Understanding Dental Code D6115

When to Use D6115 dental code

The D6115 dental code is designated for an implant/abutment supported fixed denture for a completely edentulous mandibular arch. This code should be used when a patient requires a full-arch prosthesis that is permanently attached to dental implants in the lower jaw. It is not appropriate for partial dentures or removable appliances. Use D6115 when the treatment plan involves multiple implants (typically four or more) supporting a fixed, non-removable denture that replaces all teeth in the mandibular arch.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful billing and claim approval. The clinical record should include:

• Pre-operative radiographs and diagnostic images showing complete edentulism of the mandibular arch.
• Detailed treatment notes describing the placement of implants and the fabrication of the fixed prosthesis.
• Materials used, number and location of implants, and type of abutments.
• Post-operative images and patient consent forms.

Common clinical scenarios include patients with severe bone loss, failed conventional dentures, or those seeking a permanent solution for full-arch tooth loss. Always ensure the documentation clearly supports the medical necessity and appropriateness of the D6115 procedure.

Insurance Billing Tips

Billing for D6115 requires attention to detail and proactive communication with payers. Here are best practices:

• Insurance Verification: Before treatment, verify the patient’s benefits for implant-supported prosthetics. Many dental plans have specific exclusions or limitations for implants and fixed dentures.
• Pre-Authorization: Submit a pre-authorization request with comprehensive documentation, including diagnostic images and a narrative explaining the need for a fixed, implant-supported solution.
• Claim Submission: Use the D6115 code for the final prosthesis. If separate procedures (e.g., implant placement, abutments) are performed, bill them with their respective CDT codes (such as D6010 for implant placement).
• Attachments: Always include supporting documentation—radiographs, clinical notes, and lab invoices—to minimize delays or denials.
• Appeals: If a claim is denied, review the Explanation of Benefits (EOB) for specific reasons, address them in a detailed appeal letter, and provide any additional requested documentation.

Staying organized and maintaining clear communication with insurance coordinators can significantly improve reimbursement rates for D6115 claims.

Example Case for D6115

Consider a 68-year-old patient presenting with a completely edentulous mandibular arch and significant dissatisfaction with a removable denture. After thorough evaluation, the dental team recommends a fixed, implant-supported prosthesis. Four implants are placed in the mandible, and after osseointegration, a custom fixed denture is fabricated and attached. The clinical notes detail the patient’s history, diagnostic findings, surgical steps, and prosthesis delivery. The billing team submits a claim using D6115, attaches all relevant documentation, and follows up with the insurer to ensure timely processing. The claim is approved, and the patient receives a stable, functional, and esthetic solution for their edentulous arch.