Diagnosis: Maxillary and mandibular crowding.
Treatment: Braces/Monthly visits.
The insurer denied braces/monthly visits.
The health plan's determination is upheld.

The patient is a male with maxillary and mandibular crowding and several unerupted permanent teeth. The orthodontist mentioned in the diagnosis that tooth # (number) 6 is impacted. The patient was treatment planned for Braces and Monthly Visits (x12) with palatal expansion and surgical canine exposure. This is the subject under review.

Braces and Monthly Visits (x12) are not medically necessary for this patient at this time. He is in the process of losing his remaining primary teeth as they are replaced with permanent teeth. Neither teeth #6 nor #11 appear to be erupting at a poor angle on the radiograph, and it is too early to determine if it will require an exposure as maxillary canines usually erupt at 11-12 years of age. There is still much time to see if the tooth will erupt successfully on its own without orthodontic intervention.