Crown: flagged initial but chart shows a 2015 crown

Claim 9000 · Bluebird Dental Benefits · Date of service 07/01/2026 · Source: synthetic case crown-09-flag-mismatch · 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 D2740 tooth #30
(empty) -> "Crown #30: narrative and radiograph attached"
Open Dental API call
```
PUT /procedurelogs/9001
{
  "ClaimNote": "Crown #30: narrative and radiograph attached"
}
```
Mark D2740 tooth #30 as a replacement
The chart shows a crown on tooth #30 completed 04/20/2015, but the procedure is marked as an initial placement. Set it to Replacement, placed 04/20/2015.
Changes how the crown is billed. Confirm the chart history is right before approving.
Open Dental API call
```
PUT /procedurelogs/9001
{
  "Prosthesis": "R",
  "DateOriginalProsth": "2015-04-20"
}
```

Narrative PDF in the patient's imaging

"ClaimClear narrative - claim 9000" (2 KB), ready to attach to the claim.

Open Dental API call

POST /documents/Upload
{
  "PatNum": 9000,
  "rawBase64": "<PDF, 1472 bytes>",
  "extension": ".pdf",
  "Description": "ClaimClear narrative - claim 9000",
  "ImgType": "Document",
  "ToothNumbers": "30"
}

To-do list as an Open Dental task

ClaimClear: claim 9000 (date of service 07/01/2026), there are denial risks to review.

D2740 crown, tooth #30:
- Correct the Prosthesis field (Initial vs Replacement) before submitting; a mismatch with the payer's history is a common denial reason.

Open Dental API call

POST /tasks
{
  "TaskListNum": 1,
  "UserNum": 1,
  "Descript": "ClaimClear: claim 9000 (date of service 07/01/2026), there are denial risks to review.\n\nD2740 crown, tooth #30:\n- Correct the Prosthesis field (Initial vs Replacement) before submitting; a mismatch with the payer's history is a common denial reason.",
  "KeyNum": 9000,
  "ObjectType": "Patient"
}

Claim tracking status

ClaimClear: prepared, with warnings to review

Open Dental API call

POST /claimtrackings
{
  "ClaimNum": 9000,
  "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 #30 · 07/01/2026

At risk of denial

Do this before submitting

Correct the Prosthesis field (Initial vs Replacement) before submitting; a mismatch with the payer's history is a common denial reason.

Narrative Every sentence checked against the chart

Recurrent decay under existing MOD amalgam on #30. A prior crown on #30 was completed 04/20/2015 (11 years before this date of service). Periapical radiograph of #30 taken 06/01/2026. Treatment: D2740 crown on tooth #30, date of service 07/01/2026.

248 characters

Claim note

Crown #30: 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 #30 taken 06/01/2026. Source: Open Dental Imaging: "PA #30" (Radiographs), DocNum 9201.

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

Check	Status	Detail
Radiograph of tooth #30 within 12 months	Met	Periapical radiograph of #30 taken 06/01/2026 (1 months before the date of service).
Clinical reason for the crown documented	Met	Recurrent decay under existing MOD amalgam on #30.
Extent of tooth structure loss documented (recommended)	Not documented	No note describes how much tooth structure on tooth #30 is missing or undermined.
Replacement interval (5+ years since prior crown)	Met	Prior crown placed 04/20/2015, 11 years before the date of service.
Initial/replacement flag matches chart history	Warning	The procedure is flagged as an initial placement, but the chart shows a prior crown on tooth #30: A prior crown on #30 was completed 04/20/2015 (11 years before this date of service).
Intraoral photo (recommended)	Not documented	No intraoral photo of tooth #30 in Open Dental Imaging.

Evidence used (5 facts)

ID	Fact	Where it comes from
C1	D2740 crown on tooth #30, date of service 07/01/2026.	Procedure D2740 (ProcNum 9001)
C2	Periapical radiograph of #30 taken 06/01/2026.	Open Dental Imaging: "PA #30" (Radiographs), DocNum 9201
C3	A prior crown on #30 was completed 04/20/2015 (11 years before this date of service).	Procedure D2790 completed 04/20/2015 (ProcNum 9002)
C4	Recorded as the initial crown placement on #30.	Procedure D2740: Prosthesis = Initial
N1	Recurrent decay under existing MOD amalgam on #30. "Recurrent decay under existing MOD amalgam on #30"	Clinical note: D2740 #30 on 07/01/2026 (this procedure)

Draft → check → revise loop (1 iteration)

Iteration 1: no issues

Clinical notes read (1, names redacted)

D2740 #30 on 07/01/2026 (this procedure)

Recurrent decay under existing MOD amalgam on #30. Discussed tx options; pt elected e.max crown. Local anesthetic administered. Prepped #30, final impression taken, temp cemented w/ TempBond.

Engine: extractor heuristic, narrator template, reviewer none.