Diagnosis: Dental Disorder
Treatment: Dental Implant Tooth # (number) 22
The insurer denied Dental Implant Tooth #22.
The determination is overturned.

The patient presented for evaluation and treatment of tooth number (#) 22. Provided for review are previous letters of appeal and denial, a narrative from her doctor explaining challenges with chewing function, full mouth panoramic radiographic image, multiple pages of claim forms, intra-oral clinical photos, multiple correspondence between the applicant and the health plan, appeal acknowledgement letters, and clinical notes . At issue is the medical necessity of the planned treatment of extraction of implant placement (6010) for tooth #22.

The requested health service/treatment of surgical placement of implant body in site #22 is medically necessary in order to provide support stability and retention of the denture.

This will reduce the need for a vestibule as well as reduce the compression of the tissue around the tori which would otherwise cause ulceration. The clinical images along with the radiographic images support the clinical notes and assessments. A narrative explains challenges with chewing function.