Bitewing and Periapical Dental X-Rays: Why Are the Films Rated R?

A small business client with apparently X-ray vision (pun intended) contacted us recently about our coverage of X-rays.

True story.

Delta Dental of Arkansas covers “bitewing and periapical X-rays” on its fully insured plans as required [by the dentist] in any calendar year but limits the number of films allowed by visit for members within certain age ranges. Why is that?

Thanks for the question. 

Let’s take a look inside.

Difference Between Bitewing X-rays and Periapical X-rays

In general, bitewing X-rays are primarily used to detect cavities between teeth and assess the fit of dental fillings, crowns or bridges. They are often taken during routine dental check-ups.

Periapical X-rays provide a more detailed view of individual teeth and their surrounding structures, making them useful for diagnosing a broader range of dental issues.

The choice of which X-ray to use depends on the specific diagnostic or monitoring needs of the patient, as they differ in frequency, purpose and area of focus.

Bitewing X-rays are often taken during routine dental check-ups, typically once a year or as needed for monitoring tooth decay between teeth or below the gumline. You probably heard the recommendation, “Visit your dentist regularly for professional cleanings, oral exams and X-rays.” Those X-rays are most likely bitewing X-rays.

The term comes from how patients must bite down on the specifically designed X-ray film. They can be taken right there in the dental chair with the X-ray machine positioned outside the mouth to capture the image. Bitewing X-rays visualize more teeth at once but not each complete tooth.

Some dental offices no longer use film but a sensor, which sends the X-ray to the computer, where it’s immediately available for the dentist to review. There is no need to wait for the film to be developed.

Insurance Benefit for Bitewing X-Rays

Bitewing X-rays are large enough that one film per side can cover the area needed in patients under age 10. Think of them as “horizontal” films. Once the second molars come in (usually around age 12, but sometimes as early as age 10), 2 films are needed to visualize the full side.

That’s why Delta Dental of Arkansas (and many other dental insurance companies) limit insurance benefits for bitewing X-rays to two (2) films in any single visit for children under the age of 10. While an additional film might be appropriate in an emergency, films exceeding 2 per year are not billable to the patient. Overutilization could result in a pre-payment review or audit.

If the dentist discovers something that warrants a closer inspection, they may take additional

Periapical X-rays.  These are generally used less frequently for screening but rather when pain is reported. They examine a specific tooth or area of concern that requires detailed evaluation, such as when diagnosing a tooth fracture, gum disease, bone loss or the health of the root or lesions (infections) at the tip of the root that may indicate the need for a root canal or extraction. Periapical X-rays show the entire root from the crown to the root tip, a more comprehensive view of a specific tooth and its supporting structures. 

They are less commonly taken as part of routine check-ups.

The X-ray film or sensor is placed inside the mouth near the specific tooth or area of interest using a metal rod with a ring attached to it. The patient needs to bite firmly onto the device to hold it in place for a clear X-ray image to be taken.

Insurance Benefit for Periapical X-Rays

Think of Periapical X-rays as “vertical” film. They are covered services as required in any calendar year with no age-related limitations.

Safety of Dental X-Rays

Both bitewing and periapical X-rays expose patients to a minimum amount of radiation. Dentists take additional precautions like using lead aprons and thyroid collars to minimize the exposure even more.

Quiz: What Do Dentists Call their X-Rays? And How It Relates to Dental Insurance

Tooth pics.

We had to end this blog on a funny note because bringing smiles—healthy smiles—to Arkansans is our mission.

We facilitate access to dental care through competitive, affordable rates for individuals and families, and small and mid-to-large-sized groups. Our network of dental providers is the largest in the state.

Check us out to discover what more than 800,000 Arkansans see in us.