When is D0273 used?
The D0273 dental code represents a specific CDT (Current Dental Terminology) classification for billing three bitewing X-ray images. These radiographs play a vital role in identifying cavities between teeth, evaluating bone health, and checking existing dental work. Apply D0273 when capturing exactly three bitewing films during one appointment, typically for adult patients who have elevated cavity risk or require detailed diagnostic evaluation that falls between standard two-image or four-image protocols.
Record-Keeping and Patient Situations
Thorough record-keeping ensures proper payment processing and regulatory adherence. When applying D0273, verify that patient records contain:
Medical justification for capturing three bitewing films (such as decay susceptibility, restoration background, gum disease factors).
Service date and specific teeth or regions photographed.
Dentist's assessment notes explaining why three images were chosen over typical two or four-image sequences.
Digital file storage within patient records for later review and possible insurance verification requests.
Typical situations involve patients with irregular tooth positioning, focused gum problems, or cases where earlier X-rays suggest targeted imaging requirements. Always record the particular justification for departing from routine bitewing procedures.
Reimbursement Strategy Guidelines
To optimize payment success and reduce claim rejections for D0273:
Confirm benefit details during insurance checks, since certain policies restrict how often or how many bitewing films are covered within specific timeframes.
Include comprehensive medical records with claims, particularly when image quantities differ from patient's treatment history or insurer standards.
Include X-ray images when insurers request them or if claims require additional review.
For rejections, file appeals with thorough explanations describing medical necessity and citing patient's risk elements or clinical discoveries.
Understand companion codes, including D0272 (two-image bitewings) and D0274 (four-image bitewings), and verify your code selection aligns with the precise number of films captured.
Precise coding practices and complete documentation help minimize billing delays and maintain compliance with insurance provider standards.
Clinical Example Using D0273
Patient Case: A mature patient arrives for routine checkup with previous cavity development between teeth and multiple back-tooth fillings. The dental professional decides three bitewing X-rays will best capture all problem areas, considering the patient's specific mouth structure and restoration background.
Recommended Procedure:
Note the patient's decay vulnerability and filling history in treatment records.
Specify which mouth regions were imaged and explain the three-image decision.
Apply D0273 procedure code on billing documents.
Include supporting records and X-ray files when insurers require them.
Track claim progress and address any information requests or appeals quickly.
This methodology ensures proper billing practices, validates treatment necessity, and facilitates smooth payment processing for your dental office operations.
FAQ
How does D0273 differ from other bitewing procedure codes such as D0272 and D0274?
D0273 is the specific procedure code for capturing three bitewing X-rays in a single patient visit. This differs from D0272, which covers two bitewing images, and D0274, which applies to four bitewing radiographs. The appropriate code selection is determined by how many images are clinically necessary to obtain comprehensive diagnostic information based on the patient's oral anatomy and specific treatment needs.
What are typical reasons insurance companies deny D0273 claims?
Insurance denials for D0273 commonly occur due to frequency limit violations, such as when patients exceed their plan's annual allowance for bitewing radiographs, or when clinical documentation fails to adequately justify the necessity of taking three separate images. To minimize claim denials, dental offices should verify insurance benefits beforehand and maintain detailed clinical records supporting the diagnostic need.
What steps should dental offices take when appealing a rejected D0273 claim?
When facing a D0273 claim denial, practices should first carefully examine the Explanation of Benefits to understand the specific rejection reason. Next, compile comprehensive supporting documentation and file a formal appeal with the insurance carrier. The appeal should include detailed clinical notes, relevant radiographic findings, and a thorough explanation demonstrating the medical necessity for obtaining three bitewing images to strengthen the case for claim approval.