D5213 is the CDT code for a maxillary (upper arch) removable partial denture with a cast metal framework and resin denture bases. The metal framework is precision-cast, typically from a cobalt-chromium alloy, and provides clasps, rests, and connectors that anchor the prosthesis to the remaining natural teeth. Artificial teeth are set in resin bases attached to the framework.
Last updated June 2026 · Reviewed by the PracticeAlpha billing team
Get help with D5213 claims →Patient is missing several maxillary teeth but retains enough natural teeth to serve as abutments for the clasp and rest assembly. The cast metal framework engages these teeth for support and retention.
When a durable removable prosthetic is needed and the patient is not a candidate for implants or a fixed bridge. The cast metal framework offers greater longevity than an all-resin partial (D5211).
D5213 requires that suitable abutment teeth exist in the upper arch. If the patient is edentulous in the maxillary arch, the correct code is D5110 (complete upper denture), not D5213.
This is the most common denial reason for partial denture claims. Most dental plans exclude coverage for teeth that were missing before the patient's coverage began. If the patient's missing upper teeth predate their enrollment in the plan, the payer will deny D5213 on that basis. Always check the patient's missing tooth clause before submitting. See our guide on the missing tooth clause for strategies to address this denial.
Most plans limit partial denture replacement to once every five years per arch. If the patient received a partial denture (or had one billed) for the maxillary arch within the plan's frequency window, the new D5213 claim will be denied. Document the clinical reason for early replacement, such as significant tooth loss or prosthesis failure, and submit a narrative with the claim if you believe the clinical situation warrants an exception.
Removable partial dentures typically require pre-authorization. Skipping pre-auth and billing after the prosthesis is delivered is one of the most preventable causes of denial. Verify the requirement upfront, submit pre-auth with a panoramic or full-mouth radiograph and a list of missing teeth, and wait for approval before beginning the case.
The clinical record must support the need for a removable partial. Include a list of missing teeth by tooth number, the reason natural teeth cannot adequately restore function (bridgework not indicated, implants not an option, etc.), and confirmation that remaining abutment teeth are periodontally sound. Payers increasingly request supporting documentation before paying partial denture claims.
Shows remaining teeth, bone levels, and the full extent of tooth loss. Essential for pre-authorization and for demonstrating clinical necessity. Periapical films of abutment teeth may also be requested.
Identify each missing maxillary tooth by universal number. This is the baseline the payer uses to apply the missing tooth clause and to verify that a partial denture is appropriate.
Document that a cast metal framework partial is the chosen prosthetic design and explain why. Note abutment teeth, clasp design, and that the patient understands this is a removable prosthesis.
Payers may request evidence that abutment teeth have adequate periodontal support. Include probing depths or a summary statement that abutment teeth are periodontally sound and suitable for clasping.
Record the pre-auth number, approval date, and approval details. Include the pre-auth number in the claim narrative field. Keep the approval letter in the patient record.
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Get a free AR analysisD5213 is the CDT code for a maxillary (upper arch) removable partial denture with a cast metal framework and resin denture bases. It is used when one or more upper teeth remain and can serve as abutments for the partial's clasps and rests.
D5213 has a precision cast metal framework (typically cobalt-chromium) that provides structural strength. D5211 is a resin-base partial with no cast metal framework. D5213 is generally more durable and is the preferred design for most long-term partial denture cases.
D5213 is for the maxillary (upper) arch. D5214 is for the mandibular (lower) arch. Both use cast metal frameworks with resin bases. The arch location is the only distinction between the two codes.
The most frequent reasons are the missing tooth clause (teeth were missing before coverage), frequency limitations (partial replacement within five years), missing pre-authorization, and insufficient documentation of the remaining teeth and prosthetic design.
Most plans require pre-authorization for removable partial dentures. Submit pre-auth with panoramic or full-mouth radiographs and a list of missing teeth. Wait for written approval before delivering the prosthesis.
The cast metal framework is a precision-fabricated metal skeleton, typically cobalt-chromium, that forms the structural base of the partial denture. It includes clasps, rests, and major and minor connectors. Resin bases and artificial teeth are attached to this framework. This is what distinguishes D5213 from the all-resin D5211.
Search all 206 CDT codes in our dental coding guide.