D0220 INTRAORAL – PERIAPICAL FIRST RADIOGRAPHIC IMAGE CDT-2026

D0220 is only for the first periapical (PA) radiograph taken on any date of service.
Report D0230 for each additional periapical radiographic image taken after the first image on the same service date.
Radiographs are only reimbursable when taken for a diagnostic purpose, not for documentation or as “check films” during a procedure. Images taken during or immediately after treatment (including for endodontic working length, crown seat or calculus removal verification, etc.) are not diagnostic in nature and are considered a part of the global treatment fee.
The type and frequency of diagnostic images taken should be determined by the needs of the patient, not based on the patient’s plan or limitations. To be valid, images should include documentation of why images were required, should be of diagnostic quality, and should include a written interpretation of the diagnostic findings or a note of no significant findings. Lacking these components may result in a denial of payment or recoupment in the event of an audit.
Enter the tooth number or range of teeth numbers being evaluated in Box 27 of the 2024 ADA Dental Claim Form.

Periapical radiographic images at emergency visits are routinely reimbursed. However, periapicals at checkups may require a narrative and/or chart notes and the actual image (required more and more). A caries risk assessment demonstrating increased risk, if appropriate (D0602/D0603) may help justify periapicals at a checkup taken in conjunction with bitewings. Several payors are cracking down on periapicals routinely taken with bitewings at a recare visit.
If a number of periapicals and bitewing radiographic images are taken on the same service date and the fee for those images is equal to or greater than the comprehensive series, the fee reimbursed will be limited to that of the comprehensive series. The payment of the comprehensive series will trigger the “once every three to five-year limitation.” If a comprehensive series is reimbursed, a notation should be made in the patient’s billing record for future reference.
Reimbursement for periapical images, if reported in conjunction with bitewing images, may be limited by some payors.
For intraoral – periapical radiographic image, image capture only, see D0707.
For intraoral tomosynthesis – periapical radiographic image see D0374. For image capture only, see D0389.

One, two, or three periapical images may be reimbursed on a problem focused evaluation (D0140) service date. Periapical images taken at the problem focused visit typically do not affect the “once per year/12 months” limitations for bitewing images associated with recare visits.
Intra-oral periapical first image (D0220) and an additional periapical image(s) (D0230) are often payable at any visit (including recare), if medically necessary. At an emergency, problem focused oral evaluation (D0140) or periodic oral evaluation (D0120) recare visit, the periapical image reimbursement may be subject to a deductible as well as the maximum fee limitation for multiple diagnostic images.
Periapicals, particularly at different “angles,” are often necessary to provide alternate views of the anatomy of an area for a complete diagnosis. Two periapicals are a better choice at the emergency visit from a reimbursement perspective and often from the clinical perspective as well. Billing a single bitewing at the emergency visit may trigger limitations preventing reimbursement of two/four bitewings at the recare visit.

This is a periapical intra-oral radiographic image.

Courtesy DEXIS, LLC and DEXIS®