D0274 is the CDT code for four bitewing radiographic images — the standard four-film set capturing the crowns of the upper and lower posterior teeth on both sides to detect interproximal decay and assess bone levels. It's the most common bitewing set for adult recall exams.
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 D0274 Code
Use D0274 when exactly four bitewing images are taken — typically two on each side, covering the premolar and molar contacts in both arches. This is the routine full bitewing survey for most adults at a checkup.
Match the code to the image count. Two bitewings is D0272, one is D0270, and seven or eight vertical bitewings is D0277. Reporting D0274 when only two films were taken — or splitting a four-film set across other codes — is a frequent error. Bitewings are also not periapicals: D0220/D0230 show the whole tooth and root, while bitewings show only the crowns. Bill the code that matches what was exposed.
Documentation & Clinical Scenarios
The record should support the four-image count and the diagnostic purpose:
- Number of images — four, matching the D0274 code.
- Diagnostic reason — interproximal caries detection and bone-level assessment across both posterior segments.
- Interpretation — a brief note of findings, not just that films were taken.
- The provider and date.
What's billed separately: the evaluation that day (a periodic exam, D0120), the cleaning (D1110), and any restorative work each carry their own codes. D0274 covers only the four bitewing images.
Insurance & Billing Tips
- Know the frequency limit. Many plans cover a bitewing set once or twice per benefit year; a set taken too soon after the last is commonly denied.
- Bill the actual count. Report D0274 only when four images were taken; use D0272 for two. Mismatched counts cause down-coding or denial.
- Watch annual radiograph maximums. Some plans cap total imaging per year across all radiograph codes, not just bitewings.
- Don't combine overlapping codes. D0274 and D0272 for the same posterior survey on the same day are not both payable.
- Mind full-mouth bundling. If bitewings are taken alongside many periapicals, some payers bundle everything into a complete series (D0210) at the FMX allowance.
Example Case
An established adult arrives for an annual checkup. The hygienist takes a four-film bitewing set — two per side — and the dentist reviews them, identifying early decay between two molars. The visit is coded D0274 for the four images, D0120 for the periodic evaluation, and D1110 for the cleaning, each on its own line. Because the office confirmed the patient was due for bitewings under their plan's frequency limit, the imaging claim is paid as expected.
Patients call to "book my cleaning" or ask if X-rays are included — not D0274. DentalReception AI answers and books those recall 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 D0274 and D0272?
D0274 is four bitewing images; D0272 is two. Report the code that matches the number of films actually exposed — the standard adult set of two per side is D0274, while D0272 is the smaller two-image set. Billing the wrong count is a common error that leads to down-coding or denial.
How often will insurance cover a four-bitewing set?
Most plans cover a bitewing set once or twice per benefit year, and some apply an annual maximum across all radiograph codes. A set taken sooner than the limit allows is commonly denied, so tracking each patient's bitewing history and verifying frequency before the visit keeps the claim clean.
Are bitewings the same as periapical X-rays?
No. Bitewings (D0272/D0274) show only the crowns of the upper and lower posterior teeth, which is ideal for spotting interproximal decay. Periapicals — D0220 and D0230 — show the entire tooth including the root tip. They serve different diagnostic purposes and are billed under separate codes.
Can D0274 be billed with an exam and cleaning on the same day?
Yes. The four bitewings (D0274), the periodic evaluation (D0120), and the cleaning (D1110) are separate procedures reported under their own codes on the same date. Confirm the bitewings fall within the plan's frequency limit, and document the four-image count and findings 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.