D6057 - Custom Abutment
Custom fabricated abutment includes placement.
- Procedure Code
- D6057
- Category
- Implant Services
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- Frequency Limitation
- 1 per tooth/site in a 60-month interval (5 years) (rolling_12_months)
- Age Limitation
- Restricted to patients age 19 or older. Implants are not a benefit for patients under 19 years of age.
Required Claim Attachments & Pre-Submission Checklist
- Post-operative radiograph or surgical operative report
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.
- Benefits are denied, unless the group/individual contract specifies that implant services are a benefit.
- All services and treatment provided remotely via tele-health modalities, be they synchronous or asynchronous, must be performed by a licensed dentist or their supervised staff, acting within the scope of applicable law. Services and treatment delivered virtually are only a benefit when the elements included in the descriptor of the CDT procedure code are completed and only when they meet generally accepted clinical guidelines.
- Fees for repairs to implant prosthesis 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.
- 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 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 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K08.409 | Partial loss of teeth, unspecified cause, unspecified class | Other disorders of teeth and supporting structures | Yes (Primary) | BOTH | custom fabricated abutment – includes placement indicated for Partial loss of teeth, unspecified cause, unspecified class |
| K00.00 | Anodontia | Disorders of tooth development and eruption | Secondary | BOTH | custom fabricated abutment – includes placement indicated for Anodontia |
| K08.419 | Partial loss of teeth due to trauma, unspecified class | Other disorders of teeth and supporting structures | Secondary | BOTH | custom fabricated abutment – includes placement indicated for Partial loss of teeth due to trauma, unspecified class |
| K08.429 | Partial loss of teeth due to periodontal diseases, unspecified class | Other disorders of teeth and supporting structures | Secondary | BOTH | custom fabricated abutment – includes placement indicated for Partial loss of teeth due to periodontal diseases, unspecified class |
| K08.439 | Partial loss of teeth due to caries, unspecified class | Other disorders of teeth and supporting structures | Secondary | BOTH | custom fabricated abutment – includes placement indicated for Partial loss of teeth due to caries, unspecified class |
| K08.499 | Partial loss of teeth due to other specified cause, unspecified class | Other disorders of teeth and supporting structures | Secondary | BOTH | custom fabricated abutment – includes placement indicated for Partial loss of teeth due to other specified cause, unspecified class |