Understanding Dental Code D6116

When to Use D6116 dental code

The D6116 dental code is designated for an implant/abutment supported fixed denture specifically for a partially edentulous maxillary arch. This CDT code should be used when a patient is missing some, but not all, of their upper teeth, and the treatment plan involves a fixed prosthesis supported by dental implants and abutments. It is important to distinguish this code from those used for fully edentulous arches or removable prostheses. Proper use of D6116 ensures accurate claim submission and reimbursement for the specific clinical scenario.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful billing of D6116. Clinical notes should clearly indicate:

• The patient is partially edentulous in the maxillary arch.
• The number and location of remaining natural teeth.
• Details of the implant placement and abutment connection.
• Type of fixed prosthesis fabricated (e.g., bridge or hybrid denture).
• Supporting radiographs and pre/post-operative photos as needed.

Common clinical scenarios include patients who have lost several upper teeth due to trauma, periodontal disease, or decay, but retain enough natural teeth to require a partial rather than a full arch prosthesis. D6116 should not be used for removable partial dentures or for cases where the entire arch is edentulous (see D6114 for fully edentulous maxillary arch).

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D6116:

• Pre-authorization: Submit a detailed pre-treatment estimate to the insurance carrier, including diagnostic records and a narrative explaining the clinical need for a fixed, implant-supported partial denture.
• Attach supporting documentation: Always include radiographs, periodontal charting, and intraoral photos with the claim. This substantiates the necessity for implants and the fixed prosthesis.
• Use correct CDT codes for related procedures: Bill for implant placement, abutments, and any extractions separately with their respective codes (e.g., D6010 for implant placement).
• Review EOBs carefully: If the claim is denied or underpaid, check the Explanation of Benefits for specific reasons and be prepared to submit a claim appeal with additional documentation if needed.
• Track AR: Monitor accounts receivable closely for high-value prosthetic cases to ensure timely follow-up and payment.

Example Case for D6116

Case Example: A 58-year-old patient presents with four missing upper teeth due to periodontal disease. The treatment plan includes placement of two dental implants and a fixed partial denture spanning the edentulous area, supported by custom abutments. The clinical documentation includes pre-op radiographs, a narrative detailing the patient’s history and restorative needs, and post-op photos. The office submits a pre-authorization, receives approval, and bills D6116 for the prosthesis, along with D6010 for the implants and D6057 for the abutments. The claim is paid in full after submission of all required documentation and timely follow-up on AR.

By following best practices in documentation, code selection, and insurance workflows, dental teams can ensure accurate billing and optimal reimbursement for complex implant-supported prosthetic cases using D6116.