D5130 - Immediate Denture Max
Immediate denture – maxillary.
- Procedure Code
- D5130
- Clinical Category
- Prosthodontics
- Primary ICD-10 Justification
- See mapped diagnoses below
- Reference Fee & Claim Types
- DENTAL
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D5130.
- Frequency Limitation
- 1 per arch in a 60-month interval (5 years) (rolling_12_months)
Required Claim Attachments & Pre-Submission Checklist
- Standard ADA claim form with CDT procedure code and date of service
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- For benefit purposes, anesthesia is an integral part of the procedures being performed and additional fees are not billable to the patient.
- Infection control is included in the fee for the dental services provided. Separate fees are not billable to the patient.
- For benefit purposes, local anesthesia is an integral part of the procedure being performed and additional charges are not billable to the patient.
- Full or partial dentures include any reline/rebase, adjustment or repair required within six months of delivery; Benefits may be denied if repair or replacement within the contractual time limitation is the patient’s fault. General policy - The fee for an immediate denture includes any adjustments, relines, or tissue conditioning within 3 months of delivery. Laboratory relines are benefited 3 months after delivery of an immediate denture to allow adequate time for healing.
- The fees for cast restorations and prosthetic procedures include all models, temporaries and other associated procedures. Any fees charged for these procedures in excess of the approved amounts for the indirectly fabricated restorations or prosthetic procedures by the same dentist/dental office are not billable to the patient on the same date of service.
- Benefits for restorations for altering occlusion, adjusting vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion, abfraction, corrosion, TMD or for periodontal, orthodontic, or other splinting are denied, unless covered by group/individual contract.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
ICD-10-CM Justification & Crosswalk Mappings for D5130 (0)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
No direct ICD-10 mappings recorded for D5130.
Frequently Asked Questions — D5130 (Immediate Denture Max)
Quick answers for dental billers and treatment coordinators submitting claims for D5130.
What ICD-10 diagnosis codes link to dental procedure D5130?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D5130.
Can CDT code D5130 be billed to medical insurance?▾
Billing CDT D5130 (Immediate Denture Max) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: DENTAL.
What attachments and documentation are required for billing CDT D5130?▾
Required claim attachments for CDT D5130 (Immediate Denture Max) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D5130?▾
Standard commercial insurance frequency for D5130: 1 per arch in a 60-month interval (5 years) (rolling_12_months).
What are common insurance denial reasons and appeal tips for CDT D5130?▾
Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.