Ophi packet index
Clinic: ABELDent lab (Fictional Data)
Reference: asm_2a8e39b2b77ed1fd
Procedure: 27211 (Porcelain/Ceramic/Polymer Glass Fused Metal Based Crown) on tooth #16 (FDI)
Ruleset: cdcp-preauth-crowns 2026.01.26
Prepared for review; submitted by the treating provider.

00  00_index.txt -- this index
01  01_claim_form_treatment_form.pdf -- computer-generated treatment form, prepared 2026-10-08; supports claim_form, matrix Restorative services -- Claim form: Yes.
02  02_radiograph_pa_radiograph_PA-16_2026-08-20.png -- periapical radiograph of #16, captured 2026-08-20 [placeholder plate: Fictional Data ships no image pixels]; supports radiograph_pa, matrix Restorative services -- PA+BW (R&L) <=12mo: Yes.
03  03_radiograph_bw_radiograph_BW-right_2026-08-20.png -- bitewing radiograph, right (#14, #15, #16, #17, #44, #45, #46, #47), captured 2026-08-20 [placeholder plate: Fictional Data ships no image pixels]; supports radiograph_bw, matrix Restorative services -- PA+BW (R&L) <=12mo: Yes.
04  04_radiograph_bw_radiograph_BW-left_2026-08-20.png -- bitewing radiograph, left (#24, #25, #26, #27, #34, #35, #36, #37), captured 2026-08-20 [placeholder plate: Fictional Data ships no image pixels]; supports radiograph_bw, matrix Restorative services -- PA+BW (R&L) <=12mo: Yes.
05  05_perio_chart_perio_chart_6-site-168-sites_2026-08-20.pdf -- periodontal chart, 168 sites, examiner T, captured 2026-08-20; supports perio_chart, matrix Restorative services -- Complete perio chart <=12mo: Yes, crowns only (footnote 7).
06  06_tx_plan_details_narrative_rationale_2026-10-08.docx -- documentation narrative with clinical findings quoted from the chart and clinician assertions, prepared 2026-10-08; supports tx_plan_details, matrix Restorative services -- Tx plan: Yes (footnote 1); basic_treatment_complete, guide 6.3.5 Crowns; restorability, guide 6.3.5 Crowns -- restorability; extensively_restored, guide 6.3.5 Crowns -- extensively restored.
07  07_tx_plan_details_narrative_rationale_2026-10-08.txt -- documentation narrative with clinical findings quoted from the chart and clinician assertions, prepared 2026-10-08 (ASCII text copy); supports tx_plan_details, matrix Restorative services -- Tx plan: Yes (footnote 1); basic_treatment_complete, guide 6.3.5 Crowns; restorability, guide 6.3.5 Crowns -- restorability; extensively_restored, guide 6.3.5 Crowns -- extensively restored.
