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202002-125353

2020

Healthfirst Inc.

Medicaid

Dental Problems

Dental/ Orthodontic Procedure

Medical necessity

Overturned

Case Summary

Diagnosis: Crossbite
Treatment: Braces
The insurer denied braces.
The denial is overturned.
The Braces are medically necessary.

The patient has a crossbite of an anterior tooth (#27, lower right canine) with attachment (gum) loss. This is an automatic qualifying condition according to the handicapping index scale. Orthodontic treatment is medically necessary to correct this problem.

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