The analysis of pesticide residues in food is nowadays an increasingly important task. Quality control has to be very strict in order to safeguard the consumers' health. One of the most important goals of food quality assurance is testing food for residues and contaminants. Among chemical hazards, the contamination of food with pesticides has been characterized as a significant source of many serious diseases. Consumption of food containing pesticide residues may cause cancer, malformations, and damage to the endocrine, nervous, and immune system. In order to assure human food safety, The European Community has established maximum residue limits (MRL) of pesticides permitted in products of animal or vegetable origin that are intended for human consumption. In the EU, Regulation (EC) No. 396/2005 of the European Parliament and Council on pesticide residues established the levels of pesticide residues allowed in food and feed. To ensure the compliance of marketed food commodities with the law on food safety, sensitive and reliable analytical methods for the determination of pesticide residues are required. Multiresidue liquid chromatography-mass spectrometry methods (LC-MS) are widely recognized as an ideal, highly specific, and extremely sensitive technique for testing food products. This review discusses LC-MS approaches applied most widely to pesticide residue analysis over the last few years. The main ionization methods and MS detectors used as analytical tools in quantification and/or identification/confirmation of pesticide residues in food are presented.