Partial Dentures

Policy No: 37A
Originally Created: 01/01/2011
Section: Prosthodontics
Last Reviewed: 01/01/2019
Last Revised: 01/01/2019
Approved: 01/01/2019
Effective: 01/01/2019

Description

Maxillary partial denture – resin base (including retentive/clasping materials, rests and teeth) (D5211)

Mandibular partial denture – resin base (including retentive/clasping materials, rests and teeth) (D5212)

Maxillary partial denture – cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) (D5213)

Mandibular partial denture – cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) (D5214)

Immediate maxillary partial denture – resin base (including any conventional clasps, rests and teeth) (D5221)

Immediate mandibular partial denture – resin base (including any conventional clasps, rests and teeth) (D5222)

Immediate maxillary partial denture – cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) (D5223)

Immediate mandibular partial denture – cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) (D5224)

Removable unilateral partial denture – one piece cast metal (including clasps and teeth), maxillary (D5282)

Removable unilateral partial denture – one piece cast metal (including clasps and teeth), mandibular (D5283)

Cleaning and inspection of removable partial denture, maxillary and mandibular (D9934 and D9935)

Policy/criteria

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

Administrative guidelines

Process to contract benefits.

If this is a replacement, the prosthesis must be more than 7 years old and cannot be made serviceable, or additional abutment teeth have been lost.

Temporary appliances are considered in the allowance for the permanent prosthesis. A separate benefit for a temporary is not available as a covered benefit.

Cleaning and inspection of partial dentures is not a contract benefit.

Codes

CDT - D9934-D9935; D5000-D6999 - see above.

Disclaimer

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