Canadian Dental Care Plan

Eligibility & Requirements

To qualify for the Canadian Dental Care Plan (CDCP), individuals must meet several key criteria. They must be residents of Canada for tax purposes and have an adjusted family net income of less than $90,000. Applicants must not have access to any other dental insurance coverage, whether through employment, a pension plan, a family member, or voluntary insurance. This “no access” rule is strict; even declining an offered dental plan counts as having access and disqualifies eligibility. Additionally, applicants must have filed a tax return for the previous year to confirm their income level. The CDCP was initially rolled out to seniors, children, and persons with disabilities, but by 2025 it will cover all income-qualified individuals who meet these requirements. The program aims to ensure affordable dental care access for Canadians who do not have private or workplace dental coverage.

What Dental Services Are Covered

CDCP covers a broad set of oral health services, grouped by category. However, many services require preauthorization (approval in advance) if they exceed standard limits or are more complex.

Here are the main categories:

Diagnostic & Preventive

• Dental exams (routine, emergency)
• X-rays
• Cleanings / scaling
• Fluoride applications
• Sealants

Restorative / Basic

• Fillings (permanent and temporary)
• Pain control for decayed teeth

Endodontics (root canal / related)

• Root canal treatment, pulpectomy, retreatments (with preauthorization)

Periodontal (gum and supporting structures)

• Cleaning under gumline, treating abscesses, non-surgical gum disease therapies.
• Bonding of mobile teeth, post-surgical evaluations (some require preauthorization.)

Prosthodontics (removable dentures, etc.)

• Complete dentures, partial dentures, denture repairs, relines, rebases.
• Some prosthodontic services require preauthorization for eligibility.

Oral Surgery

• Tooth extraction and root removal.
• Surgical removal of tumours, cysts; management of jaw fractures.

Sedation / Anesthesia

• Minimal sedation is covered.
• Moderate, deep sedation, general anesthesia are possible but require preauthorization.

Orthodontics (coming in 2025)

• Orthodontic services are not yet broadly covered; starting in 2025, limited coverage will be available for cases of medical necessity, under strict criteria.

Cost Sharing / Co-Payments & Fees

Because CDCP is not free care, cost sharing is structured based on adjusted family net income. The proportion covered by the CDCP (versus what the patient must pay) is roughly:

Income bracket	CDCP pays	Patient co-payment (of CDCP “established fees”)
Below $70,000	100 %	0 %
$70,000 – $79,999	60 %	40 %
$80,000 – $89,999	40 %	60 %

A few notes:

• “Established fees” means there is a fee schedule defined by CDCP for specific dental procedure codes. These may be lower than what dentists customarily charge. If a dentist charges more than the CDCP fee, the patient might have to pay the difference (if the dentist agrees to do so).
• For services beyond the frequency limits, or services that require preauthorization, the CDCP may grant exceptions, but the dental provider and the patient need to follow submission and approval rules.
• Some services are explicitly excluded (see section below).

Exclusions & Limitations (What CDCP Does Not Cover)

CDCP does not cover certain types of dental services. Some typical exclusions are:

• Cosmetic procedures (e.g. tooth whitening, veneers)
• Implants (dental implants) are not covered under CDCP.
• Fixed prosthodontics (permanently affixed bridges, etc.), bone grafting, certain specialized adjunctive procedures.
• Services already declined by the CDCP through preauthorization or not eligible under its policies.
• Some minor services or adjustments have changes in coverage over time (for example, a few services removed in the 2025 update).

Also, not all dentists necessarily participate in CDCP (i.e. agree to bill CDCP under its reimbursement rules). Patients need to check whether their dental provider participates.

Application, Enrolment & Implementation

• The government began a staggered rollout from late 2023 into 2025, starting with elderly populations and children, then expanding to all eligible income-qualified persons.
• Eligible individuals will receive a letter inviting them to apply.
• Once enrolled, individuals get a CDCP card, coverage details, and a start date for coverage. Only services rendered after the coverage start date are covered.
• Providers must confirm client’s coverage before providing treatment (via an Electronic Data Interchange estimate or via contact).
• For services needing preauthorization or exceeding certain frequency limits, providers submit documentation ahead of time; some services might also use post-determination in emergencies.
• The CDCP Dental Benefit Grids (procedure codes with allowable amounts) are published (e.g. 2025 grids).

Call us at 519-576-2170 or click here to book your dental appointment. We’re here to help because at Kitchener Dentist Sherwood Dental, your dental health is our priority.