Policy No: 54B
Originally Created: 01/01/2001
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Replacement of lost or broken retainer (D8692)
Procedure is in accordance with generally accepted standards of dental practice.
Process to orthodontic benefit.
Not a covered benefit if there is a contract exclusion for lost or stolen appliances.
CDT - D8000-D8999 - see above
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