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201905-117548

2019

Guardian Life Ins. Co.

Indemnity

Dental Problems

Dental/ Orthodontic Procedure

Medical necessity

Upheld

Case Summary

Diagnosis: Tooth decay
Issue under review: Restoration on teeth

Determination:
The Restoration on teeth was not medically necessary.

The x-rays do not show any decay or fractures in the teeth in question. The photos also do not show any decay or fractures present. There is not any restorative reason to treat these teeth that is apparent in the records.

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