![]() ![]() Not payable with D0210 on same DOS.Įxtra-oral - 2D projection radiographic image created using a stationary radiation source, and detector Not payable with D0210 on same DOS or up to six months after. ![]() Intraoral - periapical each additional radiographic image Intraoral - periapical first radiographic image 1 Panorex plus bitewings may be billed under D0210. Not billable within six months of other X-rays including D0220, D0230, D0240, D0270, D0272, D0274, and D0330 except in an emergency. One per three years, per member, per provider. Intraoral - complete series of radiographic images Radiographs/Diagnostic Imaging (Including Interpretation) One per six months, per member, per provider. Allowable in office or hospital POS (place of service). Re-evaluation - limited, problem focused (established patient not post-operative visit)Īllowed once per year, per member, per provider. One per three years, per member, per provider.ĭetailed and extensive oral evaluation - problem focused, by report One per six months, per member, per provider.Ĭomprehensive oral evaluation - new or established patient Limited oral evaluation - problem focused One per six-month period, per member, per provider, for members under the age of 21. Periodic oral evaluation - established patient This includes documenting the medical necessity of services in the member’s medical record. Reimbursement is allowable only for services that meet all program requirements. D0100-D0999 DiagnosticĬovered diagnostic services are identified by the allowable CDT (Current Dental Terminology) procedure codes listed in the following tables. Information is available for DOS (dates of service) before January 1, 2020. Topic #2808 BadgerCare Plus/Medicaid Diagnostic, Preventive, Restorative, Endodontics, Periodontics, General Codes ![]()
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