Repair of Orthodontic Appliance

Policy No: 54A
Originally Created: 01/01/2002
Section: Orthodontics
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Approved: 01/01/2018
Effective: 01/01/2018


Repair of orthodontic appliance (D8691)
Does not include bracket and standard fixed ortho appliances. It does include functional appliances and palatal expanders.


Procedure is in accordance with generally accepted standards of dental practice.

Administrative guidelines

Process to orthodontic benefit.


CDT - D8000-D8999 - see above


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