D5228 - Imm Flex Partial Mand
Immediate mandibular partial – flexible base.
- Procedure Code
- D5228
- 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 D5228.
- 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
- A posterior fixed partial denture and a removable partial denture are not benefits in the same dental arch. The benefit is limited to the allowance for the partial removable denture.
- Fixed bridges or removable cast partials are not a benefit for patients under age 16.
- For benefit purposes, anesthesia is an integral part of the procedures being performed and additional 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.
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 D5228 (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 D5228.
Frequently Asked Questions — D5228 (Imm Flex Partial Mand)
Quick answers for dental billers and treatment coordinators submitting claims for D5228.
What ICD-10 diagnosis codes link to dental procedure D5228?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D5228.
Can CDT code D5228 be billed to medical insurance?▾
Billing CDT D5228 (Imm Flex Partial Mand) 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 D5228?▾
Required claim attachments for CDT D5228 (Imm Flex Partial Mand) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D5228?▾
Standard commercial insurance frequency for D5228: 1 per arch in a 60-month interval (5 years) (rolling_12_months).
What are common insurance denial reasons and appeal tips for CDT D5228?▾
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.