Diagnosis: Dental Problems - Malocclusion.
Treatment: Dental or Orthodontic Treatment.

The insurer denied: D8080 comprehensive orthodontic treatment of the adolescent dentition. The denial is overturned.

The patient in question is a female presenting with a skeletal Class I malocclusion and minor crowding. She has an anterior open bite. She is treatment planned for orthodontic treatment address the crowding and open bite, but the treatment which was denied by the health plan due to lack of medical necessity.

The health plan's determination is overturned.

The comprehensive orthodontic treatment of the adolescent dentition was medically necessary for this patient.

Anterior open bite patients are among the most difficult patients to treat. (1) One side effect of anterior open bite is reduced maximum bite force with less muscle activity while chewing than patients without an open bite. (2) Orthodontic treatment is medically necessary for this patient due to the side effects, and the fact that this is not something that will self-correct without orthodontic intervention. Orthognathic surgery or permanent teeth extraction are often the choice of treatment to treat patients with anterior open bite. (3)