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Run: Chart Audit: Dental Sealants for Children Ages 6–9

Audit charts for children ages 6–9 to confirm caries risk, sealant placement on a first permanent molar, and any valid exclusions for the HRSA UDS Dental Sea...

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Audit Scope and Patient Identification

Patient date of birth confirms age 6–9 during the measurement year critical (required)

Verify the patient's date of birth places them between ages 6 and 9 (inclusive) at any point during the measurement year.

Yes No N/A

Patient date of birth (for age verification)

Record the patient's date of birth as documented in the chart.

At least one dental visit documented during the measurement year critical (required)

Confirm there is at least one dental visit on record within the measurement year, establishing the patient as an active dental patient for denominator inclusion.

Yes No N/A

Chart / Patient Record ID (de-identified)

Enter the de-identified chart or encounter ID for audit tracking purposes. Do not enter patient name or full date of birth here.

Caries Risk Assessment

Caries risk assessment documented in the chart critical (required)

Confirm that a formal caries risk assessment (e.g., ADA Caries Risk Assessment Form, CAMBRA, or equivalent) is present in the chart for the measurement period.

Yes No N/A

Documented caries risk level critical (required)

Select the caries risk level as documented by the clinician in the chart.

Patient is classified as moderate or high caries risk (numerator eligible) critical (required)

Confirm the documented risk level is moderate or high, making this patient eligible for the sealant measure numerator. If 'Low Risk' or 'Not Documented', the patient may not qualify for the numerator.

Yes No N/A

Sealant Application Evidence

Sealant procedure code documented (CDT D1351 or equivalent) critical (required)

Confirm that CDT procedure code D1351 (sealant – per tooth) or an equivalent approved code is present in the chart for the measurement year.

Yes No N/A

Tooth number(s) on which sealant was applied

Record the tooth number(s) documented in the chart (e.g., #3, #14, #19, #30 for first permanent molars). Enter all applicable tooth numbers.

Sealant was applied to at least one first permanent molar (#3, #14, #19, or #30) critical (required)

Confirm the sealant was placed on a first permanent molar. Sealants on primary teeth or second molars do not satisfy this measure.

Yes No N/A

Date of sealant application falls within the measurement year critical (required)

Verify the service date for the sealant procedure is within the measurement year being audited.

Yes No N/A

Exclusions and Exceptions Review

All first permanent molars have pre-existing sealants, crowns, or restorations (full exclusion applies)

If all four first permanent molars already have sealants, crowns, or full-coverage restorations, the patient may be excluded from the denominator entirely. Document accordingly.

Yes No N/A

Any first permanent molar is unerupted, extracted, or has cavitated caries precluding sealant

Note if any first permanent molar is clinically ineligible for sealant (unerupted, extracted, or has active cavitated decay). Document which teeth and the clinical rationale.

Yes No N/A

Note (optional)

Exclusion or exception is clearly documented in the clinical notes

If any exclusion or exception applies, verify it is explicitly noted in the chart by the treating clinician, not inferred from billing codes alone.

Yes No N/A

Documentation Quality and Final Determination

Clinical notes are legible, dated, and signed/authenticated by the treating provider

Verify that all relevant clinical entries are legible, include a service date, and are authenticated (signed or electronically signed) by the treating dentist or hygienist.

Yes No N/A

Caries risk assessment and sealant documentation are consistent with each other

Confirm there are no contradictions between the risk assessment findings and the treatment plan or sealant placement record (e.g., low-risk notation with no sealant, or high-risk notation with no follow-up plan).

Yes No N/A

Final audit determination for this chart

Select the overall audit outcome for this patient record based on all findings above.

Auditor notes and corrective action recommendations

Document any findings requiring follow-up, corrective action, or provider education (e.g., missing risk assessment, incomplete tooth documentation, coding discrepancies).

Auditor signature

Auditor signature confirming chart review was completed accurately.

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