeth that cannot be saved in the lower jaw, where maintaining function and appearance immediately is important. When a metal framework is utilized instead, consider D5224 for accurate billing.
Billing and Insurance Considerations
To improve payment success and minimize accounts receivable delays, implement these insurance practices for D5222:
Prior approval: Send a pre-treatment request with clinical documentation, X-rays, and study models to confirm benefits and patient financial responsibility.
Claim processing: Document the extraction date and immediate partial delivery date on claim forms. Include required supporting materials as specified by the insurance carrier.
Multiple insurance plans: When patients have two insurance plans, ensure proper primary and secondary filing to prevent processing delays.
Denied claims: Review explanation of benefits for denial reasons, gather additional clinical support, and resubmit with comprehensive narratives and documentation.
Remember that certain insurance plans may limit frequency or require waiting periods for prosthetic treatments, making benefit verification essential before starting care.
How dental practices use D5222
A 58-year-old patient comes in with loose lower front teeth caused by gum disease. Following treatment planning discussions, the dentist suggests removing teeth #22–27 and immediately fitting a lower partial denture. Study models are made before the extractions, and the prosthetic is prepared beforehand. During the surgical appointment, the teeth are removed and the immediate partial is fitted, maintaining both function and appearance. Clinical records include initial X-rays, signed consent documents, and treatment notes explaining the necessity for immediate tooth replacement. The insurance claim uses code D5222 with complete documentation and the original treatment estimate, leading to timely insurance payment.
Common Questions
How do dental codes D5222 and D5221 differ from each other?
D5222 applies to immediate mandibular (lower jaw) partial dentures with resin bases that are placed right after tooth extractions. In contrast, D5221 is designated for conventional mandibular partial dentures that are fitted after extraction sites have completely healed, rather than immediately following the procedure. To ensure proper coding, always verify the timing of delivery and denture type.
What are typical reasons insurance companies deny D5222 claims?
Insurance denials commonly occur due to inadequate documentation, including missing X-rays or insufficient narrative explaining the immediate delivery necessity. Other frequent causes include frequency restrictions on prosthodontic treatments or patients failing to meet plan requirements like waiting periods. To minimize denials, maintain comprehensive documentation and verify patient benefits prior to treatment.
What's the proper way to bill for adjustments or relines following an immediate partial denture coded as D5222?
Post-treatment adjustments and relines are typically necessary during the healing process but are not covered under D5222. These services require separate billing using appropriate codes like D5720 for relines or D5410/D5421 for adjustments. Always document the clinical necessity for each follow-up service and review coverage guidelines with the insurance provider.