CSHCN Services Program 2010 > Dental > Benefits, Limitations, and Authorization Requirements

14.2.2.5 Radiographs or Diagnostic Imaging

The number of radiograph films required for a complete intraoral series is dependent on the age of the client. An intraoral series requires at least eight films. Adults and children older than 12 years of age require 12 to 20 films to be considered an intraoral series. A panoramic film (procedure code D0330) plus a minimum of four bitewing films (procedure code D0274) may be considered equivalent to a complete intraoral series including bitewings (procedure code D0210).

Supporting documentation must be kept in the client's dental record when medical necessity is not evident on radiographs.

The following radiographs or diagnostic imaging procedure codes may be considered for reimbursement:

Procedure Code	Limitations
D0210	•Age limitation = 2 years or older
D0220	•Limited to one per day by the same provider •Age limitation = 1 year of age or older
D0230	•Age limitation = 1 year of age or older
D0240	•Limited to two per day by the same provider •Age limitation = NA
D0250	•Limited to one per day by the same provider •Age limitation = 1 year of age or older
D0260	•Age limitation = 1 year of age or older
D0270	•Limited to one per day by the same provider •Age limitation = 1 year of age or older
D0272	•Limited to one per day by the same provider •Age limitation = 1 year of age or older
D0273	•Limited to one per day by the same provider •Age limitation = 1 year of age or older
D0274	•Limited to one per day by the same provider •Age limitation = 2 years of age or older
D0277	•Limited to one per day by the same provider •Age limitation = 2 years of age or older
D0290	•Age limitation = 1 year of age or older
D0310	•Age limitation = 1 year of age or older
D0320	•Age limitation = 1 year of age or older
D0321	•Age limitation = 1 year of age or older
D0322	•Age limitation = 1 year of age or older
D0330	•Limited to one per day by any provider •Limited to one service every 3 years by the same provider •Age limitation = 3 years of age or older
D0340	•Denied when billed with procedure code D8050 or D8080 •Limited to one per day by the same provider •Age limitation = 1 year of age or older
D0350	•Must be used when billing for photographs •Accepted only when diagnostic quality radiographs cannot be taken •Documentation of medical necessity must be submitted with the claim •Limited to one per day by the same provider •Age limitation = NA
D0360	•Age limitation = NA
D0362	•Age limitation = NA
D0363	•Age limitation = NA