N.J. Admin. Code § 10:56-3.7 - D5000-D5899 PROSTHODONTICS (REMOVABLE)

(a) Complete dentures (including six months post delivery care):

Maximum Fee
HCPCS Allowance
IND Code Mod Procedure Description S $ NS
* D5110 Complete Denture--Maxillary 334.00 302.00

NOTE: Including denture I.D.

* D5120 Complete Denture--Mandibular 342.00 311.00

NOTE: Including denture I.D.

(b) Immediate complete dentures (six months post delivery care and placement of ID is included in fee):
1. Reimbursement also includes necessary rebases and/or relines for the six months following insertion.
2. In order to qualify for immediate denture reimbursement, the denture must involve the immediate replacement of anterior teeth which may include first premolars (teeth numbers 5 through 12 and 21 through 28 only). Second premolars and molars must not be included among the qualifying teeth. The date of insertion of a denture and the extractions must carry an identical date of service. List tooth code(s) of teeth involved.

* D5130 Immediate Denture--Maxillary 365.00 332.00

NOTE 1: Replacing 1 through 4 teeth

* D5130 22 Immediate Denture--Maxillary 392.00 353.00

NOTE 1: Replacing 5 through 8 teeth

* D5140 Immediate Denture--Mandibular 372.00 338.00

NOTE 1: Replacing 1 through 4 teeth

* D5140 22 Immediate Denture--Mandibular 400.00 363.00

NOTE 1: Replacing 5 through 8 teeth

(c) Partial dentures (including six month post delivery care):

* D5211 Maxillary Partial Denture--Resin 275.00 250.00
Base (Including any conventional
clasps, rests and teeth)
* D5211 52 Maxillary Partial Denture--Resin 186.00 173.00
Base (Including teeth--no clasps)
* D5212 Mandibular Partial Denture--Resin 275.00 250.00
Base (Including any conventional
clasps, rests and teeth)
* D5212 52 Mandibular Partial Denture--Resin 186.00 173.00
Base (Including teeth--no clasps)
* D5213 Maxillary Partial Denture--Cast 361.00 328.00
Metal Framework with Resin Denture
Bases (Including any conventional
clasps, rests and teeth)
* D5214 Mandibular Partial Denture--Cast 342.00 311.00
Metal Framework with Resin Denture
Bases (Including any conventional
clasps, rests and teeth)
(d) Immediate replacement of anterior teeth in conjunction with partial dentures (codes D5211 through D5214 only) in addition to denture, maximum six teeth (Teeth numbers 6 through 11 and 22 through 27 only).
1. Immediate partial dentures--Reimbursement also includes necessary rebases and/or relines for the six months following insertion.

* Y2505 Immediate Replacement of Anterior 11.00 10.00
Teeth--Per Tooth

NOTE: List tooth code(s) of tooth being replaced.

(e) Adjustments to dentures--other than dentist providing denture or after the required period of post delivery care.

D5410 Adjust Complete Denture--Maxillary 10.00 9.00
D5411 Adjust Complete Denture--Mandibular 10.00 9.00
D5421 Adjust Partial Denture--Maxillary 10.00 9.00
D5422 Adjust Partial Denture--Mandibular 10.00 9.00
(f) Repairs to complete dentures:
1. Repair Broken Complete Denture Base:
i. Includes replacing teeth on denture

D5510 YU Repair Broken Complete Denture Base 49.50 45.00

NOTE: Maxillary--Upper

D5510 YL Repair Broken Complete Denture Base 49.50 45.00

NOTE: Mandibular--Lower.

D5520 Replace Missing or Broken 15.00 15.00
Teeth--Complete Denture (Each
Tooth)

NOTE 1: Code may be used in addition to codes D5510 YU or YL above.

NOTE 2: List tooth codes of teeth being replaced.

(g) Repairs to partial denture:

D5610 YU Repair Resin Denture Base 49.50 45.00

NOTE: Maxillary.

D5610 YL Repair Resin Denture Base 49.50 45.00

NOTE: Mandibular.

D5620 Repair Cast Framework 33.00 30.00

NOTE 1: Welding in addition to repair procedure(s), limit two welds per denture.

NOTE 2: May be used in conjunction with other repair procedures or as a separate repair procedure.

D5630 YU Repair or Replace Broken Clasp 76.50 72.00

NOTE 1: Maxillary.

NOTE 2: Maximum two.

D5630 YL Repair or Replace Broken Clasp 76.50 72.00

NOTE 1: Mandibular.

NOTE 2: Maximum two.

D5640 Replace Broken Teeth--Per Tooth 15.00 15.00

NOTE 1: Code D5640 may be used in addition to partial denture repair procedure(s), D5610 YU or YL above.

D5650 Add Tooth to Existing Partial 66.00 60.00
Denture

NOTE 1: To replace extracted tooth. (List tooth code being replaced).

NOTE 2: For additional replacements beyond the first tooth, use code D5640. List tooth (teeth) being replaced.

D5660 YU Add Clasp to Existing Partial 76.50 72.00
Denture

NOTE 1: Maxillary--First Clasp.

NOTE 2: List tooth code being clasped.

NOTE 3: Maximum two.

D5660 YL Add Clasp to Existing Partial 76.50 72.00
Denture

NOTE 1: Mandibular--First Clasp.

NOTE 2: List tooth being clasped.

NOTE 3: Maximum two.

(h) Denture rebase procedures:

D5710 Rebase Complete Maxillary Denture 132.00 120.00
D5711 Rebase Complete Mandibular Denture 132.00 120.00
D5720 Rebase Maxillary Partial Denture 124.00 113.00
D5721 Rebase Mandibular Partial Denture 124.00 113.00
(i) Denture relining procedures:

D5730 Reline Complete Maxillary Denture 29.00 26.00
(Chairside)
D5731 Reline Complete Mandibular Denture 29.00 26.00
(Chairside)
D5740 Reline Maxillary Partial Denture 29.00 26.00
(Chairside)
D5741 Reline Mandibular Partial Denture 29.00 26.00
(Chairside)
D5750 Reline Complete Maxillary Denture 99.00 90.00
(Laboratory)
D5751 Reline Complete Mandibular Denture 99.00 90.00
(Laboratory)
D5760 Reline Maxillary Partial Denture 91.00 83.00
(Laboratory)
D5761 Reline Mandibular Partial Denture 91.00 83.00
(Laboratory)
(j) Other removable prosthetic services:

D5860 Overdenture--complete 342.00 311.00
D5862 Precision attachment 150.00 150.00
D5867 Replacement of replaceable part of 75.00 75.00
semi-precision or precision
attachment (male or female
component)
* D5899 Unspecified Removable BR BR
Prosthodontic Procedure, By Report

Notes

N.J. Admin. Code § 10:56-3.7
Public notice: Pursuant to the provisions of N.J.S.A. 30:4D-2, 3, 5, 6 and 7 and the New Jersey Appropriations Act (P.L. 1988, c.47), maximum fee allowances increased at (i), (j) and (k) effective 10/1/1988, January 1, 1989 and April 1, 1989.
See: 20 N.J.R. 2101(a).
Administrative Correction: In (k) 05212 effective 4/1/1989 corrected 140.00 to 165.00.
As amended by R.1989 d.135.
See: 20 N.J.R. 2558(a), 21 N.J.R. 760(a).
(k)1 deleted and NOTE changed to "a minimum of 2 cast chrome casts with rests".
Amended by R.1996 d.428, effective 9/16/1996.
See: 28 N.J.R. 3069(a), 28 N.J.R. 4243(a).
Amended by R.2000 d.426, effective 10/16/2000.
See: 32 N.J.R. 2411(a), 32 N.J.R. 3836(a).
Changed Maximum Fee Allowances throughout.
Amended by R.2003 d.16, effective 1/6/2002.
See: 34 N.J.R. 2681(a), 35 N.J.R. 232(a).
Rewrote the section.

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