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ORTHODONTIC EXCLUSIONS |
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- Pre-, mid and post treatment records which include cephalometric x-rays, tracings, photographs and study models;
- Lost, stolen or broken orthodontic appliances;
- Changes in treatment necessitated by lack of Enrollee cooperation;
- Surgical procedures incidental to orthodontic treatment;
- Myofunctional therapy;
- Surgical procedures related to cleft palate, micrognathia, or macrognathia;
- Treatment related to temporomandibular joint disturbances;
- Supplemental appliances not routinely used in comprehensive orthodontics, including, but not limited to, palatal expander, habit control appliance, pendulum, quad helix, or herbst;
- Restorative work caused by orthodontic treatment;
- Phase I orthodontics, as well as activator appliances and minor treatment for tooth guidance and/or arch expansion. Phase I orthodontics is defined as early treatment including interceptive orthodontia prior to the development of late mixed dentition.
- Extractions solely for the purpose of orthodontics;
- Treatment in progress at inception of eligibility;
- Patient initiated transfer after bands have been placed;
- Composite or ceramic brackets, lingual adaptation of orthodontic bands, and other specialized or cosmetic alternatives to standard fixed and removable orthodontic appliances.
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