Understanding Dental Code D0277

When to Use D0277 dental code

The D0277 dental code is designated for vertical bitewing radiographic images. Unlike traditional horizontal bitewings, vertical bitewings capture more of the alveolar bone and are especially valuable for monitoring periodontal disease progression. This code should be used when a series of seven to eight vertical bitewing images are taken to assess interproximal bone levels and detect caries in patients with moderate to severe periodontal conditions. It is not intended for routine caries detection in patients with healthy periodontium; instead, use this code when clinical findings or history indicate a need for a comprehensive view of bone loss.

Documentation and Clinical Scenarios

Accurate documentation is crucial when billing for D0277. The patient’s chart should clearly indicate the periodontal diagnosis or risk factors that justify the use of vertical bitewings. Include detailed clinical notes describing pocket depths, bone loss, or previous periodontal treatment. Attachments such as periodontal charting and intraoral photos can strengthen your claim. Common scenarios for D0277 include:

• Patients with a history of periodontitis requiring ongoing monitoring
• New patients presenting with generalized bone loss
• Re-evaluation visits following periodontal therapy

Always ensure that the number of images taken matches the code’s definition, and that the images are of diagnostic quality.

Insurance Billing Tips

Many insurance carriers have specific frequency limitations and documentation requirements for D0277. Before submitting a claim, verify the patient’s coverage and frequency limits for bitewing radiographs. If D0277 is denied due to frequency, review the Explanation of Benefits (EOB) and consider submitting a claim appeal with supporting clinical documentation. Best practices include:

• Pre-authorizing the procedure when possible, especially for patients with known periodontal disease
• Attaching clinical notes, periodontal charting, and images to the claim
• Using the correct CDT code—do not substitute D0277 for horizontal bitewings (D0272 or D0274)
• Tracking claim status in your accounts receivable (AR) workflow and following up promptly on denials

Staying proactive with documentation and communication can help maximize reimbursement and minimize delays.

Example Case for D0277

Consider a 52-year-old patient with a history of chronic periodontitis who presents for a periodontal maintenance visit. The hygienist notes 5-7mm pocket depths and moderate bone loss on probing. The dentist orders a full set of vertical bitewings to evaluate bone levels and monitor disease progression. The clinical notes detail the patient’s diagnosis, previous treatments, and the medical necessity for vertical bitewings. The claim is submitted with D0277, including attached periodontal charting and intraoral images. Insurance initially denies the claim due to frequency, but after submitting an appeal with comprehensive documentation, the claim is approved and paid in full.

This example highlights the importance of thorough documentation and persistence in the billing process for D0277.