What the CDCP Covers: care by category, and what needs authorization

Many new members arrive at the clinic with the same idea in mind: I'm covered, so everything is free and automatic. The reality is more nuanced. The care covered by the CDCP forms a broad list, but that list splits into two very distinct worlds: the procedures reimbursed directly, and those that must first receive an administrative green light. The official list of services covered by the plan says it plainly: many services are covered without preauthorization, others are not. Knowing where your treatment falls means avoiding the nasty surprise when it's time to settle the bill.

The care covered by the CDCP, category by category

The plan's Dental Benefits Guide, in force since April 1, 2026, sorts oral care into clear families: diagnostic, prevention, restoration, endodontics, periodontics, removable dentures, oral surgery, sedation. Orthodontic services, for their part, are announced for a still-undetermined date.

Behind this classification, a simple principle. The plan covers what prevents or treats an oral disease, not what is a matter of comfort or a magazine smile. An exam, an X-ray, a cleaning, a filling: that is the foundation. A root canal on an ordinary molar too. A detail that matters in Quebec: CDCP rates draw notably on the guide of the Association des chirurgiens dentistes du Québec, which anchors the plan in the reality of clinics here. But each procedure carries its own frequency limits, and that is often where it gets stuck. Three exams at most over twelve months, not one more. A filling reimbursed only once per tooth surface over twenty-four months. The plan counts by continuous period, tooth by tooth, surface by surface. The reasoning may seem finicky, but it has the merit of being written in black and white. Behind the scenes, it is Sun Life that administers all of it, and the list of professionals authorized to bill goes beyond the dentist alone: denturists, independent dental hygienists, and specialists are also part of it, each within their scope of practice.

Care covered without preauthorization

The majority of routine care requires no prior step. You book an appointment, the dentist treats you, and Sun Life reimburses according to the established rates. This group includes recall exams, X-rays within the set ceilings, scaling, fluoride application, sealants for those under seventeen, fillings. And, a detail many patients do not know, standard root canals on incisors, canines, premolars, and the first two molars. No authorization to obtain for those roots.

For an adult seventeen and older, a few markers come up often: one recall exam per year, up to eight intraoral X-rays over twelve months, four scaling units per year, one filling per surface every twenty-four months. None of these procedures requires preauthorization. Conversely, crowns, dentures, oral surgery, and sedation all go through approval before treatment. These figures come straight from the federal guide. A good reflex is to have your coverage confirmed by the clinic before the appointment. The dentist checks your file in seconds with Sun Life, electronically, and knows at once how many units you have left in the period. There is no need to play guessing games. Also worth knowing: a complete X-ray series comes once every five years, and a panoramic X-ray is capped at three over a lifetime. Enough to document a file without multiplying needless images.

Prevention and young patients: rules of their own

Children and teens do not follow exactly the same schedule as adults, and that is rather good news for families. Topical fluoride, for example, is covered twice a year until sixteen, versus once a year past that age. Pit and fissure sealants, those thin layers that protect molars from cavities, are covered for those seventeen and under, with a limit of two per eligible tooth over a lifetime.

The plan also provides a first orientation visit for toddlers up to age three, once in a lifetime, to get used to the chair without stress. Another modern tool covered: the application of silver diamine fluoride, which halts a cavity's progression without a drill or anesthesia, up to twice a year. For a parent, these details change everything. They make it possible to build a real prevention routine rather than chasing after emergencies.

The CDCP procedures that require preauthorization

This is where the fog sets in. Some care is covered, yes, but only after Sun Life reviews the file, and always before treatment begins. The crown is the classic example: it is considered only for those eighteen and older, on a complete X-ray and periodontal file, with a ceiling of four crowns over ten years. Same path for canal retreatments, a root canal on a third molar, oral surgery, sedation, or additional scaling units. Not all teeth are equal in the plan's eyes either. A crown or a root canal is only considered on incisors, canines, premolars, and the first two molars. The third molar qualifies only in rare cases, when it alone ensures the bite.

Removable dentures follow this approval path, whether partial or complete. If you are considering this solution, it is worth knowing in advance how a denture is prepared under the plan rather than discovering it along the way. The authorization is nothing like a formality. Requests are weighed on strict clinical criteria, backed by X-rays and a periodontal chart, and not all are granted. Worse: a crown approved today can be refused for reimbursement if your eligibility changes by the date of care. Most approvals are valid for twelve months, some for twenty-four. A refusal is not always the end, however. The plan provides a reconsideration procedure, started by the patient or their dentist, as well as a safety door in case of clinical emergency, post-determination, which assesses coverage after the fact. This last one stays the exception, never the routine.

Covered does not mean free

Here is the most stubborn misunderstanding. Contrary to a persistent belief, covered does not systematically rhyme with free. The CDCP reimburses according to its own rates, which do not always match those posted by the clinic. When your dentist bills more than the plan's rate, the gap comes back to you. A concrete case: if the CDCP rate for a procedure sits at a certain amount and the clinic asks for more, that difference comes out of your pocket, co-payment or not. On top of that comes the co-payment itself, indexed to adjusted family net income.

Under $70,000, the plan covers 100% of the established rate and you pay nothing on eligible care. Between $70,000 and $79,999, it covers 60%, the rest is yours. Between $80,000 and $89,999, the proportion drops to 40% versus 60%. Add the outright excluded procedures, starting with everything to do with dental implants, never covered and not subject to reconsideration, and you have the full picture. My rule, if I had to keep only one: always ask for a written estimate before accepting a treatment plan. The amount you will pay out of pocket must be clear before, never after.

Frequently asked questions

Does the CDCP cover dental implants?

No. Implants and all the services attached to them, including crowns on implants, are exclusions from the plan. They are never covered and cannot be the subject of a reconsideration.

How many exams can I have reimbursed per year?

Three at most over twelve months, within the limits specific to each type of exam. The complete oral exam, however, comes only once every five years.

Am I the one who receives the plan's reimbursement?

No. Only oral care providers are reimbursed by the CDCP. You should not have to advance the entire cost, but a share may remain to be settled directly with the clinic.

What happens if my income exceeds $70,000?

A co-payment comes into play. The plan then covers 60% or 40% of the established rate depending on your bracket, and you pay the difference, plus any gap with the clinic's fees.