Dental Problems.
Dental/Orthodontic Procedure.

Diagnosis: Dental Malocclusion.
Treatment: Braces.

The insurer denied Braces. The health plan's determination is overturned.

The patient in question is a female with a Class I malocclusion and anterior crossbite of tooth #9. Tooth #24 is displaced labially due to the crossbite and already has significant recession. She is treatment planned for orthodontics to correct malocclusion. This is under review.

Braces are medically necessary for this patient. The patient has maxillary anterior crowding with tooth #9 in crossbite. Tooth #24 already has significant recession that will likely require future periodontal surgery. Delaying treatment will lead to further labial movement of tooth #24 which could very well lead to the loss of this tooth. Orthodontic treatment now will save tooth 25. Braces are medically necessary.