D0274Bitewings, Four Radiographic Images

What This Code Covers

D0274 covers four bitewing radiographic images taken during a single visit. This is the standard bitewing series for adult patients and captures the right premolar, right molar, left premolar, and left molar areas. Each image shows the crowns and crestal bone levels of both upper and lower teeth in its region. D0274 is the most commonly billed bitewing code in general dental practices and is typically taken at recall visits based on the patient's caries risk, usually once every 6 to 12 months.

Billing Guide

Bill this code when:

• Four bitewing images are taken during the visit
• The patient is an adult or adolescent with full permanent posterior dentition
• The radiographs are taken as part of a recall visit or diagnostic workup for caries, bone loss, or interproximal pathology
• The clinical record documents the number of images and the reason they were taken

Do not bill this code when:

• Fewer than four bitewings are taken. Use D0270 for one or D0272 for two
• The bitewing images are part of a full mouth series (D0210). A full mouth series already includes bitewings, so do not bill D0274 separately on the same date
• The patient is a young child whose dentition only requires two bitewings. Use D0272 instead to avoid a downcode
• The images are periapical radiographs, not bitewings. Use the appropriate periapical codes (D0220 or D0230)

Insurance and Denial Prevention

Key Payer Rules:

• Most commercial plans cover D0274 once every 12 months for adults. Some plans allow every 6 months for patients classified as high caries risk
• Delta Dental and many PPO plans use a rolling date-to-date frequency (12 months from the last bitewing date), not a calendar year reset
• Medicare does not cover routine dental radiographs. If billing a Medicare Advantage plan with dental benefits, verify the specific plan terms
• Some payers automatically downcode D0274 to D0272 for patients under age 12 or 13. Know the age threshold for each plan you bill frequently
• Medicaid adult dental benefits vary by state. Several states do not cover bitewings for adults, or limit them to once every 24 months

Common Denials and How to Respond:

• Frequency exceeded - Verify the exact date of the last bitewing series. If the payer uses a date-to-date calculation and the interval is even one day short, the claim will deny. Reschedule or hold the claim if possible. If the early bitewings were clinically necessary, appeal with a narrative and supporting documentation.
• Downcoded to D0272 - This happens most often with pediatric or adolescent patients. If four bitewings were clinically appropriate (for example, the patient has full permanent dentition), appeal with documentation of the patient's dentition stage and the clinical need for all four images.
• Bundled with D0150 or D0210 - Some payers bundle radiographs into comprehensive evaluations or full mouth series. If the bitewings were a separate service on a different date or clinically distinct, appeal with documentation showing the services were independent.
• Not medically necessary - If the payer questions necessity, submit the patient's caries risk assessment, history of interproximal decay, or any clinical findings that justified the radiographs.