Understanding Dental Code D5282

When to Use D5282 dental code

The D5282 dental code is designated for a removable unilateral partial denture—one piece cast metal, including retentive/clasping materials, rests, and teeth—for the maxillary arch. This code should be used when a patient requires a partial denture that replaces teeth on only one side of the upper jaw, and the prosthesis is fabricated as a single cast metal piece. It is distinct from bilateral partial dentures, which span both sides of the arch and are billed under different CDT codes. Proper use of D5282 ensures accurate treatment records and reimbursement.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful billing and claim approval. For D5282, clinical notes should include:

• Detailed charting of missing teeth and the unilateral nature of the edentulous area.
• Rationale for choosing a unilateral partial denture over other prosthetic options.
• Pre-operative radiographs and intraoral photos showing the maxillary arch.
• Material specifications (cast metal, clasping materials, etc.).
• Patient consent and discussion of alternative treatments.

Common scenarios include trauma or localized tooth loss where a full arch prosthesis is unnecessary. Always document why a unilateral design is clinically indicated, as insurance carriers may request justification.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D5282:

• Verify patient eligibility and plan coverage for removable partial dentures before treatment begins.
• Submit pre-authorizations with supporting documentation, including diagnostic images and clinical rationale.
• Use precise CDT code descriptions on the claim form to avoid confusion with bilateral or different arch prostheses (e.g., D5213 for bilateral maxillary partial dentures).
• Attach narratives explaining the necessity for a unilateral design, especially if the patient’s dental plan typically covers only bilateral appliances.
• Review EOBs (Explanation of Benefits) carefully for denial reasons and be prepared to submit appeals with additional documentation if needed.

Staying proactive with insurance verification and thorough documentation streamlines the revenue cycle and reduces accounts receivable (AR) delays.

Example Case for D5282

Case: A 54-year-old patient presents with loss of teeth #3 and #4 due to localized trauma. The rest of the maxillary arch is intact and healthy. After evaluating options, the dentist recommends a removable unilateral partial denture fabricated from cast metal, replacing only the missing teeth on the right side. The treatment plan, radiographs, and clinical notes clearly indicate the need for a unilateral appliance.

The office submits a pre-authorization with detailed documentation, including images and a narrative. Upon approval, the claim is submitted using D5282. The insurance carrier processes the claim without delay, and the patient receives the appropriate prosthesis with minimal out-of-pocket cost.

This example highlights the importance of matching clinical indications with accurate CDT coding and thorough documentation for optimal billing outcomes.