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what could cause the total on hand count for a serialized item in a given location to not match the total number of serial numbers currently on hand in that same location?

If the serial number is changed by anyone during receipt/fulfillment, or anywhere in between, it can cause on hand/available mismatches

Another scenario could be an SO with a fulfillment and the serial item is marked as picked or packed and then the SO is closed.

Thanks <@U5DRRAXKN> - I actually found an adjustment for one of the items without a serial number specified, so that's the source of most of the discrepancies, I think

<@U29JEQVL6> sounds like it. Serial/lot numbers can be fun sometimes!