Crown: replacing a 9+ year old crown
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D2790 crown · tooth #31 · 07/20/2026
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Porcelain fractured off the existing crown on #31, exposing the metal substructure. MB and ML cusps undermined. The crown being replaced on #31 was originally placed 06/11/2015 (11 years before this date of service). Periapical radiograph of #31 taken 03/24/2026. Treatment: D2790 crown on tooth #31, date of service 07/20/2026.
Claim note
Crown #31: narrative and radiograph attached
Would strengthen the claim
- 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 #31 taken 03/24/2026. Source: Open Dental Imaging: "Periapical 31" (X-Rays), DocNum 7201. |
Documentation checks
| Check | Status | Detail |
|---|---|---|
| Radiograph of tooth #31 within 12 months | Met | Periapical radiograph of #31 taken 03/24/2026 (3.9 months before the date of service). |
| Clinical reason for the crown documented | Met | Porcelain fractured off the existing crown on #31, exposing the metal substructure. |
| Extent of tooth structure loss documented | Met | MB and ML cusps undermined. |
| Replacement interval (5+ years since prior crown) | Met | Prior crown placed 06/11/2015, 11 years before the date of service. |
| Initial/replacement flag matches chart history | N/A | Procedure is not flagged as an initial placement. |
| Intraoral photo | Not documented | No intraoral photo of tooth #31 in Open Dental Imaging. |
Evidence used (5 facts)
| ID | Fact | Where it comes from |
|---|---|---|
| C1 | D2790 crown on tooth #31, date of service 07/20/2026. | Procedure D2790 (ProcNum 7001) |
| C2 | Periapical radiograph of #31 taken 03/24/2026. | Open Dental Imaging: "Periapical 31" (X-Rays), DocNum 7201 |
| C3 | The crown being replaced on #31 was originally placed 06/11/2015 (11 years before this date of service). | Procedure D2790: Prosthesis = Replacement, original date 06/11/2015 |
| N1 | Porcelain fractured off the existing crown on #31, exposing the metal substructure."Porcelain fractured off the existing crown on #31, exposing the metal substructure" | Clinical note: D2790 #31 on 07/20/2026 (this procedure) |
| N2 | MB and ML cusps undermined."MB and ML cusps undermined" | Clinical note: D2790 #31 on 07/20/2026 (this procedure) |
Draft → check → revise loop (1 iteration)
Iteration 1: no issues
Clinical notes read (1, names redacted)
D2790 #31 on 07/20/2026 (this procedure)
Porcelain fractured off the existing crown on #31, exposing the metal substructure. MB and ML cusps undermined. Crown prep #31 for full cast gold crown. Shade A2. Temp placed.