Overview: Manage discounted rates for final full and partial dentures when insurance reimbursement falls below $750 per arch using the Dandy Portal.
Understanding the Reimbursement Program
The Reimbursement-Adjusted Pricing Program provides discounted rates on specific dentures when insurance allowed amounts are under $750 per arch. No formal enrollment is required; submitting documentation through the Dandy Portal serves as agreement to the program terms.
Eligible Products and CDT Codes
The following table outlines products eligible for the reimbursement-adjusted program:
| Product Type | CDT Codes |
|---|---|
| Immediate Dentures (Printed) | D5130, D5140 |
| Full Dentures / Overdentures (Printed) | D5110, D5120, D5835, D5836 |
| RPD – Acrylic (4+ teeth) | D5211, D5212 |
| RPD – Flexible | D5225, D5226 |
| RPD – Chrome Cobalt | D5213, D5214 |
Turnaround Times: 5–10 business days.
Ineligible Products: Milled/Aesthetic Full Dentures, Try-ins, Wax-Rims, Acrylic RPDs (1-3 teeth), Titanium RPDs, and Refabricated Orders.
Submitting for Reimbursement Credit
Follow these steps to request a pricing adjustment for a qualifying case:
Step 1: Place an Eligible Order
Submit a qualifying final full or partial denture case through the Dandy Portal or Chairside as you normally would.
Step 2: Select Insurance Plan
In the Dandy Portal, select the insurance provider, indicate network status (in-network or out-of-network), and specify the state of coverage.
Step 3: Provide Proof of Insurance
Select the eligible order and choose one of the following two options in the Insurance Tab of the Dandy Portal:
Document Upload (All Patients): Upload a redacted Explanation of Benefits (EOB) or Pre-Authorization Approval. The document must include the patient name, date of birth, CDT codes, total billed amount, and an allowed amount under $750 per arch.
- Video Summary - Non-Medicaid Plans
Eligibility Check (Medicaid Only): Submit the Insurance Provider, Member ID, Patient Name/DOB, and Practice NPI/Tax ID for automatic verification.
- Video Summary - Medicaid Plans
Watch the 2-minute walkthrough video
Step 4: Track Submission Status
Use the Insurance Tab in the Dandy Portal to monitor your requests. Approvals typically occur within 7–10 days, and credits are issued within 30 days.
| Status | Definition |
|---|---|
| Eligible | Orders that may qualify; pending proof submission. |
| Pending Review | Documentation is currently under manual or system review. |
| Approved | Documentation is verified; credit is in process. |
| Credit Applied | The credit has been successfully issued to your account. |
| Denied | The case is ineligible (e.g., allowed amount exceeds $750/arch). |