Crown #3: cusp broke on popcorn (shorthand note)

Claim 31000 · Acme Dental Mutual · Date of service 07/14/2026 · Source: synthetic case hand-01-popcorn-cusp · Generated 2026-10-12 07:01 UTC

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D2790 crown · tooth #3 · 07/14/2026

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Narrative Every sentence checked against the chart

#3 DL cusp broke off last wk eating popcorn, old MO amalgam, remaining walls thin. Patient complains of pain chewing UR. Periapical radiograph of #3 taken 06/30/2026. Treatment: D2790 crown on tooth #3, date of service 07/14/2026.

230 characters

Claim note

Crown #3: 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 #3 taken 06/30/2026. Source: Open Dental Imaging: "PA #3" (X-Rays), DocNum 31201.

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

Check	Status	Detail
Radiograph of tooth #3 within 12 months	Met	Periapical radiograph of #3 taken 06/30/2026 (0.5 months before the date of service).
Clinical reason for the crown documented	Met	#3 DL cusp broke off last wk eating popcorn, old MO amalgam, remaining walls thin.
Extent of tooth structure loss documented (recommended)	Not documented	No note describes how much tooth structure on tooth #3 is missing or undermined.
Replacement interval (5+ years since prior crown)	N/A	No prior crown on tooth #3 in the chart.
Initial/replacement flag matches chart history	Met	Flagged as initial placement; no prior crown on tooth #3 in the chart.
Intraoral photo (recommended)	Not documented	No intraoral photo of tooth #3 in Open Dental Imaging.

Evidence used (5 facts)

ID	Fact	Where it comes from
C1	D2790 crown on tooth #3, date of service 07/14/2026.	Procedure D2790 (ProcNum 31001)
C2	Periapical radiograph of #3 taken 06/30/2026.	Open Dental Imaging: "PA #3" (X-Rays), DocNum 31201
C3	Recorded as the initial crown placement on #3.	Procedure D2790: Prosthesis = Initial
N1	#3 DL cusp broke off last wk eating popcorn, old MO amalgam, remaining walls thin. "#3 DL cusp broke off last wk eating popcorn, old MO amalgam, remaining walls thin"	Clinical note: D2790 #3 on 07/14/2026 (this procedure)
N2	Patient complains of pain chewing UR. "Pt c/o pain chewing UR"	Clinical note: D2790 #3 on 07/14/2026 (this procedure)

Draft → check → revise loop (1 iteration)

Iteration 1: no issues

Clinical notes read (1, names redacted)

D2790 #3 on 07/14/2026 (this procedure)

Pt c/o pain chewing UR. #3 DL cusp broke off last wk eating popcorn, old MO amalgam, remaining walls thin. Rec FGC, pt agreed. Prep'd #3, PVS impression, temp w/ TempBond NE.

Engine: extractor heuristic, narrator template, reviewer none.