When is D5670 used?
The D5670 dental code applies to replacing all artificial teeth and acrylic material on an existing cast metal framework for the upper jaw (maxillary arch). This CDT code should be utilized when a current maxillary partial denture needs comprehensive restoration—where all prosthetic teeth and acrylic base require replacement while the underlying metal framework stays functional and usable. This treatment differs from complete denture replacement or minor repairs, so D5670 should only be applied when the clinical circumstances align with the code's specific purpose.
D5670 Charting and Clinical Use
Proper documentation plays a vital role in successful claim approval. Dental offices should verify the patient record contains:
A comprehensive narrative explaining the prosthesis condition, detailing why complete tooth and acrylic replacement is required (such as extensive wear, breakage, or poor fit).
Clinical documentation and intraoral images displaying the partial denture's current condition.
X-rays when applicable to confirm the metal framework's continued suitability.
Proof that the metal structure remains operational and doesn't need replacement.
Typical clinical situations for D5670 involve patients experiencing substantial acrylic or tooth deterioration, while their metal framework stays intact and properly fitted. This code isn't appropriate for simple repairs.
Billing and Insurance Considerations
To optimize reimbursement and reduce claim rejections, implement these strategies:
Prior authorization: File a pre-treatment request with supporting materials to confirm coverage and patient costs before starting treatment.
Comprehensive narratives: Provide clear reasoning for complete tooth and acrylic replacement, highlighting the existing framework's sound condition.
Include supporting materials: Submit photographs, X-rays, and clinical notes with claims to demonstrate treatment necessity.
Check frequency restrictions: Most dental insurance plans restrict prosthetic replacement coverage (typically every 5–7 years). Verify eligibility prior to treatment.
Contest rejections: When claims are denied, examine the Explanation of Benefits, address the insurer's concerns, and file appeals with additional supporting evidence when appropriate.
Being proactive with insurance verification and comprehensive documentation improves the billing process and minimizes accounts receivable delays.
How dental practices use D5670
Take a patient who got a maxillary cast metal partial denture seven years earlier. Through normal use, the acrylic base cracked and multiple artificial teeth became worn, yet the metal framework stays secure and fits properly. Following clinical assessment and documentation, the dental staff decides complete tooth and acrylic replacement is required. The practice files a pre-authorization including photographs and detailed notes, obtains approval, and processes the treatment using D5670. The claim gets approved efficiently, and the patient receives a completely restored partial denture without needless metal framework replacement.
This example demonstrates how proper code selection, thorough documentation, and effective insurance coordination lead to excellent patient treatment and healthy practice income.
Common Questions
Is there a specific dental code for replacing all teeth and acrylic on a lower partial denture?
Yes, dental code D5671 is designated for replacing all teeth and acrylic on a cast metal framework for the mandibular (lower) arch. This code functions similarly to D5670 but is specifically applied to lower jaw procedures.
Can D5670 be applied when the metal framework of the partial denture is damaged or requires replacement?
No, D5670 is not appropriate when the metal framework is damaged or needs replacement. This code should only be used when the framework remains in good condition and serviceable, with only the teeth and acrylic portions requiring replacement. When the framework is compromised, a different code for fabricating a new partial denture must be utilized.
What is the typical insurance coverage frequency for replacing all teeth and acrylic on a partial denture with code D5670?
Insurance coverage frequency for D5670 differs among plans, though most policies impose restrictions, commonly allowing coverage for this replacement procedure every 5 to 7 years. It is essential to confirm each patient's individual benefits and frequency restrictions prior to beginning treatment.