Continuously flushing moving bed sand filter was operated in pilot scale for phosphorus (P) and nitrogen removal with simultaneous particle removal. The wastewater tested was either final effluent from a municipal wastewater treatment plant (WWTP) with nitrogen removal in moving bed biofilm reactors (MBBRs) followed by coagulation and dissolved air flotation (DAF) for P and suspended solids (SS) removal, or different mixtures of this final effluent and effluent from the MBBR-stage. The study focused on the applicability to achieve low total phosphorus (TP) concentrations (below 0.1 mg/L) and suspended solids concentrations (below 10 mg SS/L), plus good denitrification (removal rate over 750 g NO3-N/m3-d), by treating wastewater having variable concentrations of TP (from 0.19 to 7.3 mg/L), SS (from 3 to 169 mg/L) and total nitrogen (from 8 to 27 mg/L). The target effluent TP limit was easily achieved when adding coagulant to WWTP effluent. With correct coagulant dose (Al/TP-molar ratio >4) and good particle removal the target effluent TP could also be reached when treating mixed WW with fairly high influent TP. Very high denitrification rates were achieved with adequate influent P concentration and external carbon source. Low denitrification rates were observed when limited by low concentrations of biodegradable carbon and phosphorus.