Why CDCP Claims Get Denied: How to Get Yours Approved in 2026

Last updated 2026-06-03. Fact-checked against Health Canada's Canadian Dental Care Plan pages, Health Canada's published preauthorization figures, and the Sun Life CDCP benefit grid.

Most Canadian Dental Care Plan (CDCP) claims are never denied. Routine care, like checkups, cleanings, X-rays, and fillings, does not need approval in advance, and it is paid out as a matter of course. Denials cluster around one thing: preauthorization for complex work such as crowns, dentures, orthodontics, and extra cleanings. Health Canada has confirmed that only about 1% of all CDCP claims are for services that require preauthorization. Of that small slice, roughly half of the preauthorization requests were rejected in the program's first eight months (late 2024 to mid-2025). But the leading causes are fixable paperwork and requests for services outside the plan, not a blanket "no" on care you qualify for. Here is what actually gets denied, why, and how to give your request the best chance of approval the first time.

Key Takeaways

• Routine care is rarely denied. Exams, cleanings, X-rays, and fillings do not require preauthorization. Only about 1% of CDCP claims are for services that do.
• The "half denied" headline is about preauthorization for complex work: crowns, dentures, orthodontics, and services beyond the plan's frequency limits.
• The biggest fixable cause of denial is incomplete documentation: missing or outdated X-rays, periodontal charting, or treatment-plan details.
• Most preauthorizations are now processed within seven business days, and once approved a decision is usually valid for up to 12 months.
• Approval does not always mean $0. You may owe a co-payment based on income, plus any amount your dentist charges above the CDCP fee grid. Always get a written estimate first.

What does the Canadian Dental Care Plan actually cover?

The CDCP covers four broad categories of care for eligible residents with an adjusted family net income under $90,000 and no access to private dental insurance:

• Diagnostic: complete, routine, specific, and emergency exams, plus X-rays. You are eligible for up to 3 exams in any 12-month period, subject to frequency rules.
• Preventive: scaling (cleaning), polishing, sealants, and fluoride.
• Restorative: fillings and related repairs for cavities and broken teeth. Restorations are covered once per tooth surface in any 24-month period.
• Major: treatment for severely decayed, infected, or broken teeth, and replacement of missing teeth, including complete (standard and temporary) dentures.

The key point: the everyday care most people actually use does not require preauthorization. Your dentist provides the service and bills the plan directly. There is nothing to "get approved" in advance, and these claims are rarely the source of a denial.

Which CDCP services need preauthorization?

Preauthorization is the plan's way of confirming, before treatment, that a more complex or costly service will be covered. Your dentist recommends the service, submits documentation, and the CDCP decides whether to approve it.

Services that commonly require preauthorization include:

• Crowns (covered for clients 18 and older, through preauthorization)
• Orthodontic treatment (always requires preauthorization)
• Partial dentures and certain major restorative work
• Any service beyond the plan's frequency limits: for example, additional units of scaling and root planing past what the plan normally allows

By contrast, standard root canal treatment on front teeth, bicuspids, and first and second molars does not require preauthorization. Neither do your routine exams, cleanings, and fillings. If your treatment falls into the preauthorization category, that is where denials happen, and where preparation matters most.

Why are so many CDCP preauthorization requests denied?

This is the statistic that made news. Health Canada reported that 52% of preauthorization requests between November 2024 and June 2025 were rejected (a separate count put it at 49% over a slightly different window). As CBC reported, the Canadian Dental Association has said the rejection rate for these requests runs far higher than for private dental plans, with much of the friction coming from confusion over documentation that a private insurer would normally accept.

Both figures are real. But Health Canada's own response adds the context that changes how you should read them:

1. Only about 1% of all CDCP claims are for preauthorization services. The figure applies to that small subset, not to dental coverage as a whole.
2. The headline number bundles several causes. Health Canada says the rejected total includes requests that were incomplete, requests for services not eligible under the plan, and duplicate requests, alongside requests that were simply ready for full review. It is not a count of eligible patients being turned away from care.
3. The denials break down into a handful of causes:

- Incomplete submission: the most common and most fixable. Missing or outdated radiographs, periodontal charting, or treatment-plan details. - Service not eligible under the plan, or the request did not meet the clinical criteria. - Duplicate request: something already approved was submitted again. - Plan exclusions: a few procedures are simply not covered.

1. Speed has improved. As of mid-2025, more than 80% of preauthorizations were being processed within seven business days.

The takeaway for patients: a denial often is not a final "no." It is frequently a "not yet, the file is incomplete."

How do I get my CDCP preauthorization approved?

The denial data points straight at the fix. Most rejections are documentation problems, and documentation is controllable. Here is how to give a complex-work request its best chance.

1. Make sure your dentist submits complete clinical documentation. For requests like additional scaling and root planing, the plan expects dated periapical and bitewing X-rays from within the last 12 months, plus a complete periodontal chart with six measurements per tooth, also from within the last 12 months. If your X-rays or charting are older than a year, that alone can trigger a rejection.

2. Confirm the treatment plan details are spelled out. The CDCP adjudicates against clinical criteria set by Health Canada. A request that does not clearly show why the work is necessary is the kind that comes back rejected even when the care is appropriate.

3. Use a dentist who submits preauthorizations electronically. Since November 2024, requests can be filed electronically with digital X-rays and attachments. Electronic submission with the right files attached is faster and leaves less room for missing pieces.

4. Understand the timing. Most preauthorization decisions, once approved, are valid for up to 12 months from the approval date, as long as you remain eligible on the date of service. Some preventive and periodontal approvals are valid for up to 24 months. Plan your treatment within that window.

5. Ask whether the service even needs preauthorization. If your care is routine, there is nothing to approve and no waiting. Knowing the difference saves you anxiety over a step that may not apply to you.

From Dr. Kaur

"The denials I see almost always come down to paperwork, not the patient. When a crown request comes back rejected, it is usually because an X-ray was older than 12 months or the chart did not show the full picture. We changed how our office files preauthorizations because of it. We take current X-rays, finish the periodontal charting, and write out the clinical reasoning before anything goes to the plan. It takes us a little longer up front, but it is the difference between a patient waiting one week and a patient waiting two months." > Dr. Abinaash Kaur, DDS, The Village Dentist, 750 Annette St, Toronto

If my claim is approved, what will I still have to pay?

Approval does not always mean $0. Two things can still land on your bill, and you have a right to know both before treatment starts.

Your co-payment, based on adjusted family net income:

Adjusted family net income	CDCP covers	You pay (co-payment)
Under $70,000	100% of CDCP fees	0%
$70,000 to $79,999	60%	40%
$80,000 to $89,999	40%	60%

The co-payment is the share of the CDCP's established fees that the plan does not cover. You pay it directly to your dental office.

Charges above the CDCP fee grid. The CDCP pays according to its own fee schedule, which can be lower than a clinic's usual fee. A provider may charge the difference, and you would pay that on top of any co-payment. You may also owe for any service you agree to that the plan does not cover at all. (In Ontario, this kind of balance billing is not permitted in the specific cases where provincial programs such as Healthy Smiles Ontario or ODSP supplement CDCP fees.)

The single best protection: ask your dental office for a written estimate before you accept treatment, showing what the CDCP is expected to pay, your co-payment, and any amount above the plan's fees. A clinic that works with the CDCP regularly can give you that breakdown up front.

What is new for the 2026-27 CDCP year?

A few things changed in 2026 that are worth knowing:

• The spring renewal window closed June 2, 2026. If you were already a member, your renewed coverage carries into the new benefit year.
• Applications for the 2026-27 benefit year are open to all eligible residents, including anyone who missed the renewal window. The earlier age-based rollout is complete. Eligibility now comes down to income (under $90,000 adjusted family net income) and not having access to private dental insurance.
• The new benefit year runs July 1, 2026 to June 30, 2027. Frequency limits reset on rolling periods tied to your dates of service, not the calendar, so it is worth confirming when you are next eligible for a given service.

Coverage details and procedure-level fees can change year to year. The official CDCP Dental Benefit Grids for each province are published on the Sun Life website, and your dental office can tell you how a specific procedure is covered this year.

Frequently Asked Questions

Are most CDCP claims denied? No. Health Canada reports that only about 1% of CDCP claims are for services that require preauthorization. Routine exams, cleanings, X-rays, and fillings do not need preauthorization and are rarely denied.

What was the CDCP denial rate that made the news? Health Canada reported that about half of preauthorization requests were rejected in the program's first eight months (52% per CBC, with a separate count of 49% over a slightly different window). Health Canada says that figure includes incomplete submissions, services not eligible under the plan, and duplicate requests. It applies only to the complex work that requires preauthorization (about 1% of all claims), not to dental claims overall.

Why was my CDCP crown or denture denied? The most common reason is incomplete documentation: missing or outdated X-rays, incomplete periodontal charting, or insufficient treatment-plan detail. Other reasons include the service not being eligible, a duplicate request, or the request not meeting the plan's clinical criteria.

Does a root canal need CDCP preauthorization? Standard root canal treatment on front teeth, bicuspids, and first and second molars does not require preauthorization. Crowns and orthodontics do.

How long does a CDCP preauthorization take? As of mid-2025, more than 80% of preauthorization requests were processed within seven business days. Once approved, most decisions are valid for up to 12 months (up to 24 months for some preventive and periodontal services).

Will I have to pay anything if my treatment is approved? Possibly. You may owe a co-payment based on your adjusted family net income (0%, 40%, or 60%), and you may owe the difference if your provider's fee is higher than the CDCP fee grid. Ask for a written estimate before treatment.

References

1. Government of Canada. What services are covered in the Canadian Dental Care Plan. https://www.canada.ca/en/services/benefits/dental/dental-care-plan/coverage.html
2. Government of Canada. CDCP providers: Preauthorization resources. https://www.canada.ca/en/services/benefits/dental/dental-care-plan/providers/preauthorization.html
3. Government of Canada. Do you qualify: Canadian Dental Care Plan. https://www.canada.ca/en/services/benefits/dental/dental-care-plan/qualify.html
4. CBC News. Half of requests for complex dental work are being rejected under national insurance plan. https://www.cbc.ca/news/politics/dental-care-expansion-growing-pains-1.7583230
5. Oral Health Group. Half of complex dental claims denied: Health Canada responds to concerns over CDCP. https://www.oralhealthgroup.com/dental-governance-regulations/half-of-complex-dental-claims-denied-health-canada-responds-to-concerns-over-cdcp-1003988136/
6. Sun Life. Dental benefit grids: CDCP. https://www.sunlife.ca/sl/cdcp/en/provider/dental-benefit-grids/

Bottom line

Most CDCP claims are never denied, because most care does not require preauthorization. The denials that made headlines are concentrated in the roughly 1% of claims for complex work: crowns, dentures, orthodontics, and services beyond frequency limits. About half of those preauthorization requests were rejected in the program's first eight months, but the leading causes are fixable: incomplete or outdated documentation, requests for services the plan does not cover, and duplicates. The fix is preparation, namely current X-rays, complete periodontal charting, and a clear treatment plan, submitted electronically. Ask whether your service even needs preauthorization, and get a written estimate of your co-payment and any above-schedule charges before treatment begins.

Need help using your CDCP coverage?

If you're in Toronto or the GTA: We're a CDCP-participating dental practice at 750 Annette St in Bloor West Village. If a service needs preauthorization, we will tell you, file it properly with complete documentation, and give you a written estimate of what you will owe before any treatment begins. Book a CDCP-covered visit or call (416) 760-0404.

If you're outside the GTA: Use the Sun Life provider search to find a participating dentist in your area.

Related posts

• Canadian Dental Care Plan (CDCP) 2026: Complete Guide
• Does CDCP Cover Crowns & Bridges in 2026?
• CDCP Co-Payment Calculator 2026

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Clinically reviewed by Dr. Abinaash Kaur, DDS, on 2026-06-03. Dr. Kaur is a general dentist in Toronto registered with the Royal College of Dental Surgeons of Ontario (RCDSO).