Diagnosis: Malocclusion.
Treatment: D8080 braces.
The insurer denied D8080 braces.
The denial is overturned.

The patient is a male. He has a Class II malocclusion with protrusive maxillary incisors. He has 6 millimeter (mm) overjet and 6mm overbite. Teeth 8 and 9 have a history of trauma and have large restorations. He is treatment planned for orthodontics to correct this malocclusion which was denied by the health plan based on lack of medical necessity.

The health plan's determination is overturned. Braces are medically necessary for this patient.

Teeth #8 and #9 are protruding forward within the dental arch. This makes them more prone to trauma. There is strong medical evidence that that early correction of patients with prominent maxillary front teeth can reduce the risk of incisal trauma.1 Evidence shows orthodontic treatment will reduce the chances of damage to the maxillary incisors and the associated costs and morbidity of repairing these teeth. This is particularly important for this patient since teeth 8 and 9 have already been fractured once. If one is traumatized again, it will likely result in more significant tooth damage. For this reason, treatment is deemed medically necessary.