Objective: Despite prevalence of community water fluoridation and dental sealants, approximately 20 percent of adolescents and young adults throughout the world have untreated dental caries. These conditions are exacerbated by the declining proportion of young adults receiving oral health care. Studies have identified five primary barriers to oral health utilization—income, insurance/Medicaid, fear, health awareness and transportation—but estimates of their relative magnitudes is often confounded by the intersectionality of disadvantage and other social circumstances. Methods: This study examines adolescent oral health utilization controlling for the intersectionality of demographics, social position and need. Using CART decisions tree and hurdle models, this study identified the systematic process of oral health receipt and evaluated those factors that contribute most to oral health utilization. Results: Results showed that number of local dentists, health literacy and fear contributed significantly to receipt of care. However, insurance status was the primary determinant. Conclusions: This study underscores the importance of Medicaid revision to ensure equitable access to oral health care for individuals of all income levels. Furthermore, it notes that many barriers may exist simultaneously thus any long-term solution would require a fundamental change in socio-economic circumstance.