When is D5731 used?
The D5731 dental code applies to direct relining procedures for complete mandibular (lower) dentures. This CDT code is utilized when a patient's current lower denture needs relining because of oral tissue changes, including resorption or poor fit, while the denture remains functional. The treatment is completed chairside, performed directly in the patient's mouth using suitable reline materials. This procedure differs from laboratory-based relines (D5751), which are completed outside the office. Apply D5731 exclusively when the reline is performed directly and immediately within the dental practice.
D5731 Charting and Clinical Use
Accurate documentation is essential for proper reimbursement and regulatory compliance. When submitting D5731, provide comprehensive clinical records that describe:
Patient's primary concern (such as unstable denture, pressure points)
Clinical examination findings (including tissue modifications, alveolar ridge changes)
Evaluation of current denture condition
Rationale for selecting direct reline versus new denture fabrication or laboratory reline
Reline materials and techniques employed
Follow-up care instructions and patient outcomes
Typical clinical situations involve patients with recent tooth extractions, accelerated bone remodeling, or individuals who require continuous denture wear. Documentation must always justify the clinical necessity of the treatment.
Billing and Insurance Considerations
To optimize reimbursement and reduce claim rejections when submitting D5731:
Check coverage details: Confirm benefit limitations and waiting periods for denture relines with the insurance provider prior to treatment.
Include supporting materials: Provide clinical documentation, intraoral photographs, and detailed explanations for requiring a direct reline.
Apply appropriate CDT code: Use D5731 exclusively for direct relines of complete mandibular dentures. For maxillary dentures, apply D5730.
Monitor EOBs and AR: Review Explanation of Benefits for payment verification and address outstanding Accounts Receivable quickly.
Contest claim denials: When claims are rejected, examine the denial reason, compile additional evidence, and file a detailed appeal letter citing patient clinical requirements and CDT code specifications.
How dental practices use D5731
Case: A 68-year-old patient arrives with a lower denture that became loose and causes discomfort six months following initial placement. Clinical assessment shows considerable ridge resorption, though the denture remains structurally sound. The patient requires continuous denture wear due to professional responsibilities.
Treatment: The dental practice completes a chairside direct reline using soft reline material. Comprehensive clinical documentation is recorded, including pre- and post-treatment photographs and detailed notes explaining the immediate need for direct relining. The insurance claim is filed using D5731 with complete supporting documentation. The insurance company approves the claim and processes payment efficiently.
This practical example demonstrates the significance of proper code application, complete record-keeping, and effective insurance coordination when billing D5731.
Common Questions
Are there frequency restrictions for billing D5731 to the same patient?
Yes, dental insurance plans typically impose frequency limitations on reline procedures including D5731. Most plans allow coverage for relines once every 12 to 24 months per denture, though specific restrictions vary between insurance providers. It's essential to confirm the patient's individual plan benefits prior to treatment to prevent claim rejections.
Does D5731 apply to partial dentures or is it limited to complete dentures?
D5731 is exclusively intended for direct relines of complete mandibular (lower) dentures. Partial denture relines require different CDT codes such as D5611 or D5621, based on whether the procedure is performed directly or indirectly. Submitting D5731 for partial denture work will lead to claim rejection.
Which materials are typically utilized for direct relines billed under D5731?
Direct relines coded as D5731 commonly employ chairside reline materials, available in both soft and hard acrylic formulations. Soft reline materials are frequently selected for patients with tender tissues or recent tooth extractions, while hard acrylics may be preferred for enhanced durability and longevity. The selected material type should be properly documented in the patient's clinical records.