D0230 - Periapical (Addl)
Intraoral periapical - each additional image.
- Procedure Code
- D0230
- Clinical Category
- Diagnostic
- Primary ICD-10 Justification
- Z01.20 (Encounter for dental examination and cleaning without abnormal findings)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D0230.
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
Required Claim Attachments & Pre-Submission Checklist
- Standard ADA claim form with CDT procedure code and date of service
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- Diagnostic services must be necessary and appropriate relative to an individual dental patient’s disease risk and clinical condition. If the necessity and appropriateness for diagnostic radiographic imaging is not evident from the information submitted, or the images have been acquired before such a determination is made, fees for radiographic imaging are not billable to the patient.
- Fees for duplication (copying) of diagnostic images for insurance purposes are not billable to the patient.
- Images must be of diagnostic quality; properly oriented if submitted for documentation purposes, and with the date of exposure and a patient identifier indicated on all images. If an image is not of diagnostic quality, then the fee for the image is not billable to the patient.
- Benefits for an intraoral comprehensive series and panoramic radiographic images are limited to once every five years. All other imaging frequencies are determined by the group/individual contract.
- Limit to two bitewing images for patients under age 10. A D0273 or D0274 submitted for a patient under age 10 will be benefited as D0272 and any fees in excess of the approved amount for D0272 are not billable to the patient.
- Fees for final orthodontic records (images, photos, and models) are included in the treatment and not billable to the patient.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
ICD-10-CM Justification & Crosswalk Mappings for D0230 (5)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| Z01.20 | Encounter for dental examination and cleaning without abnormal findings | Encounter for other special examination without diagnosis | ★ Yes (Primary) | BOTH | intraoral – periapical each additional radiographic image indicated for Encounter for dental examination and cleaning without abnormal findings |
| Z01.21 | Encounter for dental examination and cleaning with abnormal findings | Encounter for other special examination without diagnosis | Secondary | BOTH | intraoral – periapical each additional radiographic image indicated for Encounter for dental examination and cleaning with abnormal findings |
| Z13.84 | Encounter screening for dental disorders | Encounter for screening for other diseases and disorders | Secondary | BOTH | intraoral – periapical each additional radiographic image indicated for Encounter screening for dental disorders |
| Z86.16 | Personal History of COVID-19 | Personal history of certain other diseases | Secondary | BOTH | intraoral – periapical each additional radiographic image indicated for Personal History of COVID-19 |
| U07.1 | COVID-19 | Emergency use of U07 | Secondary | BOTH | intraoral – periapical each additional radiographic image indicated for COVID-19 |
Frequently Asked Questions — D0230 (Periapical (Addl))
Quick answers for dental billers and treatment coordinators submitting claims for D0230.
What ICD-10 diagnosis codes link to dental procedure D0230?▾
Common ICD-10-CM justification codes for CDT D0230 (Periapical (Addl)) include: Z01.20 - Encounter for dental examination and cleaning without abnormal findings (Primary); Z01.21 - Encounter for dental examination and cleaning with abnormal findings; Z13.84 - Encounter screening for dental disorders; Z86.16 - Personal History of COVID-19; U07.1 - COVID-19.
Can CDT code D0230 be billed to medical insurance?▾
Billing CDT D0230 (Periapical (Addl)) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: BOTH.
What attachments and documentation are required for billing CDT D0230?▾
Required claim attachments for CDT D0230 (Periapical (Addl)) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D0230?▾
Standard commercial insurance frequency for D0230: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D0230?▾
Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.