Methods, systems, and computer program products for flagging dental claims for further scrutiny based on processing of dental clinical images and periodontal charts using multiple artificial intelligence (ai) models

Abstract

A method includes receiving, by one or more processors, a clinical image associated with a dental procedure; identifying, by the one or more processors, one or more dental procedure codes based on processing the clinical image using a plurality of AI models; receiving, by the one or more processors, a periodontal chart image; processing, by the one or more processors, the periodontal chart image using optical character recognition to obtain pocket measurements associated with a plurality of teeth along with positional coordinates of each of the pocket measurements; identifying, by the one or more processors, a submitted dental procedure code in a dental claim for the dental procedure; determining, by the one or more processors, whether the submitted dental procedure code corresponds to a visibly detectable procedure; determining, by the one or more processors, whether the submitted dental procedure code matches any of the one or more dental procedure codes based on processing the clinical image when the submitted dental procedure code corresponds to a visibly detectable procedure; and flagging, by the one or more processors, the dental claim when at least one of the submitted dental procedure code does not match any of the one or more dental procedure codes based on processing the clinical image, the submitted dental procedure code does not correspond to a visibly detectable procedure, or the pocket measurements do not support the submitted dental procedure code.