Four bitewing radiographic images.
Get help with D0274 claims →Standard for adults with full posterior dentition during periodic examinations.
Four bitewings provide complete coverage of all interproximal surfaces in the premolar and molar regions.
Often taken as part of a new patient examination alongside a panoramic image or complete series.
These are the denial reasons we see most often for D0274. Each one is preventable with proper documentation.
Most common denial. Plans typically allow once per 6-12 months. Verify last date of service.
If a complete series was taken the same day, bitewings are included and cannot be billed separately.
Some plans only cover two bitewings. The payer pays D0272 and the patient may owe the difference if the plan allows balance billing.
Confirm four images were actually exposed.
Document reason: caries detection, monitoring restorations, bone level assessment.
Record the patient's current caries risk to justify the frequency interval.
D0274 is a single code for four images. You do not bill D0270 (single bitewing) four times. You do not bill D0272 (two bitewings) twice. One D0274 covers the entire set of four bitewing radiographs.
If the patient cannot tolerate a standard bitewing holder and you need to take the images differently, the code is still D0274 as long as four bitewing-type images are captured. The code describes the output, not the technique.
Some plans apply an "alternative benefit" clause and only pay for D0272 (two bitewings) even when four were medically necessary. In these cases, document why four bitewings were required and inform the patient they may have an out-of-pocket balance for the remaining two images. This is a benefit limitation, not a clinical error.
Our team handles D0274 billing daily. We know the denial patterns, documentation requirements, and appeal strategies that get claims paid.
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