About the C&TC data

About the C&TC (CMS-416 report) data

Child and Teen Checkups (C&TC) is Minnesota’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. EPSDT is a federal program required in every state to provide quality well-child care for children eligible for Medicaid. The Minnesota Department of Human Services administers the program and submits yearly data reports to the Centers for Medicare and Medicaid Services on the CMS-416 Report form. This page contains information on dental and oral health service use provided through the C&TC program.

Which pages include the data?

What is the Child and Teen Checkups Program?

In 1967, Congress created the federal Early, Periodic Screening, Diagnosis and Treatment (EPSDT) Program to promote preventive health, prevent disease and detect treatable problems early in order to avoid further serious health conditions and more costly health services. EPSDT is a preventive component of the Medicaid Program; it provides for coverage of comprehensive, periodic health and developmental screening for all children under age 21 years enrolled in Medicaid. These comprehensive screenings or checkups include an oral examination as part of the physical exam.

At a minimum EPSDT dental services include relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services. Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health.

Child and Teen Checkups (C&TC) is Minnesota’s EPSDT program. It is administered by the Minnesota Department of Human Services with technical and clinical assistance from the Minnesota Department of Health.

The Child and Teen Checkups Provider Manual describes an overview of the program, including eligible providers, eligible recipients, covered services and billing information.

Also, visit Information for providers to learn more about the C&TC Dental Periodicity Schedule, screenings, policy and coding.

Who is eligible for Child and Teen Checkups?

All children under age 21 enrolled in a Minnesota Health Care Program (Medical Assistance (MA) or MinnesotaCare).
States determine eligibility for their EPSDT program based on instructions from the Transformed Medicaid Statistical Information System (T-MSIS) Data Dictionary.

What is the oral health screening component?

Oral health screenings can be done by a dentist or a non-dental provider (e.g. primary care doctor) whose scope of practice includes general health screenings as part of the C&TC well-child care visit. An oral health screening includes an oral health history review, a physical examination of the child’s mouth, and referrals for preventive dental care or assessment and treatment.

The oral health history review includes:

Previous oral health problems
Diet and nutrition
Fluoride intake
- Primary source of drinking water
- Past fluoride treatment (e.g., fluoride application or fluoride varnish)
- Supplements (fluoride tablets)
- Products (tooth paste and mouth rinse)
Dental visit history
Drug or alcohol use
Medical conditions including diabetes, infections, etc.
Medications that affect the mouth
Baby bottle or sippy cup use

Physical examination of a child’s mouth

The physical examination includes checking the lips, tongue, teeth, gums, and tissues. See “Lift the lip” procedure. The screener checks for the following:

New teeth that have come in (eruption) or tooth loss
Tooth abnormalities and teeth alignment
Tarter build-up (oral plaque) and food bits (debris)
Tooth decay
Oral-dental trauma or other abnormalities

The non-dentist providers who carry out the screening will then either refer the child for a preventive dental care visit or further assessment and treatment.

For more information:

What do the data tell us?

Participation and trends in dental and oral health service use among children under age 21 enrolled in a Minnesota Health Care Program, therefore eligible for C&TC by:
- Demographic groups (age, race and ethnicity, and county of residence).
- Service type (diagnostic, preventive, treatment, dental and oral health service).
- Services provided by dental and oral health professionals versus non-dental providers such as a primary care doctor.

Why are the data important?

Dental and oral health service use provides an understanding of dental access and coverage.
Children from lower income households are more vulnerable to tooth decay and severe dental disease, compared to children from higher income households. These children are less likely to receive adequate oral and dental care or have access to proper screening and assessments.
Children with chronic oral health problems have more difficulties eating, talking, sleeping, and playing. They are more likely to miss school and activities.
Early screening is key to preventing oral health problems.

How can we use the data?

Create awareness among educators, dental, medical and public health professionals, researchers, grant makers, policy makers, and the public about Medicaid children’s dental and oral health service use.
Provide evidence to support state and local program planning, evaluation and policies.
Target outreach efforts and resources towards areas or groups with lower rates of dental and oral health screening.

What will the data not tell us?

Dental and oral health service use among low-income children not enrolled in a Minnesota Health Care Program, therefore not eligible for the C&TC program.
Dental services provided to C&TC eligible children that were not submitted as a dental claim to the Department of Human Services for reimbursement.
Specific dental procedures (e.g. root canals, dental filings, or fluoride varnish application) done during the federal fiscal year.

How are the data collected?

Data from the C&TC program is reported to the Centers for Medicare and Medicaid Services (CMS) on the CMS-416 Report form. This data comes from two main sources:

The Medicaid Management Information System (MMIS) tracks fee-for-service claims activities and encounter data from managed care health plans.
Indian Health Services and Federally Qualified Health Centers that contract with the Minnesota Department of Human Services report C&TC service use.

Dental and oral health measures (Lines 12a. through 12g. of the CMS-416 Report) are based on claims using CMS, dental and medical billing codes. See "What are the Data Indicators?" and "How are the Data Indicators Calculated" below for more information.

What are the data indicators?

The following indicators are measures of dental and oral health service use among Child and Teen Checkups (C&TC) eligible children.

C&TC eligible children (Line 1b. of CMS-416 Report) are defined as children under age 21 enrolled in a Medicaid or Children Health Insurance (CHIP) expansion program (Medical Assistance) or MinnesotaCare (collectively called Minnesota Health Care Programs) for at least 90 continuous days during the federal fiscal year.

Any dental service use (Line 12a. of CMS-416 Report): The number of C&TC eligible children that received at least one dental service visit within the federal fiscal year. A dental service is any diagnostic, preventive, or treatment service provided by or under the supervision of a dentist. Procedures for these services are defined by HCPCS codes D0100-D9999 (or equivalent Current CDT or CPT codes)*. Individuals are counted only once for this indicator (12a.), even if they have received multiple dental services.
Dental diagnostic service use (Line 12e. of CMS-416 Report): The number of C&TC eligible children that received at least one dental diagnostic service within the federal fiscal year. Dental diagnostic services include oral evaluations, screenings, x-rays, tissue biopsy, cellular or microscopic examinations provided by or under the supervision of a dentist. These procedures are defined by HCPCS codes D0100-D0999 (or equivalent CDT or CPT codes)*. Individuals are counted only once for this indicator (12e.), even if they have received multiple dental diagnostic services.
Preventive dental service use (Line 12b. of CMS-416 Report): The number of C&TC eligible children that received at least one preventive dental service within the federal fiscal year. A preventive dental service includes dental cleanings, fluoride application, dental sealants, fluoride varnish, nutrition and tobacco counseling, or oral hygiene instruction provided by or under the supervision of a dentist. These procedures are defined by HCPCS codes D1000-D1999 (or equivalent CDT or CPT codes)*. Individuals are counted only once for this indicator (12b.), even if they have received multiple preventive dental services.
Dental treatment service use (Line 12c. of CMS-416 Report): The number of C&TC eligible children that received at least one dental treatment service within the federal fiscal year. Dental treatment services include sedation or anesthesia, oral surgery, dentures, and restorative work such as dental cavity fillings, crowns and root canals provided by or under the supervision of a dentist. These procedures are defined by HCPCS codes D2000-D9999 (or equivalent CDT or CPT codes)*. Individuals are counted only once for this indicator (12c.), even if they have received multiple dental treatment services.
Dental sealants (Line 12d. of CMS-416 Report): The number of C&TC eligible children that received a dental sealant on at least one permanent molar tooth within the federal fiscal year. A dental sealant is a thin plastic coating applied to the biting surfaces of premolars and molars (8 flat teeth in the back of the mouth) to prevent tooth decay and cavities. Dental sealants are provided by any oral health professional for whom placing a sealant is within their scope of practice (e.g. collaborative practice dental hygienist). This procedure is defined by HCPCS code D1351 (or equivalent CDT code)*. Individuals are counted only once for this indicator (12d.), even if they have received multiple dental sealants (Lines 12b. and 12f. of the CMS-416 Report). MHCP pays for dental sealants only on permanent molar teeth (4 furthest back teeth, not wisdom teeth).
Non-dentist oral health service use (Line 12f. of CMS-416 Report): The number of C&TC eligible children that received at least one oral health service within the federal fiscal year. Oral health services include any diagnostic, preventive, or treatment service provided by a non-dentist such as a primary care doctor or oral health professional not under the supervision of a dentist. Procedures for these services are defined by CPT codes.* Individuals are counted only once for this indicator (12f.), even if they have received multiple dental or oral health services (Lines 12b. through 12e. of the CMS-416 Report).
Any dental or oral health service use (Line 12g. of CMS-416 Report): The number of C&TC eligible children that received as least one dental or oral health service within the federal fiscal year. A dental or oral health service is any diagnostic, preventive, or treatment service provided by or under the supervision of a dentist (dental service) or any service provided by non-dentists such as a primary care doctor or a dental health professional not under the supervision of a dentist (oral health service). Individuals are counted only once for this indicator (12g.), even if they have received multiple dental or oral health services (Lines 12a. through 12f. of the CMS-416 Report).

Note: Line 1b. and Lines 12a. through 12.g. of the CMS-416 Report include children eligible for Medicaid based on “categorically needy” and “medically needy” definitions as described in the § 1902(a)(10)(A) of the Social Security Act. * HCPCS code = Healthcare Common Procedure Coding System is set by the Centers for Medicare and Medicaid Services (CMS) and includes procedure codes, nomenclature descriptors, and other data. CDT code = Current Dental Terminology or Code on Dental Procedures and Nomenclature is set by the American Dental Association. CPT code = Current Procedural Terminology is set by the American Medical Association.

Data indicators are summarized by age, race and ethnicity, and recipients’ state and county of residence. Indicators summarized by age are for recipients ages 1-20 years , based on the Centers for Medicaid and Medicare (CMS) Core Dental Measures 13 and 17, Improving Access to Oral Health Services in Medicaid and CHIP: How States Can Report the Dental Measures in the Initial Core Set of Children’s Health Care Quality Measures. In federal fiscal years 2011 and 2012, the "other/unknown" racial category included C&TC eligible children with a single race of Hawaiian or Pacific Islander, more than one race, or did not report a race and ethnicity. Since federal fiscal year 2013, "Pacific Islanders" were included in the "Asian" racial category; individuals reporting more than one race were combined into a "mixed race" category; and race and ethnicity that was not reported or unknown were combined into an "unknown/missing" category.

How are the data indicators calculated?

Any dental service use (percent): The total unduplicated number of C&TC eligible children that received at least one dental service within the federal fiscal year (reported on Line 12a. of the CMS-416 Report) divided by the total number of children eligible for C&TC (reported on Line 1b. of the CMS-416 Report), multiplied by 100 to get a percent.

Dental diagnostic service use (percent): The total unduplicated number of C&TC eligible children that received at least one dental diagnostic service within the federal fiscal year (reported on Line 12e. of the CMS-416 Report) divided by the total number of children eligible for C&TC (reported on Line 1b. of the CMS-416 Report), multiplied by 100 to get a percent.

Preventive dental service use (percent): The total unduplicated number of C&TC eligible children that received at least one preventive dental service within the federal fiscal year (reported on Line 12b. of the CMS-416 Report) divided by the total number of children eligible for C&TC (reported on Line 1b. of the CMS-416 Report), multiplied by 100 to get a percent.

Dental treatment service use (percent): The total unduplicated number of C&TC eligible children that received at least one dental treatment service within the federal fiscal year (reported on Line 12c. of the CMS-416 Report) divided by the total number of children eligible for C&TC (reported on Line 1b. of the CMS-416 Report), multiplied by 100 to get a percent.

Dental sealants (percent): The total unduplicated number of C&TC eligible children that received a dental sealant on at least one permanent molar tooth within the federal fiscal year (reported on Line 12d. of the CMS-416 Report) divided by the total number of children eligible for C&TC (reported on Line 1b. of the CMS-416 Report), multiplied by 100 to get a percent.

Non-dentist oral health service use (percent): The total unduplicated number of C&TC eligible children that received at least one oral health service from a non-dental provider within the federal fiscal year (reported on Line 12f. of the CMS-416 Report) divided by the total number of children eligible for C&TC (reported on Line 1b. of the CMS-416 Report), multiplied by 100 to get a percent.

Any dental or oral health service use (percent): The total unduplicated number of C&TC eligible children that received at least one dental or oral health service within the federal fiscal year (reported on Line 12g. of the CMS-416 Report) divided by the total number of children eligible for C&TC (reported on Line 1b. of the CMS-416 Report), multiplied by 100 to get a percent.

Which populations do the data represent?

C&TC eligible children are defined as children under age 21 enrolled in a Medicaid or Children Health Insurance (CHIP) expansion program (Medical Assistance) or MinnesotaCare (collectively called Minnesota Health Care Programs) for at least 90 continuous days during the federal fiscal year.

What are the limitations of the data?

Dental and oral health service use measures were based on paid claims only before federal fiscal year 2014. After 2014, the Centers for Medicare and Medicaid Services developed a new reporting rule which requires states to report dental and oral health service use measures based on a total of paid, unpaid, and denied claims. Therefore, measures before 2014 cannot be compared to measures from 2014 or later.
Only dental claims from fee-for-service providers, managed health care plans, Indian Health Services, and Federally Qualified Health Centers (FHQCs) that contract with the Minnesota Department of Human Services are included in the dataset.