All evaluations are subject to a six-month (181-day) periodicity, per provider.

D0120*

A Birth-20

D0140*

When used for emergency claims, refer to Section 19.6. Denied when billed on the same date of service as D0160 or D0170 by the same provider. A Birth-20, N

D0145

Not considered medically necessary.

D0150*

May be billed once in client's lifetime per provider. A 1-20

D0160*

Not payable for routine postoperative follow-up. Denied when billed on the same date of service as procedure code D0140 or D0170 for the same provider. A 1-20, N, CCP

D0170*

Denied when billed on the same date of service as procedure code D0140 or D0160 for the same provider. A 1-20

D0180*

Limited to once per lifetime per provider; may not be paid on the same day as procedure codes D0120, D0140, D0150, D0160, or D0170. A 13-20

D0210

Number of films required is dependent on age of client. A minimum of eight films is required to be considered a full-mouth series. Adults and children over 12 years of age require 12-20 films, as is appropriate. The Panorex (D0330) with four bitewing radiographs (D0274) may be considered equivalent to the complete or full-mouth series (D0210), and the billed amount for either combination is equivalent to the maximum fee of $72.08. A full-mouth series of radiographs is allowable once every three years by the same dentist. Not allowed as an emergency service. A 2-20

D0220

A 1-20

D0230

The total cost of periapicals and/or other radiographs cannot exceed the payment for a complete intraoral series. A 1-20

D0240

May be billed once per arch and is limited to once per day by the same provider. Periapical films taken at an occlusal angle should be billed as periapical radiograph, code D0230. May be billed as an emergency service. A 7-20

D0250

A 1-20, N, CCP

D0260

A 1-20, N, CCP

D0270

A 1-20

D0272

A 1-20

D0273

Not considered medically necessary.

D0274

A 2-20

D0277

Not to be billed within 36 months of D0210 or D0330. A 2-20

D0290

A 1-20, N, CCP

D0310

A 1-20, N, CCP

D0320

A 1-20, N, CCP

D0321

A 1-20, N, CCP

D0322

A 1-20, N, CCP

D0330*

Limited to one panoramic film during 3-9 years of age and one film during 10-20 years of age, by the same dentist or a group. Not allowed on emergency claims unless third molars or a traumatic condition is involved. Supplemental bitewings are payable in addition to a panoramic with reimbursement not to exceed the total reimbursement for a full mouth radiograph ($72.08 each). Under 3 years of age, must document the necessity of a panoramic film. The Panorex (D0330) with four bitewing radiographs (D0274) may be considered equivalent to the complete or full-mouth series (D0210), and the billed amount for either combination is equivalent to the maximum fee of $72.08. A 3-20

D0340*

Not reimbursable separately when a comprehensive orthodontic or crossbite therapy work-up performed. A 1-20, N, CCP

D0350*

For all images taken. Not reimbursable separately when a comprehensive orthodontic or crossbite therapy work-up performed. A 1-20

Note: Radiograph codes do not include the exam. If an exam is also performed, providers must bill the appropriate ADA procedure code.

D0415

A 1-20, N, CCP

D0425

Not reimbursable separately. Considered part of another dental procedure.

D0460

Not reimbursable separately when any endodontic procedure code performed. A 1-20, N, CCP

D0470*

Not reimbursable separately when crown, fixed prosthodontics, diagnostic work-up, or crossbite therapy work-up performed. A 1-20, N, CCP

D0472

By pathology laboratories only. (refer to CPT codes)

D0473

By pathology laboratories only. (refer to CPT codes)

D0474

By pathology laboratories only. (refer to CPT codes)

D0480

By pathology laboratories only. (refer to CPT codes)

D0502

A 1-20, N, CCP

D0999

A 1-20, N, CCP