Understanding Dental Code D5422

When to Use D5422 dental code

The D5422 dental code is designated for the adjustment of a partial denture, specifically for mandibular (lower) partials. This CDT code should be used when a patient returns after initial delivery of a partial denture and requires an adjustment due to discomfort, sore spots, or issues with fit. It is important to note that D5422 is not for repairs, relines, or rebasing—those services have their own specific codes. Instead, D5422 covers minor modifications such as smoothing rough spots, adjusting clasps, or relieving pressure areas to improve patient comfort and function.

Documentation and Clinical Scenarios

Proper documentation is essential when billing D5422. Clinical notes should clearly describe the patient’s complaint (e.g., sore area on the lower ridge), the specific adjustment performed (e.g., acrylic trimmed from lingual flange), and the outcome (e.g., patient reports improved comfort). Supporting documentation may include intraoral photos, diagrams, or annotated models. Common clinical scenarios for D5422 include:

 
• Patient reports irritation or ulceration caused by the partial denture base.
 
• Difficulty with insertion or removal due to tight clasps.
 
• Minor occlusal adjustments to improve bite after insertion.

Always ensure that the adjustment is medically necessary and that the clinical record justifies the use of D5422 rather than another code.

Insurance Billing Tips

When submitting claims for D5422, follow these best practices to maximize reimbursement and minimize denials:

 
• Verify patient eligibility and plan limitations—some plans may include a global period after delivery of a new partial, during which adjustments are covered at no charge.
 
• Submit detailed clinical notes with the claim, including the date of original insertion and the reason for the adjustment.
 
• Use accurate CDT coding—do not use D5422 for repairs, relines, or adjustments to full dentures (use D5410 for maxillary full denture adjustments, for example).
 
• Track EOBs (Explanation of Benefits) and follow up on denied claims promptly. If a claim is denied due to frequency limitations or lack of documentation, submit a claim appeal with supporting records.

Staying organized with your accounts receivable (AR) and maintaining clear communication with patients about their benefits and out-of-pocket costs will help streamline your dental billing workflow.

Example Case for D5422

Case: A patient returns two weeks after receiving a new mandibular partial denture, complaining of soreness on the lower left side. Upon examination, the dentist identifies a pressure spot caused by the acrylic base. The dentist adjusts the partial by relieving the area and smoothing the surface. The patient reports immediate relief. The clinical note documents the complaint, adjustment, and outcome. The office bills D5422, attaches the clinical note, and receives payment after insurance review.

This example highlights the importance of precise documentation and correct code selection to ensure proper reimbursement and patient satisfaction.