D5520 is the CDT code for replacing a missing or broken tooth on a complete denture, billed once for each tooth replaced.
- When to use: A tooth on a complete denture broke or came out, and the base and remaining teeth are still serviceable.
- When not to use: A tooth on a partial is D5640, a tooth added to a partial after an extraction is D5650, and a cracked base is D5511 or D5512.
- Billing note: Bill one unit per replaced tooth and chart each tooth by position, because a three-tooth repair billed as one unit pays as one.
What D5520 covers
D5520 reports replacing a tooth on a complete denture, either a prosthetic tooth that fractured or one that came out of the base and is missing. The fee, charged per tooth, covers removing what remains of the failed tooth, setting and processing a replacement into the base, and checking the occlusion at delivery. The denture stays in service; only the tooth is replaced.
The code has no arch designation. Unlike the base-repair pair, one code serves both arches, and the arch goes in the claim’s area-of-oral-cavity field.
It does not cover:
- A cracked or fractured denture base. That’s D5511 (lower) or D5512 (upper), and it can be billed with 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, an alteration rather than a repair.
- 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
When trauma is the cause, complete-denture teeth rarely fail one at a time. A dropped denture usually loses 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” invites a dispute. Record tooth positions on the procedure in the PMS, not only in the note, so the claim carries the count the chart supports.
- Submit the real count. Use repeated lines or a quantity field, per your clearinghouse’s preference, and set D5520 to prompt for quantity rather than defaulting to one. 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 or D5512 line plus two D5520 units. Folding the teeth into the base fee undercharges; inflating the base fee to cover them invites a records request.
A denture that needs many teeth replaced, or teeth plus extensive base work, may be better served by a rebase or a replacement. A plan reviewer doing the same arithmetic may deny a large per-tooth claim in favor of replacement benefits. Present the alternative 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, or the 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.
A denture tooth that is loose but re-secured without being replaced is not a D5520. It is part of whatever repair or adjustment was actually performed.
Top reasons D5520 gets denied or underpays
- Quantity of one on a multi-tooth repair. Not a denial but an 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. Keeping D5520 and D5640 side by side in the PMS quick picks, labeled “complete” and “partial,” prevents most of these.
- Repair frequency. Prior repairs on the same prosthesis inside the plan’s window. Limits are plan-dependent and often shared across repair codes, so track repairs against the denture’s record, not the patient’s visit history.
- Repair-versus-replacement review. A high per-tooth count prompts the reviewer to compare the total against the replacement allowance.
- Missing tooth positions. Without per-tooth charting, the carrier pays one unit and pends the rest for records.
Example case
A patient’s complete upper denture slides off a nightstand. The base survives, but the two central incisors 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. 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.
FAQs
- What is the dental code for replacing a tooth on a denture?
- On a complete denture, D5520, 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 type of denture decides the code family; the number of teeth decides the quantity.
- How do I bill D5520 for multiple teeth?
- One unit per tooth replaced. Depending on the clearinghouse and the carrier, that is 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 lost 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 separately.
- 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.
- Will insurance pay to replace a denture tooth?
- Plans that cover denture services generally cover tooth replacement as a repair benefit, often with a repair-frequency limit on the prosthesis (commonly 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
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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.