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201911-123419
2020
HIP Health Plan of New York
HMO
Dental Problems
Dental/ Orthodontic Procedure
Medical necessity
Overturned
Case Summary
Diagnosis: Impacted teeth
Treatment: Braces
The braces are medically necessary.
The patient has an impacted upper right lateral incisor and canine. When there is an, "impacted permanent anterior tooth where extraction is not indicated," as is the case for both of these teeth, this is an "automatic qualifier," as per the handicapping index. The patient needs, and is justified to receive, orthodontic benefits in this case.
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