Dental claims can be denied for all kinds of reasons, but few are as annoying as a simple coding mistake. This happens often with dental X-ray codes because they look so similar, and in a busy practice, things move quickly. When the wrong code slips through, it can lead to delays, downcoding, extra documentation requests, or even a denial that could have been easily avoided.
In this guide, we explain the correct use of D0210, D0220, and D0230, point out the most frequent coding mistakes, and share simple, practical steps to avoid them.
These are taken inside the mouth and are the most common diagnostic images.
These are taken outside the mouth.
This is most often CBCT, used when a 3D view is clinically needed. Many payer policies list CBCT CDT codes in the D0364 to D0368 and D0380 to D0384 ranges.
X rays help a dentist see what is not visible during the clinical exam, like issues between teeth, under restorations, in bone, and around root tips. But the key point for billing is this: imaging should be ordered because it is needed for diagnosis and treatment planning, not because a plan “covers it.” The ADA also points dentists and payers to ADA and FDA guidance on ordering radiographs based on clinical need while limiting radiation exposure.
CDT codes are the language used on dental claim forms to describe what was done. Payers use them to apply benefit rules, evaluate frequency limits, and request documentation if something looks inconsistent.
That is why small differences matter:
Mixing them up is one of the quickest ways to trigger a denial or a request for records.
Below are the dental xray codes most offices run into often, with extra focus on the three that get confused.
The d0210 dental code is used for an intraoral comprehensive series of radiographic images, often called a full mouth series. The key is coverage, not a fixed image count. ADA guidance shows that a series can still qualify as D0210 even when the number of images varies, as long as it captures the crowns and roots of all teeth and the key supporting areas that the descriptor expects.
The d0220 dental code is for the first intraoral periapical radiographic image taken on that date of service. It is used once, then you move to D0230 for additional periapicals.
The d0230 dental code is for each additional intraoral periapical image after the first one on the same date of service.
Common related codes you will see alongside them
This is where the “common coding error” shows up.
Use d0210 dental code when the images taken are intended to be a comprehensive intraoral survey of the whole mouth and they truly capture what the descriptor expects. ADA examples show D0210 is appropriate when images capture all crowns and roots and the required areas, and also show cases where D0210 is not appropriate when the set does not meet that coverage.
Use d0220 dental code when you take a periapical, then use d0230 dental code for each additional periapical you take that same day. ADA guidance also spells out this exact situation and shows D0210 should not be used when the images are not comprehensive, and the correct approach is D0220 plus D0230 with the right quantity.
This is a common mismatch, payers notice fast.
Patients usually care about two things: “Why do I need this?” and “Will insurance pay?” A simple way to explain it:
If a patient is surprised by a bill, it often helps to show that the imaging was tied to symptoms, exam findings, or treatment planning.
Yes, many plans apply frequency limits, especially for a full mouth series. A common plan pattern is allowing a full mouth series once every few years and bitewings on an annual cycle, though rules vary by payer and plan.
Practical dental billing takeaway:
This is the big one. Offices sometimes use d0210 dental code as a shortcut when “a lot of images” were taken, even if the set was not comprehensive. How to avoid it:
Payers and coding guidance are clear that D0220 is the first periapical image, and then D0230 covers each additional periapical image. How to avoid it:
A panoramic image is extraoral. Bitewings have their own codes. They should not be reported as D0210 just because they show “most of the mouth.” That is a false match between what was done and what was billed. How to avoid it:
If the chart does not include the dentist’s evaluation or interpretation of the images, payers may deny payment or request repayment in an audit. How to avoid it:
If you bill CBCT, pick the right CBCT code based on the field of view and whether the service includes capture and interpretation, and document why 3D imaging was needed for that case. Many payer policies list these CBCT codes explicitly. A simple way to phrase it internally:
The D0210, D0220, and D0230 mix-up is avoidable when you follow two habits: match the code to the type of imaging actually taken, and count periapicals correctly. Use d0210 dental code only when the set is truly comprehensive, and use d0220 dental code once, plus d0230 dental code for additional periapicals when it is a limited set. ADA guidance supports this exact approach and even provides examples of when D0210 is and is not appropriate.
Need help tightening your imaging coding and reducing denials? Capline Dental Services can handle your billing and coding workflow so claims go out clean and supported. Visit Capline Dental Services to learn more and request support for your practice. Contact us today.
D0210 is an intraoral comprehensive series. D0220 is the first periapical image on that date of service. D0230 is each additional periapical image after the first.
A full mouth series is a comprehensive intraoral survey intended to show the crowns and roots of all teeth and key supporting areas. This is commonly billed as d0210 dental code when it meets the descriptor’s coverage.
Yes. Coding guidance notes that the descriptor was updated so the focus is on a comprehensive series intended to display the whole mouth as described, rather than tying it to a fixed number of images.
Match the claim to the images taken, count periapicals correctly, and make sure the chart includes interpretation and supports medical necessity.
CBCT commonly uses codes in the D0364 to D0368 and D0380 to D0384 families, depending on the field of view and whether it includes capture and interpretation. This is the area most people mean when they say 3d xray dental code.
