OBJECTIVE: The purpose of this study was to estimate the potential injuries and costs that could be averted by implementing evidence-based road safety policies and interventions not currently utilized in one U.S. state, North Carolina (NC). NC consistently has annual motor vehicle-related death rates above the national average. METHODS: We used the Centers for Disease Control and Prevention's Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS) tool as a foundation for examining the potential injuries and costs that could be averted from underutilized evidence-based policies, assuming a $1.5 million implementation budget and that income generated from policy-related fines and fees would help offset costs. We further examined costs by payer source. RESULTS: Model results indicated that seven interventions should be prioritized for implementation in NC: increased alcohol ignition interlock use, increased seat belt fines, in-person license renewal for ages 70 and older, license plate impoundment, seat belt enforcement campaigns, saturation patrols, and speed cameras. Increasing the seat belt fine had the potential to avert the greatest number of fatal (n = 70) and non-fatal (n = 6,597) injuries annually, along with being the most cost-effective of the recommended interventions. Collectively, the seven recommended evidence-based policies/interventions have the potential to avert 302 fatal injuries, 16,607 non-fatal injuries, and $839 million annually in NC with the greatest costs averted for insurers. CONCLUSIONS: This study demonstrates the utility of the MV PICCS tool as a foundation for exploring state-specific impacts that could be realized through increased evidence-based road safety policy and intervention implementation. For NC, we found that increasing the seat belt fine would avert the most injuries, and had the greatest financial benefits for the state, and the lowest implementation costs. Incorporating fines and fees into policy implementation can create important financial feedbacks that allow for implementation of additional evidence-based and cost-effective policies/interventions. Given the recent uptick in U.S. motor vehicle-related deaths, analyses informed by the MV PICCS tool can help researchers and policy makers initiate discussions about successful state-specific strategies for reducing the burden of crashes.