PROBLEM STATEMENT: Health risk assessments are essential tools to understand population health and are used to develop targeted interventions and policies. These assessments aid in the identification of potential health problems at an early stage to provide patient-appropriate education and guide preventive interventions. Dentistry has a caries risk assessment (CRA) tool, which can identify behaviors and lifestyles that contribute to a higher caries risk but the widespread implementation of CRA across the United States is lacking.
PURPOSE: Pacific University School of Dental Hygiene Studies partnered with CareQuest Institute for Oral Health to call attention to the utilization and prevention measures associated with CRA tools across the United States in children 0 to 18 years of age. The aim is to analyze dental claims at the patient level by Current Dental Terminology (CDT) codes to assess CRA and caries preventive procedures performed at examination visits.
METHODS: A 12-month de-identified participant list categorized by demographic characteristics was utilized from CareQuest’s Institute for Oral Health database with payor claims for dental examinations, CRA, and preventative procedures performed on the same day as the exam in the calendar year of 2022. Approval was obtained by Pacific University Oregon’s Institutional Review Board #2037100-1.
RESULTS: In the 2022 data sample of 9,351,848 patient exam claims, 86.8% had a caries preventive procedure completed at the examination visit but only 29.4% had a CRA CDTs coded at the exam. A higher utilization of CRA with examinations was noted in states with Medicaid as the payor and incentivize the CRA code with the exam.
CONCLUSIONS: While there has been a shift to focus on prevention versus restorative treatment, procedures for determination of caries risk (CRA of low, medium, or high) were relatively low in comparison to exam and preventive procedure claims, making appropriateness of care determinations impossible to determine.
All abstract authors: Kristen Moses, MS, DT, RDH Melody McGee, MBA, RDH, EPDH Kristen Simmons, PhD, MHA, RDH Ryan Brandon, MS Muhammad Walji, PhD Joel White, DDS, MS Eric Tranby, PhD Lisa Heaton, PhD
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