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Program/Plan Level Dental Quality Measures

DQA Administrative Claim-Based Measures Summary

Please refer to the DQA User Guide before implementing these measures.

Resources:

DQA User Guide - Version 2016 (PDF)

Why Adopt DQA Measures (PDF)

Elevated Caries Risk: Frequently Asked Questions (PDF)

Table 1. DQA Administrative Claims-Based Measures Summary

Evaluating Utilization

NQF#, Measure Abbreviation & Name

Description

Measure Domain

2511
UTL-CH-A

Utilization of Services (PDF)

Percentage of all enrolled children under age 21 who received at least one dental service within the reporting year.

Access/
Process

N/A
PRV-CH-A

Preventive Services for Children at Elevated Caries Risk

Percentage of all enrolled children who are at “elevated” risk (i.e., “moderate” or “high”) who received a topical fluoride application and/or sealants within the reporting year.

Related Health Care Delivery: Use of Services

N/A
TRT-CH-A

Treatment Services

Percentage of all enrolled children who received a treatment service within the reporting year.

Related Health Care Delivery: Use of Services

 

Evaluating Quality of Care

NFQ#, Measure Abbreviation & Name

Description

Measure Domain

2517
OEV-CH-A

Oral Evaluation (PDF)

Percentage of enrolled children under age 21 who received a comprehensive or periodic oral evaluation within the reporting year.

Process

2528
TFL-CH-A

Topical Fluoride for Children at Elevated Caries Risk (PDF)

Percentage of enrolled children aged 1–21 years who are at “elevated” risk (i.e., “moderate” or “high”) who received at least 2 topical fluoride applications within the reporting year.

Process

2508
SL1-CH-A

Sealants for 6–9 Year-Old Children at Elevated Caries Risk (PDF)

Percentage of enrolled children in the age category of 6–9 years at “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent first molar tooth within the reporting year.

Process

2509
SL2-CH-A

Sealants for 10–14 Year-Old Children at Elevated Caries Risk (PDF)

Percentage of enrolled children in the age category of 10–14 years at “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent second molar tooth within the reporting year.

Process

N/A
CCN-CH-A

Care Continuity

Percentage of all children enrolled in two consecutive years who received a comprehensive or periodic oral evaluation in both years.

Process

N/A
USS-CH-A

Usual Source of Services

Percentage of all children enrolled in two consecutive years who visited the same practice or clinical entity in both years.

Access/
Process

2689
EDV-CH-A

Ambulatory Care Sensitive Emergency Department Visits for Dental Caries in Children (PDF)

Number of emergency department visits for caries-related reasons per 100,000 member months for all enrolled children

Outcome

2695
EDF-CH-A

Follow-Up after Emergency Department Visit by Children for Dental Caries (PDF)

Percentage of ambulatory care sensitive Emergency Department (ED) visits for dental caries among children 0–20 years in the reporting period for which the member visited a dentist within (a) 7 days and (b) 30 days of the ED visit.

Process

 

Evaluating Utilization

NQF#, Measure Abbreviation & Name

Description

Measure Domain

N/A
CCS-CH-A

Per Member Per Month Cost of Clinical Services

Total amount that is paid on direct provision of care (reimbursed for clinical services) per member per month for all enrolled children during the reporting year.

Related Health Care Delivery: Efficiency and Cost