Beyond D0274: A Complete Guide to Coding Bitewings for Dental Billing

June 3, 2026

Coding for bitewings may seem like the simplest, most straightforward part of a dental practice’s day-to-day operations. But when has dentistry ever been straightforward? In the world of dental billing, “standard operating procedure” often meets the messy reality of patient care. While bitewings are among the most common procedures in any practice, there are times when it makes more financial sense NOT to charge for the radiograph, and other times when standard bitewings are not appropriate or even possible.

The Standard Bitewing Codes: D0270 – D0274

Choosing the appropriate CDT code for bitewings is generally based on the number of images captured. Unlike PAs (D0220/D0230) that evaluate teeth for periapical pathology, bitewings focus more on interproximal decay and the relationship between the maxillary and mandibular arches.

When NOT to Report

While these codes are the bread and butter of dental diagnostics, there are times when charging for bitewings may not be appropriate. Typical plans only cover bitewing sets once per year, regardless of the number of images taken. That means if the patient is in a new benefit period and a single bitewing (D0270) is submitted for reimbursement, the limitations are tripped, and a four-bitewing set taken at a subsequent periodic oral evaluation will not be covered. It may be more strategic to provide the single bitewing at no charge to maintain coverage for the periodic visit. Most plans do not require submission of services if no charge is made to the patient, but this should be verified with the individual plan. Additionally, radiographs taken for purposes other than diagnosis — such as endodontic check films or crown seat verification — should not be reported, as these are generally considered part of the overall procedure.

Vertical Bitewing Sets

Current reporting for periodontal claims requires that radiographs clearly demonstrate bone loss. While submitting a four-bitewing set is appropriate to document posterior bone loss, intraoral images are needed to show additional teeth involved in the anterior areas. Extraoral panoramic images are not diagnostic for decay or bone loss and are generally not accepted as supportive evidence. One possible diagnostic image type that helps demonstrate anterior bone levels is vertical bitewings. Reporting of vertical bitewings may be done using the codes listed above, as bitewing codes do not specify whether they are taken vertically or horizontally. If a full set of vertical bitewings is taken, it may be best reported using D0277.

When reporting more than four bitewings but fewer than 7 or 8, consider reporting combinations of the standard bitewing codes. Although the code descriptor notes that it is not a full mouth series, many plan designs have D0210 and D0277 share frequency limitations for reimbursement. It is best to keep this in mind when determining whether an FMX or vertical bitewing set is more appropriate.

When Intraoral Imaging Is Impossible

Occasionally, patients with severe gag reflexes, large lingual tori, or other physical limitations make traditional intraoral sensor placement impossible. In these moments, clinicians often turn to the panoramic machine’s bitewing mode to get the diagnostic information they need.

Historically, offices struggled with how to code these extraoral bitewings. Some used D0330 because of the equipment used, while others used D0272 or D0274 because of the clinical result. While the code language for bitewings does not specify if they are obtained intraorally or extraorally, the ADA Glossary of Clinical Terms definition of a bitewing does not fit these extraoral captures:

Bitewing radiograph: Interproximal radiographic view of the coronal portion of the tooth/teeth. A form of dental radiograph that may be taken with the long axis of the image oriented either horizontally or vertically, that reveals approximately the coronal halves of the maxillary and mandibular teeth and portions of the interdental alveolar septa on the same image.

To resolve this ambiguity, the ADA added a specific code to the CDT code set: D0251.

D0251 was specifically designed to describe posterior images obtained extraorally, such as those taken with a panoramic or CBCT machine in bitewing mode. This code is the most accurate reflection of a service that shows an exposure of complete posterior teeth in both arches without an intraoral sensor.

Strategy for D0251 Reimbursement

While reporting D0251 is appropriate for these types of image captures, reimbursement is not available with many plans. That said, there are steps you may take to increase the odds of reimbursement.

• Provide a narrative: Clearly state the reason this image type was chosen instead of traditional bitewing codes. Use phrases like “Patient was unable to tolerate intraoral sensor due to severe gag reflex/lingual tori.”
• Request an alternate benefit: After noting the reason why D0251 was reported, ask for the alternate benefit of the bitewings: “If no benefit is available for D0251, please pay the alternate benefit of D0274, since this procedure will replace the bitewings with this evaluation.” Due to the length of this narrative, be sure to include it as an attachment and not just as text in the Remarks section of the claim form.
• Report the correct number: If you capture both the right and left sides extraorally, report D0251 with a quantity of two on the 2024 ADA Dental Claim Form.

Always Code for What You Do

By understanding the full spectrum of bitewing codes, from the standard D0274 to the specialized D0251, you ensure that your practice remains compliant, your clinical records remain accurate, and your patients receive the care they need today.

Getting bitewing coding right is just one piece of a clean, compliant billing workflow. If your practice is leaving reimbursements on the table or spending hours chasing claims that should have been paid the first time, eAssist can help. Our dental billing specialists work with practices nationwide to take the guesswork out of coding, submission, and follow-up. Schedule a consultation today and find out what a dedicated billing partner can do for your bottom line.

Insurance administration and dental billing recommendations, as well as interpretations of the CDT codes, represent the opinions of our experts. For the latest CDT codes and official interpretations, contact the American Dental Association or visit ADA.org. You are responsible for your own use of the CDT Codes, insurance administration and dental billing.

Disclaimer: (a) Coding as presented has been researched as of publication date. Statements made do not necessarily apply to all insurance plans, as plans vary. There is no guarantee that a given plan will reimburse based on stated guidelines; (b) Always code “what you do;” (c) Follow the current CDT code set exactly to the best of your ability; (d) Consult with a licensed healthcare attorney for legal counsel, and advice on compliance with state and federal laws.