top of page

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.
bottom of page