Public health interventions in North Carolina were implemented only for children with blood lead levels (BLLs) ≥10 µg/dL until the end of the year in 2017, although the Centers for Disease Control and Prevention (CDC) established 5 µg/dL as a revised reference value for identifying children with elevated BLLs in 2012. This study quantified and characterized the children with elevated BLLs in Buncombe County, North Carolina. A review of case reports of Buncombe County children was conducted through the North Carolina Lead Surveillance System online database. In all, 23 children had confirmed elevated BLLs (≥10 µg/dL) from 2005–2015, while 146 children had BLLs within 5 to <10 µg/dL from 2012–2015. Most of the identified children (62%) lived in Asheville and were 1–2 years old (65%). A significant number of children will be aided and prevented from further lead exposure since North Carolina has lowered the BLL intervention standard to the CDC reference value in 2012. The need for additional staffing at local health departments has been identified to adapt to such change.