Crown #8: incisal third lost in a fall, with photo
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D2740 crown · tooth #8 · 05/19/2026
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#8 Class IV fractured, incisal third gone after fall. Periapical radiograph of #8 taken 05/05/2026. Treatment: D2740 crown on tooth #8, date of service 05/19/2026.
Claim note
Crown #8: 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).
Attachments
| Item | Status | Detail |
|---|---|---|
| Radiograph | In Open Dental | Periapical radiograph of #8 taken 05/05/2026. Source: Open Dental Imaging: "PA #8" (X-Rays), DocNum 36201. |
| Intraoral photo | Optional | Intraoral photograph of #8 taken 05/05/2026. Source: Open Dental Imaging: "Intraoral photo #8" (Photos), DocNum 36202. |
Documentation checks
| Check | Status | Detail |
|---|---|---|
| Radiograph of tooth #8 within 12 months | Met | Periapical radiograph of #8 taken 05/05/2026 (0.5 months before the date of service). |
| Clinical reason for the crown documented | Met | #8 Class IV fractured, incisal third gone after fall. |
| Extent of tooth structure loss documented | Not documented | No note describes how much tooth structure on tooth #8 is missing or undermined. |
| Replacement interval (5+ years since prior crown) | N/A | No prior crown on tooth #8 in the chart. |
| Initial/replacement flag matches chart history | Met | Flagged as initial placement; no prior crown on tooth #8 in the chart. |
| Intraoral photo | Met | Intraoral photograph of #8 taken 05/05/2026. |
Evidence used (5 facts)
| ID | Fact | Where it comes from |
|---|---|---|
| C1 | D2740 crown on tooth #8, date of service 05/19/2026. | Procedure D2740 (ProcNum 36001) |
| C2 | Periapical radiograph of #8 taken 05/05/2026. | Open Dental Imaging: "PA #8" (X-Rays), DocNum 36201 |
| C3 | Intraoral photograph of #8 taken 05/05/2026. | Open Dental Imaging: "Intraoral photo #8" (Photos), DocNum 36202 |
| C4 | Recorded as the initial crown placement on #8. | Procedure D2740: Prosthesis = Initial |
| N1 | #8 Class IV fractured, incisal third gone after fall."#8 Class IV fx, incisal third gone after fall" | Clinical note: D2740 #8 on 05/19/2026 (this procedure) |
Draft → check → revise loop (1 iteration)
Iteration 1: no issues
Clinical notes read (1, names redacted)
D2740 #8 on 05/19/2026 (this procedure)
#8 Class IV fx, incisal third gone after fall. Endo eval neg. Pt wants esthetic crown.