D0210, D0220 & D0230: A Common Dental Coding Error

February 16, 2024

When it comes to dental coding, things can get confusing. After all, many codes are only a digit apart. For instance, when billing radiographs, three similar codes are D0210, D0220, and D0230. They can easily be confused, leading to coding errors. In this ongoing series, we discuss common coding errors, focusing today on D0210, D0220, and D0230.  

What Is the Difference Between D0210, D0220, and D0230?

ADA Definitions for D0210, D0220, and D0230

According to the ADA, D0210 is the dental code for “intraoral – comprehensive series of radiographic images.” D0220 is the code for “intraoral-periapical first radiographic image.” D0230 is the code for “intraoral-periapical each additional radiographic image.” 

Clinical and Documentation Considerations

Note: The type and sequence of diagnostic images should be determined and ordered by the doctor on a patient-by-patient basis in compliance with ADA/FDA guidelines. This determination is based on risk assessment, observation, and medical necessity. Images should not be taken based on the patient’s plan benefits, or limitations. Patient documentation should contain the dentist’s written evaluation of the diagnostic images taken. If there is no documentation of the radiographic interpretation in the chart, the payor may deny payment of the claim or ask for reimbursement in the event of an audit.

What Is a Comprehensive Series of Radiographic Images?

The CDT code D0210 is commonly referred to as a full mouth x-ray (FMX) or a full mouth series (FMS).   What constitutes a comprehensive series of radiographs may vary from patient to patient. The critical component is that it should be a combination of intra-oral diagnostic quality radiographs that display the crown and roots of all teeth, periapical areas, interproximal areas, and alveolar bone, including edentulous areas.

What Is a Periapical Radiographic Image?

A periapical radiographic image (PA) shows the entire length of the tooth from the root tip to the crown. It allows the dentist to see the entire tooth and surrounding tissue to determine decay, damage, gum disease, bone loss, or other issues. 

Code Tip: Periapicals and Diagnostic Strategy

Code Tip: Periapicals, particularly at different “angles,” are often necessary to provide alternate views of the dental anatomy for a complete diagnosis. Two periapicals are a better choice at the emergency visit from a reimbursement perspective and, often, from a clinical perspective as well. Billing a single bitewing at the emergency visit may trigger limitations that prevent reimbursement for two/four bitewings at the recare visit.

Has the ADA Revised D0210?

Yes, in 2023, the ADA revised code D0210. Previously, it was considered “a complete series of radiographic images” and required a specific number of images(14-22). It has now been updated to “a comprehensive series of radiographic images” and is now defined as “a radiographic survey of the whole mouth intended to display the crowns and roots of all teeth, periapical areas, interproximal areas and alveolar bone.” 

Why Annual CDT Code Changes Matter

Did you know that the ADA makes changes to the CDT code set every single year?! In fact, there have been over 300 changes since 2020. To keep up with them, it’s best to have a reference guide on hand. Dental Coding with Confidence is the industry standard and includes the 60 updates coming in 2026. 

What Should I Remember When Billing Radiographic Images?

Matching Images to Claims and ADA Claim Form Accuracy

Before submitting claims, check that the images reported on the claim form match the radiographs actually taken on that date of service. When listing multiple images, it can be easy to lose count. Always double-check your numbers before submitting the claim. Remember, D0220 can only be used once per claim. For example, if you are billing four PAs, list D0220 once and D0230 three times, and note the range of teeth numbers being evaluated in Box 27 and the quantity captured in Box 29b of the 2024 ADA Dental Claim Form. 

Avoiding Misrepresentation and Incorrect Code Substitution

Always code for what you do. An extraoral panoramic radiographic image (D0330) and bitewings (D0272/D0273/D0274) should never be reported as an intraoral – comprehensive series of radiographic images (D0210). While these images may provide a radiographic survey of the whole mouth, a panoramic image is extra-oral, not intra-oral. Reporting D0210 would be a false representation of what was actually performed.

Do Frequency Limits Apply to Radiographs?

Almost all plans contain verbiage in the certificate of coverage limiting the number of radiographs within a certain timeframe. An FMX is usually covered once every three to five years. Bitewings are usually limited to once per 12-month period. Be aware that any number of bitewings taken at any particular visit may “trigger” the “once per year/12 months” limitation by most plans. One bitewing, two bitewings, three bitewings, or four bitewings taken at a particular visit date could be subject to the plan’s bitewing frequency limitation. Frequency limits are less common for periapicals. 

CDT Coding Resources

When billing radiographs, the dental codes are so similar that they can be easily confused. If you want to avoid any confusion, consider partnering with eAssist. Our Success Consultants are knowledgeable about the various nuances of CDT codes and will ensure your diagnostic images are reported to insurance correctly. To learn more, schedule a consultation here.