Top 30 ADA Dental Procedure Codes - Pediatric Patients
Ranked by Contribution to Total Pediatric Dental Claim Costs
based on 2015 Milliman Health Cost Guidelines-Dental®
Procedure Description
11
10
01
20
23
92
12
08
13
51
02
74
23
91
11
20
72
10
71
40
01
50
23
93
72
40
02
10
01
40
03
30
21
50
12
06
02
20
23
30
Prophylaxis - adult
Periodic oral evaluation - established patient
Procedure
Type
Cleaning
Resin-based composite - two surfaces, posterior
Oral
Evaluation
Restorations
Topical application of fluoride - excluding varnish
Fluoride
Sealant - per tooth
Sealant
Bitewings - four radiographic images
X-Ray
Resin-based composite - one surface, posterior
Restorations
Prophylaxis - child
Cleaning
Surgical removal of erupted tooth requiring removal of bone and/or sectioning of
tooth, and including elevation of mucoperiosteal flap if indicated
Extraction, erupted tooth or exposed root (elevation and/or forceps removal)
Surgical
Extraction
Simple
Extraction
Oral
Evaluation
Restorations
Comprehensive oral evaluation - new or established patient
Resin-based composite - three surfaces, posterior
Removal of impacted tooth - completely bony
Intraoral - complete series of radiographic images
Limited oral evaluation - problem focused
Surgical
Extraction
X-Ray
Panoramic radiographic image
Oral
Evaluation
X-Ray
Amalgam - two surfaces, primary or permanent
Restorations
Topical application of fluoride varnish
Fluoride
Intraoral - periapical first radiographic image
X-Ray
Resin-based composite - one surface, anterior
Restorations
23
31
92
20
33
30
02
72
27
50
72
30
23
32
23
35
21
40
02
30
Resin-based composite - two surfaces, anterior
Restorations
Deep sedation/general anesthesia - first 30 minutes
Anesthesia
Endodontic therapy, molar (excluding final restoration)
Endodontics
Bitewings - two radiographic images
X-Ray
Crown - porcelain fused to high noble metal
Inlays/Onlay
s/Crowns
Surgical
Extraction
Restorations
Removal of impacted tooth - partially bony
Resin-based composite - three surfaces, anterior
Resin-based composite - four or more surfaces or involving incisal angle
(anterior)
Amalgam - one surface, primary or permanent
Restorations
Intraoral - periapical each additional radiographic image
X-Ray
Restorations
These codes are expected to represent approximately 97% of pediatric utilization and 91% of pediatric
claim costs (excluding orthodontia).
Others to Consider Including:
15 Space maintainer - fixed - unilateral
10
15 Space maintainer - fixed - bilateral
15
43 Periodontal scaling and root planing - four or more teeth per quadrant
41
91 Palliative (emergency) treatment of dental pain - minor procedure
10
Space
Maintainers
Space
Maintainers
Periodontics
Emergency
Top 40 ADA Dental Procedure Codes - Adult Patients
Ranked by Contribution to Total Adult Dental Claim Costs
based on 2015 Milliman Health Cost Guidelines-Dental®
Procedure Description
11
10
27
50
01
20
27
40
23
92
33
30
02
74
23
91
43
41
49
10
11
20
27
52
23
93
01
50
27
51
02
10
33
20
72
10
03
30
Prophylaxis - adult
Crown - porcelain fused to high noble metal
Procedure
Type
Cleaning
Resin-based composite - two surfaces, posterior
Inlays/Onlay
s/Crowns
Oral
Evaluation
Inlays/Onlay
s/Crowns
Restorations
Endodontic therapy, molar (excluding final restoration)
Endodontics
Bitewings - four radiographic images
X-Rays
Resin-based composite - one surface, posterior
Restorations
Periodontal scaling and root planing - four or more teeth per quadrant
Periodontics
Periodontal maintenance
Periodontics
Prophylaxis - child
Cleaning
Crown - porcelain fused to noble metal
Inlays/Onlay
s/Crowns
Restorations
Periodic oral evaluation - established patient
Crown - porcelain/ceramic substrate
Resin-based composite - three surfaces, posterior
Comprehensive oral evaluation - new or established patient
Intraoral - complete series of radiographic images
Oral
Evaluation
Inlays/Onlay
s/Crowns
X-Rays
Endodontic therapy, bicuspid tooth (excluding final restoration)
Endodontics
Surgical removal of erupted tooth requiring removal of bone and/or sectioning of
tooth, and including elevation of mucoperiosteal flap if indicated
Panoramic radiographic image
Surgical
Extractions
X-Rays
Crown - porcelain fused to predominantly base metal
21
50
01
40
02
20
71
40
72
40
23
30
23
31
02
72
27
90
23
32
33
10
67
50
23
35
21
40
02
30
21
60
62
40
72
30
42
60
23
94
43
42
Amalgam - two surfaces, primary or permanent
Restorations
Limited oral evaluation - problem focused
Oral
Evaluation
X-Rays
Intraoral - periapical first radiographic image
Extraction, erupted tooth or exposed root (elevation and/or forceps removal)
Resin-based composite - one surface, anterior
Simple
Extractions
Surgical
Extractions
Restorations
Resin-based composite - two surfaces, anterior
Restorations
Bitewings - two radiographic images
X-Rays
Crown - full cast high noble metal
Resin-based composite - three surfaces, anterior
Inlays/Onlay
s/Crowns
Restorations
Endodontic therapy, anterior tooth (excluding final restoration)
Endodontics
Crown - porcelain fused to high noble metal
Bridges
Resin-based composite - four or more surfaces or involving incisal angle
(anterior)
Amalgam - one surface, primary or permanent
Restorations
Intraoral - periapical each additional radiographic image
X-Rays
Amalgam - three surfaces, primary or permanent
Restorations
Pontic - porcelain fused to high noble metal
Bridges
Removal of impacted tooth - partially bony
Surgical
Extractions
Periodontics
Removal of impacted tooth - completely bony
Osseous surgery (including elevation of a full thickness flap and closure) - four or
more contiguous teeth or tooth bounded spaces per quadrant
Resin-based composite - four or more surfaces, posterior
Periodontal scaling and root planing - one to three teeth per quadrant
Restorations
Restorations
Periodontics
These codes are expected to represent approximately 95% of adult utilization and 90% of adult claim
costs (excluding orthodontia).
Others to Consider Including:
92 Deep sedation/general anesthesia - first 30 minutes
20
29 Prefabricated stainless steel crown - primary tooth
30
27 Crown - full cast noble metal
92
52 Maxillary partial denture - cast metal framework with resin denture bases
13 (including any conventional clasps, rests and teeth)
51 Complete denture - maxillary
10
91 Palliative (emergency) treatment of dental pain - minor procedure
10
29 Re-cement or re-bond crown
20
Anesthesia
Inlays/Onlay
s/Crowns
Inlays/Onlay
s/Crowns
Dentures
Dentures
Emergency
Repair
(Simple)