When is D0272 used?
The D0272 dental code designates "Bitewings – two radiographic images." This billing code applies when a dental professional captures two bitewing X-ray images, commonly used to evaluate the contact surfaces between posterior teeth for decay detection and bone level assessment. D0272 is suitable for standard dental examinations for both adult and child patients when precisely two bitewing radiographs meet clinical requirements. Remember to apply this code exclusively when two images are captured; for different quantities, consider D0270 for one bitewing or D0274 for four bitewing images.
Record-Keeping and Clinical Applications
Proper record-keeping is crucial for appropriate billing and regulatory compliance. When applying D0272, verify the patient's file contains:
Medical justification for bitewing radiographs (e.g., cavity risk assessment, periodontal monitoring, routine checkup).
Service date and identification of specific tooth regions examined.
X-ray interpretations and their influence on diagnosis or treatment decisions.
Typical applications for D0272 encompass standard follow-up visits for adults presenting low to moderate cavity risk, or young patients with developing teeth where two bitewing films provide adequate information. Always ensure documentation reflects actual patient requirements and carrier policies.
Billing and Reimbursement Guidelines
To optimize payment and reduce claim rejections when submitting D0272:
Confirm coverage limits—many dental plans authorize bitewing X-rays annually or bi-annually. Verify benefits prior to treatment.
Provide high-quality images when requested by insurers during claim evaluation or appeal processes.
Include supporting records (e.g., treatment notes, imaging reports) for high-risk patients or when X-rays exceed standard intervals.
Apply the accurate CDT code—avoid using D0272 when a different image count applies.
Monitor Explanation of Benefits statements carefully to handle denials or reduced payments, and submit appeals with additional clinical evidence when needed.
Thorough benefit verification and comprehensive documentation minimize billing delays and promote successful reimbursement.
D0272 Clinical Example
Scenario: A 35-year-old individual arrives for their regular dental checkup. The practitioner decides that two bitewing radiographs adequately assess interproximal caries and periodontal status given the patient's minimal decay history. The treatment record documents the medical necessity, and two X-ray images are captured and stored in the patient file. The administrative staff confirms the patient's dental plan covers annual bitewing imaging. The insurance claim is processed using D0272, accompanied by clinical documentation and service date. The carrier approves full payment without complications or rejections.
This scenario demonstrates how proper alignment of clinical necessity, thorough documentation, and insurance policy compliance leads to smooth billing processes and quality patient treatment.
FAQ
Is it possible to bill D0272 with other radiographic procedures in the same appointment?
Generally, D0272 should not be billed together with other radiograph codes like panoramic or periapical x-rays during the same visit, unless there is documented clinical justification and the insurance carrier permits concurrent billing. It's essential to verify the patient's coverage details and maintain thorough documentation of medical necessity for any additional radiographic procedures to prevent claim rejections.
What is the typical insurance coverage frequency for D0272 procedures?
Insurance coverage frequency for D0272 varies depending on the specific plan, though most carriers typically allow reimbursement once annually or up to two times per calendar year for low-risk patients. It's crucial to confirm the individual patient's plan restrictions prior to performing the procedure and submitting claims to ensure proper coverage and avoid potential denials.
What steps should be taken when a D0272 insurance claim gets rejected?
When facing a D0272 claim denial, first carefully examine the Explanation of Benefits to identify the specific rejection reason. For denials related to insufficient documentation or frequency restrictions, compile comprehensive clinical documentation and radiographic evidence, then file an appeal with the insurance carrier. All supporting materials must clearly establish the clinical necessity and rationale for the radiographic examination.