Anthem Hld Score Sheet HLD Index Scoring Instructions The intent of the Handicapping Labio Lingual Deviation HLD Index is to measure the presence or absence and the degree with a Boley Gauge or a disposable ruler scaled in millimeters
HLD Score Sheet Page 2 of 3 Revised 12 21 Procedure 1 Occlude patient or models in centric position 2 Record all measurements in order given rounded off to the nearest millimeter 3 Enter a score of zero 0 if the condition is absent 4 Start by measuring overjet of the most protruding incisor PROCEDURE use this score sheet and a Boley Gauge or disposable ruler Indicate by checkmark next to A or B which criteria you are submitting for review Position the patient s teeth in centric occlusion Record all measurements in the order given and round off to the nearest millimeter mm
Anthem Hld Score Sheet
Anthem Hld Score Sheet
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greater than 3 5 mm if present score 12b Anterior crowding of mandible greater than 3 5 mm if present score 13 Labio lingual spread either measure a displaced tooth from thenormal arch form or labial lingual distance between adjacent anterior teeth 14 Posterior crossbite 1 must be a molar score only 1 time if present score The Handicapping Labio Lingual Deviations Form HLD is a quantitative objective method for measuring malocclusion The HLD provides a single score based on a series of measurements that represent the degree to which a case deviates from normal alignment and occlusion You will need this form and a Boley Gauge
ATTACH MEDICAL EVIDENCE AND APPROPRIATE DOCUMENTATION FOR EACH OF THE FOLLOWING EIGHT AREAS ON A SEPARATE PIECE OF PAPER IN ADDITION TO COMPLETING THE HLD SCORE SHEET ABOVE Any other relevant documentation available which may assist the DOH in making a determination Anterior crowding Anterior arch length insufficiency must exceed 3 5mm score one point for maxilla and one point for mandible 2 points maximum for anterior crowding The maximum number of points for this item is therefore 10 points 5 upper and 5 lower 8
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use this score sheet and a Boley Gauge or disposable ruler Indicate by checkmark next to A B and or C which criteria you are submitting for review Position the patient s teeth in centric occlusion Record all measurements in the order given and Initial study models of 313 patients from the orthodontic clinic at the University of Maryland were scored by both HLD Md and HLD CalMod indexes According to the scores the patients were divided into 2 groups those with handicapping malocclusions and
The handicapping labio lingual deviations HLD form is used as the basis for determining whether a member qualifies for orthodontic treatment A member must score a minimum of 15 points to qualify for coverage points are not awarded for esthetics The Handicapping Labio Lingual Deviations Form HLD is a quantitative objective method for measuring malocclusion The HLD provides a single score based on a series of measurements that represent the degree to which a case deviates from normal alignment and occlusion You will need this form and a scaled millimeter ruler or a Boley Gauge
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HLD Index Scoring Instructions The intent of the Handicapping Labio Lingual Deviation HLD Index is to measure the presence or absence and the degree with a Boley Gauge or a disposable ruler scaled in millimeters
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HLD Score Sheet Page 2 of 3 Revised 12 21 Procedure 1 Occlude patient or models in centric position 2 Record all measurements in order given rounded off to the nearest millimeter 3 Enter a score of zero 0 if the condition is absent 4 Start by measuring overjet of the most protruding incisor
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Anthem Hld Score Sheet - HANDICAPPING LABIO LINGUAL DEVIATION HLD INDEX SCORING INSTRUCTIONS The intent of the HLD index is to measure the presence or absence and the degree of the handicapped occlusion caused by the components of the Index and not to diagnose malocclusion All measurements are made with a Boley Gauge scaled in millimeters Absence
