Some Chiropractors use x-rays to help them identify patient conditions and some do not. Most Chiropractors would love a snapshot of their patients skeletal structure, but they cost time and money, and sometimes they aren't that helpful. The thought is that through a through examination a doctor can rule or out most conditions that a x-ray would show, but exams and doctors are not always perfect, and can miss things that may or may not show up during an exam.
So how do we make sure that the patient isn't getting charged for something that isn't going to help treat them, but also make sure we aren't missing something? Well they're isn't a perfect answers here, but this is what we do; We do a through history and exam findings to build probable diagnosis. This helps us rule in or out certain conditions and help determine if x-rays would help/change our treatment with you, if yes, we take them, if not, we...don't …or better yet we wait. We can always take them later if need be, say if your condition isn't improving or even worsening, we would then consider getting an image of your spine. The other thing we do to make sure our patients aren't being taken advantage of is make our x-rays affordable for out of pocket patients. So we keep the cost low and use our exam skills and clinical judgment to determine the right path for your spine health.
One area we have found taking x-rays very helpful is determining or discovery congenital (born with) spinal conditions that we previously unknown. Conditions like Sacralization or Lumbarization (when the back bones are malformed, creating abnormal joints) or even congenital fusions (where two or more back bones fail to separate, creating on solid bone).
I've included a few of this examples below, that without x-rays, would be easily missed.
Above: example of Sacralization (the yellow arrows are pointing to a boney articulation that normally isn't there)
Below: example of Congenital fused neck bones (the yellow arrows are pointing to to neck bones that are missing a joint in-between them)
In summary: Are x-rays needed for every patient? not really. Are they needed in some patients? yes, and it's up to your chiropractor to determine if taking them would be helpful in treating you.