Understanding Dental Code D5224

When to Use D5224 dental code

The D5224 dental code refers to the fabrication and delivery of an immediate mandibular partial denture—specifically, a resin base (including any conventional clasps, rests, and teeth). This code is used when a patient requires the extraction of teeth in the lower jaw and needs a partial denture placed immediately after extractions to restore function and aesthetics. D5224 is distinct from codes for conventional partial dentures, as it covers the immediate placement, which is a critical difference for both clinical and billing purposes.

Documentation and Clinical Scenarios

Proper documentation is essential for successful reimbursement of D5224. Clinical notes should clearly indicate:

• The teeth to be extracted and the medical necessity for immediate replacement.
• Pre-operative models, radiographs, and treatment planning records.
• Details of the immediate denture fabrication process, including impressions and try-in steps.
• Post-extraction insertion and patient instructions.

Common clinical scenarios include patients with advanced periodontal disease, trauma, or non-restorable teeth in the mandibular arch who cannot be without teeth during the healing phase. Always ensure the documentation supports the immediate need and the specific arch treated.

Insurance Billing Tips

To maximize reimbursement and minimize claim denials for D5224, follow these best practices:

• Verify benefits: Confirm patient eligibility and frequency limitations for partial dentures. Some plans have waiting periods or replacement intervals.
• Pre-authorization: Submit a pre-treatment estimate with supporting documentation, such as clinical notes, radiographs, and a narrative explaining the immediate need.
• Accurate coding: Use D5224 only for immediate mandibular partial dentures. For maxillary cases, use the corresponding D5223 code.
• Attach supporting documents: Include extraction dates, tooth numbers, and any relevant medical history to the claim.
• Monitor EOBs: Review Explanation of Benefits statements carefully for denial reasons. If denied, appeal promptly with additional documentation if needed.

Successful dental offices standardize these steps in their revenue cycle management (RCM) workflow to ensure timely and accurate payment.

Example Case for D5224

Consider a 58-year-old patient presenting with severe periodontal disease affecting the lower anterior teeth. The treatment plan involves extracting teeth #22–#27 and delivering an immediate mandibular partial denture. The dental team:

• Documents the diagnosis, treatment plan, and medical necessity in the patient chart.
• Takes pre-operative impressions and radiographs.
• Submits a pre-authorization to the patient’s insurance with all supporting documents.
• Performs extractions and delivers the immediate partial denture at the same appointment.
• Bills D5224, attaches the clinical narrative, and monitors the claim until payment is posted to AR.

This workflow ensures compliance, supports the claim, and provides the patient with uninterrupted function and aesthetics.