Objective This study describes processes used to develop and test pediatric oral healthcare quality measures and provides recommendations for implementation. Methods At the request of the Centers for Medicare and Medicaid Services, the Dental Quality Alliance (DQA) was formed in 2008 as a multi-stakeholder group to develop oral healthcare quality measures. For its initial focus on pediatric care, measure development processes included a literature review and environmental scan to identify relevant measure concepts, which were rated on importance, feasibility, and validity using the RAND/UCLA modified Delphi approach. These measure concepts and a gap assessment led to the development of a proposed set of measures that were tested for feasibility, reliability, and validity. Results Of 112 measure concepts identified, 59 met inclusion criteria to undergo formal rating. Twenty-one of 59 measure concepts were rated as "high scoring." Subsequently, 11 quality and related care delivery measures comprising a proposed pediatric starter set were developed and tested; 10 measures met feasibility, reliability, and validity criteria and were approved by the DQA stakeholder membership. These measures are currently being incorporated into Medicaid, Children's Health Insurance Program, and commercial quality improvement programs. Conclusions Broad stakeholder engagement, rigorous measure development and testing processes, and regular opportunities for public input contributed to the development and validation of the first set of fully specified and tested pediatric oral healthcare quality measures, which have high feasibility for implementation in both public and private sectors. This achievement marks an important essential step toward improving oral healthcare and oral health outcomes for children.