The CDT code vertical bitewings fall under is D0277, whose nomenclature reads vertical bitewings, 7 to 8 radiographic images. The image count matters more than the orientation. D0277 is the only bitewing code in CDT that names vertical images, and it applies only when seven or eight are captured. Four vertical bitewings are reported as D0274, the same code used for four horizontal bitewings, because D0270 through D0274 count images and say nothing about how the sensor was turned.
That settles most of the question. What it leaves behind are the cases that cost money: five or six images, periapicals on the same day, and a frequency clock that may not be the one you think you are spending.
The bitewing code set, by image count
| CDT code | Nomenclature | Images | Orientation in the code |
|---|---|---|---|
| D0270 | bitewing, single radiographic image | 1 | not specified |
| D0272 | bitewings, two radiographic images | 2 | not specified |
| D0273 | bitewings, three radiographic images | 3 | not specified |
| D0274 | bitewings, four radiographic images | 4 | not specified |
| none | no code exists at these counts | 5 or 6 | payer policy decides |
| D0277 | vertical bitewings, 7 to 8 radiographic images | 7 or 8 | vertical |
Nothing sits between D0274 and D0277, and the descriptor attached to D0277 states plainly that it does not constitute a full mouth intraoral radiographic series. It is not a substitute for D0210, intraoral complete series of radiographic images.
Keep the neighboring codes on the same sheet, since they are what a bitewing claim collides with: D0210 for the complete series, D0220 for the first periapical and D0230 for each additional one, D0330 for a panoramic image, and D0251 for an extra-oral posterior dental radiographic image.
Coding four, five and six vertical bitewings
Four vertical bitewings are D0274. Orientation at that count is a clinical decision, not a coding one, and no modifier exists to tell the payer you turned the sensor. Seven or eight are D0277, eight being the usual premolar and molar layout on a fully dentate adult.
Five or six is where offices improvise, and improvisation is where denials come from. Because CDT has no code at those counts, payer policy decides. Three patterns show up in the field: splitting the count across two codes, such as D0274 plus D0272 for six images, reporting the nearest lower count, or a payer instructing the office to use D0277 anyway. A plan that wants one will reject the others, so get the instruction in writing and file it with the plan record.
One rule has no exceptions: do not report D0277 for six images because the allowance is higher. The images ride along with the claim, the count is auditable, and a code billed above the images captured is a misrepresentation.
Vertical versus horizontal, and why the claim treats them differently
The vertical orientation exists to capture crestal bone that a horizontal bitewing crops out. On a patient with real bone loss, a horizontal image shows the contacts beautifully and the bone level not at all, which is why vertical bitewings cluster in periodontal charts. Four claim side consequences follow.
The allowance is different. D0277 usually carries a higher allowed amount than D0274 because it represents seven or eight images instead of four. The gap comes from your fee schedule, not from the code.
The frequency category may be different. Plenty of plan designs put D0277 in the complete series and panoramic bucket rather than the bitewing bucket. When they do, one set of vertical bitewings spends an allowance that renews every few years rather than annually. That is an employer group decision, so it varies plan to plan and has to be verified.
Same day periapicals change what gets paid. When D0277 is submitted alongside several periapicals, many payers count the total images for the date and reprice the whole day to the complete series allowance. The claim still pays, which is why it slips through.
Periodontal claims lean on these images. Scaling and root planing claims, D4341 and D4342, are reviewed against radiographs showing bone levels, and vertical bitewings often carry that burden. The same attachment discipline applies to surgical claims, as our breakdown of why a bone graft claim gets denied shows.
Here is what repricing looks like on a remittance. The numbers are illustrative.
| Line submitted | Office fee | What came back |
|---|---|---|
| D0277, vertical bitewings, 8 images | 95 | folded into D0210 |
| D0220, periapical, first image | 35 | folded into D0210 |
| D0230, periapical, each additional, 3 units | 81 | folded into D0210 |
| Net effect for the date of service | 211 billed | one complete series allowance, FMX clock started |
The second cost is invisible there. If the plan now counts a complete series against the patient, the next one may not be payable for years.
How to verify D0277 before the images are taken
Plan provisions are chosen by employer groups, so no carrier handles this uniformly and a policy confirmed on one employer's plan tells you little about the next. Verify by code, and record the answer with a reference number and date. Ask six questions:
- Is D0277 covered on this plan, and at what benefit percentage?
- Which frequency category does D0277 sit in, the bitewing category or the complete series and panoramic category?
- Is the limit measured by calendar year, benefit year, or rolling months from the last date of service?
- If a complete series or panoramic image was paid recently, does that block D0277 today?
- Does the plan reprice the date to D0210 when periapicals are billed alongside D0277, and at what image threshold?
- Do the bitewing rules differ for patients under a certain age?
Commonly quoted design patterns are bitewings once or twice per benefit period and a complete series or panoramic image once every three to five years. Treat those as the shape of the market, not as this patient's plan. The only number that belongs in an estimate is the one a representative gave you on a dated call, or the one the benefit response returned code by code.
What is CDT code D0220?
D0220 is intraoral, periapical first radiographic image. It is reported once per date of service no matter how many periapicals were exposed, and each additional one that day is D0230. Two units of D0220 on a single date is a rejection no appeal will fix, because the code says first.
D0220 and D0230 also feed the image total for the date. That total, not the bitewing code by itself, is what pushes a day of imaging into complete series territory at most payers.
What is CDT code D0367?
D0367 is cone beam CT capture and interpretation with a field of view of both jaws, with or without cranium. It shares searches with the bitewing codes because it is diagnostic imaging, but it behaves nothing like one on a claim. The CBCT codes are separated by the size of the field captured rather than by image count, and dental plan coverage tends to be narrow, situational and dependent on a narrative.
A CBCT does not replace bitewings for interproximal caries diagnosis, and submitting it as though it does invites a denial. When the indication is medical in nature, the scan may belong on the patient's medical plan, which means CPT and ICD-10-CM rather than CDT. Our comparison of CDT and CPT codes in dentistry covers that boundary, and for joint related indications see medical billing for TMJ treatments and finding diagnostic codes for TMJ disorders.
What is CDT code D2952 used for?
D2952 is post and core in addition to crown, indirectly fabricated, meaning the cast or laboratory made version. Its prefabricated counterpart is D2954, and the two are not interchangeable on a claim.
It belongs in a radiograph article because payers reliably want an image with it. Expect a request for a radiograph of the endodontically treated tooth, expect the crown code to be required on the claim or already on file, and expect some plans to bundle the post and core into the crown allowance. Settle that before the patient sits down, which is the argument for a predetermination on high dollar work. Our guide to getting a predetermination approved applies the same way to crowns.
What does the dental code D5422 represent?
D5422 is adjust partial denture, mandibular. The set runs D5410 for a maxillary complete denture adjustment, D5411 for a mandibular complete denture, D5421 for a maxillary partial and D5422 for a mandibular partial.
Two denials dominate it. The first is arch confusion, posting the maxillary code for a mandibular adjustment, which a lookup at the point of entry prevents. If your team still hunts for codes one at a time, our note on free ways to look up codes is worth ten minutes. The second is billing an adjustment inside the post delivery period, which most plans treat as included in the delivery fee. Annual caps are common and vary by plan.
What to do with this on Monday
Count the images, then code the count. Orientation changes the code only at seven or eight. Put the day's total image count where the biller can see it, since the total drives bundling. When the orientation was clinically driven, say so in the narrative: bone levels, periodontal diagnosis, furcation involvement. Track frequency by category rather than by code, because D0277 may be spending the complete series allowance. Then compare the allowed amount on the remittance against what you estimated, since a repriced day of radiographs looks exactly like a paid claim until someone checks. Curo reads the plan's frequency category and image rules for the radiograph codes before a claim goes out and flags a date heading for complete series repricing, which our claims automation page covers in depth.
The cheapest habit is the last one. Keep a dated one page code sheet at the operatory computer with the bitewing counts, the periapical pair and the complete series code on it. Most miscoding here is not a knowledge problem. It is someone recalling from memory, late in a long day, whether six images have a code of their own.