Policy No: 54A
Originally Created: 01/01/2002
Last Reviewed: 01/01/2019
Last Revised: 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.
Process to orthodontic benefit.
CDT - D8000-D8999 - see above
Your use of this Dental Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Dental Policy Disclaimer.