Diagnosis: Dental issues.
Treatment: D8080 Braces, D8670 Periodic Orthodontic Treatment Visit times 12.
The insurer denied: D8080 Braces, D8670 Periodic Orthodontic Treatment Visit times 12.
The denial is overturned.

The patient is an adolescent male. The request is for orthodontic benefits. The prior denial was due to a handicapping index scale score being remarked as nine.

The proposed treatment is medically necessary.

The patient has crossbites of several anterior teeth. Teeth numbers 7 and 10 are behind the lower teeth, which is reverse of what it should be. There is also clinical loss of gingival attachment seen in the photos. Each one of these is an "automatic qualifier' according to the handicapping index scale. In addition, the patient's upper left and right canines are "blocked" out of the arch, meaning they cannot erupt properly due to there not being enough room in the dental arch. Without the canines being in their correct positions, there can be no "canine guidance". This means that during the chewing cycle, the upper and lower teeth grind into each other in an uncoordinated fashion. This can cause trauma and tooth breakage over time. Orthodontic treatment is needed to correct this. This case has medical necessity.