Dental issues
Dental/orthodontic

Diagnosis: anterior crossbite on teeth 7 and 10
Treatment: braces/monthly visits

The insurer denied braces/monthly visits. The health plan's determination is overturned.

The patient in question is a male with an anterior crossbite on teeth 7 and 10. He presents with a Class III malocclusion with moderate crowding in the maxilla and mandible. He is treatment planned for braces and monthly visits. This is the subject under review.

Braces/monthly visits are medically necessary. This patient presents with an anterior crossbite on teeth 7 and 10, as well as significant crowding. Side effects of an untreated anterior crossbite include abnormal wear to the affected teeth and labial displacement of the mandibular incisors that can lead to periodontal defects.

If left untreated the damage that will likely occur to the patient's teeth will be much more time consuming and costly to correct than the patient's existing orthodontic problem. For this reason, braces/monthly visits are medically necessary.