What D0220 means

D0220 covers an intraoral periapical radiographic image — the first one. "D" is dental, "02" is the diagnostic imaging group, and "20" is this first periapical. A periapical ("around the apex," the root tip) X-ray captures the full length of a tooth, from the crown all the way down to the tip of the root and the bone around it. It's the go-to image for examining a specific tooth's root and the surrounding structures.

It's used to diagnose a wide range of issues: infection or abscess at the root tip, the extent of decay, bone loss around a tooth, root fractures, cysts, the status of a root canal, and to evaluate pain localized to a particular tooth. Because it shows the whole root and surrounding bone, it reveals problems below the gumline that you can't see otherwise.

D0220 is specifically the first periapical image in a series; each additional periapical is reported with D0230. This per-image structure is how individual diagnostic X-rays are billed, as opposed to a full-mouth series (D0210) or bitewings (which show the crowns of upper and lower teeth together for detecting decay between teeth). Plans typically cover X-rays subject to frequency limits.

When it's typically used

D0220 is reported for the first periapical X-ray taken — to examine a specific tooth's root and surrounding bone, diagnose root-tip infections or abscesses, assess decay or bone loss, evaluate localized pain, or check a root canal.

How much does D0220 cost?

A periapical X-ray is a low-cost diagnostic service, often roughly 25 to 50 USD for the first image depending on region. Additional periapicals and other X-ray types add modest amounts. X-rays are a small but essential part of diagnosis.

Is D0220 covered by insurance?

Commonly covered under diagnostic benefits, often at or near 100 percent, but subject to frequency limitations (plans limit how many X-rays of various types they'll cover in a given period). When taken to diagnose a specific problem, periapicals are routinely covered. Documentation of the diagnostic reason is standard.

What a periapical X-ray shows

The periapical X-ray is one of the most useful diagnostic tools in dentistry, precisely because of what it reveals that a visual exam can't.

The name means 'around the apex' — the apex being the tip of the tooth's root. A periapical image captures the entire tooth from the biting surface down through the root to its tip, plus the bone surrounding that root. This lets the dentist see structures completely hidden beneath the gum: the root anatomy, the bone supporting the tooth, and the area at the root tip where infections and abscesses form. It can reveal an abscess as a dark spot at the root tip, bone loss from gum disease, the depth of decay, a fractured root, a cyst, or the condition of a previous root canal.

This below-the-surface view is why a periapical is taken when there's pain or a suspected problem with a specific tooth. While you can see the visible crown of a tooth directly, the root and surrounding bone — where many serious problems originate — are only visible on an X-ray like this. It turns an invisible problem into something the dentist can diagnose and plan treatment for.

Periapical vs bitewing vs panoramic X-rays

Dental offices use several types of X-rays, each suited to different purposes, and knowing the differences clarifies why a particular one is taken.

A periapical (D0220) focuses on one or a few specific teeth, showing the full root and surrounding bone — ideal for diagnosing a problem with a particular tooth, like root-tip infection or pain. A bitewing shows the crowns of the upper and lower back teeth together, without the roots — excellent for spotting decay between teeth and checking the bone level for early gum disease, typically taken at routine check-ups. A panoramic (D0330) is a broad, single image of the entire mouth — all the teeth, both jaws, the sinuses, and the jaw joints — great for an overview, wisdom teeth, and jaw issues, but with less fine detail than the close-up intraoral films.

Each answers a different question. For a toothache localized to one tooth, a periapical gives the detailed root view needed. For routine decay detection, bitewings. For a big-picture look, a panoramic. Dentists choose the type (or combination) based on what they need to see, which is why you might get different X-rays at different visits.

Are dental X-rays safe?

Concern about radiation from dental X-rays is common, so it's worth putting the exposure into honest perspective.

The radiation dose from a single dental periapical X-ray is very low — among the lowest of any medical imaging, and a small fraction of the natural background radiation you're exposed to in daily life from the environment. Modern digital X-ray sensors have reduced the dose even further compared with old film. Dentists also follow safety practices: using lead aprons and thyroid collars, and taking X-rays only when there's a diagnostic reason rather than routinely beyond what's needed.

The principle is that X-rays are taken when the diagnostic benefit outweighs the very small risk — and for diagnosing hidden problems like root infections, decay between teeth, or bone loss, that benefit is significant, since these issues can't be found otherwise and worsen if missed. For the vast majority of patients, the occasional dental X-ray is a low-risk, high-value part of dental care. If you have specific concerns (for instance during pregnancy), it's always reasonable to discuss them with your dentist, who can adjust timing accordingly.

Why X-ray frequency is limited

Patients sometimes wonder why their dentist takes X-rays on a schedule, or why insurance limits how often they're covered, and there's sound reasoning behind it.

X-rays are taken based on need and risk, not arbitrarily. Someone with a history of frequent cavities or active gum disease may need them more often to catch problems early, while someone with excellent dental health and low risk needs them less frequently. Professional guidelines emphasize taking X-rays at intervals appropriate to each patient's risk, balancing the value of early detection against minimizing radiation exposure — taking them when they'll yield useful diagnostic information.

Insurance frequency limits reflect this same logic from a coverage standpoint: plans cover routine X-rays at set intervals (for example, bitewings once a year) that align with typical diagnostic needs, and cover problem-focused images like periapicals when there's a specific issue to diagnose. This is why a periapical taken to investigate a painful tooth is routinely covered even outside the routine schedule — it's diagnostically justified. The combination of clinical judgment and these limits aims to ensure X-rays are taken when genuinely useful, which is both good care and good stewardship of radiation exposure.

Frequently asked questions

What is the D0220 dental code?

It's the first intraoral periapical X-ray — a single image showing an entire tooth from crown to root tip plus surrounding bone, used to diagnose root infections, abscesses, and bone issues.

What does a periapical X-ray show?

The full length of a tooth including the root and the bone around it, revealing root-tip infections, abscesses, decay depth, bone loss, root fractures, and the status of a root canal.

What's the difference between a periapical and a bitewing?

A periapical shows the full root of specific teeth, for diagnosing a tooth's root problem. A bitewing shows the crowns of upper and lower back teeth together, for detecting decay between teeth.

How much does a periapical X-ray cost?

Often around 25 to 50 USD for the first image, with additional periapicals adding modest amounts. X-rays are a small part of diagnostic costs.

Are dental X-rays safe?

Yes — the dose from a periapical is very low, a small fraction of natural background radiation, especially with digital sensors. They're taken when the diagnostic benefit outweighs the small risk.

Does insurance cover D0220?

Commonly at or near 100 percent under diagnostic benefits, but subject to frequency limits. Problem-focused periapicals are routinely covered when diagnosing a specific issue.

This page is an independent, plain-language explanation for general information only. It is not billing, coding, or clinical advice. For the official CDT descriptor and current-year wording, refer to the American Dental Association.