The patient in question has a Class II occlusion, no crossbites, excessive overjet and overbite, and mild maxillary/mandibular crowding. The patient is in the late mixed dentition. The patient has extensive untreated decay on teeth 8 and 10. The patient is treatment planned for 24-30 months comprehensive orthodontics to correct his malocclusion.

The health plan's determination is upheld. The Orthodontic treatment (D8080) is not medically necessary in this patient. He already has major decay, and orthodontic treatment can dramatically increase the risk of tooth decay. The health of the patient's teeth must be addressed via tooth restorations before orthodontic treatment should be considered.