Medically Necessary Orthodontic Services definition
Medically Necessary Orthodontic Services means Enrollees must have a severe, dysfunctional, handicapping malocclusion. In order to qualify as medically necessary, a minimum score of 25 points using Salzmann Index criteria is required. Handicapping esthetic diagnoses (crooked, crowded or protruding teeth) due to appearance are not considered part of the determination. This Benefit does not apply to Adult Enrollees.
Medically Necessary Orthodontic Services means Comprehensive Orthodontic Treatment that meets the criteria for “Dental Necessity” as defined in this policy and also meets at least one of the following criteria: