CODE SERVICE FREQUENCY BENEFIT DETAILS D5284 Unilateral removable 1 procedure code Not covered within 5 years of D5286 partial denture for the per arch every 5 receiving an upper partial upper or lower arch. This is calendar years denture (D5211, D5213, D5225) or a ‘quadrant’ denture lower partial denture (D5212, meant to only replace 1-2 D5214, D5226) missing teeth. Denture Adjustments D5410 Adjustment of an upper 2 procedures per Not covered within 6 months of D5421 complete or upper partial calendar year receiving an upper complete denture denture (D5110) or upper partial denture (D5211, D5213, D5225) D5411 Adjustment of a lower 2 procedures per Not covered within 6 months of D5422 complete or lower partial calendar year receiving a lower complete denture denture (D5120) or lower partial denture (D5212, D5214, D5226) Denture Repairs D5511 Repair of an upper or lower 1 procedure code Not covered within 6 months of D5512 complete denture base per complete receiving an upper complete denture base every denture (D5110) or lower 5 calendar years complete denture (D5120) D5520 Replace missing or broken 1 procedure per Not covered within 6 months of teeth on a complete complete denture receiving an upper complete denture per calendar year denture (D5110) or lower complete denture (D5120) D5611 Repair of an upper or lower 1 procedure code Not covered within 6 months of D5612 partial denture base or per partial denture receiving an upper partial D5621 framework base or framework denture (D5211, D5213, D5225) or every 5 calendar lower partial denture (D5212, D5622 years D5214, D5226) D5630 Repair or replace a broken 1 procedure per Not covered within 6 months of clasp on partial denture partial denture receiving an upper partial every 5 calendar denture (D5211, D5213, D5225) or years lower partial denture (D5212, D5214, D5226) 8