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202005-128270

2020

Fidelis Care New York

Medicaid

Dental Problems

Dental/ Orthodontic Procedure

Medical necessity

Overturned

Case Summary

Diagnosis: Anterior crossbite
Treatment: Braces
The insurer denied the braces.
The denial is overturned.

The patient is a female. The request is for orthodontic benefits.

Yes, the proposed braces are medically necessary.

The patient has an anterior crossbite between teeth #'s 10 and 23, with gingival attachment loss. This is an "automatic qualifier" for orthodontic benefits according to the handicapping index scale.

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