Patient-Centered Dental Home: Clearinghouse of Existing Oral Health Quality Indicators


Total Eligibles Receiving Dental Treatment Services

Characteristics
Measures Not Included in PCDH Framework

Component
Not applicable

Measure Concept
Utilization: Any treatment services

Descriptions
Enter the unduplicated number of individuals under the age of 21 with at least 90 continuous days of enrollment during the federal fiscal year from Line 1b who received at least one dental treatment service by or under the supervision of a dentist, as defined by HCPCS codes D2000 - D9999 (or equivalent CDT codes D2000 – D9999 or equivalent CPT codes (please refer to the CPT-to-CDT crosswalk available on Medicaid.gov) that include only those CPT codes that involve periodontics, maxillofacial prosthetics, implants, oral and maxillofacial surgery, orthodontics, adjunctive general services, and only if provided by or under the supervision of a dentist, based on an unduplicated paid, unpaid, or denied claim. Numerator: Unduplicated number of individuals under the age of 21 with at least 90 continuous days of enrollment during the federal fiscal year from Line 1b who received at least one dental treatment service by or under the supervision of a dentist, as defined by HCPCS codes D2000 - D9999 (or equivalent CDT codes D2000 – D9999 or equivalent CPT codes (please refer to the CPT-to-CDT crosswalk available on Medicaid.gov) that include only those CPT codes that involve periodontics, maxillofacial prosthetics, implants, oral and maxillofacial surgery, orthodontics, adjunctive general services, and only if provided by or under the supervision of a dentist, based on an unduplicated paid, unpaid, or denied claim. Denominator: Total unduplicated number of individuals under the age of 21 from Line 1a who have been continuously enrolled in Medicaid or a CHIP Medicaid expansion program for at least 90 continuous days in the federal fiscal year and determined to be eligible for EPSDT services, distributed by age and by basis of eligibility.

Measure or Standard
Measure

Populations
Children

Level of Measure
Program/Plan

Data Source
Administrative enrollment and claims data

Measure Identification
CMS 416 Measures; DQA Starter Set Measures Environmental Scan (2012); NQF Environmental Scan (2012)

Developer/Steward

Stage of Development/Use
CMS 416 EPSDT Reporting Previously in CHIPRA Core Set (removed)

Measure Endorsement