D5214 is the CDT code for a lower (mandibular) removable partial denture built on a cast metal framework with resin denture bases, including the clasps, rests, and replacement teeth. It restores several missing lower teeth using a precision-cast metal framework — commonly cobalt-chromium — that anchors to the remaining natural teeth.
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 D5214 Code
Report D5214 when a patient is missing one or more lower teeth and receives a removable partial denture whose framework is cast metal with resin bases holding the artificial teeth. The cast framework supplies the clasps and rests that grip the remaining natural teeth, giving more strength and stability than an all-resin partial.
Pick the code by arch and base type: D5214 is the mandibular cast-metal partial; D5213 is the maxillary (upper) cast-metal partial; D5212 is a mandibular partial with a resin base only; and D5226 is a mandibular partial with a flexible base. Because these reimburse differently, code by what was actually delivered.
Documentation & Clinical Scenarios
Partials are a frequently reviewed prosthetic benefit, so chart notes should justify the restoration:
- Arch and teeth being replaced — list the missing lower teeth and the abutment teeth that carry the clasps and rests.
- A current arch/periodontal evaluation showing the remaining teeth can support the partial.
- Radiographs of abutment teeth and, where helpful, intraoral photos.
- A narrative noting whether this is an initial placement or a replacement, plus any prior partial and its age.
Adjustments at delivery are part of the partial; later adjustments (D5421/D5422), relines, and repairs are separate procedures with their own codes.
Insurance & Billing Tips
- Verify the prosthodontic benefit first. Confirm the plan covers cast-metal partials and what the patient share will be.
- Check replacement frequency. Partials commonly carry a 5-year (sometimes 7-year) replacement limit per arch; a partial replaced too soon may be denied.
- Watch for missing-tooth and waiting-period clauses. Some plans won't pay for teeth lost before coverage began, and new plans may impose a waiting period on major prosthetics.
- Expect possible alternate-benefit down-coding. A plan may reimburse a cast-metal partial at the rate of a resin partial; knowing this up front lets you set an accurate estimate.
- Confirm the benefit date rule. Whether the plan pays on the impression or the delivery date affects claims that cross a benefit-year boundary.
Example Case
A 60-year-old patient is missing three lower posterior teeth and reports difficulty chewing. The remaining lower teeth are sound and periodontally stable, so the dentist plans a cast-metal-framework partial for durability. The office submits a pre-estimate with periodontal charting and a radiograph; the plan confirms coverage with a 5-year frequency limit and notes one of the missing teeth was lost before coverage began. After impressions and a framework try-in, the partial is delivered and the claim is filed as D5214 with the delivery date. Because benefits were verified, the patient knew the out-of-pocket amount in advance.
Patients call about "getting a partial" or "my denture doesn't fit" — not D5214. DentalReception AI answers those calls 24/7, books the consult or adjustment live into your schedule, and captures insurance details for clean intake, while coverage questions route to your team. See how it handles denture calls, or book a demo.
Frequently Asked Questions
What's the difference between D5214 and D5226?
Framework material. D5214 is a mandibular partial built on a cast metal framework with resin bases, while D5226 is a mandibular partial with a flexible (typically nylon) base and no cast metal. They serve the same arch but are different prostheses, and many plans reimburse them at different rates — so code by what was actually delivered.
Does D5214 include the clasps, rests, and teeth?
Yes. The D5214 descriptor includes the retentive/clasping materials, rests, and the replacement teeth set in the resin bases, plus the adjustments done at delivery. Later adjustments, relines, rebases, and repairs are separate procedures with their own codes and should be documented and billed on their own.
How often will insurance replace a D5214 partial?
Most plans apply a replacement frequency limit — commonly every 5 years, sometimes 7 — per arch. A partial replaced before that interval may be denied unless you can document loss, theft, or a non-repairable break. Verify the patient's specific frequency and any waiting period before treatment.
Do I need a pre-authorization for a D5214 partial?
Many plans recommend or require a pre-estimate for removable partials. Submitting periodontal charting, a radiograph of the abutment teeth, and a narrative — noting initial vs. replacement and any pre-existing missing teeth — before the impression appointment lets you confirm coverage and quote the patient an accurate out-of-pocket amount.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.