Objective To report the point prevalence of primary Sjögren’s syndrome (pSS) in the first population-based study performed in the United States. Methods Cases of all potential pSS patients living in Olmsted County, Minnesota on January 1, 2015 were retrieved using the Rochester Epidemiology Project resources, and ascertained by manual medical record review. pSS cases were defined according to physician diagnosis. The use of diagnostic tests was assessed and the performance of classification criteria was evaluated. The number of prevalent cases in 2015 was also projected based on 1976–2005 incidence data from the same source population. Results A total of 106 patients with pSS were included in the study: 86% were female, with a mean (SD) age of 64.6 (15.2) years and disease duration of 10.5 (8.4) years. A majority were anti-SSA positive (75%) and/or anti-SSB positive (58%), but only 22% met American-European Consensus Group or American College of Rheumatology criteria because the other tests required for disease classification were rarely performed in clinical practice (ocular dryness objective assessment, salivary gland functional or morphologic tests, or salivary gland biopsy). According to the physician diagnosis, age and sex adjusted prevalence of pSS was 10.3/10,000 inhabitants, but according to classification criteria this prevalence was only 2.2/10,000. The analysis based on previous incidence data projected a similar 2015 prevalence rate of 11.0/10,000. Conclusion The prevalence of pSS in this geographically well-defined population was estimated between 2 and 10/10,000 inhabitants. Physicians rarely used tests included in the classification criteria to diagnose the disease in this community setting.