Understanding Dental Code D5520

When to Use D5520 dental code

The D5520 dental code is used for the replacement of missing or broken teeth on an existing removable partial denture. This CDT code specifically covers the professional service of replacing a single tooth, not the fabrication of a new partial denture. Dental teams should use D5520 when a patient’s partial denture remains functional, but one or more teeth have fractured, dislodged, or are missing and need to be replaced to restore the appliance’s integrity and function.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful claims when billing D5520. Dental offices should include:

 
• A clear clinical narrative describing the condition of the partial denture and the reason for tooth replacement (e.g., tooth #29 fractured off the partial denture).
 
• Pre-operative and post-operative photographs, if available, to support the necessity of the procedure.
 
• Chart notes indicating the date of the original partial denture delivery and any prior repairs.
 
• Details on the material used and the laboratory invoice, if applicable.

Common clinical scenarios include accidental breakage, wear and tear over time, or loss of a tooth from the partial due to trauma or chewing forces. If more extensive repairs are needed, such as replacing a base or clasp, consider referencing related CDT codes such as D5611 for repairs to partial denture bases.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D5520, follow these best practices:

 
• Verify patient eligibility and remaining benefits for prosthodontic repairs before treatment.
 
• Submit a detailed narrative with your claim, including the reason for the repair and supporting documentation.
 
• Attach photos or radiographs if they help demonstrate the need for the replacement.
 
• Check frequency limitations—many plans restrict how often repairs are covered or may require a waiting period after initial denture delivery.
 
• Review the Explanation of Benefits (EOB) carefully. If the claim is denied, use the information provided to file a timely and well-supported appeal, referencing your documentation and the CDT code descriptor.

Staying proactive with insurance verification and thorough documentation can reduce accounts receivable (AR) delays and improve claim outcomes.

Example Case for D5520

Case Study: A 68-year-old patient presents with a missing tooth on her upper partial denture after accidentally dropping it. The partial is otherwise in good condition and fits well. The dental team documents the incident, takes photographs, and notes the original delivery date of the appliance. The office verifies the patient’s insurance coverage for repairs, submits a claim with a detailed narrative and supporting images, and receives approval for the D5520 procedure. The laboratory replaces the missing tooth, and the patient’s partial is restored to full function. This real-world workflow demonstrates how proper use of D5520, combined with thorough documentation and insurance know-how, leads to efficient billing and satisfied patients.