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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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