Managing sealant utilization among insured populations: report from Vermont's "Tooth Fairy" program

The potential for overutilization of dental sealants is cited as one rationale for limitations in third-party coverage for such care. To evaluate the validity of these concerns, provider behavior was reviewed, using twelve months of claims data from one insured population with pre-existing coverage for dental sealants. A total of 13,512 procedures from Vermont's "Tooth Fairy" program for low-income children were reviewed for several variables; these related to provider, patient, procedure type, and tooth number. Although sealants were the third most frequently rendered service, only 10.5 percent of patients received sealants. Treatment was largely consistent with professional guidelines for targeting care according to patient age. The absence of excessive or unnecessary utilization, combined with evidence of caries development in older children, suggests that insurers should review the appropriateness of protocols for sealant coverage.