Services and Procedures Covered by the Canadian Dental Care Plan (CDCP)

What to Expect in this Guide

In this guide, we look at coverage provided by the CDCP in greater depth. We examine which procedures are covered and how frequently you can access dental services. We also look at how CDCP fees might compare with typical dental costs and their potential differences.

This guide aims to help you understand and navigate the CDCP more effectively. It will outline eligibility requirements and the services that are available as of November 2024. Understanding the services provided will help you manage your oral care more easily, helping to maximize the benefits of the CDCP for you and your family.

This article is specifically focused on procedures and services covered under the CDCP. For an overview of the program; roll-out timelines; eligibility requirements; and more, please refer to the “What is the CDCP” article. 

Introduction

The primary aim of the CDCP is to help prevent oral disease with regular ongoing professional dental care and treat existing dental conditions like tooth decay or gum disease. This approach will enable patients to achieve/maintain optimal dental health more easily.

Understanding the plan and its limitations is important. Not all services are covered. While some more complex procedures may be introduced later, others, such as cosmetically oriented treatments, will be excluded.

Not all patients will receive 100% coverage under the program, and it is important to understand that these services are only covered up to the fees established by the CDCP. The CDCP fees may be lower than the fee tables used by your dental office which are often based upon the provincial dental association recommendations.

Co-payments may be needed, and your dental office could apply balanced billing. Understanding all applicable fees is vital before you have any dental treatment. Your dentist will be able to provide details on any out-of-pocket costs ahead of your appointment.

Eligibility and Enrollment

Requirements for enrollment include:

• Canadian resident
• An annual net family income of less than $90,000.
• Has filed an income tax return for the previous year.
• No access to dental insurance, either privately, with an employer, or through a pension plan.

Enrollment is phased. As of June 2024,  those aged 65 and older, those with a valid Disability Tax Credit Certificate and children under the age of 18 can apply.

All other Canadian citizens and residents who do not fall into the above groups will be able to apply in2025.

Once enrolled, CDCP coverage is for twelve months. If you continue to qualify, you must re-enroll annually.

What Services are Covered by the CDCP?

Oral health services covered under the CDCP include basic, diagnostic, preventive and restorative procedures.

Services that can be covered under the CDCP include:

• Diagnostic and preventive services.
• Basic and major restorative services.
• Periodontal services.
• Certain orthodontic services from 2025.
• Endodontics.
• Anesthesia and sedation.

The following sections examine which services are covered more thoroughly, including tables showing how frequently you can access these treatments under the CDCP.

Diagnostic and Preventive Services Covered Under CDCP

Dental diagnostic services and exams

These are the services most people access regularly. They include new patient and recall dental exams and emergency and specialist dental examinations.

See the table below to understand the services covered and how frequently you can access them.

If you need to see a dental specialist or a denturist, these visits are not counted against the annual recall exams covered by the plan.

Diagnostic services and frequency of access

Diagnostic Service	Frequency
Comprehensive dental examination	1 in 60 months. This replaces recalls and new patients' limited dental exams for the eligibility period.
New patient limited examination	1 per lifetime, with the same or different dental care provider in the same dental office. 1 per year with a different dental care provider in a different dental office.
Recall dental examination	1 in 12 months.
Specific dental examination	1 in 12 months.
Emergency dental examination	No limit
Specialist dental examination - complete (requires preauthorization)	One visit per specialty in any 60 months, and up to 2 for the same period if a different provider of the same specialty gives the exam. A complete exam provided by a dental specialist in 12 months replaces a limited specialist dental exam limited and diagnosis within the same specialty in those 12 months.
Specialist dental examination -limited	1 in any 12 months with a doctor's referral. Up to 2 in 12 months if the second dental exam is given by a different dental specialist than the original dental specialist who gave the initial examination.
First dental visit up to age three	1 per lifetime.

The diagnostic services covered by the CDCP are comprehensive. The frequency limitations should allow most patients to maintain their dental health more easily and to access emergency dental care when needed.

Professional Dental Cleanings, Fluoride Applications and Dental Sealants

Professional dental cleanings (scaling and polishing) and topical fluoride applications are covered. The frequency of access to coverage is outlined in the table below.

Dental cleanings, fluoride applications and dental sealant services with frequency of access

Preventive Service	Frequency age 0-11	Frequency age 12-16	Frequency age 17+
Scaling	½ unit in 12 months.	1 unit in 12 months.	4 units in 12 months
Polishing	½ unit in 12 months.	½ unit in 12 months.	½ unit in 12 months.
Topical fluoride application, including fluoride varnish	1 treatment in any 6 months.	1 treatment in any 6 months	1 treatment in 12 months.

Dental sealants help protect certain surfaces of the teeth from decay. There is a lifetime limit of two sealant applications per eligible tooth for permanent molars and premolars in children 17 and under.

Dental X-rays

Dental X-rays are necessary periodically to assess your dental health or when your dentist needs to diagnose a specific problem, for example, if you develop a toothache and a tooth infection is the suspected cause.

X-rays and frequency of access

Dental x-ray	Frequency
Complete set of bitewing, intraoral and periapical X-rays	1 set in any 60 months.
Up to 8 intraoral, bitewing, periapical and occlusal X-rays	8 in 12 months.
Panoramic x-rays	Up to 3 per lifetime, 1 in any 60 months.

^{Basic and Major Restorative Services}

The CDCP covers a range of restorative services. These include fillings, posts and cores (used to strengthen teeth) and dental crowns. The primary purpose of these services is to preserve and protect natural teeth. Other restorative services include prosthodontics (dentures).

Dental Fillings, Crowns,Posts and Cores

Crowns, posts and cores need preauthorization. They are only covered when the loss of tooth structure is significant enough to warrant a crown, and when the tooth is still strong and healthy enough to be restored.

The plan will not cover crowns or other restorative services required only for cosmetic purposes. An example is incisal wear and tear, where you have worn down tooth enamel and dentin. The Dental Benefits Guide considers this a cosmetic issue that is therefore excluded from the plan.

The CDCP also has comprehensive guidelines on the type of restorations it will cover. The type of restorations covered can depend on whether primary (baby) teeth require treatment rather than permanent (adult) teeth. Because primary teeth are replaced with permanent teeth, the CDCP may cover the cost of a stainless steel crown that, while less aesthetically pleasing, will fall out when the adult tooth replaces the baby tooth.

Crowns, posts and cores, and dental filling and frequency of access

Dental Service	Frequency
Crowns (need preauthorization)	1 per eligible tooth in any 96 months, 4 in any 120 months per patient.
Crown repairs	1 in any 36 months per tooth.
Prefabricated posts without a core (do not require preauthorization) Prefabricated posts with a core (require preauthorization), and Cores (require preauthorization)	Only for permanent teeth, 4 in any 120 months.
Dental fillings	1 per tooth in any 24 months, by the same dental professional or different dental professional in the same dental office.

The rules surrounding restorative services are complex. If you require a dental crown, post and/or core, ask your dentist to explain what type of crown you will receive and any additional costs.

Prosthodontic Services

Prosthodontics is the use of dental prosthetics to replace one or more missing teeth. Traditional dentures have an acrylic, gum-coloured base supporting denture teeth.

If you have lost a complete arch of teeth, you would need a full denture. Partial dentures restore one or more missing teeth in the same arch and can include a metal framework. When you first have a partial denture, you may require preauthorization. Preauthorization would not be required for any replacements in the future.

The CDCP does not cover complete or partial dentures supported by dental implants or any implant procedures related to denture services.

Prosthodontic services and frequency of access

Dental Service	Frequency
Complete dentures - standard, immediate, overdentures (complete standard dentures do not require preauthorization; immediate complete dentures, complete overdentures, and standard complete dentures with long-term soft liner require preauthorization)	1 per arch in any 96 months.
Complete dentures that are provisional or transitional	1 per arch per lifetime.
Partial cast (metal) dentures (initial placements require preauthorization)	1 per arch in 96 months.
Partial acrylic dentures, including standard, overdentures, and immediate dentures (initial placements require preauthorization)	1 per arch in 60 months.
Partial acrylic dentures that are provisional or transitional (require preauthorization)	1 per arch in 60 months.
Additions and repairs	1 per denture in 12 months.
Rebasing/relining	1 per denture in 24 months.
Tissue conditioning	1 per denture in 24 months.

Periodontal Services

Scaling and root planning are services that help to treat periodontal disease (gum disease). Periodontal disease is an infection that can cause tooth loss. While scaling is required for almost all patients, you may need additional scaling and/or root planing if your gums are significantly infected and have begun to recede, and where you have considerable tartar buildup on your teeth.

People aged seventeen or over can receive up to four units of scaling, including root planning, in any twelve-month period. Preauthorization up to this limit is not required. If someone needs additional units, then preauthorization is required.

Orthodontic Services

Orthodontic services are scheduled to be introduced in 2025. Preauthorization will be needed, and orthodontics will only be available when treatment improves oral health. It will not be available for people who wish to improve the alignment of their teeth cosmetically and who do not require orthodontics for dental health purposes.

Coverage may be considered in the following situations.

• Children under age 18 with severe functionally handicapping malocclusion. Malocclusion means teeth are out of alignment and do not bite together correctly.

• Adults with issues like a cleft lip or palate associated with a severe malocclusion.

The clinical criteria for both situations must be met using a test to assess how far a person's malocclusion deviates from a normal occlusion and tooth alignment.

Endodontic Services (Root Canal Therapy)

Root canal treatment is covered and would not normally require preauthorization if it is for an adult tooth that meets all eligibility criteria. Infected wisdom teeth (third molars) would generally be extracted unless you are missing the first and second molars.

Restorability is considered, as a tooth must be suitable for restoration after root canal treatment to be eligible. Conditions such as advanced tooth decay or advanced gum disease that could affect the longevity of root canal treatment may render the tooth not eligible.

Sometimes, a tooth that has received root canal treatment can become re-infected. If this is the case, preauthorization for re-treatment is required.

Endodontic services and frequency of access

Dental Service	Frequency
Root canal, apicoectomy, re-treatment, retro-filling	1 of each service per tooth per lifetime.

Anesthesia and Sedation

Minimal sedation is available without requiring preauthorization. Moderate and deep sedation requires preauthorization. Preauthorization may be waived if you have a dental emergency.

Anesthesia and sedation services and frequency of access

Dental Service	Frequency
Minimal sedation - nitrous oxide or a single oral sedative, or a combination of both	4 sessions in 12 months.
Moderate sedation (preauthorization required, but post-determination in emergencies can be considered)	1 session in 12 months.
Deep sedation and general anesthesia (preauthorization required, but post-determination in emergencies can be considered)	1 session in 12 months.

^{Financial Aspects}

^{Provincial Fee Guides}

The dental association in each province produces an annual suggested fee guide for dentists. The guide outlines codes and code descriptions for multiple different dental treatments. The CDCP follows its own fee guide, which determines the fees the CDCP will pay for services covered under the plan. These fees can differ from provincial or territorial fee guides.

Dentists are not obligated to follow the fee guide and can determine their fees based on the costs of running their dental office. For example, a dental office in a large city with a high cost of living must factor in the cost of rent, staff wages, etc. when determining their fees.

Understanding Co-Payments and Out-of-Pocket Costs

Not all patients will receive complete financial assistance through the CDCP due to required co-payments, so it is important to ask about costs not covered by the plan. These co-payments are the portion of treatment costs you would be expected to cover out of pocket, and the percentage is determined by your family's net annual income shown on the previous year's tax return. Co-payment or fees not covered are paid directly to the dental office.

^{Table on co-payments based on adjusted family net income. Please note the percentages covered are for the CDCP fee guide, which is sometimes lower than the provincial guides.}

Net Family Income	% Covered by the CDCP	% Covered by Patient
Below $70,000	100	0
$70,000 - $79,999	60	40
$80,000 - $89,999	40	60

Additionally, when a dentist follows their established fee structure, it may be higher than the CDCP's fees, in which case there is a gap in payments. The gap can be filled by balanced billing, where the patient is billed for the difference between the CDCP fees and the fee their dentist would normally charge a patient.

For example, if a dentist follows the provincial fee guide and charges $100 for a dental procedure but the CDCP fee structure only covers $90 the patient is responsible for the $10 difference. In the same example, for a patient with a net family income of $85,000, the plan would cover $36 (40% of the CDCP established fee) and the patient would be responsible for $54 (the remaining 60% of the CDCP established fee) plus the additional $10. Please note these figures are for illustration only.

Additional Considerations

Preauthorization

Services requiring preauthorization will be available from November 2024. These are services that extend beyond the established limits outlined in the guide. Approval is necessary before you can receive the treatment.

The CDCP Dental Benefits Grid

The CDCP maximum fees for specific services are in the CDCP Dental Benefits Grid. Dental professionals use the grid to identify the correct codes to submit for payment. It is not meant for patients, but it is useful for understanding a little more about how the CDCP works.

Different grids exist for each province or territory and different types of oral health providers in the province or territory. Services requiring preauthorization are outlined in the CDCP Dental Benefits Grid.

Each grid is split into two schedules, A and B. Schedule A covers services that do not need preauthorization. Schedule B lists those services requiring preauthorization to be covered by the plan.

Dental Laboratory Fees

Some services, such as dentures or dental crowns, must be fabricated in a dental laboratory. These fees can be considered for coverage when submitted to the CDCP with the approved procedure codes. The CDCP may adjust the fees requested and might need to see a copy of the lab report.

Conclusion

The CDCP's objective is to make dental care more accessible for families who qualify and covers oral health services designed to prevent and treat oral disease and to maintain healthy teeth and gums.

• If you qualify for the CDCP, check with your dental office to see if they accept CDCP coverage. Participation is voluntary and it is up to individual providers. .
• Even if your dentist participates, you should ask about out-of-pocket costs. There can be a difference between the CDCP Dental Benefits Grid fees and those your dental office charges. You will be responsible for any outstanding fees and asked to pay at the time of your appointment..
• When you see your dentist for a dental exam and diagnosis, ensure you understand any proposed treatment plan, including co-payments and additional costs. It's important to keep in mind that the dentist will recommend treatment based on your specific dental health needs, not based on what is covered under the CDCP. The final treatment decisions are always up to the patient and should consider all the information available.

*While we strive to provide accurate and comprehensive information in this blog post, the CDCP may undergo updates or changes over time. For the most current and precise details regarding the plan, Please visit the program website.