Title
Approval of Case #26-8 Dental
Report
Issue:
Whether to approval dental procedures for LEOFF 1 retiree.
Staff Contact:
Debbi Hufana, HR Analyst, Human Resources, 360.753.8149
Background:
Retired LEOFF 1 member is requesting reimbursement for three dental procedures in the amount of $7,522.77. There are 3 separate requests in this case:
#1 - request for partial to replace teeth #’s 19, 20, 22, 23, 29, 30 & 31 in the amount of $2,700.00 - member has been reimbursed for the extractions of the teeth over the last few months. The requests for the extractions were under $2,000 per tooth which can be approved by staff. There was no mention when reimbursement requests came in the member was replacing with a partial.
#2 - request for payment of core buildup and crown for tooth #21 in the amount of $2,126.50. This work was completed in September 2025.
#3 - request for fillings and root canal on tooth #6. Tooth #6 was filled on March 9, 2026 at a cost of $764.27 (this work was done at the same time as tooth #7 and was within the staff approval limit). On March 10, 2026 the member had a root canal done in the amount of $1,932.00 for a total repair cost for tooth #6 of $2,696.27. The total is above staff level approval.
Attachments:
Application for Payment of Services 26-8 #1 and documentation
Application for Payment of Services 26-8 #2 and documentation
Application for Payment of Services 26-8 #3 and documentation
Reference:
Section III Procedures to Receive Benefits