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201912-123894
2020
United Healthcare Plan of New York
HMO
Dental Problems
Dental/ Orthodontic Procedure
Medical necessity
Overturned
Case Summary
Diagnosis: Crossbite
Treatment: Full braces
The proposed full braces are medically necessary.
Tooth #27, the lower right canine is in crossbite. When an anterior tooth is in crossbite with gingival attachment loss, this is an "automatic qualifier" for benefits according to the handicapping index. The patient is in need of orthodontic treatment to correct the problem.
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