D0230 is the CDT code for each periapical X-ray taken after the first one on the same date, billed once per extra image.
- When to use: More than one periapical is taken on a date, and D0220 has already been billed for the first image.
- When not to use: The first periapical is D0220, bitewings are D0270 through D0274, an occlusal film is D0240, and a whole-mouth survey is D0210.
- Billing note: Bill D0220 once before any D0230, and check the plan before a large set, since some plans reprice many periapicals as a full series.
What D0230 reports
D0230 reports each additional intraoral periapical image taken on the same date of service, after the first. A periapical captures a tooth from crown to root tip along with the surrounding bone, which makes it the standard film for decay at the root, periapical pathology, bone loss, and endodontic anatomy.
D0230 is defined by its position in the sequence, not by the image. The first periapical on a date is D0220. Every periapical after that, on the same date, is D0230, reported once per image.
D0230 always follows D0220
D0230 is an add-on, so it can never be the only radiograph code on a date of service. Report D0220 exactly once per date, then one unit of D0230 for each extra image:
- One periapical at a visit: D0220 only.
- Two periapicals: D0220 once, D0230 once.
- Four periapicals: D0220 once, D0230 three times.
A claim with D0230 and no D0220 on the same date has no first image for the additional ones to follow, and most carriers reject or pend it. Repeating D0220 for each film on one date is also a common reject, so confirm the PMS isn’t set to do that. Keeping D0220 and D0230 as distinct, clearly labeled entries, one for the first periapical and one for each additional, prevents both errors.
Individual periapicals vs. a full-mouth series
The common error on this code is not about what a periapical is. It is the boundary between stacking individual periapicals and reporting a full-mouth series.
Individual periapicals (D0220 plus D0230) are right when you image one tooth or a few teeth for a focused reason:
- A patient points to pain on a specific tooth, and you image it plus its neighbors to compare.
- Pre- and post-operative periapicals on an endodontic case taken at the same visit, or an apex check before or after a root canal.
- A suspected fracture or a failing restoration.
- A focused workup on one quadrant where two or three teeth need apex-level detail.
- A restorative or surgical plan that needs root and bone detail on several adjacent teeth.
A comprehensive series (D0210) is right when you take a radiographic survey of the whole mouth meant to show the crowns, roots, periapical areas, interproximal areas, and alveolar bone of all the teeth. In CDT 2026 the D0210 descriptor no longer ties the series to a number of films, so the question is whether the intent and coverage were a whole-mouth survey.
Don’t report a true whole-mouth survey as a long stack of D0220 and D0230 to chase a higher total fee, and don’t split a few diagnostic periapicals into a series. Code what you did.
Periapicals versus the rest of the radiograph family
These codes often appear on the same visit, but each reports a distinct image, and none of the others fold into the periapical count:
- D0270 (single bitewing) and D0274 (four bitewings) report interproximal views showing the crowns of upper and lower teeth in one image, used mainly to find decay between teeth and check bone levels. A bitewing is not a periapical and never rolls up into D0230.
- D0240 (intraoral occlusal) reports a larger film positioned on the biting surface to capture a wider arch segment than a periapical covers.
- D0330 (panoramic) reports a single extraoral image of both arches and surrounding structures. Because it is taken outside the mouth, it is never part of an intraoral periapical count or an intraoral comprehensive series.
The image type and, for periapicals, the first-versus-additional position decide the code. A generic “X-ray” entry at the front desk is how these get mixed up.
Documentation that supports the claim
Periapicals are routine, which is why thin documentation quietly causes trouble on review. The chart and the claim should make the count and the reason obvious:
- The teeth or areas imaged. Note which teeth each periapical covered. This supports the number of D0230 units and separates a focused workup from a whole-mouth survey.
- The clinical reason. Localized pain, an endodontic step, a suspected fracture, or a restorative or surgical plan. A periapical with no charted reason looks like a routine add-on.
- The image count and date. The number of films and the date of service, so the D0220-once-then-D0230 math on the claim matches the record.
If a carrier requests images, attach each periapical to its specific claim line so the count on the claim and the films in the record agree.
FAQs
- What is the difference between D0220 and D0230?
- D0220 is the first periapical on a date of service; D0230 is each additional periapical after it. Report D0220 once, then D0230 for every extra periapical that date, so three periapicals at one visit is D0220 plus two units of D0230. Both report the same type of image, and the distinction is purely first versus additional, not image quality, tooth, or area of the mouth.
- Can D0230 be billed by itself?
- No. D0230 is an add-on for additional images and only follows a first periapical, which is D0220. A claim showing D0230 with no D0220 on the same date of service will usually reject or pend. If you took a single periapical, the code is D0220.
- How many times can I bill D0230 on one date?
- Once per additional periapical image, with no fixed CDT limit. Six periapicals at a visit is D0220 once and D0230 five times. The carrier sets the practical ceiling. Many plans cap the number of individual periapicals they pay per date, and with enough images a carrier may reprice the whole group as a full-mouth series (D0210) at the lower series allowable. Where that line sits is plan-specific.
- When should periapicals be billed as a full-mouth series (D0210) instead of D0220 and D0230?
- Bill D0210 when you took a comprehensive survey of the whole mouth intended to show the crowns, roots, periapical areas, interproximal areas, and alveolar bone of all teeth. Bill D0220 plus D0230 when you imaged a specific tooth or a few teeth for a focused diagnostic reason. Some carriers still reprice a large stack of individual periapicals as D0210 and pay the series allowable; that is a plan repricing rule, not a coding choice on your end.
- Does insurance limit how often D0230 is covered?
- Sometimes. Frequency limits on individual periapicals are less common than on full-mouth series or bitewings, but some plans cap periapicals per date of service or per benefit period. Many also bar a full-mouth series (D0210) within a window, often three to five years, and fold a large group of periapicals into that limit. Verify the specific plan's periapical and series rules.
- Is D0230 a current CDT 2026 code?
- Yes. D0230 is active in CDT 2026 and reports every periapical taken after the first on a date of service. The first-versus-additional structure of D0220 and D0230 is unchanged in meaning. Recent CDT cycles mainly revised the comprehensive series code D0210, whose descriptor dropped the old fixed image count.
Related codes
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CDT codes are maintained by the American Dental Association. This page is an editorial billing guide, not the official ADA code descriptor. Verify current coverage policies with each carrier before submitting claims.