D0274 - Bitewings (Four)
Bitewings - four images.
- Procedure Code
- D0274
- Category
- Diagnostic
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental National / PPO Standard
- Frequency Limitation
- 1 set per 12 consecutive rolling months (or 1 per calendar year) (ROLLING_MONTHS)
- Age Limitation
- Intended for patients with erupted permanent second molars (typically age 12+). Under 12 usually downgraded to 2 bitewings (D0272).
Required Claim Attachments & Pre-Submission Checklist
- Four diagnostic radiographic bitewing images showing open contacts where possible
- Diagnostic findings documented by clinician
Bill When (Allowable Clinical Criteria)
- Routine interproximal caries and bone level monitoring on posterior teeth
Restrictions & Clinical Exclusions
- Do NOT bill on the same date as Full Mouth Series D0210
- Do NOT bill more than once every 12 months
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Billed within 12 months of previous bitewings | Verify exact date of last bitewings; adjust recall schedule to ensure 365+ days have elapsed. |
ICD-10 Justification & Crosswalk Mappings
| 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 | bitewings – four radiographic images 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 | bitewings – four radiographic images 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 | bitewings – four radiographic images indicated for Encounter screening for dental disorders |
| Z86.16 | Personal History of COVID-19 | Personal history of certain other diseases | Secondary | BOTH | bitewings – four radiographic images indicated for Personal History of COVID-19 |
| U07.1 | COVID-19 | Emergency use of U07 | Secondary | BOTH | bitewings – four radiographic images indicated for COVID-19 |