D0368 Dental Code: TMJ Cone Beam CT Series Billing

What D0368 covers

D0368 reports a cone beam CT study of the temporomandibular joints performed as a series of two or more exposures, where the provider who captured the images also interprets them and writes the report. A typical study images both joints, and protocols often add exposures in different condylar positions, closed and open.

The clinical questions are joint questions: degenerative condylar change, suspected trauma to the condyle, ankylosis, or persistent dysfunction being worked up before treatment. A complex temporomandibular assessment is also one of the situations the detailed problem-focused evaluation, D0160, was written for. The imaging and the evaluation are separate services with separate codes.

Outside the field-of-view ladder

The other capture-and-interpretation cone beam codes are sorted by arch coverage: D0364 for a limited volume of less than one whole jaw, D0365 for the full lower arch, D0366 for the full upper arch, and D0367 for both jaws. D0368 is selected by what was studied, the joints, imaged as a multi-exposure series, regardless of how the individual volumes would size up on that ladder.

A both-jaws volume taken for implant or orthodontic purposes often includes the condyles, and that does not make it a TMJ study. One acquisition is one code, picked by its field of view. D0368 applies when the office performs a joint series as such: multiple exposures, a joint-focused protocol, and joint findings in the report.

When the capture and the read split

D0368 covers two services, and that holds only when one provider performs both. TMJ studies are read by outside radiologists more often than most dental cone beam, because many general practices prefer not to sign a condylar pathology diagnosis alone. When the study goes out for interpretation, the capturing office reports D0384, the capture-only TMJ series code, and the reading practitioner reports D0391.

D0368 never appears with D0384 or D0391 for the same study, because that reports the interpretation twice. Split reads in general, including how carriers reprocess same-office capture-plus-interpretation pairs, are covered in when capture and interpretation split in the cone beam guide.

Coverage: the TMJ exclusion problem

Coverage for D0368 is two questions, and the TMJ question comes first. Many dental plans exclude TMJ services as a category, imaging included, before any cone beam policy applies. Arkansas Blue Cross’s published CDT 2026 procedure guidelines list D0368 as not a covered benefit, and that is not an unusual position. Plans that do cover cone beam generally apply a necessity standard: Aetna’s radiographic examinations policy, for example, wants the suspected pathologic condition or anatomic concern documented in the clinical record as the justification for CBCT.

So verification means asking the dental plan whether TMJ diagnostic services are covered at all, and if so, what documentation the cone beam benefit requires. When TMJ services are excluded, the medical plan is the realistic payer. Joint dysfunction, trauma, and degenerative disease are medical diagnoses, and the study is billed with a CPT imaging code and an ICD-10 diagnosis instead of the CDT code, with its own necessity documentation. The workflow is in billing cone beam to medical. Medical plans can carry TMJ exclusions of their own, so check that side too.

Documentation that supports the claim

Three things support a D0368 claim, on either the dental or medical side:

• The series itself. The acquisition record should show the exposures, sides, and positions taken, since two or more exposures is what separates D0368 from the field-of-view codes.
• The indication. The suspected joint condition, stated in the clinical note before the scan. This is the necessity language carrier policies ask for, and on medical claims it becomes the diagnosis code.
• The interpretation. A written report of joint findings signed by the provider who billed the combined code. Without an in-office report, the office performed only a capture, and the correct coding is D0384 plus an outside D0391.

In the practice management system, keep D0368 and D0384 as separate, clearly labeled entries so a study sent out for reading cannot post as a one-provider service by default, and flag D0368 for benefits verification so the TMJ exclusion check happens at scheduling. Setup for the whole family is in setting up cone beam codes in your PMS.