Canadian Dental Care Plan Oral Health Provider Newsletter Volume 3 – March 3, 2026

Canadian Dental Care Plan: Oral Health Provider News

This is your periodic oral health provider update to help keep you and your staff informed of the latest Canadian Dental Care Plan (CDCP) news.

CDCP Statistics at a glance as of January 31, 2026:

• Close to 4 million Canadians have received services
• Over 27,000 eligible oral health providers are participating in the CDCP
• More than 6 million Canadians have been deemed eligible for CDCP services

CDCP statistics are updated on a monthly basis and are found on the Government of Canada CDCP statistics webpage.

Updated CDCP Dental Benefit Grids and Guide will be posted on April 1, 2026:

The CDCP Dental Benefit Grids will be updated on April 1, 2026, to reflect the 2026 CDCP established fees. The CDCP fees have increased from the 2025 fees.

On April 1, 2026, the CDCP Dental Benefits Guide will also be updated to reflect recent changes to the CDCP.

We strongly encourage oral health providers and their staff to familiarize themselves with the updated Guide and Grids as these changes may affect treatment plans and billing processes as of April 1, 2026.

Note: CDCP client coverage under the plan may change at any time during the benefit period. As such, it remains important to validate a client's CDCP coverage at each visit and before providing and billing for services or treatments. Additionally, if these changes do affect an existing treatment plan, no retroactive payments or legacy provisions will apply.

Please see below a summary of key changes to the CDCP effective April 1, 2026:

Commercial Laboratory Fee

CDCP Commercial laboratory fees will increase effective April 1, 2026. This adjustment may result in the reduction of the co-payment amount for some CDCP clients and an increased reimbursement for some providers. Please note that no retroactive or legacy provisions will apply to this change.

Desensitization Codes

Beginning April 1, 2026, all desensitization services will require preauthorization. This change reflects expert advice from the National Oral Health Advisory Committee (NOHAC) after concerning trends in usage were identified, and is intended to support appropriate use of this service. Documentation requirements for preauthorization are outlined in the CDCP Dental Benefits Guide.

Complete Immediate Dentures

Beginning April 1, 2026, certain types of complete immediate dentures will no longer require preauthorization. They will be grouped in the Grids under the same frequency as other kinds of complete dentures (i.e., provisional/transitional).

This will mean that for situations where a client requires dentures following extractions, a provider can determine whether to provide a transitional/provisional denture, or an immediate denture (not both). These would be available within a combined frequency limit of one prosthesis per arch per lifetime. The client would be eligible for a standard denture or overdenture 6 months after the transitional/provisional denture, or 96 months after an immediate denture. 

This change aligns with the intent of CDCP policies to cover one of these types of dentures after extractions, providing more flexibility in treatment planning. Providers will continue to work with their patients to determine which temporary denture option best suits their needs.

Denture Liners

Beginning April 1, 2026, additional codes for denture liners will be available without preauthorization. This change supports the appropriate upkeep of dentures and may extend their lifespan, benefiting both patients and providers by streamlining the authorization process for these maintenance services.

For Dental Hygienists Only: Periapical Radiographs Codes for 7 and 8 Images

Beginning April 1, 2026, dental hygienists will be able to claim the codes for periapical radiographs (7 and 8 images). This change allows for streamlined billing, eliminating the need to use multiple codes to submit for this amount of radiographs.

Sedation Codes

Effective April 1, 2026, CDCP grids will be updated to reflect the 2025 Uniform System of Coding and List of Services (USC&LS) sedation codes. There are no changes to eligibility or billing rules. This update simply ensures that these codes are reflected in the published Grids, and no action is required.

December 7, 2025, Changes Reflected in the Grids Published on April 1, 2026

The changes to Quebec Root Planing, Denture Eligibility and Provider Location (Exams and Restorations) that became effective December 7, 2025, will now be reflected in the April 1, 2026, Grids to align published guidelines with current adjudication practices.

CDCP Benefit Year Renewal: Important Information for Providers

The current benefit year ends June 30, 2026, with the new one beginning July 1, 2026.

All CDCP clients will need to renew their coverage to confirm they still meet the CDCP eligibility requirements and avoid any gap in coverage. The renewal period for the 2026-2027 benefit year will begin on April 15, 2026.

For CDCP clients who do not renew by June 1, 2026, their coverage will end on June 30, 2026. For those who renew late, they may have a gap in coverage and any services or treatments received during this gap will not be covered by the plan nor paid retroactively, even if they have an approved preauthorization on file.

CDCP clients who renew and are still eligible for coverage may experience a change in co-payment starting on July 1, 2026, as applicable.

Each client will receive a direct communication from the Government of Canada with instructions on how to renew. Before renewing, clients (and their spouse or partner, if applicable) must have filed their 2025 tax return and received their 2025 Notice of Assessment from the Canada Revenue Agency.

Renewals can be completed through a My Service Canada Account, online at Canada.ca/dental, or by phone at 1-833-537-4342 (TTY: 1-833-677-6262).

Providers should confirm each CDCP client's coverage and co-payment level at every appointment. Coverage can be verified by submitting an EDI estimate, calling the Sun Life CDCP Contact Centre at 1-888-888-8110, or using the CDCP coverage look-up tool in Sun Life Direct.

Claims will be paid based on the client's coverage and co-payment level on the date the service is rendered, which may differ from earlier estimates or approved preauthorizations. For example, if a client's co-payment increases (e.g., from 40% to 60%), they will owe more than originally estimated; if it decreases (e.g., from 40% to 0%), they will owe less. If a preauthorization was approved but the client is no longer eligible on the day of care, the claim will be denied.

To learn more call 1-888-888-8110, visit Sun Life's CDCP website or the Government of Canada CDCP website.