Quick Summary
Canadian residents enrolled in the Canadian Dental Care Plan (CDCP) can now request pre-authorized services through their dentist or oral healthcare provider. Here are the most important points:
A brief overview of the most important points is below.
- Routine dental care is covered and does not require pre-authorization, including checkups, cleanings, extractions, and fillings.
- Only specific services need pre-authorization. Obtaining this approval before booking a treatment is essential to ensure treatment is covered under the CDCP. Services that require pre-authorization include, but are not limited to, root canals on molars and multi-rooted teeth, dentures (both full and partial), crown restorations, oral surgery procedures like complex extractions and surgical implants, and major periodontal procedures (such as deep cleaning and gum surgery).
- Dental care providers submit all approval requests. Patients cannot submit requests directly.
- Approval is typically valid for 12 months. Certain services (such as periodontal care) are valid for up to 24 months.
- If pre-authorization is denied, your provider can appeal with new information. All appeals must be made within 60 days of a request being denied.
What to Expect in This Guide
This article covers the pre-authorization process in detail. The points covered include:
- An easy-to-read table showing which services need pre-authorization.
- A clear explanation of how a request is submitted. Learn which documents are needed and how a request is processed.
- The process for appealing a decision.
- Treatments not covered by the CDCP.
Introduction
The CDCP covers essential preventive and restorative services needed to maintain oral health. However, as the CDCP Dental Benefits Guide outlines, these services are limited.
Pre-authorization is necessary if you require more specialized treatment or if limits are exceeded. Approval must be obtained before treatment begins to ensure the cost is covered up to the amount defined by the CDCP.
Co-Payments Still Apply to Pre-Authorized Services
Pre-authorized services are still subject to co-payments and, where applicable, balanced billing fees. Your oral healthcare provider can advise you on any out-of-pocket costs before the work begins.
Where to Find Information on Services Covered
The CDCP Dental Benefits Grid provides extensive information on all services covered under the CDCP. It has sections for each service. Services in these grids are divided into Schedule A and Schedule B.
Schedule A covers all the routine treatments needed for optimal dental health.
Schedule A Treatments – Pre-Authorization Generally Not Needed
These treatments include:
- Routine exams and X-rays
- Cleanings and scaling
- Fluoride and sealants
- Fillings and uncomplicated root-canal therapy (except wisdom teeth or re-treatments)
- Simple extractions
- Repair or relining of full or partial dentures
You wouldn't generally need pre-authorization if you require a service outlined in Schedule A.
However, if you require additional Schedule A services that exceed the dental benefits limits, then pre-authorization is needed. For example, if additional scaling is needed during a routine hygiene treatment, pre-authorization is required.
Schedule B Treatments – Pre-Authorization Always Needed
| Service / Category | When Pre-Authorization Is Needed | Frequency Limits |
|---|---|---|
| Specialist examination – complete (periodontist, oral surgeon, etc.) | Always | 1 per specialty every 60 months (max 2 if a different provider performs the second exam) |
| Crowns, posts & cores | All crowns and associated cores/posts | Max 4 crowns per patient / 120 months; 1 per tooth / 96 months |
| Complex endodontics – root-canal re-treatment, apicoectomy, retrofilling, or RCT on third molars | Always | 1 procedure per tooth / lifetime |
| Additional periodontal scaling / root planing (extra units) | When requested units exceed the annual limit | Std limits: 4 units / 12 mo (17+ yrs). Extra units considered only via pre-auth |
| Interproximal disking of teeth | Always | 1 unit / 12 mo |
| Removable partial dentures (acrylic or cast) – initial placement | Always | Acrylic: 1 per arch / 60 mo; Cast: 1 per arch / 96 mo |
| Immediate complete dentures, overdentures, complete dentures with long-term liner, or transitional/provisional complete dentures | Always | 1 per arch / 96 mo (transitional complete: once per lifetime) |
| Denture labelling (adding ID to a new denture) | Always, even if the denture itself didn't need pre-auth | Considered with denture request |
| Major oral-surgery procedures (e.g., impacted tooth exposure, fracture reduction, jaw surgery) | Always (except true emergencies – then post-determination) | Procedure-specific; consult the benefit grid |
| Sedation | Minimal sedation – extra sessions above 4 / 12 mo; Moderate sedation – always; Deep sedation & general anesthesia – always | Minimal: 4 sessions / 12 mo; 1 session / 12 mo for moderate or deep / general anesthesia (extra sessions require separate pre-auth) |
| Medically necessary orthodontics (available 2025) | Always | Strict criteria (severe cases as determined by the HLD score; children <18 or adults with craniofacial anomaly) – distinct plan-set limits |
| Any Schedule A service requested above its normal frequency limit (e.g., extra hygiene, fluoride, exams) | When exceeding published limits | Limits vary – see Benefits Guide; exceeding them triggers pre-auth |
The table above covers all treatments needing pre-authorization. The CDCP Dental Benefits Guide provides more extensive information and is the official source.
However, asking your oral healthcare provider for a more detailed explanation of the services covered and those needing pre-authorization is best. This is because the information provided in the CDCP Dental Benefits Guide is detailed and can contain technical terms that are confusing without a clinical background in dentistry.
Your oral healthcare provider should be able to explain the proposed treatment plan to you clearly and without using hard-to-understand technical terms.
Only Dental Health Professionals Can Request Pre-Authorization
Pre-authorization can only be requested by your oral health practitioner. Patients cannot apply directly as the application must be supported by relevant documentation, such as X-rays and completed forms.
How Is Pre-Authorization Requested?
Several steps are involved to secure pre-authorization:
1. Discussion of Your Treatment Plan
After your dental exam, your oral healthcare provider can provide you with a custom treatment plan. They can explain why they recommend a Schedule B treatment or if your care plan exceeds the CDCP coverage limits.
Your oral healthcare provider can explain each proposed dental treatment clearly, including any required co-payments.
2. Gathering Clinical Information
Your oral healthcare provider must complete specific forms and provide clinical evidence to support their pre-authorization request. The information typically includes your treatment plan, recent X-rays, dental charts and photos.
3. Submitting Your Claim to Sun Life
Sun Life administers the CDCP on behalf of the Government of Canada, and they process all pre-authorization requests. Your oral healthcare provider securely submits your request via Electronic Data Interchange (EDI) or mail.
It may take several weeks to receive an answer.
4. Decision
Once Sun Life has decided, your oral healthcare provider receives an Explanation of Benefits (EOB). The EOB will show whether your claim is approved or denied and the dollar amount covered.
Once received, your dentist will share this information and explain which benefits are covered and if any have been denied.
If you receive a copy of your EOB and have not heard from your dentist, call the practice to either speak with the dentist or book an appointment for the procedure if you're comfortable.
5. Book Your Appointment
If your treatment is approved, you can book your appointment and begin treatment. Approval is valid for at least 12 months. Some treatments, such as periodontal or preventive care, are valid for 24 months. To receive coverage, you must still be eligible for the CDCP when the treatment is provided.
What if Pre-Authorization is Denied?
Not every pre-authorization request will be approved. If frequency limits for a treatment have already been reached, a new submission may not be approved. It may be denied if the submission does not meet the required clinical criteria.
Don't panic, as it can be appealed.
Appealing a Decision
If your request is denied, your oral healthcare provider can appeal on your behalf. Below are some points to consider.
- A reconsideration request must be filed via EDI or mail within 60 days of treatment denial.
- You can only appeal once.
- New information is needed. Your dentist must provide additional or new information showing that treatment is clinically necessary. The information might be new X-rays or a letter from a dental specialist.
- A different adjudicator at Sun Life reviews your resubmission.
- Their decision is final. If treatment is denied again, you must consider financing it yourself or discuss other treatment options with your oral healthcare provider.
Post-Determination – When Emergency Dental Care is Needed
Some emergency treatments requiring pre-authorization cannot wait. If you need an emergency procedure that requires pre-authorization, your oral healthcare provider can submit a claim for post-determination.
In this case, they must explain why they couldn't wait for pre-authorization and provide clinical information to support this claim. Eligibility for post-determination coverage is based on the same criteria as for pre-authorization.
Pre-Authorization for Treatment Exceptions
If your oral healthcare provider believes you genuinely need a service not covered by the CDCP and there is no alternative and it is not an exclusion, they can request an exception.
These requests are submitted to Sun Life but are adjudicated by Health Canada. Treatment exceptions are rare.
Services Not Covered by the CDCP
The CDCP does not cover some services. These are mainly cosmetically oriented but also include dental implants and treatments associated with implants.
Below are some examples of treatments where you are responsible for 100% of the costs.
- Cosmetic veneers (porcelain or composite)
- Inlays, onlays or ¾ crowns
- Teeth whitening
- Implants and bone grafts
- Fixed bridges
- TMJ (jaw joint) therapy and appliances
- Night-guards / bruxism splints
- Precision-attachment dentures
Key Takeaways from This Article
- Check your provider's CDCP participation when you book.
- Most routine dentistry is covered automatically under Schedule A.
- Your dental team does the paperwork; you simply consent and wait for the green light.
- Keep an eye on timelines: approval can take weeks but is valid for a year.
- Appeal quickly (within 60 days) if denied — and provide extra evidence.
- Know the exclusions, co-payment, and balanced billing costs so there are no surprises.
Pre-authorization approval does not determine if the proposed treatment plan is right for you; this is decided between you and your oral healthcare provider. The process is to confirm if the treatment plan meets coverage criteria and can be covered under the CDCP.
