What CDCP Actually Pays at the Dentist: A Vaughan Patient's 2026 Breakdown
What does CDCP cover at the dentist?
CDCP pays a set percentage of its own fee for exams, cleanings, X-rays, fillings, simple extractions and some larger work, and you pay the remainder. That is the whole mechanism. Everything confusing about the plan comes from two numbers layered on top of it.
The first is your co-pay tier, which comes from your household income and is printed in your Sun Life welcome package. The second is the difference between what CDCP has decided a procedure is worth and what the Ontario fee guide says it is worth. Most people never hear about the second one until they are standing at the desk.
This post assumes you are already approved. If you are still working out whether you qualify, that is a different question, and it lives on our CDCP page.
The 100, 60 and 40 percent tiers explained
There are three tiers, set by adjusted family net income: under $70,000 means CDCP pays 100 percent of its fee, $70,000 to $79,999 means it pays 60 percent, and $80,000 to $89,999 means it pays 40 percent.
The part people misread is what that percentage applies to. It is a percentage of the CDCP fee, not of your dentist's fee. So if the plan's fee for a procedure is $100:
- Under $70,000: the plan pays $100. You owe nothing.
- $70,000 to $79,999: the plan pays $60. You owe $40.
- $80,000 to $89,999: the plan pays $40. You owe $60.
Notice that in the highest income band you pay more than the plan does. Worth knowing before you agree to a big treatment plan, which is why we put the arithmetic in front of you in writing before anything gets scheduled.
What does a first visit actually cost?
A new-patient appointment is not one charge. It is three or four, billed separately: a complete exam, scaling (the actual cleaning, billed in 15-minute units), polishing, fluoride if it applies, and X-rays.
Say you are in the middle tier, where the plan pays 60 percent and you pay 40. Run each line through it:
- Complete exam. Plan pays 60 percent of the CDCP exam fee. You owe the other 40 percent.
- Scaling, two units. Same split, doubled, because two units cost twice one unit.
- X-rays. Same split again, and the count depends on what we need to see.
- Polish and fluoride. Small line items, same math.
The scaling is the part nobody can pin down over the phone. If you have been in every six months, one or two units usually does it. Eight years and hard buildup below the gumline can mean four units, sometimes across two appointments. That is a clinical judgement made with a mirror in your mouth, not a number a receptionist can quote, so treat any exact total offered before an exam as a guess.
Four units is also the entire annual allowance for an adult, shared with root planing, so one heavy first cleaning can use up the year. Anything past that needs pre-authorization.
What we can do is examine you, count the units, and hand you the figure before we start the cleaning. Every cost we quote comes as a written estimate first, and you decide from there.
Does CDCP cover fillings?
Yes. Fillings are covered, and what you owe moves with two things: how many surfaces of the tooth are involved, and where the tooth sits in your mouth.
A single-surface filling on a front tooth is about the cheapest restoration in dentistry. A three-surface filling on an upper molar can run several times that fee, because it takes longer, needs more material, and is harder to place well. Both are covered, and both fall under routine general dentistry. Your co-pay percentage does not change. The dollar amount does, because the underlying fee is different.
There is a frequency limit worth knowing. CDCP pays for one restoration per surface, per tooth, in any 24 months. If a filling on the same surface fails sooner than that, the replacement is usually yours to pay for, and you will see it quoted in writing before we touch the tooth.
Who pays the fee guide difference?
You do, when an office charges it. CDCP set its own fee schedule, and those fees sit below the Ontario Dental Association guide that most practices in Vaughan and across Ontario follow. The plan pays its percentage of the CDCP fee. The gap between the CDCP fee and the office's regular fee is a separate amount, and no insurer covers it.
Here is the shape of it. Suppose a filling is $200 on the ODA guide and CDCP's fee for the same filling is $160. In the 60 percent tier, CDCP pays $96, which is 60 percent of $160. Your co-pay is $64. The $40 between $160 and $200 is the third number. Left as is, you are out $104 on a bill you thought was going to be $64.
That third number is the line most people do not expect. Dentists are allowed to charge it. Some do, some do not, and some say nothing either way until the appointment is over.
At our office you get the full breakdown in writing before treatment: what CDCP pays, what your co-pay is, and any fee guide difference, itemized. No line appears on your bill that was not on the estimate you already read.
Which treatments need pre-authorization?
Routine work does not. Exams, cleanings, X-rays, fillings, simple extractions and root canals go ahead the day you sit down.
Some larger items need Sun Life to review the case first: crowns, partial dentures, immediate dentures and overdentures, deeper sedation, and re-treatment of a root canal done previously. Standard complete dentures do not need it. We take the X-rays, write up the case, submit the request, and you wait. Turnaround is usually a few weeks, longer if Sun Life asks for more documentation.
Extra scaling units past the plan's yearly limit also need approval. That is the most common request we send.
Some things the plan does not cover at all, so there is no approval to wait for: fixed bridges, orthodontics including braces and clear aligners, implants, veneers, whitening, and night or sports guards. If you want any of those, we quote them as regular fees, in writing, and you decide.
We submit the paperwork the same day we see the tooth, because the clock does not start until the file lands. If you are in pain while you wait, we treat the pain now: a temporary filling, a dressing, an extraction if the tooth is not worth saving. Waiting on a crown approval does not mean waiting a month in pain.
One limit worth stating plainly. Facial swelling spreading toward your eye or under your jaw, or trouble swallowing, belongs in a hospital emergency department tonight, not in a dental chair tomorrow. Everything short of that is emergency dental care we can handle here.
Do you pay upfront, or does the dentist bill Sun Life?
You pay your co-pay at the front desk and nothing else. We submit the claim to Sun Life ourselves, electronically, the same day.
Not every office works that way, and with this plan that matters more than it sounds. Sun Life does not reimburse patients directly. If an office will not submit the claim, paying the full amount yourself does not get the plan's share back later. It is simply gone. Direct billing is not a convenience under CDCP, it is the only route to the coverage you qualified for. Ask that question when you call any office, ours included. One sentence on the phone saves a bill you cannot recover.
How do you get a written estimate before deciding?
Every treatment plan we present comes as a written estimate showing three things: the CDCP portion, your co-pay, and any fee guide difference. You take it home. Nothing gets booked until you say so.
Sometimes the estimate is very short. If we look and nothing needs work, we say exactly that: nothing needs work, come back in six months. A clean bill of health is a legitimate outcome of an appointment.
Common questions
How many scaling units does CDCP cover in a year?
Four units in any 12 months if you are 17 or older, and those four are shared with root planing. Under 17 gets less: one unit for ages 12 to 16, half a unit below 12. Polishing is half a unit per 12 months, and fluoride is one treatment a year for adults. A recall exam is one in any 12 months, so the honest answer to the six month question is that the plan pays for one recall a year, not two. If your gums need more than that, we can request additional units through pre-authorization, or quote you an extra visit in writing. Either way you see the number before you commit.
What if my income changed since I applied?
Your co-pay tier is set from the income you reported at application and gets reassessed each year when you renew. If your household income dropped into a lower band, that changes your co-pay at the next renewal, not retroactively. Sun Life and Service Canada handle that side, not your dentist.
Can I use CDCP alongside another dental plan?
If you have access to private dental insurance through work or a spouse, you are not eligible for CDCP, even if you never use it. Healthy Smiles Ontario is a separate provincial program for children 17 and under in lower income households, so it does not apply to adult coverage. If a child in your family is on it, bring both cards and we will sort out which one bills first.
Will CDCP pay for a crown?
Sometimes, and only with pre-authorization. Sun Life reviews the X-rays and the reason for the crown, then decides. There is a clinical crown policy applied on top of the pre-authorization, so approval depends on the state of the tooth and not just the paperwork. Approval takes a few weeks, so plan on two appointments with a wait between them. There are frequency caps as well: four crowns per patient in any 120 months, and one crown per individual tooth in any 96 months. If a crown on the same tooth is replaced sooner than that, expect to pay for it, and you will see the figure in writing first.
Does CDCP cover braces or Invisalign?
No. Orthodontic services are not available under CDCP, and no date has been set for adding them. Health Canada has signalled that a limited range of orthodontic care may be added at some point, but nothing is confirmed, so plan around the coverage that exists today. Braces and clear aligners are quoted as regular fees, in writing, before anything starts.
Find out your actual number
The only way to know what you will owe is to have someone look and count. Bring your Sun Life card to your first visit at Keele & Steeles Dental Office, at Keele and Steeles in Concord, Vaughan, and you will leave with an itemized estimate showing your co-pay to the dollar, whether or not you book anything that day. Our new patient page covers what else to bring and what the first appointment looks like.
Prefer to ask first? Call the office at 905-760-8181. No pressure either way.
Not sure where you stand?We will look, tell you what we see, and put the cost in writing before anything starts. New patients welcome six days a week.Book an Appointment905-760-8181