Crown #19: diagnosis added in a later note revision; PA only billed

Claim 38000 · Harborview Dental Plan · Date of service 03/30/2026 · Source: synthetic case hand-08-edited-note · Generated 2026-10-12 07:06 UTC

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D2750 crown · tooth #19 · 03/30/2026

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This radiograph is billed but not in Open Dental Imaging: export it from your imaging software to attach it.

Narrative Every sentence checked against the chart

Diagnosis: cracked tooth syndrome, MB cusp fracture line visible, pain on release. Periapical radiograph of #19 taken 03/16/2026. Treatment: D2750 crown on tooth #19, date of service 03/30/2026.

194 characters

Claim note

Crown #19: 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	Export from imaging	Periapical radiograph of #19 taken 03/16/2026. Source: Procedure D0220 completed 03/16/2026; image not found in Open Dental Imaging, so export it from your imaging software.

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

Check	Status	Detail
Radiograph of tooth #19 within 12 months	Met	Periapical radiograph of #19 taken 03/16/2026 (0.5 months before the date of service).
Clinical reason for the crown documented	Met	Diagnosis: cracked tooth syndrome, MB cusp fracture line visible, pain on release.
Extent of tooth structure loss documented (recommended)	Not documented	No note describes how much tooth structure on tooth #19 is missing or undermined.
Replacement interval (5+ years since prior crown)	N/A	No prior crown on tooth #19 in the chart.
Initial/replacement flag matches chart history	Met	Flagged as initial placement; no prior crown on tooth #19 in the chart.
Intraoral photo (recommended)	Not documented	No intraoral photo of tooth #19 in Open Dental Imaging.

Evidence used (5 facts)

ID	Fact	Where it comes from
C1	D2750 crown on tooth #19, date of service 03/30/2026.	Procedure D2750 (ProcNum 38001)
C2	Periapical radiograph of #19 taken 03/16/2026.	Procedure D0220 completed 03/16/2026; image not found in Open Dental Imaging, so export it from your imaging software
C3	Recorded as the initial crown placement on #19.	Procedure D2750: Prosthesis = Initial
N1	Diagnosis: cracked tooth syndrome, MB cusp fracture line visible, pain on release. "Dx: cracked tooth syndrome, MB cusp fracture line visible, pain on release"	Clinical note: D2750 #19 on 03/30/2026 (this procedure)
N2	Diagnosis: cracked tooth syndrome, MB cusp fracture line visible, pain on release. "Dx: cracked tooth syndrome, MB cusp fracture line visible, pain on release"	Clinical note: D2750 #19 on 03/30/2026 (this procedure)

Draft → check → revise loop (1 iteration)

Iteration 1: no issues

Clinical notes read (1, names redacted)

D2750 #19 on 03/30/2026 (this procedure)

prep #19 crown. Dx: cracked tooth syndrome, MB cusp fracture line visible, pain on release.

Engine: extractor heuristic, narrator template, reviewer none.