Panoramic Radiograph

A panoramic radiograph, also known as a panorex or orthopantomogram, is an extraoral imaging technique that produces a single two-dimensional image of the entire maxillofacial complex, including all teeth, both jaws, the temporomandibular joints, maxillary sinuses, nasal cavity, and surrounding osseous structures. The image is captured as the X-ray tube and film or digital sensor rotate around the patient's head in a coordinated arc, creating a tomographic slice through the curved plane of the dental arches. The resulting image provides a broad overview of the dentition and supporting structures that cannot be achieved with any single intraoral radiograph. While panoramic images offer less detail and resolution than periapical radiographs for individual teeth, their value lies in the complete survey they provide.

Panoramic radiographs are indicated for a wide range of diagnostic purposes, including evaluation of developing dentition in children and adolescents, assessment of impacted third molars, screening for pathologic conditions such as cysts, tumors, and calcified entities, evaluation of jaw fractures and temporomandibular joint abnormalities, and treatment planning for dental implants, orthodontics, and full-mouth reconstruction. The image is particularly useful as a screening tool for new patients because it reveals conditions that may not be apparent on clinical examination alone, such as unerupted or supernumerary teeth, radiolucent or radiopaque lesions within the jaws, and gross bone loss patterns. Panoramic radiographs deliver a relatively low radiation dose compared to a full mouth series of periapical and bitewing radiographs, though they do not replace intraoral images when detailed evaluation of individual teeth or periodontal bone levels is required.

The panoramic radiograph is billed under CDT code D0330. Most dental insurance plans cover panoramic radiographs at intervals of three to five years, and the billing team must verify each carrier's frequency limitation to avoid submitting claims that will be denied for exceeding the allowable interval. Some carriers require a specific clinical indication beyond routine screening, particularly when a panoramic radiograph is requested within a year or two of a previous image. The clinical note should document the reason the panoramic radiograph was ordered, such as evaluation of third molar status, assessment of a suspected pathologic lesion, or initial imaging for a new patient complete exam. Practices that track each patient's last panoramic date in the practice management system can proactively schedule imaging at the appropriate interval and submit claims that align with carrier frequency policies.