D0220 is the CDT code for the first intraoral periapical radiographic image taken on a date of service — a single, focused X-ray showing a tooth (or teeth) and the surrounding bone from crown to root tip.
Informational only — confirm the official CDT descriptor and your payers' rules independently. This is general guidance, not billing, coding, or clinical advice.
When to Use the D0220 Code
Use D0220 for the first periapical image captured on a given date — most often to evaluate a specific tooth's root, surrounding bone, and apex, such as for a toothache, suspected abscess, or pre-treatment assessment. A periapical shows the full length of the tooth, unlike a bitewing, which focuses on the crowns.
D0220 is only the first periapical of the date; each additional periapical the same day is reported with D0230. Don't confuse a series of periapicals with a complete intraoral series, D0210 — if the images together make up a full-mouth set, payers typically expect D0210 instead of stacked D0220/D0230 lines.
Documentation & Clinical Scenarios
The record should connect the image to a clinical purpose:
- The date and the tooth/area imaged, and the reason (symptom, diagnosis, or pre-treatment).
- That this is the first periapical of the date, with any additional images coded D0230.
- The interpretation/findings noted by the dentist.
- The associated evaluation or procedure, documented and billed under its own code.
If multiple periapicals or other films are taken, the chart should make clear how many and why, so the first-vs-additional coding is supported and a complete series isn't billed as separate images.
Insurance & Billing Tips
- First vs. additional. Bill D0220 once per date for the first periapical, then D0230 for each additional — a frequent error is reporting D0220 multiple times.
- Watch the complete-series bundle. If the periapicals and bitewings together equal a full-mouth set, payers may re-bundle them into D0210.
- Verify frequency. Many plans limit the number of intraoral images covered per period; excess images may be patient responsibility.
- Tie to a diagnosis. A periapical taken to evaluate a specific complaint is well supported by a brief narrative or diagnosis.
- Bill the exam separately. The evaluation (such as D0140) is reported on its own line, not bundled with the image.
Example Case
A patient presents with pain in a single upper molar. The dentist takes one periapical image of that tooth to evaluate the root and surrounding bone, identifying a periapical radiolucency consistent with an abscess. The image is coded D0220 as the first periapical of the date, and the problem-focused evaluation is reported separately as D0140. Because only one periapical was taken and it was tied to a documented complaint, the claim processes cleanly without confusion over additional-image or complete-series coding.
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Frequently Asked Questions
What's the difference between D0220 and D0230?
D0220 is the first intraoral periapical image taken on a date of service, while D0230 is each additional periapical that same day. So a date with three periapicals is reported as one D0220 plus two D0230s. Billing D0220 more than once for the same date is a common coding error — only the first periapical uses D0220, and every subsequent one uses D0230.
When should I use D0210 instead of D0220?
Use D0210 when the images taken together amount to a complete intraoral series (a full-mouth set covering all teeth and surrounding bone). If you capture enough periapicals and bitewings to constitute a full series, payers generally expect the single D0210 code rather than many separate D0220/D0230 and bitewing lines, and may re-bundle them. For a few focused periapicals, D0220 (and D0230) is appropriate.
How often will insurance cover periapical X-rays?
Coverage varies by plan, and many payers limit the number of intraoral images reimbursed within a given period. A periapical taken to evaluate a specific symptom is usually well supported, but images beyond the plan's allowance may become the patient's responsibility. Verifying the imaging benefit and the patient's recent X-ray history before the visit helps set expectations and avoid surprise balances.
Does D0220 include the dentist's exam?
No. D0220 covers only the single periapical image. The evaluation performed at the visit — such as a limited, problem-focused exam (D0140) — is reported separately under its own code. Each service is billed on its own line, and the chart should document both the image (with its clinical purpose) and the evaluation distinctly.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.