Diagnosis: Dental Disorder.
Treatment: braces; monthly visit; orthodontic retention.
The insurer denied braces; monthly visit; orthodontic retention.
The determination is upheld.

This is a male patient with a Class I occlusion with appropriate overbite and overjet. He has minor maxillary and mandibular crowding. He has a fully erupted supernumerary maxillary left lateral incisor. He is treatment planned for orthodontics to correct his malocclusion at issue is the medical necessity of braces; monthly visit; orthodontic retention.

There is no medical reason to correct the malocclusion with braces. While the patient has minor crowding, there is no anterior or posterior crossbite. There is no evidence of wear or periodontal recession. There are functional problems that may occur in the dentition that become more difficult, if not impossible, to correct if not addressed in adolescence. (1) This patient presents with none of those conditions. This patient has a Class I occlusion and masticatory efficiency is highest in patients with a Class I occlusion. (2) If his teeth were aligned it would provide a minor esthetic improvement but it would not create a medically significant improvement to the patient's health. For these reasons, the requested treatment is not medically necessary.