D0230 is the CDT code for each additional intraoral periapical radiographic image taken after the first periapical at the same visit. A periapical (PA) film shows the whole tooth — crown to root tip — plus the surrounding bone, and D0230 is reported once for every extra image beyond the first.
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 D0230 Code
Use D0230 for each additional periapical image captured during an appointment once the first PA has been reported. The first periapical is always coded D0220 (intraoral periapical, first radiographic image); every subsequent PA at that visit is D0230. So three periapical films equal one D0220 plus two D0230.
Do not confuse D0230 with the bitewing codes — D0272 (two bitewings) and D0274 (four bitewings) — which capture the crowns of opposing posterior teeth, not full roots. Also keep it separate from D0210, the complete intraoral series; once you reach the threshold for a full-mouth series, most payers expect D0210 rather than a long stack of D0220/D0230 lines. D0230 is strictly the "each additional" periapical add-on.
Documentation & Clinical Scenarios
The record should justify why multiple periapical images were needed and how many were taken:
- Tooth or region for each image and the diagnostic reason (suspected periapical pathology, fracture, endodontic evaluation, trauma).
- Image count — the number of D0230 units must match the number of additional PAs in the chart.
- The interpretation — a brief note of the radiographic findings, not just that films were exposed.
- The provider and date.
Radiograph codes are billed by image, so each PA carries its own line. Any clinical procedure performed the same day (an exam, an extraction, endodontics) is documented and billed under its own code, separately from the imaging.
Insurance & Billing Tips
- Report units accurately. Bill one D0220 for the first PA and D0230 for each additional image; submitting D0230 with no first-image code can trigger a review.
- Watch full-mouth thresholds. Many plans bundle a high count of individual films into a complete series (D0210) and reimburse at the FMX allowance, not per image.
- Frequency limits apply. Radiograph frequency (for example, a full-mouth series once every 3–5 years) varies by payer; verify before exposing a large set.
- Avoid duplicate-imaging denials. If recent films exist elsewhere, document medical necessity for re-exposure.
- Attach images when requested. Some payers require the actual radiographs to adjudicate multiple-image claims.
Example Case
A patient presents with pain in the upper-left quadrant. The dentist exposes one periapical of the suspected tooth, then two more of the adjacent teeth to rule out a referred source and check the apical bone — three periapical films in total. The visit is coded D0220 for the first image and D0230 × 2 for the two additional images, each documented with its region and findings. Because the office verified the patient's radiograph benefits in advance, the claim adjudicates as expected.
Patients call about pain or "do I need X-rays?" — not D0230. DentalReception AI answers and books those calls 24/7, captures insurance details, and routes clinical and billing questions to your team. See how it handles dental X-ray calls, or book a demo.
Frequently Asked Questions
What's the difference between D0220 and D0230?
D0220 is the first intraoral periapical image at a visit; D0230 is each additional periapical after that. They are billed together — one D0220 plus a D0230 for every extra PA. Reporting D0230 without a corresponding first-image code is a common error that can delay payment.
How many D0230 units can I bill?
Bill one unit of D0230 per additional periapical image actually taken and documented. The code itself sets no fixed cap, but once you reach a high image count, most payers expect a complete intraoral series (D0210) and reimburse at the full-mouth allowance instead of per film.
Is D0230 the same as a bitewing?
No. D0230 is a periapical image showing the whole tooth and root apex. Bitewings — D0272 and D0274 — show only the crowns of upper and lower posterior teeth for interproximal decay and bone levels. They are separate codes and should not be substituted for one another.
Does insurance always cover additional periapical images?
Not automatically. Coverage depends on the plan's radiograph frequency limits and full-mouth-series rules. Verify benefits before exposing a large set, document the diagnostic need for each image, and be ready to attach the films if the payer requests them to support the claim.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.