Crown: note only describes the prep, no reason

Claim 5000 · Harborview Dental Plan · Date of service 09/07/2026 · Source: synthetic case crown-05-no-reason · Generated 2026-10-12 07:02 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 5000 (date of service 09/07/2026), documentation is missing.

D2790 crown, tooth #4:
- Add a clinical note for tooth #4 stating why a crown is needed (e.g., fracture, recurrent decay, failing large restoration, root canal treated tooth).

Open Dental API call

POST /tasks
{
  "TaskListNum": 1,
  "UserNum": 1,
  "Descript": "ClaimClear: claim 5000 (date of service 09/07/2026), documentation is missing.\n\nD2790 crown, tooth #4:\n- Add a clinical note for tooth #4 stating why a crown is needed (e.g., fracture, recurrent decay, failing large restoration, root canal treated tooth).",
  "KeyNum": 5000,
  "ObjectType": "Patient"
}

Claim tracking status

ClaimClear: documentation missing, see task

Open Dental API call

POST /claimtrackings
{
  "ClaimNum": 5000,
  "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.

D2790 crown · tooth #4 · 09/07/2026

Needs documentation

Do this before submitting

Add a clinical note for tooth #4 stating why a crown is needed (e.g., fracture, recurrent decay, failing large restoration, root canal treated tooth).

Narrative Every sentence checked against the chart

Periapical radiograph of #4 taken 06/05/2026. Treatment: D2790 crown on tooth #4, date of service 09/07/2026.

109 characters

Claim note

Crown #4: 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 #4 taken 06/05/2026. Source: Open Dental Imaging: "Periapical 4" (X-Rays), DocNum 5201.

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

Check	Status	Detail
Radiograph of tooth #4 within 12 months	Met	Periapical radiograph of #4 taken 06/05/2026 (3.1 months before the date of service).
Clinical reason for the crown documented	Missing	No note or chart entry states why tooth #4 needs a crown.
Extent of tooth structure loss documented (recommended)	Not documented	No note describes how much tooth structure on tooth #4 is missing or undermined.
Replacement interval (5+ years since prior crown)	N/A	No prior crown on tooth #4 in the chart.
Initial/replacement flag matches chart history	Met	Flagged as initial placement; no prior crown on tooth #4 in the chart.
Intraoral photo (recommended)	Not documented	No intraoral photo of tooth #4 in Open Dental Imaging.

Evidence used (3 facts)

ID	Fact	Where it comes from
C1	D2790 crown on tooth #4, date of service 09/07/2026.	Procedure D2790 (ProcNum 5001)
C2	Periapical radiograph of #4 taken 06/05/2026.	Open Dental Imaging: "Periapical 4" (X-Rays), DocNum 5201
C3	Recorded as the initial crown placement on #4.	Procedure D2790: Prosthesis = Initial

Draft → check → revise loop (1 iteration)

Iteration 1: no issues

Clinical notes read (1, names redacted)

D2790 #4 on 09/07/2026 (this procedure)

Crown prep #4 for full cast gold crown. Shade A2. Temp placed.

Engine: extractor heuristic, narrator template, reviewer none.