Caries Risk Assessment

Texas Health Steps (THSteps) requires that a caries risk assessment and related documentation be included in all dental exams. Reimbursement for dental exams will be denied by Medicaid unless a caries risk assessment has properly been conducted, documented and coded.

HHS offers training with step-by-step guidance about conducting and documenting caries risk assessment for patients ages 6 months to 20 years. Take the First Dental Home training module for children ages 6–35 months; and the Assessments, Education, and Prevention in the Dental Home module for children ages 3–20 years. Both trainings provide links to all caries risk assessment forms and include documentation and billing information. To take the online trainings, visit THSteps Online Provider Education and click on "Courses." Select "Oral Health" in the Topic menu, and a list of courses will pop up. Click on “First Dental Home” or “Assessments, Education and Prevention in the Dental Home” for more information and enrollment.

Prevention of dental caries is a fundamental aspect of comprehensive dental care. It is imperative that Texas' statewide dental programs manage caries risk in the child population to ensure optimum oral health and provide appropriate preventive services. HHS staff made the decision to utilize Dental Quality Alliance (DQA) measures in 2017 so Texas would have nationally recognized standards for dental care.

HHSC staff initiated steps to track documented caries risk assessments performed by all Texas Medicaid and CHIP dental providers to implement the DQA sealant measure as part of its quality program. The American Dental Association and the American Academy of Pediatric Dentistry support DQA measures. The measure is part of the Centers for Medicare & Medicaid Services Core Set of Children's Health Care Quality Measures for Medicaid and CHIP. Utilizing these measures helps THSteps policy align with best practices and standards of care.

Professionally developed caries risk assessment tools and the Dental Anticipatory Guidance materials are available at: