A radiograph of a single tooth or group of teeth showing the entire tooth and surrounding bone.
Get help with D0220 claims →When a patient presents with localized pain and you need to evaluate the root, periapical area, and surrounding bone of a specific tooth.
Before, during, and after root canal treatment to assess the pulp chamber, root canals, and periapical pathology.
Evaluating a tooth after injury to check for root fracture, displacement, or alveolar bone damage.
These are the denial reasons we see most often for D0220. Each one is preventable with proper documentation.
Many plans limit the total number of radiographic images per year. Track cumulative images across all visit dates.
If a complete series (D0210) was taken the same day, individual periapicals are denied as included in the series.
Document why this specific image was necessary. "Routine" is not sufficient justification.
Document the specific reason the radiograph was needed (pain, swelling, trauma, follow-up).
Record which tooth or teeth the image covers.
Document what the radiograph revealed and how it affected the treatment plan.
D0220 is the first periapical image. Each additional periapical taken during the same visit is billed as D0230. If you take four periapicals, you bill one D0220 and three D0230s.
Do not bill individual periapicals if you are taking a complete series. A complete series (D0210) includes all necessary periapical and bitewing images. Billing D0220 separately on top of D0210 will be denied as a duplicate.
Every radiograph needs a clinical reason. "Patient due for x-rays" is not a valid indication. Document the symptom, finding, or clinical question that required the image. Examples: "Patient reports sharp pain on biting #19, periapical taken to evaluate for vertical root fracture" or "6-month post-endodontic evaluation #14, periapical to assess periapical healing."
The ADA recommends using selection criteria based on the patient's clinical condition rather than arbitrary time intervals. Payers increasingly audit radiograph frequency, and practices that take images on a strict time schedule without clinical justification face higher denial rates.
Our team handles D0220 billing daily. We know the denial patterns, documentation requirements, and appeal strategies that get claims paid.
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