The Canadian Dental Care Plan (CDCP) may help cover an eligible dental crown, but crown coverage is not automatic. Dental crowns require preauthorization, which means the treatment must be reviewed against the CDCP’s clinical criteria before coverage is confirmed.
Coverage can depend on the condition of the tooth, whether it can be predictably restored, your current CDCP eligibility, frequency limits and other treatment needs. Even when a crown is approved, you may still have a co-payment or additional charges.
Eagle Family Dentistry currently welcomes patients covered by the Canadian Dental Care Plan in Newmarket. If a dentist determines that a crown may be appropriate, the next step is to review your treatment needs and the CDCP requirements that apply to your situation. Learn more about our CDCP information for Newmarket patients.
Does the CDCP Cover Dental Crowns?
Yes, the CDCP can consider certain single-unit dental crowns for coverage when the plan’s clinical requirements are met. However, crowns are among the services that require preauthorization.
According to the current Government of Canada Dental Benefits Guide, crown coverage may be considered for CDCP clients who are 18 years of age or older. Eligible crown types include:
- cast metal crowns;
- porcelain or ceramic fused to metal crowns; and
- porcelain or ceramic crowns.
Being enrolled in the CDCP does not mean every crown request will be approved. The tooth and proposed treatment must meet the program’s eligibility and restorability criteria.
Why Do Dental Crowns Require Preauthorization?
Preauthorization is the process used by the CDCP to review certain treatments before they are carried out. For a dental crown, the dental provider submits information supporting why the crown is needed and why the tooth is suitable for restoration.
The CDCP assesses these requests using clinical criteria established by Health Canada. Preauthorization allows the patient and dental provider to know whether the requested service has been approved for coverage before proceeding.
A preauthorization decision does not replace your general CDCP eligibility. Your coverage must still be active on the date the service is provided.
What Information May Be Needed for Crown Preauthorization?
The dental office may need to submit clinical documentation with a crown request. The current CDCP Dental Benefits Guide lists documentation that may include:
- a treatment plan showing relevant completed and pending treatment;
- recent dental X-rays;
- periodontal measurements or an appropriate periodontal assessment; and
- clinical findings or notes supporting the request.
The required documentation is submitted by the oral health provider. Patients should not assume that a crown has been approved until the preauthorization decision has been received.
What Makes a Tooth Eligible for CDCP Crown Coverage?
The CDCP does not base crown coverage solely on whether a tooth is cracked, filled or uncomfortable. The tooth must meet both eligibility and restorability requirements.
In general, the program considers whether the tooth has adequate periodontal support, sufficient healthy tooth structure and a condition that makes a direct restoration such as a filling inadequate. The dentist also needs to consider whether the tooth can be predictably restored.
Active dental disease can also affect the timing of a crown request. The current CDCP policy states that basic treatment addressing active caries and periodontal disease must be completed before a crown request is submitted.
If you are unsure whether a damaged tooth needs a crown, a dental exam in Newmarket can help determine the condition of the tooth and the available restorative options.
Does CDCP Cover a Crown After Root Canal Treatment?
A tooth that has received root canal treatment may be considered for CDCP crown coverage when the applicable crown criteria are satisfied.
However, the CDCP states that an endodontically treated tooth must have healed before a crown request is submitted. The amount of remaining tooth structure and the restorability of the tooth are also part of the assessment.
Not every root-canal-treated tooth automatically qualifies for a crown, and not every tooth requires the same restoration. Learn more about root canal therapy in Newmarket.
Are Cosmetic Crowns Covered by the CDCP?
The CDCP does not consider a crown for coverage when the purpose is solely to improve appearance. Crown requests are assessed based on oral-health and restorative criteria rather than cosmetic preference alone.
A tooth may still qualify when there is significant structural damage and the clinical requirements are met, but the decision is based on the condition and restorability of the tooth rather than an aesthetic goal.
Does CDCP Cover Implant Crowns?
No. Implant-supported crowns are excluded from CDCP coverage. The current Dental Benefits Guide states that implant-supported crowns and other implant-related procedures are not covered by the CDCP.
This distinction is important because a crown placed on a natural tooth is different from a crown attached to a dental implant. The two treatments are subject to different CDCP rules.
How Often Can CDCP Cover a Dental Crown?
The CDCP applies frequency limitations to eligible crowns. Under the current Dental Benefits Guide, the limits are:
| Coverage Limit | Current CDCP Rule |
|---|---|
| Total crowns per client | Up to 4 crowns in any 120-month (10-year) period |
| Same eligible tooth | 1 crown in any 96-month (8-year) period |
These frequency rules do not guarantee approval. The tooth must still meet the CDCP’s clinical criteria and the crown must receive preauthorization.
How Much Does the CDCP Pay for a Crown?
The amount paid by the CDCP depends partly on your adjusted family net income and is based on the CDCP’s established fees for eligible services.
| Adjusted Family Net Income | CDCP Portion of Eligible CDCP Fee | Patient Co-payment |
|---|---|---|
| Below $70,000 | 100% | 0% of the CDCP established fee |
| $70,000–$79,999 | 60% | 40% of the CDCP established fee |
| $80,000–$89,999 | 40% | 60% of the CDCP established fee |
A 0% co-payment does not necessarily mean that treatment will cost the patient nothing. The dental office’s fee may differ from the CDCP-established fee, and services outside CDCP coverage can also result in additional charges.
Before starting treatment, ask what amount the CDCP is expected to cover and whether you may have an amount to pay directly.
What Does Preauthorization Approval Mean?
An approved preauthorization means the requested treatment has been reviewed under the CDCP rules in effect at that time. Most preauthorization decisions are valid for up to 12 months, provided the patient’s CDCP coverage remains active on the date of service.
Approval does not necessarily mean that the CDCP will pay the entire dental-office fee. Your co-payment level, CDCP-established fees and any additional charges still need to be considered.
What If CDCP Does Not Approve the Crown?
A denied crown preauthorization does not necessarily mean that the tooth requires no treatment. It means the request did not receive coverage approval under the CDCP criteria based on the information submitted.
Your dentist can explain whether another restorative option may be appropriate. In some cases, a provider can also request reconsideration of a denied service when additional or new clinical information is available, provided the procedure is not an excluded service.
Getting a Dental Crown With CDCP in Newmarket
Eagle Family Dentistry welcomes patients with active CDCP coverage. The first step is a clinical assessment to determine what treatment the tooth requires.
If a dental crown in Newmarket is recommended and the service requires CDCP preauthorization, the coverage process must be completed before assuming that the crown will be covered.
Because CDCP eligibility, preauthorization decisions and patient costs can vary, confirm your current coverage and expected out-of-pocket amount before proceeding with treatment.
Frequently Asked Questions
Does CDCP pay for dental crowns?
The CDCP may cover an eligible single-unit crown for a client aged 18 or older when the clinical requirements are met and preauthorization is approved. Coverage is not automatic.
Do dental crowns need CDCP preauthorization?
Yes. Crowns are services that require preauthorization under the current CDCP Dental Benefits Guide.
Does CDCP cover porcelain or ceramic crowns?
Porcelain or ceramic single-unit crowns are among the crown types that may be eligible for coverage when CDCP criteria and preauthorization requirements are satisfied.
Does CDCP cover crowns for cosmetic reasons?
No. The CDCP does not consider crowns for coverage when the purpose is solely aesthetic.
Does CDCP cover an implant crown?
No. Implant-supported crowns and implant-related procedures are exclusions under the current CDCP rules.
Will CDCP pay 100% of my crown?
Not necessarily. Your CDCP co-payment depends on adjusted family net income, and the dental office may charge an amount above the CDCP-established fee. Confirm expected costs before receiving treatment.
Have Questions About a Crown and Your CDCP Coverage?
Eagle Family Dentistry welcomes CDCP patients in Newmarket. A dental assessment can determine whether a crown or another restoration may be appropriate, while coverage must be confirmed through the applicable CDCP process.
