D5110 is the CDT code for a conventional complete upper denture, made and delivered after the extraction sites have healed.
- When to use: The upper arch has no remaining teeth and the denture is delivered on a healed ridge, usually at least 6 to 8 weeks after the last extraction.
- When not to use: A denture seated the day the teeth are extracted is D5130, the conventional lower denture is D5120, and adjustments after the included period bill as D5410.
- Billing note: Most plans pay one complete denture per arch every five to seven years, so confirm the prior denture date and any pre-existing edentulism exclusion first.
What D5110 covers
D5110 reports a conventional complete denture on the maxillary (upper) arch: a removable prosthesis with a full set of artificial teeth on an acrylic resin base shaped to the healed ridge and palate. It applies when the arch has no remaining teeth and any extraction sites have healed enough for definitive impressions, typically at least 6 to 8 weeks after the last extraction.
The code includes the diagnostic impressions, bite registration, wax try-in, laboratory fabrication, delivery appointment, and the initial post-delivery adjustments within the standard delivery workflow. Bill it once, on the delivery date. The earlier visits don’t get separate code entries.
It does not cover:
- A conventional complete denture on the mandibular arch. Use D5120. A wrong arch is a common preventable rejection.
- An immediate complete denture delivered the same day as extractions. Use D5130 for the upper arch and D5140 for the lower.
- Partial dentures, including any case where natural teeth remain. Use the D5211–D5228 codes, which split by arch, base (resin, cast metal framework, or flexible), and immediate versus conventional delivery.
- Implant-supported overdentures. Use the D6110–D6113 series.
- Adjustments after the included period, relines, rebases, and repairs on an existing denture. See the post-delivery codes below.
Conventional versus immediate denture
The most consequential decision on a complete-denture claim is whether the prosthesis is conventional (D5110) or immediate (D5130).
Conventional (D5110):
- Extractions come first, followed by weeks to months of healing.
- Final impressions are taken on the healed, stable ridge.
- The denture is fabricated to the post-healing anatomy and delivered at a later appointment.
- It generally fits better long-term because the ridge has stabilized.
Immediate (D5130):
- Extractions and denture delivery happen the same day.
- Impressions are taken before the extractions, typically a few weeks earlier, on a model that includes the teeth to be removed.
- The patient leaves the surgical visit wearing the denture.
- It needs relines or a remake as the ridge resorbs over the following months.
Immediate suits patients who can’t be without teeth; conventional suits patients who can wait. The claim carries the code for the workflow actually delivered.
Top reasons D5110 gets denied or downgraded
- Frequency limit. The prior denture falls inside the plan’s five- or seven-year window. Confirm the prior denture date before the first impression, since a frequency denial after delivery is hard to walk back. An appeal documenting clinical necessity (lost denture, structural failure, ridge resorption requiring new fabrication) succeeds on some plans but not others.
- Pre-existing edentulism exclusion. Some newer commercial plans exclude prosthetic coverage on arches that were edentulous before the policy started. Verify before treatment planning.
- Immediate denture billed as D5110. The denture was delivered the same day as extractions. Recode as D5130 and resubmit. Carriers may catch this from the extraction history and request the correction.
- Missing documentation of edentulism. Some plans require proof the arch is fully edentulous. A panoramic radiograph or chart entry confirming no remaining teeth typically satisfies it.
The post-delivery sequence: adjustments, relines, repairs
D5110 ends at delivery. Everything after it bills separately, on its own date of service, with its own code and coverage rules. Treating post-delivery work as part of D5110 is the most common billing pitfall on complete dentures.
Adjustments:
- D5410 (adjust complete denture, maxillary).
- D5411 (adjust complete denture, mandibular).
Most plans include adjustments for a set window after delivery, and the length varies by plan (Blue Cross & Blue Shield of Rhode Island’s dental policy uses six months). After that, bill D5410 per adjustment visit.
Relines and rebases:
- D5710 (rebase complete maxillary).
- D5711 (rebase complete mandibular).
- D5730 (reline complete maxillary, chairside).
- D5731 (reline complete mandibular, chairside).
- D5750 (reline complete maxillary, laboratory).
- D5751 (reline complete mandibular, laboratory).
Relines and rebases are typically not covered for a period after the original denture, often 6 to 24 months, and have their own frequency limits afterward.
Repairs:
Repairs have separate frequency rules, and most plans cover them.
Documentation that supports the claim
The claim needs:
- Date of service: the delivery date, not the impression or wax try-in dates.
- Arch designation in the tooth code field (most PMSes use the upper arch indicator UA or area-of-oral-cavity code 01).
- A panoramic radiograph or other supporting documentation if the plan requires evidence of edentulism.
In the patient record, document:
- Impression and bite registration dates.
- Wax try-in date and patient acceptance.
- Delivery date.
- Material and shade selected.
- Post-delivery instructions and adjustment schedule.
- Date of the last extractions, if recent, to support the conventional workflow.
For a replacement denture, also record the prior denture’s date (for the frequency calculation) and the clinical reason for replacement.
Example case
A 68-year-old patient has worn a maxillary complete denture for 11 years. It has lost retention as the ridge resorbed, and the patient reports daily discomfort. The dentist confirms the ridge changes, takes diagnostic impressions, and treatment-plans a new conventional maxillary complete denture.
Treatment sequence:
- Visit 1: diagnostic impressions, shade selection.
- Visit 2: final impressions on custom trays.
- Visit 3: bite registration.
- Visit 4: wax try-in and patient verification.
- Visit 5: delivery of the new denture.
Billing steps:
- Verify denture coverage and the frequency rule (most likely 5 or 7 years). The 11-year-old prior denture is outside the window.
- Submit D5110 on the delivery date with arch designation 01 (upper).
- Attach a panoramic radiograph if the plan requires evidence of edentulism.
- Bill D5410 per adjustment visit after the delivery-included period.
Had the prior denture been inside the frequency window, the appeal would need to document clinical necessity: ridge resorption beyond what relining can address, structural failure of the existing base, or anatomic change that makes the existing denture unusable.
FAQs
- What's the difference between D5110 and D5130?
- D5110 is a conventional complete denture, made after the extraction sites have healed, typically 6 to 8 weeks or longer. D5130 is an immediate complete denture, delivered the same day the teeth are extracted and seated directly on the surgical sites. The workflows differ, so bill the code that matches what was delivered.
- What's the typical frequency limit on D5110?
- One complete denture per arch every five years on most plans, sometimes seven. The clock starts from the date of the prior covered denture, not from when the patient joined the plan. A replacement inside the window usually needs an appeal documenting clinical necessity, such as a lost denture, structural failure, or anatomic change requiring new fabrication.
- Why was D5110 denied for pre-existing edentulism?
- The plan excludes prosthetic coverage for arches that were already edentulous when the policy started, on the reasoning that the tooth loss predates coverage. Some newer commercial plans and a handful of marketplace plans carry this exclusion. It typically turns on documentation of the extraction date or the prior denture's delivery date. Check the plan's benefit booklet before treatment planning.
- Does D5110 include adjustments and relines?
- No. D5110 covers fabrication and delivery. Most plans treat adjustments in an initial window after delivery as part of the denture fee, and the window varies by plan (Blue Cross & Blue Shield of Rhode Island's dental policy uses six months). After that, adjustments bill as D5410. Relines bill as D5750 (laboratory) or D5730 (chairside), and repairs as D5512 (repair base) or D5520 (replace teeth), each with its own allowable.
- Can D5110 be billed on the same day as extractions?
- No. A denture placed the same day the teeth are extracted is D5130 (immediate complete denture, maxillary). Billing D5110 on the extraction date misrepresents the procedure and creates audit risk. The conventional workflow runs extractions, healing, impressions, fabrication, and delivery, with weeks or months between the first and last steps.
Related codes
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CDT codes are maintained by the American Dental Association. This page is an editorial billing guide, not the official ADA code descriptor. Verify current coverage policies with each carrier before submitting claims.