Diagnosis: Crossbite.
Treatment: D8080 Braces, D8680 Monthly Visit x12.

The insurer denied: D8080 Braces, D8680 Monthly Visit x 12.
The denial is overturned.

The patient is a teenage female. The request is for orthodontic benefits with monthly visits. The patient has skeletal Class I and canine class II malocclusion. She also has moderate upper and lower arch crowding with a deep bite. The prior denial was due to a handicapping index score of 12.

The proposed treatment is medically necessary.

The patient has an anterior permanent tooth in crossbite with gingival attachment loss and recession of the gum tissue (tooth #22, lower left canine). This is an automatic qualifier according to the handicapping index scale. Orthodontic treatment is needed to correct this problem and the monthly visits are needed to make sure treatment is progressing. This case has medical necessity.