
201911-122954
2019
Empire BlueCross BlueShield HealthPlus
Medicaid
Dental Problems
Dental/ Orthodontic Procedure
Medical necessity
Upheld
Case Summary
PD:Dental/Orthodontic Procedure
PT:Dental/Orthodontic Procedure
ST:Dental/Orthodontic Procedure
The patient has a Class I occlusion with appropriate overjet and a slightly deep bite. The maxillary and mandibular arches have some minor crowding. No treatment plan was provided. The patient has some mild crowding but a solid Class I occlusal relationship. His bite is slightly deep but there is no indication of damage to the incisors or the palate in the photographs, and his cephalometric radiograph show the lower incisors are contacting the maxillary teeth in occlusion, not the palate.There is no medical reason to correct his mild crowding with braces. There are many ways to correct patients with a deep bite and retroclined incisors, and there is strong evidence that one treatment is not better than another. Futhermore, deep bites may be corrected in adulthood. The health plan's denial of medical necessity is upheld.