CDCP Preauthorization: What Canadian Dental Clinics Need to Submit in 2026

Preauthorization is the CDCP’s prior-approval process: for crowns, additional scaling and root planing, partial dentures, sedation and several other services, you must send documents to Sun Life and get an approval before treatment starts. Without it, those services are not covered, except in rare emergencies where post-determination applies. Most approvals stay valid for up to 12 months, and a denial can be reconsidered once, within 60 days.

Key facts

• Who reviews requests: Sun Life adjudicates against rules set by Health Canada.
• How to submit: electronically through EDI, or by mail to Sun Life in Montreal (mail takes longer).
• Validity: most approvals last up to 12 months; some preventive and periodontal approvals last up to 24 months.
• Reconsideration: one level, requested within 60 days of the denial.
• Source of the rules: the CDCP Dental Benefits Guide, effective April 1, 2026.

Why preauthorization matters more than it did in 2024

When the Canadian Dental Care Plan opened to seniors in 2024, many clinics treated it like any other third-party plan: confirm eligibility, treat, bill. Two years on, the plan covers millions of patients and its rules have matured. Preauthorization sits at the centre of that shift, because it decides whether the most expensive procedures in a treatment plan are paid at all.

The numbers show why clinics should take it seriously. A new Canadian Dental Association assessment reported by CTV News says about half of complete preauthorization requests are denied. The report does not say every denial is an error by the clinic. But a request that arrives without the right radiographs, charting or notes is the easiest kind to deny, and it is the one you can control.

Preauthorization also protects the patient. According to the Dental Benefits Guide, it lets both the provider and the client understand whether a service will be covered, and up to what limits, before anyone commits to treatment.

Which services need preauthorization

The CDCP Dental Benefit Grids list every procedure code as either Schedule A (no preauthorization needed within frequency limits) or Schedule B (always requires approval). The grids change, so check the current version on Sun Life’s CDCP provider site. The 2026 grids apply to services rendered from April 1, 2026. In summary, the Dental Benefits Guide requires preauthorization for:

• Specialist complete examinations, limited to one in any 60 months per specialty.
• Crowns (cast metal, porcelain-fused-to-metal and porcelain or ceramic), for clients aged 18 and older, with limits of four per client in any 10 years and one per eligible tooth in any 8 years.
• Cores, and prefabricated posts combined with a core, only alongside an approved crown.
• Root canal re-treatment, apicoectomy, retrofilling and root canal treatment on third molars. Standard root canal treatment on anterior teeth, bicuspids and first and second molars does not need it.
• Additional units of scaling and root planing beyond the annual maximum.
• Desensitization.
• Initial partial dentures, overdentures, complete dentures with a long-term soft liner, and denture labelling.
• Certain oral surgery procedures, parenteral conscious sedation, and deep sedation or general anesthesia.
• Some frequency-limited services where a clinic asks for coverage beyond the usual limit.

Some procedures can never be approved. Implants and all implant-related procedures, veneers, cosmetic treatment including whitening, bridges, night guards, temporomandibular joint therapy, crown lengthening and bone grafts are exclusions. Orthodontic services are currently not available under the plan. Exclusions are not eligible for reconsideration.

What to submit

The documents depend on the procedure, and the Dental Benefits Guide lists requirements for restorative, endodontic, periodontal, denture, oral surgery and sedation requests. For services that do not list their own requirements, the baseline package is:

1. A claim form. Use the CDA/CLHIA Standard Dental Claim Form, the Quebec ACDQ form, the CDHA hygiene claim form, the Denturist Association form, or a computer-generated treatment form.
2. A treatment plan showing completed and pending treatment. A provider whose scope of practice does not cover everything can instead confirm that basic needs are being referred or addressed. It does not need to be a separate document if the information is in the package.
3. Dated radiographs: periapical and bitewing images from the last 12 months, or a dated panoramic image. If radiographs are not available, dated alternative documentation will be considered.
4. A dated complete periodontal chart with six measurements per tooth, from the last 12 months. A dated Periodontal Screening and Recording for each sextant, plus six-site measurements for the teeth in question, can be accepted when a full chart is not available. A PSR score of 4 in any sextant, or 3 in two or more sextants, means a full chart is required.
5. Clinical findings, notes and a rationale that connect the evidence to the request.

The guide encourages providers to send everything relevant, and says incomplete packages may still be considered. In practice, a missing chart or an undated image gives the adjudicator a reason to ask for more information or deny.

Basic treatment needs come first

For crowns, root canals and dentures, the CDCP expects active disease to be under control. The guide defines basic treatment needs as any treatment required to address existing active caries, periodontal disease or periapical disease. A crown request will not be considered while those needs are outstanding, and the plan will not cover a crown or root canal for patients with long-standing, uncontrolled, rampant disease.

For crowns specifically, the tooth must also meet restorability criteria. These include adequate periodontal support with a crown-to-root ratio of 1:1 or better, enough sound tooth structure for a margin 3 mm from the alveolar crest, and an “extensively restored” tooth as the plan defines it. Crowns are not covered to improve aesthetics.

What happens after you submit

Requests go to Sun Life, which reviews them using clinical criteria set by Health Canada. Not every submission is approved. Once a decision is issued, most approvals are valid for 12 months from the approval date, provided the client is still eligible on the date of service. Some preventive and periodontal decisions are valid for 24 months.

That last condition matters. Eligibility can change during a benefit period, and in October 2025 Health Canada reminded oral health providers to validate coverage at each visit and before providing and billing for services. An approved preauthorization is not a substitute for checking coverage on the day of treatment.

Emergencies: post-determination

If treatment must change during an emergency and coverage cannot be verified in advance, the CDCP may review a procedure after it is done. This is meant to be used rarely. The request must include everything a preauthorization would need, plus a written reason why post-determination was necessary. Before agreeing to care, discuss with the patient which services the CDCP may cover and what amounts may be charged.

If a request is denied

The guide provides one level of reconsideration. The clinic submits it on the patient’s behalf, with the patient’s consent or a parent or guardian’s if the patient is under 18, within 60 days of the denial. It must include new or additional clinical information, and a different adjudicator reviews it using the same criteria. The decision is final.

Because there is only one chance, treat the first submission as the one that counts. If a denial cites missing documentation, supply exactly what was missing. If it cites clinical criteria, explain how the patient meets them rather than repeating the original request.

A checklist for your team

1. Confirm the patient’s coverage on the day of the visit, using an EDI estimate, the CDCP Coverage Look-up tool in Sun Life Direct, or the Sun Life CDCP Contact Centre at 1-888-888-8110.
2. Check the current Dental Benefit Grids for the procedure code and note whether it is Schedule A or B.
3. Complete and chart basic treatment needs first.
4. Collect dated radiographs and a periodontal chart from the last 12 months.
5. Write a short rationale tied to the CDCP criteria for that procedure.
6. Submit through EDI where possible.
7. Record the decision date, the validity period and any conditions in the patient file.
8. Tell the patient the estimated portion they will pay before treatment.

Common mistakes

• Starting a Schedule B service before approval arrives.
• Sending an undated radiograph, or one older than 12 months.
• Using a partial periodontal chart when the PSR score requires a full chart.
• Requesting a crown to fix cosmetic concerns, or on a tooth with untreated disease.
• Assuming one approval covers a second tooth or a later date.
• Skipping the conversation about the patient’s share. The CDA reports that 59 per cent of patients expected CDCP care to be completely free.

FAQ

Does every CDCP service need preauthorization?

No. Most routine services, including examinations, standard radiographs, cleanings, fillings and standard root canals on the teeth listed above, are billed directly within frequency limits. Check the Dental Benefit Grids for each code.

How long does a CDCP preauthorization last?

Most approvals are valid for up to 12 months from the date of approval. Some preventive and periodontal approvals last up to 24 months. In every case the patient must still be eligible on the date of service.

Can I submit a preauthorization by mail?

Yes, but Sun Life says mailed submissions need extra time to arrive and be processed. EDI is faster.

What if the patient already started treatment?

If the service requires preauthorization, it needs approval first. The only exception is post-determination in an emergent clinical situation, which is intended to be rare.

Can a denial be appealed?

Once. A reconsideration request must be submitted by the provider within 60 days with new clinical information. The outcome is final.

Sources and update date

Sources: the CDCP Dental Benefits Guide (effective April 1, 2026), Sun Life CDCP Dental Benefit Grids, a Health Canada statement of October 21, 2025, and CTV News reporting on the CDA assessment. Last updated: October 7, 2026. CDCP rules change, so confirm requirements in the current Dental Benefits Guide before submitting.

Next step: bookmark the Dental Benefit Grids and add the checklist above to your front-desk procedures.