Dental X-Ray Codes: Bitewings, D0220, D0210 and Pano

Dental x-ray codes appear on more claims than almost any other part of the CDT Code, and most of the billing trouble comes from frequency limits and bundling, not from the codes themselves. D0220 is the first periapical image of a visit, D0272 and D0274 are two- and four-image bitewing sets, D0210 is the full mouth series, and D0330 is the pano dental code. This guide explains how plans count each one, when separate images get paid as a full series, and what our team checks before an imaging line goes out.

This article is general information, not coding advice. Choosing a code is the treating dentist’s decision, based on what was done and what the clinical record shows. We describe codes here in our own plain words; for the exact nomenclature and descriptors, use the current CDT manual published by the American Dental Association.

What are the most common dental x-ray codes?

In plain words, the imaging codes general offices use most are:

• D0210: a full mouth series, a set of intraoral images meant to survey the whole mouth.
• D0220: the first periapical image taken at a visit.
• D0230: each additional periapical image after the first.
• D0270 to D0274: bitewings, coded by the number of images (one, two, three or four). D0272 is two images and D0274 is four.
• D0277: vertical bitewings, a larger set often used for periodontal patients.
• D0330: a panoramic image.
• D0240: an occlusal image.

The code set also includes image-capture-only codes, used when one office takes an image and another interprets it, and newer tomosynthesis codes. Codes are revised every year, so check the current CDT manual and our summary of CDT 2026 code changes.

When is D0220 billed?

D0220 is reported once per visit for the first periapical image, with D0230 for each additional one. It is common at emergency visits alongside a limited exam, and before endodontic or surgical treatment.

The billing risk is quantity. When an office takes several periapicals and bitewings on one date, many plans compare the total fee with the fee for a full mouth series. The 2023 Delta Dental handbook of national processing policies, for example, treated a set of separate images as a full mouth series for payment and frequency once their combined fee reached or passed the full series fee. The ADA lists this kind of recoding among the bundling complaints it hears from dentists, noting that the images may not amount to a full series.

How often will insurance pay for bitewings like D0272 and D0274?

Plans set bitewing frequency in their contracts, often once or twice per benefit period, and some vary it by age. A few examples from published carrier policies:

• The 2023 Delta Dental handbook limited patients under age 10 to two bitewing images, paying a three- or four-image set as D0272.
• Northeast Delta Dental’s 2023 policy changes stated that additional bitewings within six months of a full mouth series are not billable to the patient when the same office takes them, and are denied when a different office does.
• The same Delta Dental handbook folded bitewings taken on the same date as a full mouth series into the full series fee.

Clinical timing is a separate question. The ADA and FDA guidance on selecting patients for dental radiographs says recall imaging frequency should be based on caries risk assessment, and it is written as a resource for the dentist, not a standard of care. So the dentist may order bitewings sooner than the plan pays for them. When that happens, the office should know in advance and tell the patient about the likely cost.

What is the pano dental code, and how does it compare with a full mouth series?

D0330 is the panoramic image. A full mouth series (D0210) is made of intraoral images. Plans often put the two in the same frequency bucket, so one can block the other:

• The 2023 Delta Dental handbook limited both full mouth series and panoramic images to once every five years, and counted a pano, with or without other images, as a complete series for frequency purposes.
• Under that kind of rule, a pano taken this year can cause a full mouth series next year to be denied.
• Starting in January 2024, according to the Washington State Dental Association, a national Delta Dental policy change exempted panoramic images from the rule that bundled them with other same-day images into the full series fee.

The ADA notes that some payers combine a pano with bitewings and pay them as a full mouth series, and that dentists object because a panoramic image lacks the detail needed for many diagnoses. Because these policies change and vary by plan, check the current rule for each carrier rather than relying on older habits.

Do dental x-ray claims need attachments?

Imaging lines rarely need attachments of their own. More often, the images are the attachments for other procedures: crowns, buildups, scaling and root planing, extractions and endodontic treatment. Still, a few habits protect imaging claims:

• Make sure the chart shows the dentist’s interpretation. Carrier policies such as the Delta Dental handbook treat the imaging codes as including both capture and interpretation.
• Keep images dated and labeled with the patient and tooth, so a reviewer can tell the image is current.
• Send images electronically through your clearinghouse attachment service rather than by mail.
• Match the code to the count. A four-image bitewing code with only two images in the chart is an audit problem.

Because plans count dental x-ray codes so closely, the date of every image matters as much as the code. An image taken at a previous office, a hospital visit or a specialist referral may still sit in the carrier’s history and affect what your office can be paid. When a patient transfers in, ask whether recent images exist and request copies. That can save the patient an unneeded exposure and the office a denied line.

Why do x-ray claims get denied or downgraded?

1. The plan’s frequency for that image type was already used, sometimes by another office.
2. Several images on one date were bundled and paid as a full mouth series.
3. A pano fell inside the full series frequency window, or the reverse.
4. Bitewings were taken within a set period after a full mouth series.
5. The patient’s age limited the number of bitewing images the plan pays.

Our Dental Claims Management team reviews these lines before submission. When a payment looks like bundling that the plan’s own policy does not support, our Denial Management & Appeals team can ask for review.

How does our dental RCM team check x-ray codes?

Inside Open Dental, Dentrix or Eaglesoft, we track dental x-ray codes by recording the dates of the patient’s last full mouth series, pano and bitewings, including those taken at other offices when the carrier portal shows them. During Insurance Verification & Eligibility we note how the plan counts imaging and flag any appointment where an expected image would fall outside coverage. The dentist still decides what to take; our job is to make sure the office and the patient know what the plan will do. These checks matter on every hygiene schedule in general dentistry and pediatric dentistry offices.

Tired of imaging lines paid as something else?

If bitewings and panos keep coming back bundled or denied, book a free consultation. We will look at how your office tracks imaging history and where carrier rules are catching you.