
202003-127042
2020
Fidelis Care New York
Medicaid
Dental Problems
Dental/ Orthodontic Procedure
Medical necessity
Overturned
Case Summary
Diagnosis: Rotated teeth; Crossbite
Treatment: Braces; Monthly visits
The insurer denied Braces; Monthly visits.
The denial is overturned.
The patient is a male child. The patient has teeth #s 9 and 10 rotated approximately 90 degrees. They are hitting the lower teeth cockeyed. Also, when the patient bites down, tooth #10 is behind the tooth below it. Being behind the tooth is called a "crossbite." When teeth are in crossbite, they are more susceptible to chipping and fracturing. In order to prevent breaking these rotated teeth and/or the teeth below them, orthodontic treatment is medically necessary to correct this severe problem. The monthly visits are also medically necessary to monitor the treatment progress.