Bitewing

A bitewing radiograph is a type of intraoral dental X-ray that captures the coronal portions of the upper and lower teeth in a single image, along with the crestal alveolar bone between them. The name derives from the tab or wing that the patient bites down on to hold the film or digital sensor in position during exposure. Bitewing radiographs are the primary diagnostic tool for detecting interproximal caries, which are cavities that form on the surfaces between adjacent teeth where visual examination alone cannot reach. These radiographs also reveal the presence of secondary or recurrent caries beneath existing restorations, overhanging restoration margins, early crestal bone loss indicative of periodontal disease, and calculus deposits on proximal root surfaces.

The frequency of bitewing radiographs is determined by the patient's individual caries risk assessment, with evidence-based guidelines recommending intervals ranging from every six months for high-risk patients to every twenty-four to thirty-six months for low-risk adults. These guidelines are published by professional organizations and serve as the clinical standard that dental practices reference when establishing their radiographic protocols. The transition from traditional film-based bitewings to digital sensors and phosphor plate systems has reduced radiation exposure, improved image quality, and enabled immediate chairside review and electronic storage. Regardless of the imaging technology used, proper technique including correct angulation, sensor placement, and exposure settings is essential for diagnostic quality images that accurately represent the interproximal surfaces.

Bitewing radiographs are among the most commonly billed diagnostic procedures in dental practice, and their CDT codes are differentiated by the number of images taken during the visit. Billing teams must select the code that matches the actual number of bitewing images captured, as submitting the four-image code when only two images were taken constitutes a coding error. Payers frequently apply frequency limitations to bitewing reimbursement, typically allowing one set of bitewings every six to twelve months, and claims submitted outside the allowed frequency window will be denied. The billing team should track each patient's last bitewing date in the practice management system and verify payer-specific frequency rules during eligibility checks to avoid submitting claims that are certain to be denied based on frequency limitations.