Dental ADA Codes
Translation of Current Dental Terminology © American Dental Association ® (updated January 2023)
| ADA Code | Description | Amount |
| Examinations | |
| D010 0 | Missed Appointment (without proper cancellation) | 45.00 |
| D012 0 | Periodic Oral Evaluation (Patient is seen within one year) | 60.00 |
| D0140 | Limited Oral Evaluation – Problem Focused | 85.00 |
| D015 0 | Comprehensive Oral Evaluation – New or Established Patient | 90.00 |
| D016 0 | Detailed & Extensive Oral Evaluation – Problem Focused (Emergency Exam) | 150.00 |
| D017 0 | Re-evaluation – Limited, Problem Focused | 85.00 |
| D018 0 | Comprehensive Periodontal Evaluation – New or Established Patient | 115.00 |
| Radiography | |
| D021 0 | Intraoral – Complete Series (including bitewings) | 120.00 |
| D022 0 | Intraoral – Periapical First Film | 35.00 |
| D0230 | Intraoral – Periapical Each Additional Film | 20.00 |
| D024 0 | Intraoral – Occlusal Film | 55.00 |
| D025 0 | Extraoral – First Film | 55.00 |
| D0260 | Extraoral – Each Additional Film | 55.00 |
| D027 0 | Bitewing – Single Film | 25.00 |
| D027 2 | Bitewing – Two Films | 40.00 |
| D0274 | Bitewing – Four Films | 57.00 |
| D027 7 | Vertical Bitewings – 7 or 8 Films | 90.00 |
| D028 0 | Copy of X-Rays | 50.00 |
| D033 0 | Panoramic Film | 115.00 |
| | |
| D033 3 | Custom Tray | 40.00 |
| | |
| D111 0 | Prophylaxis – Adult | 105.00 |
| D133 0 | Oral Hygiene Instructions | 40.00 |
| Restorations | |
| D214 0 | Amalgam – One Surface, Primary or Permanent | 130.00 |
| D215 0 | Amalgam – Two Surfaces, Primary or Permanent | 145.00 |
| D2160 | Amalgam – Three Surfaces, Primary or Permanent | 160.00 |
| D216 1 | Amalgam – Four or More Surfaces, Primary or Permanent | 180.00 |
| D233 0 | Resin-Based Composite – One Surface, Anterior | 170.00 |
| D2331 | Resin-Based Composite – Two Surfaces, Anterior | 235.00 |
| D233 2 | Resin-Based Composite – Three Surfaces, Anterior | 285.00 |
| D233 5 | Resin-Based Composite – Four or More Surfaces, Anterior or Involving Incisal Area | 295.00 |
| D239 1 | Resin-Based Composite – One Surface, Posterior | 200.00 |
| D239 2 | Resin-Based Composite – Two Surfaces, Posterior | 265.00 |
| D2393 | Resin-Based Composite – Three Surfaces, Posterior | 295.00 |
| D239 4 | Resin-Based Composite – Four or More Surfaces, Posterior | 310.00 |
| | |
| D270 0 | Crown Delivery | 0.00 |
| D271 0 | Crown – Resin (indirect) | 550.00 |
| D2740 | Crown – Porcelain/Ceramic | 1250.00 |
| D275 1 | Crown – Porcelain Fused to Predominantly Base Metal | 900.00 |
| D279 9 | Provisional Crown (for Crown Prep) | 0.00 |
| D2920 | Recement Crown | 95.00 |
| D294 0 | Sedative Filling (Temp Filling IRM/Cavity) | 85.00 |
| D295 0 | Core Buildup, including any pins | 240.00 |
| D2954 | Prefabricated Post & Core in Addition to Crown | 240.00 |
| D297 0 | Temporary Crown (for Fractured Tooth or Long-Term Use) | 350.00 |
| | |
| D311 0 | Pulp Cap – Direct (Excluding Final Restoration) | 60.00 |
| D312 0 | Pulp Cap – Indirect (Excluding Final Restoration) | 55.00 |
| D3220 | Therapeutic Pulpotomy (Excluding Final Restoration) | 250.00 |
| D322 1 | Pulpal Debridement, Primary & Permanent Teeth | 200.00 |
| D330 1 | Root Canal Finish | 0.00 |
| D3310 | Anterior Root Canal Therapy (Excluding Final Restoration) | 650.00 |
| D332 0 | Bicuspid Root Canal Therapy (Excluding Final Restoration) | 750.00 |
| D333 0 | Molar Root Canal Therapy (Excluding Final Restoration) | 850.00 |
| D3346 | Retreatment of Previous Root Canal Therapy - Anterior | 800.00 |
| D334 7 | Retreatment of Previous Root Canal Therapy – Bicuspid | 850.00 |
| D334 8 | Retreatment of Previous Root Canal Therapy – Molar | 900.00 |
| | |
| D4210 | Gingivectomy or Gingivoplasty –Per Quadrant | 600.00 |
| D4211 | Gingivectomy or Gingivoplasty – 1-3 Teeth | 250.00 |
| D4249 | Clinical Crown Lengthening – Hard Tissue | 750.00 |
| D4341 | Periodontal Scaling & Root Planing –Per Quad | 198.00 |
| D4342 | Periodontal Scaling & Root Planing– 1-3 Teeth | 75.00 |
| D4355 | Full Mouth Debridement to Enable Comprehensive Periodental Eval | 200.00 |
| D4910 | Periodontal Maintenance | 85.00 |
| Prosthodontics | |
| D5100 | Denture/Partial/Interim Delivery | 0.00 |
| D5106 | Denture Adjustment | 75.00 |
| D5110 | Complete Denture – Maxillary | 1450.00 |
| D5120 | Complete Denture – Mandibular | 1450.00 |
| D5130 | Immediate Denture – Maxillary | 1750.00 |
| D5140 | Immediate Denture – Mandibular | 1750.00 |
| D5211 | Maxillary Partial Denture – Resin Base | 1450.00 |
| D5212 | Mandibular Partial Denture – Resin Base | 1450.00 |
| D5281 | Removable Unilateral Partial Denture – One Piece Cast Metal | 1400.00 |
| D5410 | Adjust Complete Denture – Maxillary | 85.00 |
| D5411 | Adjust Complete Denture – Mandibular | 85.00 |
| D5421 | Adjust Partial Denture – Maxillary | 85.00 |
| D5422 | Adjust Partial Denture – Mandibular | 85.00 |
| D5510 | Repair Broken Complete Denture Base | 450.00 |
| D5520 | Replace Missing or Broken Teeth – Complete Denture (Each Tooth) | 150.00 |
| D5610 | Repair Resin Denture Base | 200.00 |
| D5620 | Repair Cast Framework | 250.00 |
| D5630 | Repair or Replace Broken Clasp | 250.00 |
| D5640 | Repair Broken Teeth – Per Tooth | 175.00 |
| D5650 | Add Tooth to Existing Partial Denture | 175.00 |
| D5660 | Add Clasp to Existing Partial Denture | 275.00 |
| D5670 | Replace All Teeth & Acrylic on Cast Metal Framework (Maxillary) | 850.00 |
| D5671 | Replace All Teeth & Acrylic on Cast Metal Framework (Mandibular) | 850.00 |
| D5730 | Reline Complete Maxillary Denture (Chairside) | 350.00 |
| D5731 | Reline Complete Mandibular Denture (Chairside) | 350.00 |
| D5740 | Reline Maxillary Partial Denture (Chairside) | 350.00 |
| D5741 | Reline Mandibular Partial Denture (Chairside) | 350.00 |
| D5750 | Reline Complete Maxillary Denture (Laboratory) | 400.00 |
| D5751 | Reline Complete Mandibular Denture (Laboratory) | 400.00 |
| D5760 | Reline Maxillary Partial Denture (Laboratory) | 400.00 |
| D5761 | Reline Mandibular Partial Denture (Laboratory) | 400.00 |
| D5820 | Interim Partial Denture Maxillary (Flipper) | 750.00 |
| D5821 | Interim Partial Denture Mandibular - (Flipper) | 750.00 |
| Bridges | |
| D6200 | Bridge Delivery | 0.00 |
| D6242 | Pontic – Porcelain Fused to Noble Metal | 950.00 |
| D6752 | Crown – Porcelain Fused to Noble Metal | 960.00 |
| Extractions | |
| D7130 | Root Removal of Exposed Roots | 175.00 |
| D7140 | Extraction, Erupted Tooth or Exposed Root (elevation &/or forceps) | 150.00 |
| D7210 | Surgical Removal of Erupted Tooth Requiring Elevation | 450.00 |
| D7220 | Removal of Impacted Tooth – Soft Tissue | 300.00 |
| D7230 | Removal of Impacted Tooth – Partially Bony | 450.00 |
| D7240 | Removal of Impacted Tooth – Completely Bony | 500.00 |
| D7250 | Surgical Removal of Residual Tooth Roots (Cutting Procedure) | 300.00 |
| Miscellaneous | |
| D9970 | Enamel Microabrasion (Smoothing/Filing of a Tooth) | 90.00 |
| D9910 | Application of Desensitizing Meds | 85.00 |
| Pharmaceuticals | |
| D9001 | Penicillin (1 tab) | 0.50 |
| D9002 | Amoxicillin 4 tabs (premed) | 1.20 |
| D9003 | Amoxicillin 4 tabs (premed) | 0.30 |
| D9004 | Ibuprofen (1 tab) | 0.60 |
| D9005 | Cephalexin (1 tab) | 1.33 |
| D9006 | Clindamycin 2 x 150mg | 5.87 |
| D9007 | Clindamycin 2 x 300mg | 10.45 |
| D9008 | Clindamycin HCl 2 x 150mg | 1.67 |
| D9009 | Clindamycin HCl 2 x 300mg | 5.31 |
| D9010 | Clindamycin Azasan 2 x 75mg | 4.40 |
| | |
| Fees with No Buttons Created (You must manually input these in the patient’s ledger) | |
| D0100 | Missed Appointment (without proper cancellation) | 45.00 |
| D0280 | Copy of X-Rays | 50.00 |
| D2710 | Crown – Resin (indirect) | 550.00 |
| D3346 | Retreatment of Previous Rooth Canal Therapy - Anterior | 800.00 |
| D3347 | Retreatment of Previous Rooth Canal Therapy – Bicuspid | 850.00 |
| D3348 | Retreatment of Previous Rooth Canal Therapy – Molar | 900.00 |
| D4249 | Clinical Crown Lengthening – Hard Tissue | 750.00 |
| D5750 | Reline Complete Maxillary Denture (Laboratory) | 400.00 |
| D5751 | Reline Complete Mandibular Denture (Laboratory) | 400.00 |
| D5760 | Reline Maxillary Partial Denture (Laboratory) | 400.00 |
| D5761 | Reline Mandibular Partial Denture (Laboratory) | 400.00 |
| D6242 | Pontic – Porcelain Fused to Noble Metal | 950.00 |
| D6752 | Crown – Porcelain Fused to Noble Metal | 960.00 |
| D7130 | Root Removal of Exposed Roots | 175.00 |
| D7250 | Surgical Removal of Residual Tooth Roots (Cutting Procedure) | 300.00 |
| D9910 | Application of Desensitizing Meds | 85.00 |
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