Understanding Dental Code D5612

When to Use D5612 dental code

The D5612 dental code is designated for the repair of a resin partial denture base in the maxillary (upper) arch. Dental practices should use this CDT code when a patient presents with a fractured or damaged resin base on their upper partial denture, and the repair does not involve any tooth or clasp replacement. This code specifically applies to repairs where only the base material is being restored, ensuring the structural integrity and fit of the existing prosthesis without the need for a full remake.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing for D5612. Dental teams should include detailed clinical notes describing the nature of the damage, the specific area of the maxillary partial denture affected, and the steps taken during the repair. Intraoral photographs and pre- and post-repair images can strengthen the claim. Common clinical scenarios include: a patient drops their partial, resulting in a cracked base; or the base wears thin over time, compromising fit and comfort. Always document the reason for the repair, the materials used, and the outcome to support the necessity for this procedure.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D5612, follow these best practices:

• Verify patient eligibility and coverage for removable prosthesis repairs prior to treatment. Some plans may have frequency limitations or waiting periods.
• Submit a detailed narrative with your claim, explaining why the repair was needed and confirming that no teeth or clasps were replaced (which would require a different code, such as D5611 for mandibular repairs).
• Attach supporting documentation such as clinical photos, radiographs (if applicable), and lab invoices to substantiate the repair.
• Review the Explanation of Benefits (EOB) carefully. If denied, check for missing documentation or misapplied frequency limitations and be prepared to submit a claim appeal with additional details.

Example Case for D5612

A 68-year-old patient presents with a fractured upper partial denture base after accidentally dropping it. The clinical team examines the appliance, confirms that only the resin base is damaged, and documents the findings with photos. The dentist repairs the base using appropriate resin material, restoring the partial’s function and comfort. The office submits a claim using D5612, includes the narrative and supporting images, and receives timely reimbursement after insurance review. This scenario highlights the importance of precise documentation and code selection for successful claims processing.