In this paper, we report on the design and performance of a 1 cm2, 90 × 92-pixel image sensor. It is made X-ray sensitive by the use of a scintillator. Its pixels have a charge packet counting circuit topology with two channels, each realizing a different charge packet size threshold and analog domain event counting. Here, the sensor’s performance was measured in setups representative of a medical X-ray environment. Further, two-energy-level photon counting performance is demonstrated, and its capabilities and limitations are documented. We then provide an outlook on future improvements.