CODE SERVICE FREQUENCY BENEFIT DETAILS D5640 Replace a broken tooth or 1 procedure code Not covered within 6 months of D5650 add tooth to partial per partial denture receiving an upper partial denture per calendar year denture (D5211, D5213, D5225) or lower partial denture (D5212, D5214, D5226) D5660 Add a clasp to partial 1 procedure per Not covered within 6 months of denture partial denture receiving an upper partial every 5 years denture (D5211, D5213, D5225) or lower partial denture (D5212, D5214, D5226) Denture Rebase D5710 Rebase of an upper 1 procedure code Not covered within 6 months of D5720 complete or upper partial per denture every 5 receiving an upper complete denture calendar years (D5110) or upper partial denture (D5211, D5213, D5225) D5711 Rebase of a lower 1 procedure code Not covered within 6 months of D5721 complete or lower partial per denture every 5 receiving a lower complete denture calendar years (D5120) or lower partial denture (D5212, D5214, D5226) Denture Relines D5730 Chairside or laboratory 1 procedure code Not covered within 6 months of D5740 reline of upper complete every 2 calendar receiving an upper complete D5750 and upper partial dentures years (D5110) or upper partial denture (D5211, D5213, D5225) D5760 D5731 Chairside or laboratory 1 procedure code Not covered within 6 months of D5741 reline of lower complete every 2 calendar receiving a lower complete D5751 and lower partial dentures years (D5120) or lower partial denture (D5212, D5214, D5226) D5761 D5765 Soft reline for complete or 1 procedure per Not covered within 6 months of partial dentures denture per receiving an upper complete calendar year denture (D5110), upper partial denture (D5211, D5213, D5225), lower complete denture (D5120), or lower partial denture (D5212, D5214, D5226) 9