D5765 - Soft Liner
Soft liner for complete or partial denture.
- Procedure Code
- D5765
- Category
- Prosthodontics
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- 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 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|