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 |
Ineligible Products: Milled/Aesthetic Full Dentures, Try-ins, Wax-Rims, Acrylic RPDs (1-3 teeth), Titanium RPDs, and Refabricated Orders.
Please note: Dandy is discontinuing Signature Printed Dentures. We highly recommend our Dandy Fusion Denture due to its superior strength, aesthetics, and quality at the same price.
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). |