Peri-implantitis narrative

An insurance narrative template for treatment of peri-implantitis, addressed to the dental claims consultant. It has blanks for the date, patient name, date of birth, member ID, and affected teeth, and states that x-rays, photos, and a narrative are attached. A list of procedure codes from the file, including D4241, D6101, D6102, D6103, and D6081, lets the office circle what was performed.

Attach it to the claim after peri-implant treatment. The insurance coordinator or billing team should complete it from the clinical notes, circle only the procedures actually done, and have the doctor review it before submission. Adapt the wording to the patient’s records rather than sending it as is.