Understanding Dental Code D6114

When to Use D6114 dental code

The D6114 dental code is designated for an implant/abutment supported fixed denture specifically for an edentulous maxillary arch. This code should be used when a patient is missing all teeth in the upper arch and is receiving a fixed prosthesis that is supported by implants or abutments. Unlike removable dentures, this restoration is permanently attached and cannot be removed by the patient. It is critical to distinguish D6114 from related codes, such as those for mandibular arches or removable prostheses. Always verify that the clinical scenario matches the code description to ensure accurate billing and minimize claim denials.

Documentation and Clinical Scenarios

Proper documentation is essential when billing for D6114. The clinical record should clearly indicate total edentulism of the maxillary arch, the number and type of implants placed, and the specific prosthesis delivered. Include pre- and post-operative radiographs, detailed treatment notes, and a copy of the laboratory prescription. For best results, document the patient’s consent for the procedure and any medical necessity for a fixed solution versus a removable option. This thorough documentation supports the claim and expedites insurance processing.

Insurance Billing Tips

When submitting a claim for D6114, start with a comprehensive insurance verification to confirm coverage for implant-supported prostheses. Many dental plans have exclusions or waiting periods for implants, so obtain a pre-authorization whenever possible. Attach all supporting documentation, including clinical notes, radiographs, and a narrative explaining the necessity of a fixed maxillary prosthesis. If the claim is denied, review the Explanation of Benefits (EOB) for specific denial reasons and be prepared to submit a detailed appeal with additional documentation. Track all claims in your accounts receivable (AR) system and follow up regularly to ensure timely reimbursement.

Example Case for D6114

Consider a 65-year-old patient presenting with a fully edentulous upper arch. After comprehensive evaluation, the dentist recommends a fixed implant-supported denture for improved function and aesthetics. Four implants are placed in the maxilla, and after osseointegration, a fixed full-arch prosthesis is fabricated and delivered. The clinical notes detail the edentulous state, implant placement, and final prosthesis. The dental office submits a claim using D6114, attaches all supporting documentation, and receives approval after a brief pre-authorization process. This case highlights the importance of precise coding, thorough documentation, and proactive insurance communication for successful reimbursement.