Crown: 7-month-old PA under a carrier that requires 6 months

Claim 12000 · Northwind Dental PPO · Date of service 06/20/2026 · Source: synthetic case crown-12-carrier-override · Generated 2026-10-12 07:05 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 12000 (date of service 06/20/2026), documentation is missing.

D2740 crown, tooth #19:
- Attach a current pre-treatment radiograph of tooth #19, or document why one could not be taken.

Open Dental API call

POST /tasks
{
  "TaskListNum": 1,
  "UserNum": 1,
  "Descript": "ClaimClear: claim 12000 (date of service 06/20/2026), documentation is missing.\n\nD2740 crown, tooth #19:\n- Attach a current pre-treatment radiograph of tooth #19, or document why one could not be taken.",
  "KeyNum": 12000,
  "ObjectType": "Patient"
}

Claim tracking status

ClaimClear: documentation missing, see task

Open Dental API call

POST /claimtrackings
{
  "ClaimNum": 12000,
  "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 #19 · 06/20/2026

Needs documentation

Do this before submitting

Attach a current pre-treatment radiograph of tooth #19, or document why one could not be taken.

Narrative Every sentence checked against the chart

#19 has secondary caries around the margins of an old large amalgam. DB and ML cusps undermined. Patient reports pain on biting. Treatment: D2740 crown on tooth #19, date of service 06/20/2026.

193 characters

Claim note

Crown #19: 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 #19 is from 11/17/2025 (7.1 months before the date of service); the guideline is within 6 months.

Documentation checks (Northwind Dental PPO (synthetic test carrier))

Check	Status	Detail
Radiograph of tooth #19 within 6 months	Missing	The newest radiograph of tooth #19 is from 11/17/2025 (7.1 months before the date of service); the guideline is within 6 months.
Clinical reason for the crown documented	Met	#19 has secondary caries around the margins of an old large amalgam.
Extent of tooth structure loss documented (recommended)	Met	DB and ML cusps 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 (6 facts)

ID	Fact	Where it comes from
C1	D2740 crown on tooth #19, date of service 06/20/2026.	Procedure D2740 (ProcNum 12001)
C2	Periapical radiograph of #19 taken 11/17/2025.	Open Dental Imaging: "PA #19" (Radiographs), DocNum 12201
C3	Recorded as the initial crown placement on #19.	Procedure D2740: Prosthesis = Initial
N1	#19 has secondary caries around the margins of an old large amalgam. "#19 has secondary caries around the margins of an old large amalgam"	Clinical note: D2740 #19 on 06/20/2026 (this procedure)
N2	DB and ML cusps undermined. "DB and ML cusps undermined"	Clinical note: D2740 #19 on 06/20/2026 (this procedure)
N3	Patient reports pain on biting. "Pt reports pain on biting"	Clinical note: D2740 #19 on 06/20/2026 (this procedure)

Draft → check → revise loop (1 iteration)

Iteration 1: no issues

Clinical notes read (1, names redacted)

D2740 #19 on 06/20/2026 (this procedure)

#19 has secondary caries around the margins of an old large amalgam. DB and ML cusps undermined. Pt reports pain on biting. Discussed tx options; pt elected zirconia crown. Local anesthetic administered. Prepped #19, final impression taken, temp cemented w/ TempBond.

Engine: extractor heuristic, narrator template, reviewer none.