Diagnosis: Over retained deciduous molar tooth.
Treatment: D8080 Braces and D8670 Monthly Visit x4, Pre-service.

The insurer denied the D8080 Braces and D8670 Monthly Visit x4, Pre-service. The denial is upheld.

The patient is a female requesting dental benefits for orthodontic treatment (braces) and four monthly visits. The patient presents with an over retained deciduous molar tooth on the lower right side. A treatment plan was created to extract this tooth and use orthodontic treatment (braces) to close the space. Three-dimensional (3D) imaging, photos and panoramic x-ray have been taken.

No, the proposed treatment of orthodontic therapy (braces) and four monthly visits are not medically necessary.
Orthodontic treatment is an invasive treatment that is used to straighten and correct teeth that are misaligned. The patient does not exhibit any misaligned teeth, excessive overjet, overbite, crossbite to warrant orthodontic therapy. The documentation submitted does not show that any of these condition are present.

The need for orthodontic treatment is not supported by any of the records presented.