Crown: complete documentation (phrasing variant)
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D2740 crown · tooth #21 · 06/04/2026
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Large failing MO amalgam on #21 with open margins. More than half of the remaining tooth structure is lost. Periapical radiograph of #21 taken 04/15/2026. Treatment: D2740 crown on tooth #21, date of service 06/04/2026.
Claim note
Crown #21: narrative and radiograph 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 | In Open Dental | Periapical radiograph of #21 taken 04/15/2026. Source: Open Dental Imaging: "Periapical 21" (X-Rays), DocNum 13201. |
Documentation checks
| Check | Status | Detail |
|---|---|---|
| Radiograph of tooth #21 within 12 months | Met | Periapical radiograph of #21 taken 04/15/2026 (1.6 months before the date of service). |
| Clinical reason for the crown documented | Met | Large failing MO amalgam on #21 with open margins. |
| Extent of tooth structure loss documented | Met | More than half of the remaining tooth structure is lost. |
| Replacement interval (5+ years since prior crown) | N/A | No prior crown on tooth #21 in the chart. |
| Initial/replacement flag matches chart history | Met | Flagged as initial placement; no prior crown on tooth #21 in the chart. |
| Intraoral photo | Not documented | No intraoral photo of tooth #21 in Open Dental Imaging. |
Evidence used (5 facts)
| ID | Fact | Where it comes from |
|---|---|---|
| C1 | D2740 crown on tooth #21, date of service 06/04/2026. | Procedure D2740 (ProcNum 13001) |
| C2 | Periapical radiograph of #21 taken 04/15/2026. | Open Dental Imaging: "Periapical 21" (X-Rays), DocNum 13201 |
| C3 | Recorded as the initial crown placement on #21. | Procedure D2740: Prosthesis = Initial |
| N1 | Large failing MO amalgam on #21 with open margins."Large failing MO amalgam on #21 with open margins" | Clinical note: D2740 #21 on 06/04/2026 (this procedure) |
| N2 | More than half of the remaining tooth structure is lost."More than half of the remaining tooth structure is lost" | Clinical note: D2740 #21 on 06/04/2026 (this procedure) |
Draft → check → revise loop (1 iteration)
Iteration 1: no issues
Clinical notes read (1, names redacted)
D2740 #21 on 06/04/2026 (this procedure)
Large failing MO amalgam on #21 with open margins. More than half of the remaining tooth structure is lost. Crown prep #21 for zirconia crown. Shade A2. Temp placed.