Bitewing Images – Addressing the CDT Code and Technology Conundrum

WVDA member Dr. Scott Eder of Charleston provided the below email from the ADA.   Dr. Eder serves on the ADA Council on Dental Benefit Programs.

Bitewing Images – Addressing the CDT Code and Technology Conundrum

Today, extra-oral imaging devices are capable of acquiring similar diagnostic information to that seen on multiple bitewings.  This image may also capture additional information, all by a single exposure captured on one extra-oral receptor.  How does a dentist document this procedure – is it a bitewing or bitewings, an extra-oral image, or what? Before answering the question let’s look at the definition found in the ADA’s online Glossary of Dental Clinical and Administrative Terms (

bitewing radiograph: Interproximal radiographic view of the coronal portion of the tooth/teeth.  A form of dental radiograph that may be taken with the long axis of the image oriented either horizontally or vertically, that reveals approximately the coronal halves of the maxillary and mandibular teeth and portions of the interdental alveolar septa on the same image

With all this in mind, there is more than one CDT Code to consider –

D0270  bitewing – single radiographic image


D0250  extra-oral – first radiographic image

Both are consistent with the glossary definition, but is one more appropriate than the other?  It depends.  A bitewing (e.g., D0270), with the film or receptor placed in the oral cavity, is the well-known method for imaging posterior teeth.  But what about patients who are not able to accept placement of an intra-oral film or receptor?  D0250 is more appropriate since the imaging media would be extra-oral as specified in this code’s nomenclature.

Some may disagree, saying the bitewing nomenclature does not limit it to intra-oral imaging.  No matter what CDT Code is selected by the dentist, the choice must be supported by information and images placed in the patient’s records. There is a more elegant and specific solution on the horizon – a new code in CDT 2016 that dentists may use on patient records and claims – but we will have to wait until January 1, 2016 before using it.

D0251  extra-oral posterior dental radiographic image

Image limited to exposure of complete posterior teeth in both dental arches.  This is a

unique image that is not derived from another image.

The addition of D0251 is one of three interrelated changes to the extra-oral imaging codes in CDT 2016.  As illustrated below: D0250 is revised to clarify the procedure’s scope and methodology so there is no overlap with D0251 and it is no longer a “…first…” image procedure; D0260 is deleted as it becomes redundant by the D0250 revision.  Multiple D0250 images are documented on a claim using the “Qty.” (Quantity) field on the service line.

D0250  extraoral – first 2D projection radiographic images created using a stationary radiation source, and detector

These images include, but are not limited to: Lateral Skull; Posterior-Anterior Skull; Submentovertex; Waters; Reverse Tomes; Oblique Mandibular Body; Lateral Ramus.

D0260  extraoral – each additional radiographic image

CDT Code maintenance requests from ADA members prompted these coming changes, and exemplify the importance of member participation in the CDT Code maintenance process.  For information about this and other CDT Codes, and how the CDT code set is maintained, go online (, email ([email protected]), or call ADA Practice Institute staff at 800-621-8099.