D0260 is the CDT code for an extraoral occlusal radiographic image. The receptor is positioned outside the oral cavity rather than inside the mouth, distinguishing it from the intraoral occlusal image captured under D0240. This code is used when intraoral sensor or film placement is not possible or not clinically practical, such as in patients with limited mouth opening, severe gag reflex, or significant oral pathology.
Last updated June 2026 ยท Reviewed by the PracticeAlpha billing team
Get help with D0260 claims →Patients with trismus, restricted mouth opening from surgery or trauma, or significant oral pathology that makes intraoral sensor placement impractical. Extraoral positioning allows a comparable view without requiring wide mouth opening.
Patients who cannot cooperate with intraoral film placement due to developmental, physical, or behavioral factors. The extraoral technique can be completed with less patient cooperation than intraoral positioning requires.
When a patient's gag reflex prevents intraoral imaging and the clinical need requires an occlusal-type view, D0260 provides the same diagnostic projection without placing the receptor inside the mouth.
Do NOT use D0260 for: Intraoral occlusal images where the film is placed inside the mouth (use D0240). Standard periapical images (use D0220 or D0230). Panoramic images (use D0330). Bitewing images for caries detection (use D0272 or D0274). The code specifies the receptor is extraoral, so technique accuracy is required.
D0260 is a less commonly billed code, and some payer systems may not have it in their fee schedule or may default it to a denial or manual review. If you receive an "invalid code" denial, verify the payer is using a current CDT edition and submit a corrected claim with documentation of the technique used.
If D0260 is billed alongside a panoramic or full-mouth series on the same date, payers may bundle or deny it. The claim must include documentation explaining why the extraoral occlusal projection provided distinct diagnostic information not captured in the other images taken that day.
Payers may question why an extraoral rather than intraoral occlusal image was taken. The clinical note must explain the patient's limitation, for example trismus with a measurement, a documented gag reflex, or an oral condition preventing intraoral access. Without that note, the claim looks like a miscoded D0240.
D0240 and D0260 look similar and are sometimes confused. Filing D0260 when the image was actually taken intraorally, or vice versa, creates a mismatch between the record and the claim. Verify the actual technique before coding.
Document the patient-specific reason intraoral placement was not possible or practical. Specific clinical language matters: trismus with approximate mouth opening, documented severe gag reflex, or an identified condition limiting intraoral access.
Specify whether the image was of the maxillary or mandibular arch and the projection type taken. Clear documentation prevents coding questions from payers or auditors.
The image date must match the claim date of service. The treating or supervising provider must be identified. The actual radiographic image must be accessible in the patient record.
Record what was evaluated and what was observed or ruled out. A brief interpretation note connects the image to the clinical decision-making process, which is important if the claim is reviewed by the payer.
If other diagnostic images were taken the same day, document what diagnostic information D0260 provided that the other images did not. This is particularly important when billing alongside D0330 or D0210 to counter bundling denials.
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Learn about our billing servicesD0260 is the CDT code for an extraoral occlusal radiographic image. The receptor is placed outside the oral cavity to capture an occlusal-plane view of the arch. It is used when intraoral sensor placement is not possible due to patient anatomy, limited mouth opening, or intolerance of intraoral film.
D0240 places the receptor inside the mouth (intraoral occlusal). D0260 places the receptor outside the mouth (extraoral occlusal). Both produce an occlusal-type view, but the technique differs. The clinical reason for choosing extraoral placement should be documented when billing D0260.
D0260 is appropriate when intraoral placement is not possible: severe gag reflex, trismus, limited mouth opening from trauma or surgery, or behavioral/physical conditions that prevent intraoral sensor positioning. Document the specific reason in the clinical record.
Coverage policies vary. Some payers cover D0260 under the standard diagnostic x-ray benefit. Others may require a narrative if it is billed alongside other same-day images. A small number of older payer systems may not recognize the code and require manual processing or resubmission.
D0260 is used less frequently than D0240 in general practice. It is more common in pediatric dentistry, hospital dentistry, or practices treating patients with special needs, where intraoral imaging is regularly limited by patient cooperation or anatomy.
Billing both on the same date requires documentation showing each image provided distinct diagnostic information. Without a clear clinical rationale, payers will likely bundle or deny one. In most clinical scenarios, one technique or the other is appropriate, not both on the same visit.
Search all CDT codes in our dental coding guide.