More than 16 million U.S. children go without even basic dental care each year. Pew's report card, The State of Children's Dental Health: Making Coverage Matter, assesses states' ability to serve insured and soon-to-be-insured children. In this year's 50-state report card by the Pew Children's Dental Campaign, 27 states earned grades of an A or B, while 23 states and the District of Columbia received a C or lower grade. However, the 2011 grades for 22 states were higher than their 2010 grades, revealing that even in a time of fiscal distress, dental health policies can be improved.