Understanding Dental Code D5283

When to Use D5283 dental code

The D5283 dental code is designated for a removable unilateral partial denture—one piece cast metal (including retentive/clasping materials, rests, and teeth), specifically for the mandibular arch. This CDT code is used when a patient requires replacement of teeth on only one side of the lower jaw, and a traditional bilateral partial denture is not indicated. The D5283 code is appropriate when the clinical situation calls for a one-piece, cast-metal appliance that restores function and aesthetics while preserving remaining teeth and oral structures.

Documentation and Clinical Scenarios

Proper documentation is key to successful billing and reimbursement for D5283. Clinical notes should clearly indicate:

• The specific teeth being replaced and their location (unilateral, mandibular).
• Why a unilateral partial is clinically appropriate versus a bilateral or other prosthesis.
• Details of the appliance design, including cast metal framework, clasps, rests, and artificial teeth.
• Any relevant radiographs, intraoral images, or periodontal charting supporting the need for this treatment.

Common clinical scenarios include patients with a limited number of missing teeth on one side due to trauma, localized periodontal disease, or congenital absence. The D5283 code should not be used for bilateral cases or when a temporary appliance is provided (see D5820 for interim partial dentures).

Insurance Billing Tips

To maximize reimbursement for D5283, follow these best practices:

• Verify benefits: Confirm with the patient’s insurance if unilateral partial dentures are a covered benefit, as some plans may have exclusions or frequency limitations.
• Pre-authorization: Submit a pre-treatment estimate with supporting documentation to minimize claim denials.
• Accurate coding: Ensure the clinical documentation matches the D5283 code description. Do not substitute this code for bilateral or maxillary cases (see D5282 for maxillary unilateral partials).
• Appeals: If a claim is denied, review the Explanation of Benefits (EOB) for the denial reason, prepare a detailed appeal letter, and include additional clinical justification and images as needed.
• Track AR: Monitor accounts receivable closely for partial denture claims, as these can be subject to delays or additional documentation requests.

Example Case for D5283

Case Example: A 57-year-old patient presents with missing teeth #20 and #21 due to localized periodontal disease. The remaining mandibular teeth are stable and healthy. After evaluating the patient’s occlusion and oral health, the dentist determines a removable unilateral partial denture (one piece cast metal) is the most appropriate solution. The clinical notes detail the rationale, and radiographs are attached to the claim. The office submits a pre-authorization, receives approval, and bills using D5283. The claim is paid in full after timely submission and proper documentation.

By understanding when and how to use the D5283 dental code, dental teams can ensure accurate billing, reduce denials, and provide optimal care for patients needing unilateral mandibular partial dentures.