Understanding Dental Code D5670

When to Use D5670 dental code

The D5670 dental code is designated for the replacement of all teeth and acrylic on a cast metal framework for the maxillary arch (upper jaw). This CDT code is specifically used when an existing maxillary partial denture requires a complete overhaul—meaning all artificial teeth and the acrylic base are replaced, but the underlying cast metal framework remains intact and serviceable. This procedure is distinct from a full denture replacement or a simple repair, making it essential to use D5670 only when the clinical situation matches the code’s intent.

Documentation and Clinical Scenarios

Accurate documentation is critical for successful claims processing. Dental teams should ensure the patient’s chart includes:

 
• A detailed narrative describing the condition of the existing prosthesis, including why replacement of all teeth and acrylic is necessary (e.g., severe wear, fracture, or loss of fit).
 
• Clinical notes and intraoral photographs showing the current state of the partial denture.
 
• Radiographs if relevant to demonstrate the suitability of the existing metal framework.
 
• Evidence that the metal framework is still functional and does not require replacement.

Common clinical scenarios for D5670 include patients with significant wear of the acrylic or teeth, but whose metal framework remains undamaged and well-adapted. This code should not be used for minor repairs.

Insurance Billing Tips

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

 
• Pre-authorization: Submit a pre-treatment estimate with supporting documentation to verify coverage and patient responsibility before proceeding.
 
• Detailed narratives: Include a clear explanation of why a full replacement of teeth and acrylic is needed, emphasizing the integrity of the existing framework.
 
• Attach evidence: Upload photos, radiographs, and chart notes with the claim to support medical necessity.
 
• Review frequency limitations: Many dental plans limit how often prosthetic replacements are covered (often every 5–7 years). Confirm eligibility before treatment.
 
• Appeal denials: If a claim is denied, review the Explanation of Benefits (EOB), address the payer’s rationale, and submit an appeal with additional documentation if warranted.

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

Example Case for D5670

Consider a patient who received a maxillary cast metal partial denture seven years ago. Over time, the acrylic base has fractured and several artificial teeth are worn down, but the metal framework remains stable and fits well. After clinical evaluation and documentation, the dental team determines that a full replacement of the teeth and acrylic is necessary. The office submits a pre-authorization with photos and a narrative, receives approval, and bills the procedure using D5670. The claim is processed smoothly, and the patient receives a fully restored partial denture without unnecessary replacement of the metal framework.

This scenario highlights the importance of code selection, documentation, and insurance communication for optimal patient care and practice revenue.