Posterior composite, two surfaces note template
A complete, fill-in-the-blank D2392 note written around what insurance reviewers ask for — with the documentation checklist, the denial patterns, and an Open Dental auto-note format built in.
01 · Before you bill it
Know what the payer wants first.
The note should answer every item on the left — and read so that nothing on the right applies.
What documentation D2392 requires
Missing any of these is why the claim pends for records.- Tooth number and both surfaces named, matching the code
- Caries diagnosis with clinical AND radiographic (or photographic) confirmation
- Isolation and bonding steps — evidence of definitive technique
- Occlusal adjustment and contact verification noted
Why D2392 gets denied
The denial patterns payers actually use for this code.- Surfaces on the claim don\u2019t match surfaces in the note or on the film
- Downgraded to amalgam rate — plan limitation, not a documentation failure; an intact narrative still supports appeal of outright denials
- Replacement of an existing restoration inside the plan\u2019s replacement window without a documented failure reason
02 · The template
Copy it, chart with it.
Square brackets are the blanks — replace each one as you chart. Switch the format to turn every blank into an Open Dental auto-note prompt.
MEDICAL HISTORY: Reviewed [date]; changes: [none]. CHIEF COMPLAINT: [Patient's words / asymptomatic lesion found at exam]. DIAGNOSIS: Caries [tooth #] [surfaces], confirmed [clinically and on radiograph dated ___]; lesion into dentin; tooth restorable. ANESTHETIC: [Agent, concentration] [__] mL via [IANB/infiltration]; profound. ISOLATION: [Rubber dam / isolation system]. PROCEDURE: Caries excavated to [firm dentin]; [caries indicator used / visual-tactile verification]. [Liner/base if used]. [Selective/total] etch; [adhesive]; composite [shade] placed incrementally and cured; contacts verified with floss; occlusion adjusted; polished. POST-OP: [Sensitivity guidance]; call if bite feels high after [interval]. NEXT VISIT: [Recall / remaining restorative].
03 · Common questions
Frequently asked about D2392
What if I replace an existing filling?
Does a bitewing need to show the lesion?
More templates
Or never fill in a blank again.
Molaris listens to the visit and drafts this exact note in your wording — placeholders already filled from what was actually said. You review, you sign, it files to Open Dental.
Book a 15-minute demo →Reviewed August 2026. These templates are original Molaris reference samples showing how the scribe structures documentation. They are educational examples, not billing, coding, or legal advice; payer requirements vary by plan and state. CDT codes are maintained by the ADA.