Audience
Zip code - drawer
County - drawer

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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

Description

Repair of orthodontic appliance (D8691)

Does not include bracket and standard fixed ortho appliances. It does include functional appliances and palatal expanders.

Policy/criteria

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

Administrative guidelines

Process to orthodontic benefit.

Codes

CDT - D8000-D8999 - see above

Disclaimer

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.