D5213 is the CDT code for an upper (maxillary) removable partial denture built on a cast metal framework with resin denture bases — a more rigid, durable partial than an all-resin one. The descriptor includes the retentive/clasping materials, rests, and artificial teeth, distinguishing it from the resin-base maxillary partial (D5211).
Informational only — confirm the official CDT descriptor and your payers' rules independently. This is general guidance, not billing, coding, or clinical advice.
When to Use the D5213 Code
Report D5213 when an upper partial denture is fabricated on a precision-cast metal framework (commonly a cobalt-chromium alloy) with resin bases holding the artificial teeth, anchored by clasps and rests to remaining natural teeth. The clasps, rests, and teeth are part of the code — they are not billed separately.
Pick the code by arch and framework: D5213 is the upper cast-metal-framework partial; D5214 is the lower cast-metal-framework partial; D5211 is an upper resin-base partial with no metal framework. Don't use D5213 when only a resin base is fabricated, or when the arch is fully edentulous — a complete denture (D5110) applies.
Documentation & Clinical Scenarios
Cast-framework partials are a reviewed prosthetic benefit, so the chart should show the remaining teeth and the framework material:
- Arch (maxillary), the teeth being replaced, and the abutment teeth carrying the clasps and rests.
- Framework material — a cast metal framework with resin bases, since this drives code selection and reimbursement.
- Clinical notes on the impression, framework try-in, and delivery date; many payers tie the benefit to the seat date.
- Prior-partial history — first placement vs. replacement, since replacements carry frequency limits.
Insurance & Billing Tips
- Verify benefits and frequency first. Partials commonly carry a replacement frequency limit (often once every 5–7 years per arch).
- Watch the framework downgrade. Some plans apply an alternate benefit and pay a cast-metal partial at the rate of a resin partial; verify up front so the patient estimate is accurate.
- Clasps, rests, and teeth are bundled into D5213 — they aren't separate line items.
- Confirm the seat-date rule. Many plans pay on the insertion/delivery date, not the impression date.
- Pre-authorize when in doubt. A pre-estimate confirms whether the cast framework is covered at full rate before fabrication.
Example Case
A 62-year-old patient is missing several upper teeth and wants a durable partial. The dentist plans an upper cast-metal-framework partial with resin bases. The office verifies benefits, confirms no partial on file within the plan's frequency limit, and submits a pre-estimate, which shows the plan pays the cast framework at full rate. The framework is cast and tried in, the teeth are set in resin bases, and the appliance is delivered. The claim is filed as D5213 with the insertion date. Because benefits were verified and the framework material was documented, the claim is paid at the expected level.
Patients call about "a metal partial for my top teeth," not D5213. DentalReception AI answers and books those calls 24/7, captures insurance details for clean intake, and routes clinical and billing questions to your team. See denture calls, or book a demo.
Frequently Asked Questions
What's the difference between D5213 and D5211?
Framework. D5213 is an upper partial with a cast metal framework and resin denture bases, while D5211 is an upper partial built on a resin (acrylic) base with no cast metal. The cast-metal version is more rigid and durable, and some plans reimburse the two differently or downgrade the cast partial to the resin rate — so code by the framework actually fabricated.
Does D5213 include the clasps, rests, and teeth?
Yes. The D5213 descriptor covers the cast metal framework, resin bases, retentive/clasping materials, rests, and artificial teeth as a single partial — these are not billed as separate line items. Later repairs, additions, or adjustments are reported with their own codes when clinically necessary.
How often will insurance pay for a cast metal upper partial?
Most plans apply a replacement frequency limit, commonly once every five to seven years per arch, and some apply an alternate benefit that pays a cast-metal partial at the lower resin-partial allowance. Verify the specific frequency and any framework downgrade before treatment so the patient knows whether the cast partial is covered and what their share will be.
Do I need a pre-authorization for a D5213 partial?
Many plans recommend or require a pre-estimate for cast-framework partials, since framework downgrades and frequency limits are common. Submitting one confirms whether the cast metal partial is covered at the full rate or downgraded to a resin allowance, clarifies the seat-date rule, and establishes the patient's out-of-pocket portion before fabrication begins.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.