D6067 Implant Crown — High Noble Metal Template

The template

Pick your PMS to format the placeholders, then copy.

PMS format

[Prompt:"name"]

Implant supported metal crown.

RMH: Medical history reviewed/updates

Implant site: #Tooth number(s)

Implant crown/bridge support: Extraction date, implant placement date, implant site/system
Support/retention type: Abutment-supported vs implant-supported; separate abutment reported or not
Abutment/component details: Abutment type, screw access, torque, component records
Material/lab/shade: Material, shade guide, lab instructions
Image support: Diagnostic-quality radiographs/photos labeled site/date
Metal type: Metal type

Visit type: Visit type

Impressions:
Impression coping placed.
Implant level impression taken.
Bite registration recorded.

Delivery:
Crown seated on implant.
Fit verified.
Screw torque: Torque value/manufacturer specification.
Contacts adjusted.
Occlusion adjusted.
Screw access sealed.

Patient instructions: Instructions reviewed.

Complications: None or describe.
Patient tolerance: Tolerance/response.

NV: Next visit

Field glossary

What each placeholder represents.

Medical history reviewed/updates
Note that medical history was reviewed and any changes since last visit — meds, conditions, allergies, ASA status. For D6067 specifically, document any history of metal/jewelry contact dermatitis, gold/platinum sensitivity, or nickel hypersensitivity (rare but relevant to material choice). Diabetes control (recent A1c) is worth noting given peri-implantitis risk.
Tooth number(s)
Universal numbering for the restored implant position (#1-#32). D6067 is per-implant; one code per crown. Most carriers cover D6067 only in posterior positions; anterior and premolar submissions are routinely alternate-benefited.
Extraction date, implant placement date, implant site/system
Audit trail — original tooth extraction date (or note that the site was congenitally absent / long-term edentulous), implant placement date, implant manufacturer / system / model / fixture diameter and length, surgeon, and integration period. If placement was external, cite the referring surgeon and the records received.
Abutment-supported vs implant-supported; separate abutment reported or not
The single most important coding line for D6000-series billing. State explicitly whether the crown is implant-supported (screws directly to the implant, no separately-reported abutment) or abutment-supported (separate D6056 prefab or D6057 custom abutment is being reported). D6067 is the implant-supported full-cast high noble code — if a separate abutment is reported, the abutment-supported equivalent (D6058-D6064 family) is correct instead.
Abutment type, screw access, torque, component records
Abutment or screw component details — abutment lot or screw lot, screw access location (occlusal, lingual, screw-access channel angled), final torque value applied with a calibrated torque wrench, and any component records (CAD-CAM file ID, library used, manufacturer specification sheet). Torque is non-negotiable for screw-retained restorations.
Material, shade guide, lab instructions
Alloy class explicitly named (high noble metal — gold ≥40%, total noble ≥60%), specific alloy product (e.g., Argedent 75, Firmilay, Olympia), shade if applicable (often N/A on full metal), and lab Rx contents — occlusal scheme, opposing-arch material, contacts, screw-access location, and any patient-specific considerations (bruxism, opposing crown material).
Diagnostic-quality radiographs/photos labeled site/date
Confirm that supporting PA, post-seat PA, and intraoral photos are labeled with site number and date. Post-seat PA confirming complete seat at the implant-crown interface and absence of subgingival cement is the standard expected image.
Metal type
Explicit alloy class — high noble metal per ADA classification (≥60% noble metal content, gold ≥40%). State the lab certificate is on file. Silence on alloy class is the most common D6067 audit-downgrade trigger.
Visit type
Definitive implant crown delivery (final restoration), or definitive implant crown delivery following interim D6085. Don't bill D6067 for an interim restoration — that's D6085.
Torque value/manufacturer specification
Specific final torque applied with a calibrated torque wrench, citing the implant manufacturer's specification (e.g., "35 Ncm per Straumann BLX RC manufacturer specification"). Common values: Nobel 35 Ncm, Straumann RC/RN 35 Ncm, Zimvie 30 Ncm, Hiossen 30 Ncm, Neodent 32 Ncm, BioHorizons 30 Ncm. Always cite the specification rather than a generic number.
Instructions reviewed
Post-op instructions covered — soft diet 24 hours, peri-implant hygiene (floss, water flosser, end-tuft brush; avoid abrasive whitening pastes around the access seal), watch for screw-loosening symptoms (food packing, mobility sensation, percussion change), call if access composite dislodges. Note verbal review and whether a written handout was provided.
None or describe
Complications during delivery — explicit "None" when accurate, or describe (screw fracture, abutment fit issue requiring lab return, contact open at delivery requiring adjustment, occlusal interference requiring chairside adjustment, residual subgingival cement requiring additional removal).
Tolerance/response
Patient response — tolerated well, no adverse events. Specific is better than "WNL." Note whether anesthesia was required (often unnecessary for screw-retained delivery on a healed implant).
Next visit
Post-seat occlusion re-check timing (often 6 weeks for implant crowns to allow opposing-dentition equilibration and to confirm screw stability), recall interval (6-month standard, with D0120/D1110/D6080 implant maintenance), and any same-arch restorative work or nightguard fabrication still planned.

Documentation requirements

Implant-crown documentation has to support why a crown is being placed on this implant now and why high noble cast metal is the right material choice — neither is automatic. A defensible D6067 note includes:

Implant site (tooth number) — universal numbering for the restored position. D6067 is per-implant; one code per crown.
Implant placement context — extraction date (or "site has been edentulous for X years"), implant placement date, implant system / manufacturer / model, fixture diameter and length, and surgeon. If placement was in your office, cite the prior D6010 visit; if external, note the referring surgeon and the records you received. This is the audit trail that proves an implant exists in the position being restored.
Osseointegration / load readiness — clinical and radiographic confirmation that the implant is osseointegrated, has stable peri-implant bone, healthy peri-implant mucosa, no mobility, no pain on percussion, and is ready for definitive load. Loading a non-integrated implant with a definitive crown is a quality-of-care issue and a recurrent denial pattern.
Support / retention type — abutment-supported vs implant-supported, screw-retained vs cement-retained. This is the single most important documentation line for D6000-series billing: the carrier's bundling rules and the choice between the D6058-D6064 family (abutment-supported), D6065-D6067 family (implant-supported), and D6075-D6077 family (bridge retainers) all turn on it. State explicitly whether a separate abutment (D6056 prefab or D6057 custom) is being reported, or whether the crown is connected directly to the implant via a manufacturer screw channel.
Abutment / component details — abutment type and lot, screw type, screw access location (occlusal, lingual, screw-access channel angled), torque value applied, and any component records (CAD-CAM file ID, library used, manufacturer specification sheet). The torque line is non-negotiable for screw-retained restorations and is the artifact carriers and risk-management reviewers ask for first.
Material details (alloy class) — explicitly state high noble alloy and, ideally, the specific alloy product (e.g., Argedent 75, Firmilay, Olympia). The lab invoice and alloy certificate documenting noble-metal content (gold ≥40%, total noble ≥60%) should be retained in the chart or scanned to the patient record. Several state Medicaid programs require the alloy certificate to be submitted with the claim or held on file — D6067's most common audit downgrade is to a lower-alloy implant crown code when the certificate can't be produced.
Image support — diagnostic-quality periapical (preferred) labeled with site and date, plus an intraoral photo of the prosthesis seated. Post-seat PA confirming complete seat and absence of subgingival cement is the standard expected image for a screw- or cement-retained implant restoration. Pre- and post-seat photos materially strengthen audit defense.
Lab instructions — alloy class explicitly named, occlusal scheme (centric stops only, group function, canine guidance), opposing-arch material, contacts, screw-access location and seal plan, and any specific patient considerations (bruxism, opposing crown material). The lab Rx is the documentary backbone of D6067 and the artifact most carriers request first on audit.
Impression / digital scan — material (PVS, polyether) or scanner (iTero, TRIOS, Primescan), impression coping type and lot for analog impressions, scan body system and library version for digital. Opposing impression and bite registration / interocclusal records noted explicitly.
Delivery sequence — provisional or healing abutment removed, implant platform cleaned, crown seated, fit verified clinically and on PA, screw torqued to manufacturer specification (e.g., 30 Ncm for Nobel, 35 Ncm for Straumann, varies by system), contacts and occlusion adjusted, screw access sealed (Teflon tape + composite is the modal protocol), excess cement removed for cement-retained cases (subgingival residual cement is the leading cause of late peri-implantitis and is a recoupment trigger when documented).
Occlusion design — light or no centric contact at light bite with full contact at firm bite, no posterior interferences in lateral or protrusive movements, no balancing-side contacts. Implant-protective occlusion language is patient-care best practice and is increasingly reflected in carrier clinical policies.
Anesthesia — not always required for crown delivery, but document if used (agent, concentration, vasoconstrictor, carpules) and skip the line if not used. Don't leave defaulted-template anesthesia text on a no-anesthesia visit.
Consent / PARQ — material alternatives (D6065 zirconia, D6066 PFM high noble, D6094 abutment-supported titanium), retention alternatives (screw vs cement), risks (post-seat occlusal adjustment, screw loosening, decementation in cement-retained cases, fracture, peri-implantitis, rare metal hypersensitivity), and costs including PPO alternate-benefit possibility to a lower-alloy implant crown fee. Document any patient gold/nickel hypersensitivity screen — true noble-metal hypersensitivity is rare but documented in the literature; nickel hypersensitivity is more common and pushes the case toward high noble or titanium.
Complications — explicit "none" or describe (screw fracture, abutment fit issue requiring lab return, contact open at delivery requiring adjustment, occlusal interference requiring chairside adjustment).
Patient tolerance / response — tolerated well, no adverse events. Specific is better than "WNL."
Post-op instructions — soft diet for 24 hours, peri-implant hygiene (floss, water flosser, end-tuft brush; avoid abrasive whitening pastes around the access seal), watch for screw-loosening symptoms (food packing, mobility, percussion change), call if access composite dislodges. Note verbal review and whether a written handout was provided.
Next visit — recall interval (most practices recommend 6-month recall for implant maintenance; some carriers cover D6080 implant maintenance at 6-month intervals as part of recall hygiene), occlusion re-check on the new implant crown at recall, any same-arch restorative work still planned.

Two recurring "soft" defects to avoid: (1) defaulted-template language that lists every step on the body even when half weren't actually performed (e.g., "impression coping placed" on a digital intraoral-scan workflow that used a scan body, not an impression coping), and (2) silence on alloy class — a note that says only "implant crown delivered" without identifying high noble vs PFM vs zirconia cannot defend the D6067 fee against a downgrade audit. Match the chart language to what was actually done and to the alloy class on the lab certificate.

Common denial reasons

The most frequent reasons D6067 is denied, downgraded, or recouped:

Alternate-benefit downgrade to D6065 or D6066 — the dominant economic outcome. Carrier pays at the porcelain/ceramic or PFM fee schedule; office must collect the difference or write it off depending on PPO contract. Not a "denial" technically, but the most common payment surprise on D6067.
No alloy certificate / unable to substantiate high noble class — carrier requests the lab alloy certificate on audit; the office can't produce one or the certificate shows the alloy was actually noble or predominantly base metal. Recoupment to the lower-alloy implant crown fee schedule. With CDT 2023's expansion of the implant-crown family by alloy class, this pattern has tightened.
Replacement inside frequency window (typically 5 years) — second implant crown on the same site without narrative + radiograph showing fracture, screw fracture, peri-implantitis, or trauma. Auto-denial on most PPOs.
Implant not osseointegrated / not load-ready — chart and PA don't establish osseointegration before definitive crown delivery. Quality-of-care denial pattern, particularly in Medicaid audits.
Implant + abutment + crown coding inconsistency — D6067 (implant-supported) billed alongside D6057 (custom abutment) when the carrier expects either D6067 alone (no separate abutment) or D6057 + D6058-D6064 (abutment-supported crown). Some carriers will deny one of the two as inconsistent; appealing requires a clear retention-type narrative.
Pre-authorization not obtained — PPO required pre-auth for the implant crown above an allowed threshold; office submitted without one. Standard "no pre-auth" denial; some carriers will accept retro-auth with narrative, others won't.
Anterior or premolar D6067 submission — D6067 on a tooth in the smile zone (#4-#13, #20-#29). Most carriers deny outright as "not medically necessary" because esthetic alternatives (D6065 zirconia, D6066 PFM) are clinically appropriate. Even some posterior premolar D6067 submissions are alternate-benefited.
Pediatric patient / open growth plates — implant restorations in patients with incomplete craniofacial growth are denied by most carriers; pediatric ectodermal-dysplasia or oligodontia narratives are the exception.
Implant placement not documented in records — D6067 submitted without records showing the underlying implant was placed (D6010) or without records of the placement system / fixture. Carrier denies pending records; office produces them and the claim is reprocessed.
Default-template wording — every D6067 note in the chart reads identically (same alloy, same torque, same complications, same instructions). Pattern-recognized as fabricated by auditors and a recurrent finding in state OIG audits of dental practices, especially in Medicaid programs.
Interim implant crown billed as definitive — D6085 (interim implant crown) submitted as D6067; carrier discovers a final crown was placed later and recoups the duplicative payment. Bill D6085 if the crown is interim and re-bill D6067 only when the definitive crown is placed.
Subgingival residual cement complication — late peri-implantitis with documented subgingival cement on PA leads to crown removal and re-make; the original D6067 is sometimes recouped under quality-of-care provisions in Medicaid MCO contracts. Cement-removal documentation at delivery is the standard defense.