FYI

Delta Dental is dedicated to collaborating with providers to enhance the health of our shared members and optimize the quality of services. We have selected an initial group of quality measures to assess member engagement in oral preventive care, as research demonstrates that participation in these visits and services leads to improved oral health outcomes. Most of these measures are sourced from the Dental Quality Alliance (DQA), an organization affiliated with the American Dental Association.

Outlined below is an explanation of each measure, along with practical tips you may consider implementing within your practice. We appreciate your continued commitment and partnership in delivering high-quality care that positively affects our members’ oral and overall health.
 

Quality measure tips checklist by code

Children’s quality measures:

Oral evaluation, dental services (D0120, D0150, D0145) - Percent of children 1-20, who received an oral evaluation (regular check-up) in the year.

Tips

• Reach out to your patients who are overdue for their oral evaluation visit.
• Set up appointments in advance at the patient’s last check-up.
• Implement appointment reminder systems.
• Educate parents about the importance of ongoing preventive oral health care visits.

Topical fluoride for children (D1206, D1208) - Percent of children 1–21, who received at least two topical fluoride applications in the year.

Tips

• Deliver fluoride as a standard of care regardless of insurance coverage. Most Delta Dental plans cover fluoride for children. Use Provider Tools to check member specific coverage.
• Inform parents about the role that fluoride plays in strengthening teeth and preventing tooth decay.
• If parents are resistant, ask for their reasons and listen to build trust. Respect their choice but explain the risks if their child is not treated.

Sealant receipt on permanent 1st molars (D1351) - Percent of children who received sealants on their permanent first molar teeth by their 10th birthday.

Tips

• Explain the role to parents that sealants play in preventing cavities: dental sealants prevent 80% of cavities over 2 years in the back teeth.¹
• Deliver sealants as a standard of care regardless of insurance coverage. Most Delta Dental plans cover sealants. Use Provider Tools to check member specific coverage.
• Consider that children aged 6 to 15 are the best candidates for sealants because their newly erupted, permanent teeth are most susceptible to cavities.

Adult quality measures:

Non-Surgical ongoing periodontal care for adults with periodontitis (D1110, D4910, D4341, D4342, D4346) - Percent of adults aged 30+ with a history of periodontitis (gum disease) who received ongoing care at least two times in the year.

Tips

• Educate members about the importance of periodontitis treatment including preventing tooth loss and the impact on the entire mouth (e.g., bone loss and receding gums).
• Explain that the disease is common and impacts over 40% of adults 30 years or older in the United States. Reducing the disease is a national focus (goal of the CDC Healthy People 2030).²^,³
• Provide both a written and oral treatment plan that explains periodontal procedures.

Periodontal evaluation in adults with periodontitis (D0120, D0150, D0180) - Percent of adults aged 30+ with a history of periodontitis (gum disease) who received an oral/periodontal evaluation (check-up) in the year.

Tips

• Educate members about the importance of regular oral evaluations for periodontitis: early detection leads to better treatment results.
• Explain that regular oral evaluations for members who have a history of periodontitis help prevent recurrence and the progression of disease.
• Teach your patients about the connection between oral health and overall health. Studies show a link between periodontitis and conditions such as heart disease and diabetes.⁴
•  If the disease is not stable, consider further periodontal treatment or possible referral.

Topical fluoride for adults at elevated caries risk (D1206, D1208) - Percent of at-risk adults 18+ who received at least two topical fluoride applications in the year.

Tips

• Educate members about existing American Dental Association evidence-based guidelines which suggest that professionally applied fluoride is effective in preventing caries for at-risk adults.⁵
• Explain the factors that make members at-risk for caries (e.g., history of cavities, restorations).
• Consider using a caries risk assessment tool in your practice to identify members at higher risk.⁶

Both children and adult quality measure:

Established dental home (D0120, D0145, D0150, D0180) - Percent of members (children and adults) that had at least one oral evaluation (check-up) in the year.

Tips

• Encourage the formation of a dental home by 12 months of age as there are many benefits.⁷
• Implement dental home components in your practice including delivering care in a coordinated, compassionate, and accessible way.
• Consider reaching out to members in the language they speak and cultural factors which may influence oral health beliefs and practices.
• See additional tips in the oral evaluation, dental services measure that also apply.