Understanding Dental Code D5120

When to Use D5120 dental code

The D5120 dental code is designated for a complete denture – mandibular. This CDT code should be used when a patient requires a full replacement of all teeth in the lower jaw with a removable prosthesis. D5120 is appropriate when all natural teeth in the mandibular arch are missing or must be extracted, and the dentist is providing a complete denture as the definitive prosthetic solution. It is not used for partial dentures, immediate dentures, or repairs—those scenarios have their own specific CDT codes, such as D5110 for maxillary complete dentures or D5130 for immediate dentures.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful billing and insurance reimbursement. When using D5120, ensure the patient’s chart clearly indicates:

• All mandibular teeth are missing or require extraction
• Clinical notes describing the condition of the alveolar ridge and oral tissues
• Pre-operative radiographs or intraoral images supporting the need for a complete denture
• Details of the impression, bite registration, and try-in appointments
• Final delivery and patient acceptance of the denture

Common clinical scenarios include patients with advanced periodontal disease, severe caries, or trauma resulting in the loss of all lower teeth. Proper documentation not only supports the claim but also protects your practice in the event of an audit or claim appeal.

Insurance Billing Tips

Billing D5120 successfully requires attention to payer-specific guidelines and proactive communication with insurance carriers. Here are best practices followed by top-performing dental offices:

• Verify eligibility and frequency limitations: Many dental plans cover complete dentures only once every 5–7 years. Always verify benefits and document frequency limits before treatment.
• Pre-authorization: Submit a pre-treatment estimate with supporting documentation to avoid claim denials. Include clinical notes, radiographs, and a narrative explaining the medical necessity.
• Accurate claim submission: Use the correct CDT code (D5120), specify the arch (mandibular), and attach all required documentation. Double-check that the treatment dates and provider information are correct.
• Follow up on EOBs: Review Explanation of Benefits (EOBs) promptly. If the claim is denied or underpaid, initiate a claim appeal with additional documentation as needed.
• Patient communication: Clearly explain coverage, out-of-pocket costs, and estimated timelines to patients to avoid confusion and AR issues.

Example Case for D5120

Consider a 68-year-old patient presenting with no remaining mandibular teeth due to advanced bone loss and periodontal disease. The dentist documents the edentulous arch, takes diagnostic radiographs, and discusses treatment options. After verifying insurance coverage and obtaining pre-authorization, the clinical team proceeds with impressions, bite registration, and fabrication of a complete lower denture. Upon delivery, the patient is educated on care and maintenance. The billing team submits a claim with D5120, attaching clinical notes, radiographs, and the pre-authorization approval. The claim is processed without delay, and the patient receives their new denture with a clear understanding of their benefits and financial responsibility.