Crown: replacing a ~3 year old crown

Claim 6000 · Bluebird Dental Benefits · Date of service 03/25/2026 · Source: synthetic case crown-06-early-replacement · Generated 2026-10-12 07:08 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 D2740 tooth #5
(empty) -> "Crown #5: narrative and radiograph attached"
Open Dental API call
```
PUT /procedurelogs/6001
{
  "ClaimNote": "Crown #5: narrative and radiograph attached"
}
```

Narrative PDF in the patient's imaging

"ClaimClear narrative - claim 6000" (2 KB), ready to attach to the claim.

Open Dental API call

POST /documents/Upload
{
  "PatNum": 6000,
  "rawBase64": "<PDF, 1585 bytes>",
  "extension": ".pdf",
  "Description": "ClaimClear narrative - claim 6000",
  "ImgType": "Document",
  "ToothNumbers": "5"
}

To-do list as an Open Dental task

ClaimClear: claim 6000 (date of service 03/25/2026), there are denial risks to review.

D2740 crown, tooth #5:
- Confirm the early replacement is justified and documented, or discuss patient responsibility before submitting.

Open Dental API call

POST /tasks
{
  "TaskListNum": 1,
  "UserNum": 1,
  "Descript": "ClaimClear: claim 6000 (date of service 03/25/2026), there are denial risks to review.\n\nD2740 crown, tooth #5:\n- Confirm the early replacement is justified and documented, or discuss patient responsibility before submitting.",
  "KeyNum": 6000,
  "ObjectType": "Patient"
}

Claim tracking status

ClaimClear: prepared, with warnings to review

Open Dental API call

POST /claimtrackings
{
  "ClaimNum": 6000,
  "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.

D2740 crown · tooth #5 · 03/25/2026

At risk of denial

Do this before submitting

Confirm the early replacement is justified and documented, or discuss patient responsibility before submitting.

Narrative Every sentence checked against the chart

Porcelain fractured off the existing crown on #5, exposing the metal substructure. Patient reports pain on biting. The crown being replaced on #5 was originally placed 03/02/2023 (3 years before this date of service). Periapical radiograph of #5 taken 02/13/2026. Treatment: D2740 crown on tooth #5, date of service 03/25/2026.

327 characters

Claim note

Crown #5: narrative and radiograph attached

Would strengthen the claim

Document the extent of the damage (e.g., % of the crown missing, cusps involved, size of the existing restoration).
Attach an intraoral photo; photos make fracture and decay findings easier for reviewers to accept.

Attachments

Item	Status	Detail
Radiograph	In Open Dental	Periapical radiograph of #5 taken 02/13/2026. Source: Open Dental Imaging: "Periapical 5" (Radiographs), DocNum 6201.

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

Check	Status	Detail
Radiograph of tooth #5 within 12 months	Met	Periapical radiograph of #5 taken 02/13/2026 (1.3 months before the date of service).
Clinical reason for the crown documented	Met	Porcelain fractured off the existing crown on #5, exposing the metal substructure.
Extent of tooth structure loss documented (recommended)	Not documented	No note describes how much tooth structure on tooth #5 is missing or undermined.
Replacement interval (5+ years since prior crown)	Warning	Prior crown placed 03/02/2023, only 3 years before the date of service (eligible again 03/02/2028). Most plans replace crowns once every 5 years, so expect a frequency denial unless a qualifying cause (e.g., fracture) is documented.
Initial/replacement flag matches chart history	N/A	Procedure is not flagged as an initial placement.
Intraoral photo (recommended)	Not documented	No intraoral photo of tooth #5 in Open Dental Imaging.

Evidence used (5 facts)

ID	Fact	Where it comes from
C1	D2740 crown on tooth #5, date of service 03/25/2026.	Procedure D2740 (ProcNum 6001)
C2	Periapical radiograph of #5 taken 02/13/2026.	Open Dental Imaging: "Periapical 5" (Radiographs), DocNum 6201
C3	The crown being replaced on #5 was originally placed 03/02/2023 (3 years before this date of service).	Procedure D2740: Prosthesis = Replacement, original date 03/02/2023
N1	Porcelain fractured off the existing crown on #5, exposing the metal substructure. "Porcelain fractured off the existing crown on #5, exposing the metal substructure"	Clinical note: D2740 #5 on 03/25/2026 (this procedure)
N2	Patient reports pain on biting. "Pt reports pain on biting"	Clinical note: D2740 #5 on 03/25/2026 (this procedure)

Draft → check → revise loop (1 iteration)

Iteration 1: no issues

Clinical notes read (1, names redacted)

D2740 #5 on 03/25/2026 (this procedure)

Porcelain fractured off the existing crown on #5, exposing the metal substructure. Pt reports pain on biting. Crown prep #5 for zirconia crown. Shade A2. Temp placed.

Engine: extractor heuristic, narrator template, reviewer none.