D5222 is the CDT code for an immediate partial denture on the lower arch with a resin (acrylic) base, made ahead of the surgery and delivered the day the condemned mandibular teeth are extracted, clasps, rests, and teeth included.
Lower immediates loosen faster than uppers. The mandibular ridge resorbs more aggressively after extractions and gives the base less surface to grip, so a D5222 case tends to reach the reline conversation months before its maxillary twin, often while the plan's post-delivery waiting period is still running. Getting the refit covered is mostly a scheduling problem, and it starts at verification.
What D5222 covers
D5222 reports an immediate partial denture on the mandibular (lower) arch with a resin base. The sequence is what earns the “immediate”: impressions while the doomed teeth are still present, lab fabrication against the predicted post-surgical ridge, then extraction and delivery in the same visit so the patient never leaves without lower teeth. The one fee carries the retentive clasping, rests, replacement teeth, records, fabrication, delivery, and the limited follow-up care the code’s scope allows, and, by that same scope, no future relines or 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 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 other treatment finishes. 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 clinical difference between the arches becomes a billing difference on immediate cases. The mandibular ridge resorbs faster after extractions than the maxilla, and a lower partial has no broad palate-equivalent to distribute load; it rides a narrower ridge between the tongue and the cheeks. On an immediate case that means:
- The fit deteriorates sooner. The reline a D5222 case is built to need often becomes clinically necessary earlier than on a D5221 upper.
- The plan’s reline waiting period matters more. If the plan holds relines behind a post-delivery window and the lower loosens before it closes, the patient either waits with a rocking partial, pays out of pocket, or the office manages with adjustments in the interim.
- Adjustment visits cluster early. Post-delivery adjustments beyond the included follow-up bill on D5422 (adjust partial denture, mandibular). Note the arch: D5421 is the maxillary partial adjustment, a pairing that has produced wrong-arch denials before.
None of those timelines are universal. Waiting periods, adjustment allowances, and reline frequency rules all vary by plan; the point is to pull the actual numbers during verification because the lower arch will test them sooner.
When to bill D5222
Bill D5222 when the patient keeps some lower teeth, the partial was fabricated before the surgical visit, the base is acrylic resin, and delivery happens the day of the extractions. If the ridge healed first, it’s D5212. If the appliance is transitional while an implant or bridge is pending, it’s D5821. If the base is flexible nylon, it’s D5228; a cast framework case is D5224.
Top reasons D5222 gets denied
- Wrong arch on the claim. D5221 and D5222 differ only in arch, and the immediate-partial workflow (surgery plus prosthesis on one claim) gives the carrier extraction tooth numbers to cross-check against. A lower partial with upper extraction codes bounces.
- Reline billed inside the waiting period. The early refit the lower arch demands 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, 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 current; 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 fight 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, the note that later supports the D5741/D5761 claim.
- The date each replaced tooth was lost, for the missing-tooth clause.
What to get right in your PMS
- Lock the arch. Immediate resin partial, lower arch, is D5222. Check it against the extraction tooth numbers before the claim leaves.
- Calendar the reline for a lower immediate at delivery. The mandibular timeline is compressed; get the plan’s waiting period on record and schedule the refit claim against it.
- Use the mandibular partial follow-up codes. D5422 for adjustments, D5741/D5761 for relines, D5721 for a rebase, not the maxillary or complete-denture equivalents.
- Keep interim and definitive intent separate. A stayplate is D5821; D5222 is the definitive immediate. The frequency clock cares which one you filed.
FAQs
- What's the difference between D5222 and D5221?
- The arch. D5222 is the immediate resin partial on the mandibular (lower) arch; D5221 is the maxillary (upper) version. Everything else matches: fabricated before the extractions, seated the day the teeth come out, resin base, clasps and rests and teeth in the one fee. The arch designation on the claim is the only structural difference, which also makes it 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, using the mandibular partial reline codes: D5741 chairside or D5761 laboratory (D5721 for a full rebase). D5222 explicitly excludes future relining. The catch is timing: many plans won't cover a reline within a set period after delivering a new prosthesis, and the length varies by plan. Because lower immediates loosen early, the clinical need can arrive before the coverage does; verify the window before quoting the patient 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 intent that matches the treatment plan.
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.