CDCP Challenges for Canadian Dentists: Audits, Payment Holds and Patient Mix

The Canadian Dental Care Plan is changing dentistry in Canada at extraordinary speed. For millions of Canadians who previously delayed treatment because of cost, the CDCP is opening the door to examinations, preventive care, restorations and other necessary dental services. That is a meaningful improvement in access to oral health care—and participating dentists and their teams are essential to making it work.

But inside many dental practices, a more complicated story is emerging. Schedules may be filling rapidly with CDCP patients. Administrative work is increasing. Team members are spending more time confirming eligibility, explaining co-payments, submitting supporting records and following up on preauthorizations. Some complex treatment requests are delayed or denied. Sun Life can also verify claims, request extensive documentation and temporarily hold or delay payment while that verification takes place.

CDCP Has Become a Major Force in Canadian Dentistry

The scale of the program explains why its effects are being felt so quickly. As of August 31, 2026, federal statistics reported that more than 7.5 million unique Canadians had been enrolled at some point since the CDCP launched, while nearly 4.83 million had used their coverage during at least one benefit period. For the 2026–2027 benefit period alone, 4.76 million people were enrolled. Ontario accounted for approximately 1.96 million of them. The government also reported 29,293 participating oral health providers, including 25,409 dentists and dental specialists.

The CDCP Is Not the Same as a Conventional Private Dental Plan

One source of tension is the expectation gap between what some patients think the CDCP provides and what the program actually covers. The CDCP helps pay for eligible services, but it is not necessarily 'free dentistry.' CDCP fees are established independently of provincial and territorial dental association fee guides. A patient may still owe an income-based co-payment, a difference between the practice fee and the CDCP-established fee, or the full cost of a service the program does not cover.

Sun Life Claims Verification and Audits: What Dentists Need to Know

Concern about audits is not merely anecdotal. Sun Life publishes a formal CDCP Claims Verification Program. Its stated purposes include detecting administrative errors and inaccurate claims, recovering overpayments, verifying that services were delivered, confirming that providers retained appropriate documentation, and determining whether a provider should remain eligible to submit future CDCP claims when intentionally false or incomplete information is found.

The Capacity Problem: Busy Does Not Always Mean Healthy

For years, I have helped dental practices move beyond the vague goal of attracting 'more patients' and focus instead on attracting more of their ideal patients. An ideal patient is someone whose needs align with the practice's clinical strengths, service mix, philosophy, capacity and long-term goals. CDCP demand can expose weak points: insufficient hygiene availability, limited emergency capacity, weak documentation, and crowding out high-value restorative or cosmetic cases.

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