Canada is beginning it’s rollout of the new Canadian Dental Care Plan (CDCP). This will provide dental care to eligible Canadian residents who don’t already have dental coverage.
individuals who wish to apply will have to meet the following criteria
- Should not have access to dental insurance: This applies if you do not have dental insurance purchased personally, through employer, though a student or professional organization, or through pension benefits
- Have an adjusted family net income of less than $90,000: This would include the 23600 income of yourself and spouse or common law partner in your tax returns.
- Be a Canadian Resident: You would have to be a Canadian Resident for tax purposes
- Have filed your tax return in the previous year
Individuals who are able to meet the above requirements are eligible to apply based on their current age. The application schedule for the different age groups are as follows,
| Age Group | Eligibility Date to Apply |
| 65+ | Can apply now |
| 18-64 | Jan 2025 |
| 0-18 | June 2024 |
| Adults with valid Disability tax Credit Certificate | June 2024 |
What is the Coverage?
Coverage is based on the adjusted household income. Different income levels affect the co-payment amount. In addition, the patient will pay the difference between the CDCP Fee Guide and the Official Provincial Fee Guide.
They will be as follows
| Adjusted Household Income | Coverage and Copayment Details |
| $0 – $70,000 | CDCP will cover all eligible fees. Patient will only pay differential between the CDCP fee and Provincial Fee Guide amount. |
| $70,000-$79,999 | CDCP will cover 60% of eligible fees while patient will pay 40% of the CDCP Fee and differential between the CDCP Fee and Provincial Fee Guide Amount |
| $80,000-$90,000 | CDCP will cover 40% of eligible fees while patient will pay 60% of the CDCP Fee and differential between the CDCP Fee and Provincial Fee Guide Amount |
CDCP Fee guide comparison to BC Dental Fee Guide
CDCP has a Provincial Level Fee guide which shows how much they will charge out for each Fee Code. This differs from the general Provincial Level Fee Guide which practices will typically use as reference to charge out their patients.
We have found that on average the difference between the CDCP Fee Guide and 2024 BC Fee Guide is approximately 17-20% for a clinic.
The variances across Procedure Types vary, i.e. Crown related fee codes will have a larger variance between the CDCP and general fee guide while hygiene related fee codes will have lower differential.
Click here to get the complete list of CDCP Fee Guide for BC
Hygiene Codes
| Fee Code | Description | 2024 BC Fee Guide | CDCP Fee Guide | Diff (%) |
| 11111 | One Unit of Time Scaling | $55.80 | $50.50 | -9.5% |
| 43421 | One Unit of Time Root Planning | $55.80 | $40.36 | -27.7% |
| 12113 | Varnish Fluoride Treatment | $23.50 | $21.10 | -10.2% |
Restorations Codes
| Fee Code | Description | 2024 BC Fee Guide | CDCP Fee Guide | Diff (%) |
| 23322 | Two Surface Bonded Perm Molars | $317.00 | $262.68 | -17.1% |
| 23323 | Three Surface Bonded Perm Molars | $390.00 | $317.60 | -18.6% |
| 23312 | Two surface Bonded Perm Bicuspids | $269.00 | $223.62 | -16.9% |
| 23321 | One Surface Bonded Perm Molars | $212.00 | $171.60 | -19.1% |
| 23313 | Three Surface Bonded Perm Bicuspids | $328.00 | $267.55 | -18.4% |
| 23311 | One Surface Bonded Perm Bicuspids | $195.00 | $160.08 | -17.9% |
| 23113 | Three Surface Bonded Technique Anterior | $254.00 | $211.59 | -16.7% |
Crowns Codes
| Fee Code | Description | 2024 BC Fee Guide | CDCP Fee Guide | Diff (%) |
| 27201 | Porcelain/Ceramic Jacket Crown, Porcelain/Ceramic | $1,051.00 | $794.66 | -24.4% |
| 27211 | Porcelain Crown Fused to Metal | $1,051.00 | $794.66 | -24.4% |
| 23602 | Resin core in conj with crown or fixed bridge ret Acid Etched/Bonded | $221.00 | $168.10 | -23.9% |
| 27301 | Normal Full Metal Crown | $979.00 | $736.90 | -24.7% |
| 29101 | One unit of time Recementing/Rebonding | $103.00 | $75.97 | -26.2% |
Exam Codes
| Fee Code | Description | 2024 BC Fee guide | CDCP Fee Guide | Diff (%) |
| 01202 | Limited Oral Previous Pat Examination and Diagnosis | $39.50 | $29.97 | -24.1% |
| 01204 | Specific Examination and Diagnosis | $53.00 | $37.60 | -29.1% |
| 01103 | Permanent Dentition Complete Oral | $141.00 | $103.21 | -26.8% |
| 01201 | Limited Oral New Patient Examination and Diagnosis | $63.40 | $44.31 | -30.1% |
| 01205 | Unmounted Cast Diagnostic | $133.00 | $83.63 | -37.1% |
Extraction Codes
| Fee Code | Description | 2024 BC Fee Guide | CDCP Fee Guide | Diff (%) |
| 02144 | Four films Intraoral Bitewing | $47.20 | $40.60 | -14.0% |
| 02601 | Single film Panoramic | $84.50 | $73.97 | -12.5% |
| 02142 | Two films Intraoral Bitewing | $30.50 | $26.23 | -14.0% |
| 02111 | Single film Intraoral Periapical | $22.30 | $19.09 | -14.4% |
| 02112 | Two films Intraoral Periapical | $30.50 | $26.23 | -14.0% |
Root Canals
| Fee Code | Description | 2024 BC Fee Guide | CDCP Fee Guide | Diff (%) |
| 33111 | Permanent One Canal | $628.00 | $458.49 | -27.0% |
| 33121 | Permanent Two Canals | $801.00 | $597.57 | -25.4% |
| 33131 | Permanent Three Canals | $1,124.00 | $848.96 | -24.5% |
| 33141 | Permanent Four Canal | $1,238.00 | $946.07 | -23.6% |
Coverage Maximums
Click here to view a full guide on the coverage maximums
The following is a Summary of what the coverage maximums would look like.
Examinations
Patients are eligible for up to 3 examinations in any 12 month period. In addition, there are restrictions based on specific exams codes. They are as follows
| Fee Description | Limitation |
| Complete Oral Examination | 1 in 60 months period |
| New patient Limited Examination | 1 per lifetime within the same office 1 in any 12 months if it’s a different office and different provider |
| Recall Examination | 1 in any 12 months |
| Specific Examination | 1 in any 12 months |
| Emergency Examination | No Specific Limit. Subject to general limit of 3 exam in any 12 month period. |
| Specialization Examination | 1 in any 60 month period per specialty (subject to GP Referral) 2 in any 60 month period if second exam is performed by different provider but within the same specialty |
| Specialist examination (limited) | 1 in any 12 month per specialty (subject to GP Referral) 2 in any 12 month period if second exam is performed by different provider but within the same specialty |
Restorations
- Once per tooth in any 24-month period
- Coverage is maximum between procedure codes prescribed or the cost of a 5 surface restoration at ~$431.6. However, if the procedure is a mix of composite and amalgam, coverage is maximum between the prescribed cost or a five surface amalgam at ~ $284
- If procedure is a mix of composite and amalgam, coverage is maximum between the prescribed cost or a five surface amalgam at ~ $284
Crowns
- Requires Preauthorization. Eligible crown types are Cast full metal, porcelain/ceramic-fused to metal, and porcelain/ceramic
- One Crown per same tooth in any 8 year period
- 4 crowns in any 10 year period in different teeth per patient
- Any crowns that are supported by implant or an implant related procedure is not covered
- Any crown procedure done for improving aesthetic or to treat sensitivities such as cracked tooth syndrome, erosion, abrasion or attrition is not covered
- Any crown procedure used to treat stress fractures or chipping on teeth that have minimal to no restoration is not covered
- Any crown procedure on patients who have generalized moderate to severe periodontal disease where there is evidence of long-standing, uncontrolled and/or untreated rampant biological disease is not covered.
Hygiene
The coverage for preventative procedures relating to Hygiene are as follows, however additional scaling units may be able to be preauthorized above 4 units per year
| Type of Procedure | Limit |
| Polishing | 0.5 units in any 12 months |
| Topical Fluoride (includes Fluoride varnish and other topical fluoride eligible treatments) | 1 treatment in any 12 months |
| Topical application to hard tissue lesion(s) of an antimicrobial or remineralization agent | 2 treatments in any 12 months |
| Scaling and Root Planing | 4 units any 12 months |
| Desensitization | 2 units in any 12 months |
Root Canals
- Preauthorization is not required for a standard Root Canal Treatment on anterior teeth, bicuspids, and first and second molar. Preauthorization is however required for root canal re-treatment, apicoectomy, retrofilling on all teeth and standard root canal on third molar.
- 1 Root Canal re-treatment, 1 apicoectomy and 1 retrofilling per tooth per lifetime
- Root Canal is subject to teeth eligibility. To be eligible. the treatment should be on incisors, canines. bicuspids, first and second molars. Third molars are only covered where the first and second molar are missing and the third molar is in occlusion due to a prosthetic or natural molar.
Example of CDCP Coverage
The following is an example of how CDCP can benefit a patient. Traditionally speaking, when a patient is charged for a procedure, a portion of the amount is charged to the patient’s insurance company and the remaining portion is charged to the patient.
In the example , the fee differential refers to the amount that the patient is responsible for.
Scenario 1
John has been approved for the CDCP plan and his adjusted household income is less than $70,000 per annum. Throughout the year, he does one recall appointment. He does 3 units of scaling, 1 unit polishing, 1 unit fluoride and 1 limited recall examination.
In addition, he gets 1 crowns done on tooth where he’s never had a crown. His provider was able to get him pre-authorized for a porcelain crown (Fee Code 27211). In addition he gets a Root Canal done on an anterior tooth meeting all the restorability requirements.
Below is the differential calculation
Recall Exam
| Fee Description | 2024 BC Fee Guide | CDCP Coverage | Patient Portion | Comments |
| 11113 – 3 Units of Time Scaling | $167.40 | $151.50 | $15.90 | Using up 3 units of coverage out of the 4 that patient has annual coverage for |
| 11101 – One Unit Polishing | $46.40 | $25.30 | $21.10 | Using up the 0.5 units of total annual coverage |
| 12113 – Varnish Fluoride Treatment | $23.50 | $5.27 | $18.23 | Using up the 0.5 units of total annual coverage |
| 01202 – Limited Oral Previous Patient Exam | $39.50 | $29.97 | $9.53 | Using up 1 examination off the 3 exams patient has annual coverage for |
| Total | $276.80 | $212.04 | $64.76 |
Crown Appointment
| Fee Description | 2024 BC Fee Guide | CDCP Coverage | Patient Portion | Comments |
| 27211 – Porcelain Crown | $1,051.00 | $794.66 | $256.34 | Using up 1 of the 4 crowns available in 10 year period |
| Total | $1,051.00 | $764.66 | $256.34 |
Root Canals Appointment
| Fee Description | 2024 BC Fee Guide | CDCP Coverage | Patient Portion | Comments |
| 33141 – Permanent Four Canals | $1,238.00 | $946.07 | $291.93 | |
| Total | $1,238.00 | $946.07 | $291.93 |
Summary of Coverage
| Appointment Detail | 2024 BC Fee Guide | CDCP Coverage | Patient Portion |
| Recall Exam | $276.80 | $212.04 | $64.76 |
| Crown Appointment | $1051.00 | $764.66 | $286.34 |
| Root Canal Appointment | $1,238.00 | $946.07 | $291.93 |
| Total | $2,565.80 | $1,922.77 | $643.03 |
John is obtaining 75% coverage for his dental services. The CDCP is covering over $1,922 of the $2,565 costs, leaving John with only $643 out of pocket to pay.
Key Takeaway
By analyzing the fee guide, we found that that the weighted average difference between the 2024 BC Fee Guide and the CDCP Guide was about 18%. The Production types and their weighted difference are as follows
| Procedure Type | Diff (%) |
| Restorations | 19% |
| Hygiene | 13% |
| Crowns | 24% |
| Exams | 27% |
| X-Rays | 14% |
| Extractions | 18% |
| Root Canals | 25% |
How To Apply?
Individuals who are eligible for application should have received a letter from Service Canada with instructions to apply by phone. Those who meet the requirements but have not received a letter can visit a Service Canada office. Click here to find a Service Canada Location nearest to you
Alternatively, eligible applicants can apply online here
Upon application, if an individual qualifies for the CDCP, they will receive a welcome package from Sun Life detailing the coverage provided and the expenses covered
Imran Sattar is the Lead Developer and Analyst for 360PowerDent, the leading Business Intelligence Tool for the dental industry.
Farooq Chaudhry is the Principal of ADA CPA, an accounting and advisory firm for Dentists and CEO of 360PowerDent, the leading business intelligence tool for the dental industry
