CODE SERVICE FREQUENCY BENEFIT DETAILS D5130 Complete upper denture 1 procedure per Only covered on or after the day that is delivered on the lifetime of upper tooth extractions same day of extracting remaining upper teeth. This denture is meant to be temporary and is called an immediate complete upper denture. D5140 Complete lower denture 1 procedure per Only covered on or after the day that is delivered on the lifetime of lower tooth extractions same day of extracting remaining lower teeth. This denture is meant to be temporary and is called an immediate complete lower denture. Partial Dentures D5211 Upper partial denture (for 1 procedure code Not covered within 5 years of D5213 patients missing some of every 5 calendar receiving an upper unilateral D5225 their upper teeth) years removable partial denture (D5284, D5286) D5212 Lower partial denture (for 1 procedure code Not covered within 5 years of D5214 patients missing some of every 5 calendar receiving a lower unilateral D5226 their lower teeth) years removable partial denture (D5284, D5286) D5221 Upper partial denture that 1 procedure code Not covered on same day as D5223 is delivered on the same per lifetime receiving an upper partial D5227 day of extracting some denture (D5211, D5213, D5225) upper teeth. This denture is meant to be temporary and is called an immediate upper partial denture. D5222 Lower partial denture that 1 procedure code Not covered on same day as D5224 is delivered on the same per lifetime receiving a lower partial denture D5228 day of extracting some (D5212, D5214, D5226) lower teeth. This denture is meant to be temporary and is called an immediate lower partial denture. 7