Understanding Dental Code D0364

Dental billing professionals and office managers know that accurate coding is the backbone of efficient revenue cycle management. D0364 is a CDT code specifically used for cone beam computed tomography (CBCT) capture and interpretation with a limited field of view—less than one whole jaw. Understanding when and how to use D0364 ensures proper reimbursement and compliance with payer requirements.

When to Use D0364 dental code

The D0364 dental code should be used when a CBCT scan is performed and interpreted, but the scan covers less than an entire jaw. This typically applies in cases where a focused, high-resolution image is needed for a specific area, such as evaluating a single tooth, implant site, or localized pathology. Unlike codes for full-jaw or maxillofacial scans, D0364 is reserved for targeted diagnostics, minimizing radiation exposure and supporting precise treatment planning.

Common scenarios include:

• Pre-implant site assessment for a single tooth
• Evaluation of localized lesions or cysts
• Assessment of root fractures or endodontic complications
• Planning for surgical extractions in a limited area

Documentation and Clinical Scenarios

Proper documentation is critical for successful claims processing. To support the use of D0364, ensure the patient’s clinical notes clearly state:

• The specific reason for the limited field CBCT scan
• The area imaged (e.g., tooth number, quadrant)
• Interpretation findings and how they impact treatment planning

Attach the radiology report and, if possible, annotated images to the patient’s record and insurance claim. This level of detail not only supports medical necessity but also streamlines claim approval and reduces the risk of denials.

Insurance Billing Tips

When billing D0364, follow these best practices to maximize reimbursement and minimize AR delays:

• Verify coverage: Not all dental plans cover CBCT scans. Check benefits before the appointment and inform the patient of any out-of-pocket costs.
• Use accurate narratives: Include a concise description of why the limited field scan was necessary, referencing clinical findings and treatment needs.
• Submit supporting documentation: Attach clinical notes, radiology interpretation, and images when submitting the claim.
• Appeal denials promptly: If a claim is denied, review the EOB for reasons, supplement documentation as needed, and submit a timely appeal with additional justification.

Remember, using the correct CDT code for the specific type of CBCT scan prevents confusion and supports compliance. For scans covering a full jaw or both jaws, refer to D0367 or other relevant codes.

Example Case for D0364

Case: A patient presents with persistent pain in the upper right first molar. Clinical exam and 2D radiographs are inconclusive. The dentist orders a limited field CBCT scan focused on the affected tooth and adjacent area. The scan reveals a vertical root fracture, altering the treatment plan from root canal therapy to extraction and implant placement.

In this scenario, D0364 is the appropriate code. The claim should include:

• Clinical notes detailing the symptoms and inconclusive findings on standard radiographs
• The CBCT scan report highlighting the fracture
• A narrative explaining how the scan changed the treatment approach

This thorough documentation supports medical necessity and increases the likelihood of claim approval.

By understanding when and how to use D0364, dental teams can ensure accurate billing, better patient care, and optimized practice revenue.