From 2D to 3D: Navigating Intraoral Tomosynthesis Coding in Dentistry

April 2023
Greg Grobmyer, DDS

CDT 2023 introduced several new codes to the code set, six of which deal with stationary intraoral tomosynthesis (sIOT). While a similar concept has been used in mammography for some time, it is a new technology for dental practices. So what is stationary intraoral tomosynthesis and how do you confidently code for it? 

What is tomosynthesis?


Stationary intraoral tomosynthesis uses an x-ray head and intraoral digital sensors similar in appearance to those likely already in your office. The x-ray source, however, contains a collimator made up of carbon nanotubes, which directs seven separate beams of radiation from slightly different angles. The specialized sensor converts this data into image slices on the computer, which can be scrolled through from facial to lingual, similar to CBCT but the size of a periapical radiograph. This means any obstructions, overlaying restorations or tooth structure, overlapping contacts, etc., can be bypassed to reveal a crisp image of a 0.5mm slice of tooth.

What are the potential applications of sIOT in dentistry? 


What can it do better than 2D radiography or CBCT? Here are just a few potential uses:


  • Improved caries detection:An in-vitro study using sIOT demonstrated a 36% increase in sensitivity without significant decrease of specificity (the ability to correctly identify teeth without caries).

  • Greater potential for fracture detection (including enamel): sIOT, with no image obstruction from metal artifacts or overlying tooth structure, has the potential to detect fractures that neither 2D radiography nor CBCT can detect.

  • More accurate root canal assessment: The ability of sIOT to isolate individual roots of a tooth on a radiograph allows for improved assessment of abnormal root anatomy, and the clarity of canals is greater than conventional 2D radiography.

  • Better periodontal bone assessment: An improved assessment of the 3D architecture of periodontal bone from facial to lingual is possible by scrolling through a stack of 0.5 mm slices.


As clinical usage and research continue, more applications of sIOT will be identified, so make sure you stay in the know!

Are tomosynthesis (sIOT) codes covered by insurance companies?


We recommend that you ask if the specific sIOT codes (D0372, D0373, D0374, D0387, D0388, D0389) are covered when completing a full dental insurance coverage breakdown. New codes often are not fully incorporated into payor processing policies. It may take several years before insurers have a solid understanding of how they will appropriately reimburse. 


Nevertheless, it is always correct to code what you do using the appropriate CDT codes. Report these procedures using the new tomosynthesis codes, but then attach a narrative that states, "If benefits are not available for D0373, please consider the alternative benefit of D027x” ( x depending on how many bitewings were taken). 

Should I appeal a tomosynthesis (sIOT) code denial?


You can certainly appeal if needed. Hopefully, the narrative will “guide” payors on how they need to reimburse. It should be higher than reimbursement than traditional bitewings, but payors don’t fully understand the technology yet. The more the codes are used, the better chances it will be considered for reimbursement in the future.


In addition,  if the office is a contracted PPO provider, the PPO may "deny" the procedure (the insurance does not pay but the patient is responsible) or "disallow" the procedure (the insurance does not pay and the office is required to write off the charge).

Need more help?


This is just one of the many questions our Call Center Support Advisors answer on a daily basis. Do you have more coding conundrums that could benefit from expert coding support? We’ve got you covered.


Call Center Support is just one of the incredible features of Practice Booster’s Online Code Advisor, the most up-to-date and comprehensive online database of CDT codes available. Practice Booster, with the support of the American Dental Association, provides dental offices with an in-depth review of all CDT codes to enable dental teams to code dental procedures properly and maximize legitimate revenue.


CLICK HERE to see all of the benefits Code Advisor has to offer!



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