Crown: only radiograph is ~20 months old

Claim 4000 · Summit Smile Insurance · Date of service 07/27/2026 · Source: synthetic case crown-04-old-radiograph · Generated 2026-10-12 07:03 UTC

Prepare in Open Dental

Needs documentation

Not ready: 1 item to fix in the chart before this claim goes out. Re-run ClaimClear afterwards.

To-do list as an Open Dental task

ClaimClear: claim 4000 (date of service 07/27/2026), documentation is missing.

D2740 crown, tooth #31:
- Attach a current pre-treatment radiograph of tooth #31, or document why one could not be taken.

Open Dental API call

POST /tasks
{
  "TaskListNum": 1,
  "UserNum": 1,
  "Descript": "ClaimClear: claim 4000 (date of service 07/27/2026), documentation is missing.\n\nD2740 crown, tooth #31:\n- Attach a current pre-treatment radiograph of tooth #31, or document why one could not be taken.",
  "KeyNum": 4000,
  "ObjectType": "Patient"
}

Claim tracking status

ClaimClear: documentation missing, see task

Open Dental API call

POST /claimtrackings
{
  "ClaimNum": 4000,
  "TrackingDefNum": 2,
  "Note": "ClaimClear: documentation missing, see task"
}

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 #31 · 07/27/2026

Needs documentation

Do this before submitting

Attach a current pre-treatment radiograph of tooth #31, or document why one could not be taken.

Narrative Every sentence checked against the chart

Patient presents with fractured DL cusp on #31. Patient complains of sensitivity to cold on #31. Treatment: D2740 crown on tooth #31, date of service 07/27/2026.

161 characters

Claim note

Crown #31: narrative 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	Missing	The newest radiograph of tooth #31 is from 12/04/2024 (19.7 months before the date of service); the guideline is within 12 months.

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

Check	Status	Detail
Radiograph of tooth #31 within 12 months	Missing	The newest radiograph of tooth #31 is from 12/04/2024 (19.7 months before the date of service); the guideline is within 12 months.
Clinical reason for the crown documented	Met	Patient presents with fractured DL cusp on #31.
Extent of tooth structure loss documented (recommended)	Met	Patient presents with fractured DL cusp on #31.
Replacement interval (5+ years since prior crown)	N/A	No prior crown on tooth #31 in the chart.
Initial/replacement flag matches chart history	Met	Flagged as initial placement; no prior crown on tooth #31 in the chart.
Intraoral photo (recommended)	Not documented	No intraoral photo of tooth #31 in Open Dental Imaging.

Evidence used (6 facts)

ID	Fact	Where it comes from
C1	D2740 crown on tooth #31, date of service 07/27/2026.	Procedure D2740 (ProcNum 4001)
C2	Periapical radiograph of #31 taken 12/04/2024.	Open Dental Imaging: "Periapical 31" (X-Rays), DocNum 4201
C3	Recorded as the initial crown placement on #31.	Procedure D2740: Prosthesis = Initial
N1	Patient presents with fractured DL cusp on #31. "Pt presents w/ fractured DL cusp on #31"	Clinical note: D2740 #31 on 07/27/2026 (this procedure)
N2	Patient presents with fractured DL cusp on #31. "Pt presents w/ fractured DL cusp on #31"	Clinical note: D2740 #31 on 07/27/2026 (this procedure)
N3	Patient complains of sensitivity to cold on #31. "Pt c/o sensitivity to cold on #31"	Clinical note: D2740 #31 on 07/27/2026 (this procedure)

Draft → check → revise loop (1 iteration)

Iteration 1: no issues

Clinical notes read (1, names redacted)

D2740 #31 on 07/27/2026 (this procedure)

Pt presents w/ fractured DL cusp on #31. Pt c/o sensitivity to cold on #31. Crown prep #31 for e.max crown. Shade A2. Temp placed.

Engine: extractor heuristic, narrator template, reviewer none.