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N928 Remark Code: Bitewing or Periapical X-Ray Issue

N928 means the bitewing or periapical x-ray the dental payer needed was missing, incomplete, or invalid. These focused images show decay, existing restorations, the tooth root, and surrounding bone, and payers commonly require them for restorative, crown, endodontic, and extraction claims.

Quick facts

Code
N928 (RARC N928)
Status
Active In use since July 1, 2026.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The unpaid dental charge while the required image is missing or unacceptable. It is the dental office's responsibility, not the patient's.
Official description
Missing/Incomplete/Invalid bitewing or periapical x-ray.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N928 means

Dental payers rely on images to confirm what the claim describes. For many single-tooth procedures, the image they want is a bitewing or a periapical. N928 means that image either was not sent or did not do its job, perhaps because it was the wrong view, poor quality, or did not show the tooth billed.

Common causes

  • No image attached to a claim for a crown, root canal, or extraction.
  • A bitewing sent when the payer needed to see the root, which only a periapical shows.
  • The tooth billed is not visible, or the image is not labeled with left and right.
  • The image is dated too long before the procedure.

How to fix it

  1. Confirm the tooth number on the claim matches the tooth treated.
  2. Select the right view. Use a periapical when the root or apex matters, and a bitewing for interproximal decay.
  3. Label the image with patient name, date taken, and orientation.
  4. Submit it through the payer’s attachment channel with the claim or reprocessing request.

How to prevent it

Build procedure-based attachment rules into your practice management system so claims for crowns, endodontics, and extractions cannot be sent without an image attached.

Codes that may appear with N928

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment is required; N928 specifies a bitewing or periapical image.
  • CO-250 (The attachment/other documentation that was received was the incorrect attachment/document.): The attachment received was the wrong document, for example a panoramic image when a periapical was needed.
  • CO-251 (The attachment/other documentation that was received was incomplete or deficient.): The image received was incomplete or deficient.
  • N931 (Missing/Incomplete/Invalid pre- and/or post-operative bitewing or periapical x-ray.): The same image types, but taken before and/or after the procedure.
  • N934 (Missing/Incomplete/Invalid full mouth x-ray.): A full mouth series is needed instead of individual images.
  • N927 (Missing/Incomplete/Invalid x-ray.): A general x-ray remark that does not name the image type.
  • N37 (Missing/incomplete/invalid tooth number/letter.): The tooth number or letter is missing or invalid.

N928 FAQ

What is the difference between a bitewing and a periapical?

A bitewing shows the crowns of upper and lower back teeth together and the bone crest between them, which helps detect decay between teeth. A periapical shows an entire tooth from crown to root tip and the surrounding bone.

Which one should I send?

Match the image to the procedure. Payers usually want a periapical for root canals and extractions, and a bitewing or periapical for fillings and crowns. Check the payer's guidelines.

Can the image be from a prior visit?

Often yes, if it is recent enough under the payer's rules and still shows the current condition. Label it with the date it was taken.