D5222 is the CDT code for an immediate lower partial denture on a resin base, seated the same day the failing lower teeth are extracted.
- When to use: The patient keeps some lower teeth, the resin partial was made before surgery, and it goes in on the same date as the extractions.
- When not to use: The upper immediate is D5221, a lower resin partial on a healed ridge is D5212, a flexible immediate is D5228, and an interim lower stayplate is D5821.
- Billing note: Lower immediates loosen early, and a D5741 or D5761 reline billed inside the plan's post-delivery waiting period denies, so get that window at verification.
What D5222 covers
D5222 reports an immediate resin-base partial denture on the mandibular (lower) arch, for a patient who keeps some lower teeth. Impressions are taken while the failing teeth are still present, the lab fabricates against the predicted post-surgical ridge, and extraction and delivery happen in the same visit, so the patient never leaves without lower teeth. The one fee covers the clasping, rests, replacement teeth, records, fabrication, delivery, and the limited follow-up care the code’s scope allows. By that same scope, it excludes future relines and rebases.
It does not cover:
- The upper-arch immediate resin partial. That is D5221.
- A conventional lower resin partial on a healed ridge. That is D5212.
- An immediate lower partial on a cast metal framework (D5224) or flexible nylon base (D5228).
- The same-day extractions, which bill per tooth on D7140 or D7210.
- The later refit: D5741 (chairside reline, mandibular partial), D5761 (laboratory reline), or D5721 (rebase).
- An interim lower partial worn while an implant, bridge, or other treatment is pending. That is D5821.
- An immediate complete lower denture when the whole arch is cleared. That is D5140.
Why the lower arch changes the billing timeline
The mandibular ridge resorbs faster after extractions than the maxilla, and a lower partial has no palate to distribute load; it rides a narrower ridge between the tongue and the cheeks. On an immediate case that changes the billing:
- The fit deteriorates sooner. The reline a D5222 case is built to need often becomes clinically necessary earlier than on a D5221 upper. Calendar it at delivery.
- The reline waiting period matters more. If the plan holds relines behind a post-delivery window and the lower loosens before it closes, the patient waits with a rocking partial, pays out of pocket, or the office manages with adjustments in the meantime.
- Adjustment visits cluster early. Adjustments beyond the included follow-up bill on D5422 (adjust partial denture, mandibular). D5421 is the maxillary partial adjustment, a pairing that has produced wrong-arch denials. Don’t use the maxillary or complete-denture equivalents for any of the follow-up codes.
Waiting periods, adjustment allowances, and reline frequency rules all vary by plan. Pull the actual numbers during verification, because the lower arch tests them sooner.
Top reasons D5222 gets denied
- Wrong arch on the claim. D5221 and D5222 differ only in arch, and the extraction tooth numbers on the same claim give the carrier something to cross-check. A lower partial with upper extraction codes bounces, so check the code against the extraction teeth before the claim goes out.
- Reline billed inside the waiting period. The early refit denies as part of the prosthesis benefit if it lands inside the plan’s post-delivery window. Timing, not coding.
- Frequency limit. A prior covered lower partial inside the plan’s replacement window, commonly five years or more and plan-dependent, blocks the new one without an appeal showing why replacement is necessary.
- Missing-tooth clause on the older gaps. Teeth extracted at delivery are lost under current coverage, but teeth lost before the effective date may be carved out of the payment or, on some plans, used to deny the prosthesis. Ask during verification how the plan applies it.
- Interim appliance billed as definitive. A transitional stayplate submitted as D5222 misrepresents the treatment plan, and the definitive prosthesis that follows will then run into the frequency limit the immediate partial started.
Documentation that supports the claim
- Delivery-date claim with the mandibular arch designation and the per-tooth extraction codes on the same date of service.
- Pre-extraction radiograph and treatment plan showing the teeth being removed and the abutments that remain.
- Chart notes: pre-surgical impression date, ridge condition at delivery, the adjustment schedule, and the anticipated reline timeline, which later supports the D5741 or D5761 claim.
- The date each replaced tooth was lost, for the missing-tooth clause.
FAQs
- What's the difference between D5222 and D5221?
- The arch. D5222 is the immediate resin partial on the mandibular (lower) arch, and D5221 is the maxillary (upper) version. Everything else matches: fabricated before the extractions, seated the day the teeth come out, resin base, with the clasps, rests, and teeth in the one fee. Because the arch designation is the only structural difference, it is also the easiest field to get wrong.
- What's the difference between D5222 and D5212?
- Delivery timing. D5212 is the conventional lower resin partial, made on a ridge that has already healed. D5222 is fabricated in advance and seated over the fresh extraction sites the same day the teeth are removed. If the partial and the extractions share a date of service, the code is D5222.
- When can the reline on an immediate lower partial be billed?
- As its own claim, on its own date, after the plan's post-delivery waiting period. D5222 explicitly excludes future relining, so the refit uses the mandibular partial codes: D5741 chairside or D5761 laboratory, or D5721 for a full rebase. Many plans won't cover a reline within a set period after a new prosthesis, and the length varies by plan. Lower immediates loosen early, so the clinical need can arrive before coverage does; verify the window before quoting a covered refit.
- Is a lower flipper the same thing as D5222?
- No. An interim lower partial, the transitional appliance sometimes called a lower flipper or stayplate, is D5821, worn while a definitive restoration is pending. D5222 is a definitive prosthesis that happens to be delivered immediately after extractions. Plans treat the two benefits differently, and some exclude interim appliances entirely, so bill the code that matches the treatment plan's intent.
Related codes
Need help billing this code?
We handle D5222 claims daily.
If your team is spending time on denials, narratives, or carrier follow-up for this code, our outsourced dental insurance billing service can take it off your plate. We submit the claims, post what comes back, and follow up on anything unpaid. Already sitting on older claims that never paid? Our AR cleanup project works the backlog.
“Claims, posting, denials, all of it gets handled, and it costs far less than hiring another employee. My front desk got hours of their week back, and honestly I just don't think about billing anymore.”
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.