D0220Intraoral Periapical First Radiographic Image

What This Code Covers

D0220 covers the first intraoral periapical radiographic image taken during a patient visit. A periapical image captures the entire tooth from crown to root tip, along with the surrounding bone, giving the dentist a focused diagnostic view of a specific area. This code is used when the clinician needs to evaluate one or two teeth for a targeted concern rather than imaging the full mouth. Any additional periapical images taken during the same visit are billed separately under D0230.

Billing Guide

Bill this code when:

• The dentist takes the first periapical image during a visit to evaluate a specific tooth or localized area
• The image is being used to diagnose a complaint such as pain, swelling, suspected fracture, or periapical pathology
• A single periapical is needed for treatment planning on a specific tooth, such as before an extraction or root canal
• The image is taken as a follow-up to monitor healing or changes in a previously treated area

Do not bill this code when:

• The periapical image is part of a full mouth series (bill D0210 instead)
• You are billing for the second or subsequent periapical image during the same visit (use D0230 for each additional image)
• A bitewing image is taken instead of a periapical (use D0270 or D0272)
• The image is a retake of the same view due to poor film quality or positioning error (retakes are not separately billable)
• No clinical indication for the image is documented in the patient record

Insurance and Denial Prevention

Key Payer Rules:

• Most commercial plans cover periapical images when there is a documented clinical reason, with no strict annual limit on the number of periapical films
• Some payers bundle periapical images into the allowance for a comprehensive exam or FMX, so check the plan's bundling rules
• Medicaid plans may limit the total number of intraoral images per year or per visit
• If the image is taken on the same day as a comprehensive exam, some payers expect the radiograph to be part of the exam and may deny it as a separate line item

Common Denials and How to Respond:

• Bundled with exam or FMX: Appeal with documentation showing the periapical was taken for a separate clinical reason not addressed by the exam or existing series, and include the tooth number and diagnosis
• Frequency exceeded: Submit a narrative explaining why the image was clinically necessary despite prior imaging, such as new symptoms or a change in condition
• Missing tooth number or diagnosis: Resubmit the claim with the specific tooth number, the ICD diagnosis code, and a clinical note describing the reason for the image