Understanding the Canadian Dental Care Plan (CDCP)

The Canadian Dental Care Plan (CDCP) is a federal program designed to improve access to dental care for eligible Canadians who do not have private dental insurance and whose household income is below certain thresholds.

While the program helps reduce the cost of dental treatment, it is important to understand that CDCP operates differently than traditional dental insurance plans.

Coverage levels may vary depending on:

• Household income
• Type of treatment
• Eligibility requirements
• Pre-authorization approvals

Below is an overview of how CDCP coverage typically works in a dental office setting.

Fee Guide Differences

CDCP helps reduce the cost of dental care, but it does not always cover the full cost of treatment.

The program uses a separate government fee schedule, which is generally lower than the Ontario Dental Association (ODA) fee guide used by most dental offices. Because of this difference, even when a CDCP plan shows 100% coverage, the reimbursement may still be lower than the actual treatment cost.

This means a patient balance may still remain after CDCP payment.

To help reduce this gap, our office offers a 10% courtesy discount on eligible services. However, any remaining balance after CDCP reimbursement is the patient’s responsibility.

Coverage levels also vary depending on household income, and some services may only be partially covered.

Cleaning Coverage Limits

CDCP has strict annual limits for routine hygiene services.

For adults, coverage typically includes up to 4 units of scaling per benefit year, which generally allows for one routine hygiene appointment per year to be largely covered. Additional hygiene visits within the same benefit year often receive limited or no coverage.

Children’s hygiene coverage may be more restricted and can vary depending on age.

When CDCP coverage is limited or unavailable, our office offers reduced hygiene rates to help manage treatment costs:

Adults: up to $144.00.
Children (0–11 years): up to $75.00.
Children (12–16 years): up to $120.00.

These reduced hygiene rates apply when CDCP does not fully cover the appointment.

Pre-Authorization for Certain Treatments

Some dental procedures require prior approval (pre-authorization) from the CDCP administrator before treatment can be completed.

This may apply to services such as:

• Crowns
• Dentures
• Additional scaling beyond the yearly limit
• Certain treatments outside routine preventive care

Important things to know about pre-authorization:

• Approval is not guaranteed and is determined by the CDCP administrator.
• Requests for additional scaling units often have a low approval rate.
• Major treatments may be more likely to receive approval when eligibility criteria are met.
• When approval is granted, authorizations are usually time-limited and may change if the plan updates or renews.

Fee Estimates and Appointment Changes

If you would like an estimate of fees or potential copayments, please contact our office at least one week before your appointment. This allows our team time to review your coverage and submit an estimate.

If, after reviewing the estimate, you decide to adjust or postpone your appointment, we are happy to help.

Please note:

• Appointment changes must be made at least 48 hours in advance to avoid our cancellation policy.
• Fee estimates are based on the information available at the time and are not a guarantee of insurance payment.
• Final coverage is determined when the claim is processed by CDCP.
• Claims are submitted on your behalf, but any portion not covered remains the patient’s responsibility.

Benefit Year Responsibility

Active CDCP coverage must be confirmed before your appointment.

If your plan has not yet been activated, regular office fees will apply.

Patients are responsible for knowing their CDCP benefit year start date, which is based on the activation date listed on their CDCP approval letter. Coverage limits and available services reset according to this benefit year.

Questions About Your CDCP Coverage

Our team is happy to help patients understand how the Canadian Dental Care Plan works and how it applies to their treatment. Because coverage details can vary, we encourage patients to contact our office ahead of their appointment if they have questions about eligibility, copayments, or treatment estimates.