One of the biggest financial mistakes dentists make is not realizing how labs bill for denture services. If your coding doesn’t align with what the lab is charging, you could end up underbilling or running into claim issues with insurance. Let’s go over a couple of common scenarios where this can happen and how to avoid them.
Flippers: Coding Based on the Number of Teeth
When ordering a flipper (or acrylic denture) from the lab, remember that pricing is usually based on the number of teeth involved.
- If the flipper has 1–4 teeth, it may fall under the code for an interim partial denture (D5820/D5821).
- If the flipper has more than 4 teeth, it might be more appropriate to use the code for a resin-based partial denture (D5211/D5212), which comes with a higher fee.
Always double-check with the lab to ensure your claim coding and pricing match what’s being fabricated.
Adding Teeth to Partial Dentures: The Hidden Cost of Metal
If a patient needs an additional tooth added to their partial denture, the cost can vary depending on how the lab completes the process.
- In some cases, they can simply add acrylic and the tooth, which is a relatively low-cost adjustment.
- However, if they need to add to the metal framework, they may need to use laser welding, which significantly increases the lab fee.
In this situation, coding should reflect the work done:
- D5650 – Adding a tooth to an existing partial denture.
- D5621/D5622 – If the lab modifies the metal framework, this is considered a partial denture repair and should be coded accordingly.
Since lab work can change mid-process, keep an open line of communication with the lab so you can update the claim coding and patient fees as needed.
Insurance Limits: One Denture Code Per Claim
Keep in mind that insurance typically only reimburses for one denture code per claim. This is important to consider when estimating costs for patients and choosing how to handle repairs versus replacements.
Keeping Costs Down: A Possible Alternative
One way to control costs is to instruct the lab never to add metal when making modifications. This keeps the lab bill lower, but it also means the unsupported resin around the new tooth may be more prone to breaking. If that happens, creating an entirely new partial denture would be the next step.
By paying close attention to lab billing, coding, and insurance reimbursement rules, you can avoid unexpected costs and ensure your practice gets properly compensated for the work done.