| Year | Name | Hometown | Age[b] | Local title | Placement at Miss USA | Special awards at Miss USA | Notes |
|---|
| 2024 | Christell Foote | Rocky Top | 23 | Miss Rocky Top | 3rd runner-up | Best in Evening Gown |
| 2023 | Regan Ringler | Nashville | 25 | Miss Downtown Nashville |
| 2022 | Emily Suttle | Franklin | 25 | Miss Franklin | Top 12 |
| 2021 | Elizabeth Graham Pistole | Franklin | 20 | Miss Historic Franklin | Top 16 | Best State Costume |
| 2020 | Justice Enlow | Nashville | 26 | Miss Belle Meade | Longest reigning Miss Tennessee USA at 1 year, 5 months and 1 day |
| 2019 | Savana Hodge | Nashville | 25 | Miss Davidson County |
| 2018 | Alexandra Harper[4] | Brentwood | 25 | Miss Williamson County | Top 10 | Daughter of Sharon Kay Steakley, Miss Tennessee USA 1981 |
| 2017 | Allee-Sutton Hethcoat | Franklin | 25 | Miss Williamson County | Top 10 |
| 2016 | Hope Stephens | Livingston | 20 | Miss Upper Cumberland | Previously 1st runner-up a
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