Prosthodontic Coding for Dental Practices

Accurate prosthodontic coding is essential for dental practice success. Precise code selection accelerates insurance reimbursement, reduces claim denials, and ensures compliance with payer requirements. Whether coding bridges, dentures, partials, or implant-supported prostheses, understanding the correct CDT codes, documentation requirements, and coverage limitations is critical for your practice.

According to the American Dental Association (ADA), precise dental coding reduces administrative errors and streamlines practice revenue cycle management.

This article covers all major prosthodontic procedures, provides step-by-step coding workflows, identifies common coding errors, and reviews the latest 2026 CDT updates. 

You’ll find comprehensive code tables and actionable strategies to improve claim accuracy and maximize reimbursement for prosthodontic services.

Why Prosthodontic Coding Matters?

Prosthodontic coding assigns standardized CDT codes to prosthodontic procedures for accurate insurance billing and clinical documentation. These codes, maintained by the ADA, ensure consistent communication between dental practices and insurance carriers.

Prosthodontic coding includes

• Fixed Prosthodontics: Bridges, veneers, and inlays/onlays
• Removable Prosthodontics: Complete dentures, partial dentures, relines, rebases, and repairs
• Implant Prosthodontics: Implant-supported crowns, implant bridges, overdentures, and abutments

Precise code selection ensures:

• Proper reimbursement
• Reduces claim denials
• Maintains compliant clinical records

What Procedures Are Included in Prosthodontics?

Prosthodontic procedures restore function and aesthetics through the fabrication and placement of dental prostheses. These procedures are divided into three main categories based on the type of restoration.

Fixed Prosthodontics (Bridges, Veneers)

Fixed restorations are permanently cemented and cannot be removed by the patient.

Crowns

• Porcelain-fused-to-metal (PFM): Metal substructure with porcelain overlay for strength and aesthetics
• Full cast metal: Gold or base metal crowns for posterior teeth requiring maximum durability
• All-ceramic: Zirconia or lithium disilicate crowns for optimal esthetics in anterior regions

Bridges

• Traditional fixed bridges: Pontic (artificial tooth) supported by crowns on adjacent abutment teeth
• Cantilever bridges: Pontic anchored on one side only, typically used when only one adjacent tooth is available

Veneers

• Porcelain laminate veneers: Thin ceramic shells bonded to anterior teeth to improve shape, color, or alignment
• Composite resin veneers: Direct or indirect resin restorations for conservative esthetic enhancement

Removable Prosthodontics (Dentures, Partials, Adjustments)

Removable prostheses can be taken out by the patient for cleaning and maintenance.

Complete Dentures

• Conventional complete dentures: Full-arch prostheses for fully edentulous patients (maxillary or mandibular)
• Immediate dentures: Placed immediately after extractions to maintain function during healing

Partial Dentures

• Cast metal framework partials: Durable cobalt-chromium or titanium framework with clasps for retention
• Flexible partials (Valplast): Thermoplastic nylon-based dentures for patients with metal allergies or clasp concerns
• Acrylic interim partials: Temporary prostheses used during healing or fabrication of definitive restorations

Adjustments and Repairs

• Relines: Adding new acrylic to the denture tissue surface to improve fit as bone resorbs
• Rebases: Replacing the entire denture base while retaining existing teeth
• Repairs and additions: Fracture repair, tooth replacement, or clasp adjustments

Implant Prosthodontics (Implant Crowns, Abutments, Overdentures)

Implant-supported restorations provide fixed or removable options anchored to osseointegrated implants.

Single-Unit Restorations

• Implant-supported crowns: Individual crown cemented or screw-retained on a single implant, commonly used for replacing single missing teeth

Multi-Unit Restorations

• Implant-supported bridges: Fixed prostheses spanning multiple units, supported by two or more implants
• Full-arch implant bridges: Fixed complete dentures supported by 4–6 implants (e.g., All-on-4 or All-on-6 protocols)

Implant Overdentures

• Bar-retained overdentures: Removable denture clipped onto a bar connecting multiple implants
• Locator-retained overdentures: Denture snapped onto individual locator abutments for improved retention and stability

Abutments

• Prefabricated abutments: Stock titanium or zirconia components for standard implant connections
• Custom abutments: CAD/CAM-designed abutments for optimal emergence profile and esthetics in challenging cases

How Do You Code Fixed Prosthodontics?

Fixed prosthodontic procedures use codes from two main series: D6200–D6999: Bridges, pontics and retainers

Tip: Always select codes based on the exact material and prosthesis component. Material misclassification is a common cause of denials in dental billing and coding.

How Do You Code Removable Prosthodontics?

Removable prosthodontic procedures use codes from the D5000–D5899 series and cover complete dentures, partial dentures, adjustments, repairs, and maintenance procedures.

How Do You Code Implant Prosthodontics?

Implant prosthodontics codes generally fall under D6000–D6199. Examples:

What Documentation Is Required to Support Prosthodontic CDT Codes?

Proper documentation is essential for claim approval and minimizing insurance denials. For prosthodontic procedures, ensure the following items are documented accurately:

Radiographs: Include clear pre-treatment and post-treatment radiographs showing tooth structure, bone levels, and adjacent anatomy. Bitewing, periapical, or panoramic images should demonstrate the clinical need for the prosthodontic restoration.

Clinical Chart Notes: Document the diagnosis (e.g., fractured tooth, missing teeth, edentulous arch), treatment plan, and informed consent. Notes should justify the specific CDT code billed and include any prosthesis specifications.

Intraoral Photographs or Digital Scans: Capture pre-treatment and post-treatment images, especially for esthetic cases (veneers, anterior crowns) and complex restorations (implant-supported prostheses, full-mouth rehabilitations). Many payers require visual documentation for prior authorization.

Material Specifications: Specify the exact material used:

• Crown substrate: zirconia, lithium disilicate, PFM (high noble, noble, or base metal)
• Denture base: heat-cured acrylic, flexible thermoplastic
• Partial framework: cast chrome-cobalt, titanium, or acrylic resin

Material documentation affects code selection and reimbursement rates.

Procedure Dates: Record all relevant dates:

• Initial exam and diagnosis date
• Tooth preparation date
• Impression date
• Temporary prosthesis placement date (if applicable)
• Final restoration delivery/insertion date
• Follow-up adjustment dates

Accurate date documentation helps insurers verify frequency limitations, waiting periods, and coverage eligibility.

Step-by-Step Prosthodontic Coding Workflow

1. Treatment Planning & Diagnosis

Determine the specific prosthodontic treatment needed for bridge, denture, partial, or implant restoration. Document the tooth number(s), arch (maxillary or mandibular), and clinical indication for treatment (e.g., missing teeth, edentulous arch, failed prosthesis).

Example: Patient is missing tooth #9 with healthy abutments #8 and #10. Diagnosis: Single missing anterior tooth. Treatment plan: 3-unit PFM bridge with retainers on #8, #9, #10 (D6750, D6240, D6750).

2. Code Selection

Select the appropriate CDT code based on the restoration type, material, and location. Match the procedure exactly to avoid claim denials.

Example: For a 3-unit all-ceramic bridge replacing tooth #7 (pontic) with retainers on #6 and #8, use D6740 (retainer crowns) and D6245 (ceramic pontics), not D6240 (PFM pontics).

3. Documentation Verification

Before claim submission, confirm all required documentation is complete:

• Pre-treatment radiographs
• Clinical chart notes with diagnosis
• Material specifications
• Intraoral photographs (if required by payer)
• Patient consent and treatment plan

Example: For a porcelain/ceramic crown (D6058), attach a periapical radiograph showing osseointegrated implant and abutment placement date.

4. Claim Submission

Submit the claim with accurate CDT codes and payer-required attachments. Include narratives for complex cases and verify coverage limitations (frequency limits, waiting periods, annual maximums).

Example: Submitting D5110 (complete maxillary denture), attach pre-extraction panoramic radiograph, and note that the patient is fully edentulous.

5. Claim Tracking & Appeals

Monitor claim status until payment is received. If denied, review the explanation of benefits (EOB), identify missing documentation or coding errors, and submit a corrected claim or formal appeal with supporting evidence.

Example: Claim for D6066 (implant-supported PFM crown) denied for “missing documentation”, resubmit with implant placement date (D6010) and radiograph showing implant integration.

Most Common Prosthodontic Coding Errors

Avoid these frequent mistakes that delay reimbursement:

Incorrect Code Selection

• Using repair codes (D5610) instead of replacement codes (D5211) when fabricating a new partial denture
• Coding pontic repair (D6980) when a complete bridge replacement was performed

Missing Documentation

• Submitting bridge codes without pre-treatment X-rays showing abutment tooth condition
• Failing to provide photos for implant cases requiring prior authorization

Anatomical Errors

• Recording the wrong arch (maxillary vs. mandibular) for denture or partial codes
• Incorrect tooth numbering for bridge pontics or retainers

Implant Coding Confusion

• Using abutment-supported crown codes (D6058) for screw-retained restorations (D6065)
• Billing D6057 (custom abutment) separately when the payer’s contract already includes it in the implant crown fee (D6058–D6066)

Incomplete Claims

• Missing material details (high noble vs. base metal) for bridge retainers
• Omitting dates for frequency-limited prosthodontic procedures (e.g., denture relining within 6 months)

How Do You Prevent Denials for Prosthodontic Claims?

Preventing claim denials requires proactive verification, accurate documentation, and adherence to payer policies. Many practices use dental billing and coding services to handle these complex verification and coding tasks, allowing clinical staff to focus on patient care. Follow these best practices to maximize claim acceptance:

Verify Eligibility and Benefits Before Treatment

Confirm active coverage, remaining annual maximums, deductible status, and specific prosthodontic benefits. Check for waiting periods on major restorations (crowns, bridges) and coverage limitations for materials (e.g., posterior all-ceramic crowns may require downgrading to PFM).

Document Comprehensively

Maintain complete clinical records, including:

• Pre-treatment radiographs showing tooth condition or bone levels
• Detailed chart notes with diagnosis and clinical justification
• Material specifications (substrate type, metal classification)
• Intraoral photographs for aesthetic cases
• Patient consent and treatment plan acceptance

Use Procedure-Specific Checklists

Create verification checklists for each prosthodontic category:

• Bridges: Pontic/retainer documentation, abutment teeth, span length
• Dentures: Edentulous status confirmed, impressions documented, try-in notes
• Implants: Implant placement date (D6010), osseointegration verified, abutment type

Stay Current with CDT Code Updates

Review annual CDT changes published by the ADA in January. Make sure you’re using the latest codes. Outdated codes get denied automatically.

Follow Payer-Specific Requirements

Review each insurance carrier’s policies for:

• Frequency limitations (e.g., one crown per tooth every 5 years)
• Material downgrades or alternate benefit clauses
• Prior authorization requirements for high-cost procedures
• Narrative requirements for complex cases
• Exclusions (cosmetic veneers, implant coverage restrictions, etc.)

Submit Clean Claims on First Attempt

Ensure claims include:

• Correct CDT codes matched to procedures performed
• Accurate tooth numbers and arch designations
• All required attachments per payer guidelines
• Procedure dates that align with eligibility periods

Do Prosthodontic Procedures Require Prior Authorization?

Yes, many dental insurance plans require pre-authorization before they approve certain prosthodontic treatments.

This is especially true for:

• Complete dentures
• Multi-unit dental bridges
• Implant-supported restorations

To get pre-authorization approved, a dental practice should send:

• Procedure details (what treatment will be done and why)
• Tooth numbers or arch information (maxillary or mandibular)
• Material information (e.g., acrylic denture, zirconia crown, PFM bridge)
• Supporting radiographs and clinical photos that show the need for treatment

This helps insurance reviewers understand the case clearly and increases the chances that the prosthodontic claim will be approved without delays.

When Should Prosthodontic Procedures Be Billed to Medical Insurance?

Prosthodontic procedures can be billed to medical insurance only when treatment is required due to a medical condition, not routine dental needs. Medical-dental crossover billing applies in these specific situations:

1. Traumatic Injury or Accidents

When teeth, supporting bone, or jaw structures are damaged due to accidental trauma, medical insurance may cover prosthodontic restoration necessary to restore function and appearance.

Example: A 28-year-old patient loses teeth #7, #8, and #9 in a motor vehicle accident. Medical insurance covers the 3-unit bridge because the tooth loss resulted from accidental trauma, not dental disease.

ICD-10 Code: S02.5 (Fracture of tooth) or S03.2 (Dislocation of tooth)

2. Congenital Anomalies or Developmental Conditions

Medical insurance may cover prosthodontic treatment when tooth loss or malformation results from conditions present at birth or developmental abnormalities affecting oral structures.

Example: A 16-year-old patient with a cleft lip and palate (repaired) is congenitally missing teeth #7 and #10 (hypodontia). Medical insurance covers implant placement (D6010) and implant-supported crowns (D6058) to restore normal function and esthetics.

ICD-10 Code: Q35.9 (Cleft palate) or K00.0 (Anodontia/hypodontia)

3. Systemic Disease or Medical Treatment Complications

When tooth loss or bone destruction occurs due to cancer treatment, radiation therapy, chemotherapy side effects, or systemic disease, prosthodontic restoration may be medically necessary and covered by medical insurance.

Example: A 55-year-old patient undergoes radiation therapy for oral cancer, resulting in osteoradionecrosis and loss of teeth #18–#21. Medical insurance covers a partial denture (D5213) to restore chewing function after medically necessary extractions.

ICD-10 Code: M87.180 (Osteoradionecrosis of jaw) or C00-C14 (Malignant neoplasm of oral cavity)

CDT Updates Affecting Prosthodontic Coding In 2026

Digital Fabrication Codes: CDT now includes codes for digitally made bridges, dentures, and partials using CAD/CAM technology or 3D printing. You can also bill for intraoral scans used as impressions.

Clearer Material Classifications: Bridge and implant codes now clearly separate metal types (high noble, noble, base metal) and ceramic types (zirconia, lithium disilicate). You must document exactly which material you used.

Stricter Date Documentation: Insurance now wants all these dates recorded: preparation date, impression date, try-in date (if done), and final delivery date. This proves coverage is active and procedures aren’t done too frequently.

Digital Documentation Accepted: Most insurance companies accept digital impressions, scans, and STL files as proof. AI tools can help suggest codes from your notes, but a dental professional must check and approve the final code before submitting.

Payer Limitations Affecting Prosthodontic Coverage

Age Limits: Many insurance plans only cover dentures for patients 18 and older. For younger patients, coverage may require special approval or fall under medical insurance if related to birth defects.

Frequency Limits: Most insurance allows one denture replacement every 5–7 years per arch (upper or lower). Bridges and implants have similar timeframes. To replace a prosthesis early, you need to show it has failed or document medical necessity.

What’s Not Covered: Cosmetic treatments (like veneers for appearance only) usually aren’t covered. Some plans don’t cover implants at all, or only cover them for specific medical reasons.

Downgrade Clauses: Insurance may only pay for the cheapest acceptable option. For example, if you get an all-ceramic bridge, they might only reimburse what a metal bridge costs. The patient pays the difference.

Should You Outsource Prosthodontic Coding?

Partnering with an expert billing company for prosthodontic procedures helps practices maintain compliance, optimize reimbursement, and allow clinical staff to focus on patient care.

• Reduce errors and claim denials
• Save your staff’s time so they can focus on patients
• Keep your coding accurate and compliant with payer and CDT rules
• Improve reimbursements, especially for crowns, bridges, dentures, and implant cases

You can achieve that by choosing to work with a trusted company such as TransDental, which specializes in dental billing & coding, having strong experience in implant prosthodontics, fixed prosthodontics, and removable prosthodontics, making them a reliable partner for practices that want clean, correct coding and faster payments.

Conclusion

Accurate prosthodontic coding is essential for smooth dental billing, faster insurance payments, and fewer claim denials. By using the correct CDT codes, documenting procedures properly, and following insurance rules, dental practices can improve efficiency and avoid common errors. 

Whether you are handling bridges, dentures, or implants, careful coding and proper documentation make a big difference. Staying updated with 2026 CDT codes, payer requirements, and best practices ensures your prosthodontic claims are approved quickly and correctly.

Frequently Asked Questions (FAQs)