Audience
Zip code - drawer
County - drawer

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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

Your use of this Dental Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Dental Policy Disclaimer.