How should an All-on-4 treatment be reported?

If a complete denture has been fabricated and placed immediately after the extractions are done, the denture may be reported using the corresponding immediate denture code.

  • D5130   Immediate denture – maxillary
  • D5140   Immediate denture – mandibular

On the other hand, if a new denture is provided for the patient to wear while the implants are being placed and at any time during the integration and healing process, report that prosthesis as a provisional denture.

  • D5810   Interim complete denture (maxillary)
  • D5811   Interim complete denture (mandibular)

If an immediate denture, previously existing denture, or a provisional denture is modified to accommodate healing caps and/or when the existing prosthesis is modified to receive retentive elements, this service is reported using code D5875. D5875 is not typically reimbursed, but a denture reline may be reimbursed as an alternate benefit if a limitation or exclusion does not apply and the entire prosthesis is relined as part of the modification process.  Be aware, if the reline is reimbursed, the normal 5 to 7 year replacement limitation may be “reset.”  Generally either prefabricated abutments (D6056) or custom abutments (D6057) support the fixed substructure (D6114 or D6115).

  • D5875   Modification of removable prosthesis following implant surgery
  • D6056   Prefabricated abutment – includes modification and placement
  • D6057   Custom prefabricated abutment – includes placement
  • D6114   Implant/abutment supported fixed denture for edentulous arch – maxillary
  • D6115   Implant/abutment supported fixed denture for edentulous arch – mandibular

The final All-on-Four prosthesis can be reported using code D6114/D6115 for the fixed complete denture prosthesis for each arch restored. This is commonly referred to as a “hybrid prosthesis.” 

Again, there will be frequency limitations associated with the delivery of multiple prostheses for each arch. Be aware of the frequency limitations associated with the plan(s) covering the patient and submit the claims accordingly. Consider the payer’s mandated write-offs if you are a participating provider.

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