When is D5622 used?
The D5622 dental code applies to repairing cast partial frameworks in the upper jaw. This CDT code is appropriate when a patient's current maxillary cast partial denture framework needs repair due to fractures, warping, or similar damage, while the appliance remains functional overall. This code excludes minor adjustments or fixes to clasps, artificial teeth, or acrylic parts—these require different codes. Proper code usage ensures correct payment and meets dental insurance standards.
D5622 Charting and Clinical Use
Thorough documentation is crucial when billing D5622. Patient records must clearly outline the framework damage, specific repair work completed, and why repair was chosen over replacement. Include clinical photos, x-rays when relevant, and comprehensive notes. A common D5622 situation involves a patient whose upper partial denture framework broke at the main connector while remaining otherwise usable. The dentist decides repair is clinically sound and records the assessment, repair steps, and patient approval in the treatment notes.
Billing and Insurance Considerations
When processing claims for D5622, apply these strategies to improve acceptance rates and minimize rejections:
Check benefits: Confirm the patient's dental plan covers cast partial framework repairs and review any frequency limits or waiting requirements.
Include supporting materials: Provide clinical documentation, photographs, and comprehensive explanations of repair necessity. This establishes medical justification and speeds claim review.
Apply appropriate CDT codes: Use D5622 exclusively for cast framework repairs. For acrylic or tooth repairs, consider alternatives like D5611 or D5670.
Examine EOBs thoroughly: When claims are rejected, check the Explanation of Benefits for denial reasons and submit appeals with extra documentation when appropriate.
How dental practices use D5622
Practice Example: A 68-year-old patient arrives with an upper cast partial denture showing framework damage near the right canine area. The appliance otherwise fits properly, and the patient chooses repair instead of replacement. The dentist records the damage, captures images, and discusses the repair procedure with the patient. Following patient approval, the framework goes to the laboratory for restoration. The practice files a claim with D5622, includes clinical notes and images, and receives insurance authorization. The patient pays their portion based on their plan's prosthetic repair benefits.
Proper understanding and application of D5622 enables dental practices to maintain accurate billing, secure timely payments, and deliver quality patient care.
Common Questions
Is the D5622 code applicable for mandibular partial denture repairs?
No, D5622 is designated exclusively for cast partial framework repairs in the maxillary (upper) jaw. For mandibular (lower) partial denture framework repairs, a different CDT code must be used.
Is it possible to bill D5622 alongside other repair codes during one appointment?
Yes, when multiple repair procedures are completed in a single visit—for example, framework repair (D5622) combined with tooth addition (D5781)—each service should be properly documented and billed using its corresponding CDT code. Make sure documentation clearly justifies the medical necessity of each procedure performed.
Does D5622 have any billing frequency restrictions per patient?
Most dental insurance carriers establish frequency limitations for prosthetic repair procedures, including D5622. It's essential to verify the patient's specific policy details regarding these restrictions, as excessive repair frequency within a designated period may result in claim denials.