Negotiated reimbursement rates for D5212 across 49 states, sourced from CMS Transparency in Coverage data. 722 rate records.
D5212 is the code for a lower partial denture with a resin base, including clasps and rests. This procedure is clinically indicated for patients who have lost teeth in the lower arch and need a removable prosthesis for improved chewing function and aesthetics. Documentation should include the patient's dental history, clinical examination findings, and a description of the proposed denture. The average reimbursement for D5212 is approximately $828, but this can vary widely depending on the patient's insurance plan and state regulations. Some payors may have specific criteria for coverage, such as the necessity of prior treatments or the number of missing teeth. It is crucial for dental billing professionals to confirm coverage details to ensure appropriate reimbursement.
Reimbursement rates for D5212 vary significantly by state, payor, and provider network. The national average negotiated rate is $828. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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