D0274 Dental Code: Four Bitewing Radiographic Images

The short version

# D0274 Dental Code: Four Bitewing Radiographic Images

D0274 is the CDT code for a set of four bitewing radiographic images, captured with horizontal or vertical orientation. The dentist selects the images from the patient's examination, history, disease risk, and available prior films. A plan may pay only two images or apply a frequency limit even when four were clinically needed.

• Bill D0274 when the office captures and interprets four bitewing images as one set.
• Use D0272 for two bitewings and D0277 for seven or eight vertical bitewings. D0210 is a comprehensive intraoral series, not another name for four bitewings.
• The ADA says image selection must be patient-specific. A recall schedule alone isn't the clinical reason for exposure.
• The ADA reported a payer paying a four-bitewing claim as two images, which is downcoding when the submitted service was D0274.
• In a worked example, a $95 fee becomes a $70 allowable. The plan pays $70 at 100%, the patient owes $0, and the office adjusts $25.
• Record the reason for the images, date, number, orientation, diagnostic quality, findings, and prior-image review.

What is D0274?

D0274 reports four bitewing radiographs that show crowns and interproximal areas of upper and lower posterior teeth on the same images. The image axis may be horizontal or vertical.

The ADA image-capture guide lists D0274 separately from D0708, which reports bitewing image capture without the treating dentist's interpretation.

When do you bill D0274?

Bill D0274 when four bitewings are clinically selected, captured, and interpreted.

• Review the patient's age, dentition, caries risk, periodontal condition, symptoms, and prior images.
• Choose four images because that set supplies the needed posterior coverage.
• Confirm the images are diagnostic and identify the patient, date, and right/left orientation.
• Record the findings or the absence of new disease.
• Avoid retaking usable recent images only because a routine interval arrived.

D0274 vs D0272, D0210, and D0277

The number and intended coverage of the images decide the code.

Four bitewings don't become D0210 because they show many posterior teeth. D0210 is a comprehensive series with broader whole-mouth diagnostic coverage.

What does insurance actually do with D0274?

Plans often apply a set frequency across D0272, D0274, and other bitewing codes. Delta Dental's women's-health program lists one additional bitewing set per year for eligible members, showing that plan benefits can add imaging outside the base schedule for defined circumstances. Verify the normal and supplemental benefits separately.

The ADA's 2026 downcoding column describes four submitted bitewings paid as two. Compare the EOB code and quantity with the image record before posting. If the plan intentionally limits the benefit, the EOB and contract should say so.

• Office fee: $95
• Contracted allowable: $70
• Contractual adjustment: $25
• Plan payment at 100%: $70
• Patient balance: $0

Why does D0274 get denied?

• The history doesn't clear the plan's bitewing frequency limit.
• The attachment doesn't support the four images reported.
• The claim doesn't separate D0274 from a same-day D0210 series.
• The images aren't diagnostic, labeled, and dated.
• The note doesn't show a patient-specific reason when the payer requests one.

What documentation gets D0274 paid?

1. Don't omit the clinical reason for choosing four bitewings.
2. Note the patient's caries and periodontal risk plus relevant symptoms or history.
3. Don't omit any image, date, orientation, or quality finding.
4. Don't leave the radiographic findings out of the treatment record.
5. Confirm the prior bitewing and complete-series dates.
6. Keep the images available for attachment when the payer requests them.

Common questions about D0274

Can D0274 use vertical bitewings?

Yes. The ADA's image guide says the D0274 image axis may be horizontal or vertical. D0277 is reserved for a set of seven or eight vertical bitewing images. Count the delivered images and select the code that matches the set.

Can D0274 be billed with D0120?

Yes, when the dentist performs the periodic evaluation and separately selects four clinically necessary bitewings. The D0120 guide covers the exam. Document the reason for the images and keep the examination findings separate from the radiographic service in the patient record.

Is D0274 included in D0210?

When bitewings are part of the comprehensive intraoral series, they aren't separately added to D0210. Report the service actually delivered. A four-image bitewing set without the complete series remains D0274. The record should show whether the dentist ordered a full series or a separate bitewing set.

How often can D0274 be taken?

The dentist selects imaging from clinical need and prior-image availability. The benefit interval is plan-specific. Check the last D0272, D0273, D0274, D0277, and D0210 dates because plans can group them. A payment limit doesn't decide clinical need; it decides whether current images receive a benefit.

Compare the image log with the claim

Before filing, match the claim to four dated diagnostic images and the recorded reason for the set.

Sources

• ADA, X-Rays and Radiographs
• ADA, Guide to Image Capture Only Procedures
• ADA, bundling and downcoding
• ADA News, Dear ADA: Downcoding
• Delta Dental, Next Stage women's health benefits
• Oregon Medicaid, June 2025 fee schedule
• Washington, DC Medicaid fee schedule, May 17, 2025
• FAIR Health Consumer, dental cost lookup

CDT codes and nomenclature are copyright © American Dental Association. This guide explains the code in plain language; the current CDT manual is the authoritative source.