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Action Items
Dr. Smith has recommended a crown restoration for tooth #14. The estimated cost is $1,200 with an insurance estimate of $720, leaving a patient responsibility of $480. Please review the treatment details and provide your consent to proceed.
Your deep cleaning procedure is scheduled for January 15th. The total cost is $450 with insurance covering $360. Please set up a payment arrangement for the remaining $90 balance before your appointment.
Treatment Plan
Crown Restoration - Tooth #14
Deep Cleaning - Full Mouth
Composite Filling - Tooth #30
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Consultation Notes
Date: November 15, 2024
Provider: Dr. Emily Chen
Findings: Bitewing radiograph reveals early interproximal decay on the mesial surface of tooth #14. The lesion appears to extend into the outer third of the dentin. Crown restoration is recommended to prevent further progression.
Recommendation: Crown restoration for tooth #14. Patient has been informed of treatment options and associated costs.
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