Provider updates

Immediate and complete dentures: what is the difference? One of the most common referral errors we receive from our primary dental providers is the incorrect use of these codes.

A complete denture (D5110, D5120) requires all planned extractions to be complete and a period of healing to occur prior to fabrication of the denture. An immediate denture (D5130, D5140) is fabricated prior to extractions and inserted immediately following the extractions. We commonly receive referrals for complete dentures even though teeth planned for extractions are still present. This also applies to partial dentures (D5211, D5212).

Complete = tooth extractions completed when referral is submitted.

Immediate = teeth still present and denture to be inserted immediately at the time of extractions.

Referrals for complete dentures (D5110, D5120) should be submitted after all planned extractions are complete. This will prevent the patient from receiving a denial letter for services that might otherwise be covered and will help you, the provider, in completing your patient’s treatment. Denturists we work with are prompt in contacting patients who have been referred to them. The denturist will contact the patient as soon as they receive the referral. If the patient still has teeth, but is planned for a complete denture, this may result in a scheduling error. The patient may accidentally schedule an appointment with the denturist prior to extractions or prior to healing from extractions. We want to avoid unnecessary appointment scheduling with our valuable specialty providers, which can result in lost production. We also want to avoid unnecessary appointments for our members which may require travel expense, lost work hours, child care or other burdens.

If there is a question about whether a patient is eligible for a partial or complete denture, a CareOregon Dental pre-authorization request can be submitted prior to the extractions.