Awareness of coronary artery calcium scanning by computed tomography as a reproducible, low-radiation dose means to estimate plaque burden in patients necessitates clinical recommendations for interpretation. Coronary artery calcium scanning is best applied in the intermediate risk, asymptomatic adult population. Calcium scores >100 or >75th percentile transform the intermediate risk patient to high risk with recommendations for more aggressive therapy. Scores exceeding the 90th percentile or >400 define the group at the highest risk of a cardiovascular event and may suggest further cardiac testing. Scores from 11 to 100 and <75th percentile confirm intermediate risk status, and scores from 0 to 10 and <75th percentile convert the patient to low or very low risk.