You snap the X-rays, diagnose the issue, and provide top-notch care, but are your billing practices reflecting the full scope of what you’ve done?
Many dental practices unknowingly leave money on the table when billing for intraoral periapical radiographs, D0220 and D0230. These two simple codes, when misunderstood or underused, can quietly chip away at your practice’s revenue over time.
Here’s how to ensure your practice is coding intraoral periapical images accurately and ethically.
Understanding the Codes
Let’s break down the key CDT codes that involve periapical images:
- D022o Intraoral – Periapical first radiographic image. This is used for the first periapical image taken during a visit.
- D023o Intraoral – Periapical each additional radiographic image. This is used for the first periapical image taken during a visit.
- D0210 Itraoral – Comprehensive series of radiographic images. A full-mouth series (FMX) is intended to show the entire dentition and supporting bone structure, which typically includes periapicals and bitewings.
D0220 and D0230 are mutually exclusive. That means if you are reporting D0210, you should not report D0220 or D0230 on the same date.
The Undercoding Risk
A common undercoding mistake occurs when a provider takes a series of periapicals but only bills D0230 once. If three separate periapical images were taken, the correct coding would be:
- D0220 for the first image
- D0230 x2 for the additional images
By omitting the D0230 codes, you’re not capturing the full scope of work and potentially reducing reimbursement unnecessarily.
When to Use D0210
What constitutes a comprehensive series of radiographs (D0210) may vary from patient to patient. The critical component is that it should be a combination of intraoral diagnostic quality radiographs that display the crown and roots of all teeth, periapical areas, interproximal areas, and alveolar bone, including edentulous areas.
Don’t default to D0210 just because multiple images were taken. If only a few targeted periapicals were captured (e.g., to assess pain in one area), use D0220 and D0230 as appropriate.
Documentation Matters
Insurers often request supporting documentation for radiographic services. Here’s how to strengthen your claims:
- Chart clearly which images were taken and why (e.g., “periapical of #30 to evaluate suspected abscess”)
- Indicate whether bitewings are included (especially if reporting D0210)
- Record image counts when more than one periapical image is taken to support the number of D0230 counts reported on the claim form
Pro Tips to Avoid Common Mistakes
- Don’t double-dip: Never bill D0210 with D0220 or D0230 on the same day.
- Train your team: Make sure both clinical and administrative team members understand the difference between D0220 and D0230.
- Check frequency: Most plans cover D0210 once every 3–5 years, while D0220/D0230 generally do not carry a frequency limitation. If the fee for individually listed intraoral radiographic images equals or exceeds the fee for D0210, generally payors will remap these images to a complete series (D0210). Regardless of plan policies for determining benefits, always code for what you actually do.
A Real-World Example
Let’s say a patient presents with localized pain in the lower right quadrant. The provider takes three periapical images of teeth #28, #29, and #30.
Incorrect coding:
- D0220 only
Correct coding:
- D0220 (first image)
- D0230 x2 (for the other two images)
If the fee for a periapical image is $20, this small correction can mean the difference between a $20 reimbursement and a $60 reimbursement.
The Bottom Line
You’re already doing the work – don’t shortchange your practice by underbilling it. By understanding the proper use of CDT codes D0220 and D0230, you can ensure accurate reimbursement, maintain compliance, and boost the financial health of your practice.
Picture this: clean claim submission, proper documentation, and a stronger bottom line. That’s a win for everyone!
Need help getting it right every time?
eAssist’s dental billing experts can take the guesswork out of coding, documentation, and claim submission. From radiographs to full treatment plans, we help dental teams boost accuracy, reduce denials, and get paid what they deserve.
Schedule a free consultation with eAssist and see how we can support your practice.
Disclaimer: Insurance administration and dental billing recommendations presented here represent the opinions of the author or our staff and are for informational purposes only. You are responsible for your own use of the CDT Codes, insurance administration, and dental billing. For the latest CDT codes and official interpretations, contact the American Dental Association or visit ADA.org.
