Diagnosis: Impacted teeth
Treatment: D8070 Braces, D8670 Monthly Visit
The insurer denied: D8070 Braces, D8670 Monthly Visit
The denial is overturned.

The patient is a preteen female. The request is for orthodontic treatment (braces) and monthly visits. Per the Provider's dental clinical summary, the patient presents with impacted bilateral upper canines.

The health plan denied coverage for the request, because the patient did not score a 26 on the Handicapping Labio-Lingual Deviation (HLD) Index report. The denial was appealed because of the diagnosis of impacted canines.

The requested orthodontic treatment (braces) and monthly visits are medically necessary.

As supported by the x-rays, the patient presents with bilateral impacted maxillary canines. Typically, most maxillary canines erupt in the mouth by age 11-12. The x-rays show that the canines are impacted and there is insufficient space to allow the natural eruption process to be completed.

Under these circumstances, surgical exposure of this tooth coupled with orthodontic treatment is indicated as the corrective measure. Therefore, the requested orthodontic treatment and monthly visits are medically necessary.