Interim Prosthesis

Policy No: 37B
Originally Created: 01/01/2003
Section: Prosthodontics
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Approved: 01/01/2018
Effective: 01/01/2018

Description

A provisional prosthesis designed for use over a limited period of time, after which it is to be replaced by a more definitive restoration.

  • Interim complete denture (maxillary) (D5810)
  • Interim complete denture (mandibular) (D5811)

Interim partial denture (maxillary) (D5820)

  • Includes any necessary clasps and rests.

Interim partial denture (mandibular) (D5821)

  • Includes any necessary clasps and rests.

Policy/criteria

Procedures are in accordance with generally accepted standards of dental practice.

Administrative guidelines

No benefit - contract exclusion.

Codes

CDT - D5000-D6999 - see above

Disclaimer

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