D0220 — Periapical Radiograph (First Image)
D0220 is a single intraoral X-ray showing one or two teeth in full, including the root tip and the bone around it.
A periapical image is the close-up. It shows a small region — usually one to three teeth — from the biting surface all the way past the root tip into the surrounding bone. When a specific tooth hurts, when a root canal is being planned or checked, or when an abscess is suspected, this is the image that answers the question.
D0220 is specifically the first periapical at a visit. Each additional one taken in the same appointment is reported with D0230, at a lower fee. An emergency visit for one painful molar typically produces a D0140 exam plus a D0220, and perhaps a D0230 or two.
What it is used to find
Periapical imaging is the tool for anything happening at or below the root: periapical abscesses and granulomas, cysts, vertical root fractures, internal and external root resorption, retained root fragments after an extraction, the position of an unerupted tooth, the length and curvature of canals before endodontic treatment, and the density of bone around an implant site.
It is also the standard confirmation image after treatment — a post-operative periapical after a root canal shows whether the filling material reaches the full working length, and one taken a year later shows whether the bone has healed.
Why the count on your bill matters
Because the first image and each subsequent one use different codes, the arithmetic on an imaging bill is worth checking. Four periapicals is one D0220 plus three D0230s. If you see four D0220 lines, that is a billing error rather than a clinical one.
There is also a ceiling effect: once enough individual images are taken in one visit, most plans reprice the whole set to the complete-series allowance (D0210). Offices usually watch that threshold, because past it the extra images generate no extra payment.
Questions about D0220
What does a periapical X-ray show?
One to three teeth in full, from the biting surface through the root tip and into the surrounding bone — which is where abscesses, cysts and root fractures appear.
What is the difference between D0220 and D0230?
D0220 is the first periapical image taken at a visit; D0230 covers each additional one and carries a lower fee.
Why does the dentist need a periapical rather than a bitewing?
Bitewings stop at the bone crest and cannot show root tips. Anything involving the nerve, the root or the bone beneath it needs a periapical.
Is a single X-ray covered by insurance?
Yes, almost always at the diagnostic rate, though plans cap the total number of images per year and per visit.
Also known as: periapical, PA X-ray, single dental X-ray, root tip image.