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The Regence Group Dental Policy
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Prosthodontics Section - Partial Dentures

Topic: Partial Dentures Date of Origin: January 2011
Section: Prosthodontics Policy No: 37A
Last Reviewed: January 2013 Last Revised:
Approved: January 2013  


IMPORTANT INFORMATION
This Dental Policy has been developed through consideration of generally accepted standards of dental practice, review of dental literature, dental necessity, and as appropriate, government approval.

Benefit determinations should be based in all cases on the applicable contract language. To the extent there are any conflicts between these guidelines and the contract language, the contract language will control.

The purpose of dental policy is to provide a guide to coverage. Dental policy is not intended to dictate to providers how to practice dentistry. Providers are expected to exercise their clinical judgment in providing the most appropriate care.


Description

(D5211) Maxillary partial denture – resin base (including any conventional clasps, rests and teeth):
Includes acrylic resin base denture with resin or wrought wire clasps.

(D5212) Mandibular partial denture – resin base (including any conventional clasps, rests and teeth):
Includes acrylic resin base denture with resin or wrought wire clasps.

(D5213) Maxillary partial denture – cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)

(D5214) Mandibular partial denture – cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)

(D5281) Removal unilateral partial denture – one piece cast metal (including clasps and teeth)

Policy/Criteria
Procedures are in accordance with generally accepted standards of dental practice.

Administrative Guidelines
Process to contract benefits.

If this is a replacement, the prosthesis must be more than 7 years old and cannot be made serviceable, or additional abutment teeth have been lost.

Temporary appliances are considered in the allowance for the permanent prosthesis. A separate benefit for a temporary is not available as a covered benefit.

Codes Number Description
CDT
D5000-D6999  

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