Understanding Utilization and Prevention Measures Associated With a Caries Risk Assessment in Oral Health Transformation

Abstract

Objectives: Dental decay is endemic in the United States, underscoring the need to measure the utilization of caries risk management tools to elucidate the effect of prevention interventions in reducing the dental decay rates of individuals. An academic institution partnered with a third-party institute to call attention to the utilization and prevention measures associated with caries risk assessment (CRA) used with children 0–18 years. This environmental scan examined claims across the United States to evaluate the proportion of dental examinations, CRAs, and caries prevention procedures within a calendar year. Methods: A 12-month deidentified participant list categorized by age, race, sex, state of residence, and treatment dates was provided from the third-party database containing 14,625,751 Medicaid and commercial claims for dental examinations, CRAs, and caries prevention procedures performed in the calendar year 2022. Results: The final data set (N = 9,351,848 patient examinations), 86.8% had a caries prevention procedure completed at the examination visit. Still, only 29.4% had a CRA Current Dental Terminology (CDT) coded on the same day of the dental examination. There were higher numbers of CRAs in the Medicaid payor group in states that require CRAs in conjunction with a dental examination. Conclusions: The utilization of the ADA CRA CDT codes, designed to stratify patients into caries risk categories of low, moderate, or high, was relatively low compared to the examination and prevention procedure claims. Consistent utilization of these codes would allow for more effective monitoring of patient outcomes, supporting a data-driven approach to assessing oral health over time.