D5765 - Soft Liner
Soft liner for complete or partial denture.
- Procedure Code
- D5765
- 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 D5765.
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
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
- Fee for relines cannot exceed one-half of the fee for a new appliance, and any excess fee by the same dentist/dental office is not billable to the patient on the same date of service.
- Relines include adjustments required within six months of delivery. Fees for adjustments by the same dentist/dental office are not billable to the patient if done within six months of initial placement.
- Benefits for adjustments beyond two in a 12 month interval are denied and chargeable to the patient.
- 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.
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 D5765 (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 D5765.
Frequently Asked Questions — D5765 (Soft Liner)
Quick answers for dental billers and treatment coordinators submitting claims for D5765.
What ICD-10 diagnosis codes link to dental procedure D5765?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D5765.
Can CDT code D5765 be billed to medical insurance?▾
Billing CDT D5765 (Soft Liner) 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 D5765?▾
Required claim attachments for CDT D5765 (Soft Liner) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D5765?▾
Standard commercial insurance frequency for D5765: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D5765?▾
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.