D5520 is the CDT code for replacing a missing or broken tooth on a complete denture, reported once for each tooth that is replaced.
Per-tooth is the whole game on this code. One D5520 fee covers one replaced tooth, so a three-tooth repair goes out as three lines (or a quantity of three), and underbilling it as a single line is self-inflicted revenue loss no carrier will correct for you. The other filter is the prosthesis: D5520 belongs to complete dentures only. A tooth on a partial is D5640, an entirely different code family.
What D5520 covers
D5520 reports replacing a tooth on a complete denture: either a prosthetic tooth that fractured or one that popped out of the base entirely and is missing. The fee, charged once per tooth, covers removing what remains of the failed tooth, setting and processing a replacement into the base, and verifying the occlusion at delivery. The denture itself stays in service; only the tooth is renewed.
The code carries no arch designation. Unlike the base-repair pair (D5511 lower / D5512 upper), one code serves both arches, with the arch recorded in the claim’s area-of-oral-cavity field rather than the code number.
It does not cover:
- A cracked or fractured denture base. That’s D5511 (lower) or D5512 (upper), and it can accompany D5520 when both repairs occurred.
- A broken tooth on a partial denture. That’s D5640, per tooth.
- Adding a tooth to a partial denture after an extraction. That’s D5650.
- Replacing every tooth and all the acrylic on a cast-framework partial. That’s D5670 (upper) or D5671 (lower), a rebuild rather than a per-tooth repair.
- Relines, rebases, or adjustments, which are fit procedures with their own series, such as D5750 for an upper lab reline.
- A new complete denture, D5110/D5120 conventional or D5130/D5140 immediate.
The per-tooth math
Complete-denture teeth rarely fail one at a time when trauma is the cause; a dropped denture that sheds teeth usually sheds two or three. Each replaced tooth is its own billable unit:
- Chart by position. “Replaced teeth #8, #9, #10 on complete maxillary denture” supports three units. “Replaced anterior teeth” supports an argument.
- Submit the real count. Repeated lines or a quantity field, per your clearinghouse’s preference. Carriers pay the per-tooth allowable times the count they can verify.
- Don’t fold teeth into a base-repair fee. A base fracture plus two lost teeth is one D5511/D5512 line plus two D5520 units. Bundling the teeth into the base fee undercharges; inflating the base fee to cover them invites a records request.
At some point the count argues for a different plan entirely. A denture that needs many teeth replaced, or teeth plus extensive base work, may be better served by a rebase or a replacement, and a plan reviewer doing the same arithmetic may deny a large per-tooth claim in favor of replacement benefits. Present the alternative honestly at treatment planning instead of discovering it on the EOB.
When to bill D5520
Bill it when:
- A prosthetic tooth on a complete denture fractured (a corner sheared off, a tooth split at the ridge lap) or debonded and is missing.
- The base and remaining teeth are serviceable, so replacing the tooth restores the denture.
- You can chart each replaced tooth by position.
Do not bill it for:
- The identical repair on a partial denture. Use D5640.
- A tooth added to a partial because a natural tooth was extracted. That’s D5650, an alteration rather than a repair.
- A denture tooth that is loose but re-secured without replacement; that’s part of the repair or adjustment actually performed, not a per-tooth replacement.
Top reasons D5520 gets denied or underpays
- Quantity of one on a multi-tooth repair. This isn’t a denial; it’s a quiet underpayment the office caused. The carrier pays what was billed.
- Prosthesis mismatch. D5520 on an arch where the carrier has a partial or natural teeth on file. The partial equivalents are D5640 and D5650.
- Repair frequency. Prior repairs on the same prosthesis inside the plan’s window; limits are plan-dependent and often shared across repair codes.
- Repair-versus-replacement review. A high per-tooth count triggers the reviewer’s arithmetic against the replacement allowance.
- Missing tooth positions. No per-tooth charting, so the carrier pays one unit and pends the rest awaiting records.
Example case
A patient’s complete upper denture slides off a nightstand. The base survives, but the two central incisor teeth snap off at the necks. The dentist confirms the base and remaining teeth are sound and replaces both incisors.
Billing steps:
- Verify repair coverage and any repair-frequency history on this denture.
- Chart the failure and the replaced teeth by position (#8, #9).
- Submit two units of D5520 with the maxillary arch designation, and no base-repair code, because the base wasn’t fractured.
- Post the payment per unit; if the plan caps repairs annually, note the date against future repairs on this prosthesis.
What to get right in your PMS
- Set D5520 to prompt for quantity. The default-quantity-of-one habit is where this code loses money.
- Separate the complete and partial repair families in your quick picks. D5520 next to D5640 with clear “complete” / “partial” labels kills the most common mismatch.
- Record tooth positions on the procedure, not just in the note. The claim can then carry the count the chart supports.
- Track repairs against the prosthesis record. Frequency limits and replacement-clock conversations both run on the denture’s history, not the patient’s visit history.
FAQs
- What is the dental code for replacing a tooth on a denture?
- On a complete denture, D5520: replace a missing or broken tooth, billed per tooth. On a partial denture, a broken tooth is replaced under D5640 (also per tooth), and adding a tooth to a partial after a natural-tooth extraction is D5650. The complete-versus-partial distinction decides the family; the per-tooth count decides the quantity.
- How do I bill D5520 for multiple teeth?
- One unit per tooth replaced. Depending on your clearinghouse and the carrier, that's either repeated D5520 lines or one line with the quantity set to the number of teeth. Chart which teeth were replaced by position so the count is defensible. Billing one unit for a three-tooth repair leaves two allowables unclaimed.
- Can D5520 be billed with a base repair like D5511 or D5512?
- Yes, when both happened: a dropped denture that split its base and knocked out two teeth is a base-repair line (D5511 lower or D5512 upper) plus two units of D5520. They are separate procedures with separate fees. Whether the plan pays all lines on the same date without a records request is plan-dependent, so chart each repair distinctly.
- Does D5520 apply when a tooth breaks off a partial denture?
- No. D5520 is a complete-denture code. A broken tooth on a partial is D5640, per tooth. If the carrier's records show remaining natural teeth or a partial on that arch, a D5520 claim will be questioned as a prosthesis mismatch. The same repair, on the other prosthesis, under a different number.
- Will insurance pay to replace a denture tooth?
- Plans that cover denture services generally cover tooth replacement as a repair benefit, often subject to a repair-frequency limit on the prosthesis (commonly framed per 12 months) and sometimes a cap relative to replacement cost. All of that is plan-dependent. A repair typically doesn't reset the denture's 5-to-7-year replacement clock, but verify rather than assume.
Related codes
Need help billing this code?
We handle D5520 claims daily.
If your team is spending time on denials, narratives, or carrier follow-up for this code, we can take it off your plate. We work inside your PMS and post payments the same week.
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.