D5222Mandibular Partial Denture - Flexible Base (Including Retentive/clasping Materials, Rests, and Teeth)

What This Code Covers

D5222 covers mandibular partial denture - flexible base (including retentive/clasping materials, rests, and teeth). The prosthesis replaces one or more missing teeth and is designed to be removed and reinserted by the patient. Fabrication includes impressions, try-in, and final delivery.

Billing Guide

Bill this code when:

• The specific denture procedure described by D5222 is performed
• The arch (maxillary or mandibular) matches the code description
• The prosthesis type and material match the code specifications

Do not bill this code when:

• The arch does not match. Verify maxillary vs. mandibular coding
• A different prosthesis type was delivered (partial vs. complete, fixed vs. removable)
• The procedure (reline vs. rebase vs. repair) does not match this code
• The procedure is better described by D5211 (Maxillary partial denture - resin base (including ...)

Insurance and Denial Prevention

Key Payer Rules:

• Most plans have frequency limits for denture replacement (typically once every 5-10 years)
• Relines, rebases, and repairs have separate frequency limits
• Prior authorization is commonly required for new complete and partial dentures
• Maxillofacial prosthetic codes may not be covered under standard dental plans

Common Denials and How to Respond:

• Frequency limit for replacement - Document why the current prosthesis cannot be repaired or relined and must be replaced.
• Prior authorization not obtained - Submit post-service with full documentation if prior auth was not obtained before delivery.
• Not a covered benefit - For maxillofacial prosthetics, check if coverage exists under the patient's medical plan rather than dental.