Buildup billed without a crown

Claim 16000 · Harborview Dental Plan · Date of service 04/23/2026 · Source: synthetic case buildup-03-no-crown · Generated 2026-10-12 07:09 UTC

Prepare in Open Dental

Ready, with warnings

Prepared, with warnings: review the risks before approving, then send the claim from Open Dental.

Claim note on D2950 tooth #28
(empty) -> "Buildup #28: narrative and radiograph attached"
Open Dental API call
```
PUT /procedurelogs/16001
{
  "ClaimNote": "Buildup #28: narrative and radiograph attached"
}
```

Narrative PDF in the patient's imaging

"ClaimClear narrative - claim 16000" (2 KB), ready to attach to the claim.

Open Dental API call

POST /documents/Upload
{
  "PatNum": 16000,
  "rawBase64": "<PDF, 1492 bytes>",
  "extension": ".pdf",
  "Description": "ClaimClear narrative - claim 16000",
  "ImgType": "Document",
  "ToothNumbers": "28"
}

To-do list as an Open Dental task

ClaimClear: claim 16000 (date of service 04/23/2026), there are denial risks to review.

D2950 core buildup, tooth #28:
- Confirm the crown is charted (planned or completed) and billed with or before the buildup.

Open Dental API call

POST /tasks
{
  "TaskListNum": 1,
  "UserNum": 1,
  "Descript": "ClaimClear: claim 16000 (date of service 04/23/2026), there are denial risks to review.\n\nD2950 core buildup, tooth #28:\n- Confirm the crown is charted (planned or completed) and billed with or before the buildup.",
  "KeyNum": 16000,
  "ObjectType": "Patient"
}

Claim tracking status

ClaimClear: prepared, with warnings to review

Open Dental API call

POST /claimtrackings
{
  "ClaimNum": 16000,
  "TrackingDefNum": 1,
  "Note": "ClaimClear: prepared, with warnings to review"
}

Preview the narrative PDF

ClaimClear never sends claims. After approving, staff attach the narrative PDF and radiographs to the claim in Open Dental and send it as usual.

D2950 core buildup · tooth #28 · 04/23/2026

At risk of denial

Do this before submitting

Confirm the crown is charted (planned or completed) and billed with or before the buildup.

Narrative Every sentence checked against the chart

Buildup needed to retain the crown due to minimal remaining tooth structure. Approximately 50% of coronal structure missing after caries removal. Periapical radiograph of #28 taken 01/26/2026. Treatment: D2950 core buildup on tooth #28, date of service 04/23/2026.

264 characters

Claim note

Buildup #28: narrative and radiograph attached

Attachments

Item	Status	Detail
Radiograph	In Open Dental	Periapical radiograph of #28 taken 01/26/2026. Source: Open Dental Imaging: "PA 28 pre-op" (Radiographs), DocNum 16201.

Documentation checks (Default (common plan guidelines - verify per carrier))

Check	Status	Detail
Radiograph of tooth #28 within 12 months	Met	Periapical radiograph of #28 taken 01/26/2026 (2.9 months before the date of service).
Insufficient remaining structure to retain a crown documented	Met	Buildup needed to retain the crown due to minimal remaining tooth structure.
Extent of tooth structure loss documented (recommended)	Met	Approximately 50% of coronal structure missing after caries removal.
Crown on the same tooth	Warning	No crown on tooth #28 is recorded for the same visit or on this claim. Buildups are generally only payable together with a crown.

Evidence used (4 facts)

ID	Fact	Where it comes from
C1	D2950 core buildup on tooth #28, date of service 04/23/2026.	Procedure D2950 (ProcNum 16001)
C2	Periapical radiograph of #28 taken 01/26/2026.	Open Dental Imaging: "PA 28 pre-op" (Radiographs), DocNum 16201
N1	Buildup needed to retain the crown due to minimal remaining tooth structure. "Buildup needed to retain the crown due to minimal remaining tooth structure"	Clinical note: D2950 #28 on 04/23/2026 (this procedure)
N2	Approximately 50% of coronal structure missing after caries removal. "Approx 50% of coronal structure missing after caries removal"	Clinical note: D2950 #28 on 04/23/2026 (this procedure)

Draft → check → revise loop (1 iteration)

Iteration 1: no issues

Clinical notes read (1, names redacted)

D2950 #28 on 04/23/2026 (this procedure)

Buildup needed to retain the crown due to minimal remaining tooth structure. Approx 50% of coronal structure missing after caries removal.

Engine: extractor heuristic, narrator template, reviewer none.