Is prior authorization required for D5520?

It depends on the patient's insurance plan. Always check with the insurer for specific requirements.

How is the cost determined for each tooth replaced?

Costs are typically based on the dental lab fees and the complexity of the repair, billed per tooth.

What materials are used for replacing teeth in dentures?

Common materials include acrylic or porcelain, chosen based on the original denture material and patient needs.

How long does the repair process take?

Repairs can often be completed within a few days, depending on lab turnaround times and the extent of the repair needed.

D5520

Replace Missing Teeth Denture - CDT Code Guide

Prosthodontics, removable/Repairs to Complete Dentures

Overview

CDT code D5520 is used for the replacement of missing or broken teeth in a complete denture, with the procedure being billed per tooth. This code falls under the category of prosthodontics, specifically focusing on removable repairs to complete dentures. The procedure involves the careful removal of the damaged or missing tooth from the denture base and replacing it with a new one, ensuring proper fit and function. This is typically necessary when a patient experiences tooth loss or breakage in their existing complete denture, which can occur due to wear and tear, trauma, or improper handling. Dental professionals must assess the condition of the denture and the patient's oral health to determine the best approach for repair.

When to Use This Code

A patient presents with a broken tooth in their complete denture.
A tooth is missing from a patient's complete denture due to wear or trauma.
The denture requires an update to improve aesthetics and function.
A patient complains of discomfort due to a missing tooth in their denture.
Routine maintenance reveals a compromised tooth in the denture.

Documentation Requirements

Detailed patient history and examination notes.
Clinical justification for the replacement of each tooth.
Description of the denture's condition before and after repair.
Photographic evidence of the broken or missing tooth, if applicable.
Laboratory work order and materials used for the repair.
Patient consent and acknowledgment of the procedure.

Billing Considerations

When billing for D5520, it's important to note that this code is used per tooth, so the number of teeth replaced should be accurately documented. Frequency limitations may apply depending on the patient's insurance plan, and it's advisable to verify coverage beforehand. Common modifiers may not be necessary unless specified by the insurance provider. Ensure that the procedure is medically necessary and documented as such to avoid claim denials.

Related CDT Codes

D5510 D5630 D5640 D5650 D5670

Frequently Asked Questions

No, D5520 is specifically for complete dentures. Use appropriate codes for partial denture repairs.

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