Dental benefits

About dental benefits

The Program covers a range of dental services that are described in the Dental Benefits Guide, including:

• diagnostic services, including:
  • examinations
  • radiographs (X-rays)
• preventive services, including:
  • scaling
  • polishing
  • sealants
  • fluorides
• restorative services, including:
  • fillings
  • crowns
• endodontic services, including root canal treatments
• periodontal services, including deep scaling
• removable prosthodontic services, including:
  • partial dentures
  • complete dentures
• oral surgery services, including extractions
• orthodontic services, including braces
• adjunctive services, including:
  • sedation
  • general anaesthesia

This Program provides eligible clients with coverage for benefits not available under other federal, provincial, territorial or private health insurance.

How to access dental benefits

Dental services must be provided in Canada, by a licensed dental professional, such as:

• dentist
• denturist
• independent dental hygienist
• dental specialist

Service providers who are enrolled with the Program generally send in claims to bill the Program directly. This means that you should not have to pay when receiving your dental services, including any deductible or co-payment. You will need to show client identification in order for providers to bill the Program directly.

Certain dental services are covered without prior approval (predetermination). For these services, the dental professional can provide the service and send the bill directly to the Program.

For dental services that do require prior approval, the dental professional must contact the Program before you receive services. This is done to make sure the service is covered under the Program's rules.

Express Scripts Canada administers claims for providers on behalf of the Program. Information can be found on their website, including:

• forms
• newsletters
• a dental claims submission kit
• a provider enrolment form
• regional dental benefit grids