Diagnostic Imaging (D0200 - D0299)

Dental radiographs (commonly known as "x-rays") and intraoral photographs should be taken only for clinical reasons as determined by the dentist. In other words there really is no "set schedule."  Some patients who are very healthy may have these images taken every 12 months, perhaps even two years. Some patients who are at extreme risk of dental caries would get these images every 6 months. And there are many schedules and needs in between. 

Our office uses digital radiography for this process. What this means is that the x-ray images are generated by the computer for both viewing and for documentation. There are many benefits to digital radiography that include:

  • an 80% reduction in radiation to produce the dental images.
    • this is a result of the digital sensors being much more sensitive and efficient than film.
    • a full series of 18 radiographic images taken digitally creates as much radiation as about 10 minutes of standing in the sunshine, i.e. they are very safe.
  • Immediate viewing, so there is no wasted time waiting for the developing process.
  • Viewing images on a large flat screen monitor with digital enhancement such as contrast and magnification control.
    • perhaps for the first time, you as the patient will get to actually see your dental radiographs in close up detail.
    • our office will teach you how to read your own radioraphs so you can follow the doctor every step of the way
  • Much more comfortable in the mouth
    • the digital sensors do not have that "sharp edge" of the film packet that would frequently feel  like it was digging into the soft, tender parts of the mouth under the tongue. So, it is a lot more comfortable!
  • The ability to place images side by side and evaluate them for any changes.
    • this is very helpful when you are monitoring a tooth for any changes such as decay, bone loss, etc.
    • we also use this technique to show you "before and after" images during treatment.

Bite-Wing Radiographs

There are generally two types of intraoral radiographs that we take during our examinations. One type is called a "bitewing" film. This is a very old term that came from the cardboard tabs that we used to bite on when film used to be used. The bitewing film is more properly called a "cavity checking film" but nobody, including myself calls it that. 

Bitewing are excellent screening films for dental decay. They are dimensionally very accurate and will show the most common areas to get dental decay,  mainly the chewing parts of the tooth, called the crown, and in the "in between" surfaces called the interproximal areas.  

At right is a bitewing film. Can you notice the darker areas in between the lower back teeth where decay has begun to break the tooth down? Can you also notice the places on the tooth that have already received restorations? 2-4 Bitewings are generally taken every 6 months for anyone who has had a history of restorations or who is at a high risk of decay.


Periapical Radiographs

The second type of intraoral radiograph is called a "periapical" film. The "apex" of the tooth is the very end of the root which goes down into the bone. If you look again at the bitewing radiograph above you will notice that this images stops before you can see the entire root of the tooth. A periapical image shows the area completely "around the apex." This is important in that if the pulp tissue inside the tooth is not healthy, it will produce a dark shadow at the apex of the root which can only be seen with this type of radiograph.

At right is a periapical film. Can you see the area at the end of the root which looks like a dark circle?  That is a tooth which has a periapical abscess of the pulp and will require endodontic treatment in order to save the tooth. Can you also see the decay which is under the whitish looking filling on that same tooth?

Periapaical images can also show areas of bone loss around the root, a sign of advanced periodontal disease.

Periapical images are very important but do not need to be taken as routinely as the bitewings. An initial visit will include a complete series of intraoral radiographs which includes the four bitewing films and periapical images of each tooth in the mouth.

A full series of films is taken about every 3-5 years depending on the patient.

There are many dental radiographic codes, but we have included only those which we offer in this office including:

D0210: Complete Series of intraoral radiographs

Commonly known as a "full series of x-rays" this is a radiographic survey of the entire mouth, usually consisting of anwhere from 14-22 images known as bitewings (pictures of just the chewing surfaces of the back teeth) and periapicals (images of the entire tooth, right down to the apex (tip) of the root.

D0220: the first intraoral periapical image taken

Sometimes a complete series is not necessary, but only a few periapical images are required. This code is used to document the first of these images.

D0230: Each additional periapical intraoral image

D0270: a single  bitewing image

D0272: two bitewing images

D0274: four bitewing images

D0277: vertical bitewings - 7-8 radiographic images

Traditional bitewing images are horizontal in nature and show many teeth, but not much of the root interface and the bone around the roots. Vertical bitewings are taken when you wish to see more of the bone around the tooth, but a full series of periapical images are not indicated. This code does not constitute a full mouth series of radiographs.

D0350: oral or facial photographic images obtained either intraorally or extrarally.

Our office is equipped with a sophisticated digital intraoral photography camera. Taken photographic images of the teeth are very valuable to demonstrate those clinical issues that do not show up on a radiograph such as soft tissue problems, fractures of teeth, etc.

D0370: Maxillofacial ultrasound capture and interpretation.

Although we do not take ultrasound images of the TMJ, we do listen to this joint using an ultrasound. This code is often used for this particular test.


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