Diagnosis: Crossbite
Treatment: Insertion of Braces and Adjustment of Braces
The insurer denied: Insertion of Braces and Adjustment of Braces
The denial is overturned

The patient is an adolescent male requesting orthodontic benefits. He has a Class I malocclusion, mild upper crowding and moderate lower crowding, and a deep bite. The prior denial was due scoring 13 on the handicapping index score.

The proposed treatment is medically necessary.

Even though the handicapping index score was only 13, the patient has an anterior tooth (#27) in crossbite (reverse bite). This means this tooth is in front of the upper tooth. There is also gingival (gum) attachment loss with recession. This is an "automatic qualifier' according to the Salzmann index. This patient needs orthodontic treatment to correct his bite.