Canadian Dental Procedure Codes: A Comprehensive Guide - Insurdinary (2024)

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• What Are Canadian Dental Procedure Codes?
• Canadian Dental Code Categories
• Why Are Dental Codes Important?
• How Can I Avoid Overpaying?

Codes 00001-09999 refer to all dental services that diagnose diseases and problems. Dental exams start from 01011, which refers to dental exams for children up to 3 years old. They increase in price and complexity to in-depth exams for maxillofacial and dental problems.

This range also includes tests, X-rays and other photography,professional consultations, and making models of teeth such as dental casts.

Codes 10000-19999 include services that prevent dental disease and maintain oral health. Since these tend to be the most common reasons Canadians visit the dentist, you'll see this range of codes most frequently.

In this range, you'll see regular services such as cleaning, fluoride treatment, polishing, and scaling. Less common services like oral appliances and nighttime retainers fall into this category as well.

Codes 20000-29999 include services that restore your teeth after damage. They may include tooth crowns (whether applying them or removing them to re-apply), and tooth fillings.

Tooth fillings have many different components, from the pin that holds the filling to the tooth's root to the visible core and crown. Each of these services has a unique code and can be billed separately.

Codes 30000-39999 relate to procedures that treat the live part of your tooth (including the nerve and pulp) rather than the bony enamel.

Root canals (removing the soft tissue and nerve from inside a tooth when it becomes infected) are the most well-known procedure from this service range. Children who still have their primary teeth can also suffer from pulp infection. In their case, they will have a pulpectomy (removing the soft tissue without the nerve) to keep the infection from spreading.

Codes 40000-49999 deal with corrective procedures to the gum and periodontium.

In periodontal disease, bacteria infect your gums and cause them to pull away from your teeth. To correct this problem, you may need periodontal services like in-depthteeth scaling and root planing.

Codes 50000-59999 account for insertion, removal, maintenance, and repair of removable dentures.

Dentures can be costly. Remember that these codes only account for the service costs for denture maintenance. The actual costs of dental prosthetics, such as partial or full dentures, aren't included.

The last digit in a code often refers to how many units of that service you received. For instance, the dental code 11111 refers to 1 unit of scaling (scraping plaque buildup from your teeth).

A "unit" of scaling means the amount of scaling that the dental hygienist did in 15 minutes. If it took 30 minutes to scale your teeth, you would be charged for 2 units of scaling instead. The code for 2 units of scaling is 11112; the code for 3 units is 11113, and so on.

When you look at the invoice your dentist's office issues, you'll see the services you received along with their 5-digit dental procedure code.

For instance, you'll see something like:

• 11111: 1 unit of scaling
• 02112: 2 radiographic images

They'll be listed along with the amount that the dentist is charging you for each service.

Many insurance plans cover a fixed amount for each standardized service. Most commonly, they cover the amount that your province suggests that those standardized services are worth. That amount is determined by your province's dental fee guide.

Every Canadian province and territory has its own Dental Association, and each provincial association issues a fee guide for the dentists who work inthat province. This is a guide that states how much a dental procedure is worth under normal conditions, and sets the norm for the prices that all provincial dentists use.

By listing every standardized dental procedure by its code number, the fee guide suggests how much each dentist should charge for those procedures.

While your province's dental association issues a suggested fee amount for every service in the Canadian dental procedure code, the final amount that you pay for a service is up to your dentist.

Dental practices are private businesses. That means they are free to charge as much or as little for their services as they choose.

For example, if your provincial fee guide suggests charging a $45 fee for a service, your dentist may charge $40, $50, or whatever they choose.

But your insurance provider usually only covers the suggested fee for a dental procedure. In the example above, your insurance may cover the suggested fee of $45. If your dentist charges $50, you will end up paying the difference out of pocket.

Of course, dental procedures can be much more costly than this example. Braces, prostheses, and surgeries can cost hundreds or even thousands of dollars, and the difference between the suggested cost and your dentist's actual cost can be proportionally larger. That means you can end up paying a surprising amount for your dental work.

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If your insurance only covers the suggested fee, you don't necessarily have to pay out of pocket. Instead, compare the prices of different dentists in your area.

You might not be able to know exactly which dentists are sticking to the suggested dental fees. However, you may still find a range of prices.

Some dentists choose to keep their fees at or under the suggested cost to stay competitive in the dental market. Others charge more than the suggested cost, whether to offset their own fees or for other reasons. While you won't know exactly which fees are within the suggested range— the range that your insurance is more likely to cover— you can still find the lowest cost and avoid higher out-of-pocket costs.

While 32% of Canadians still don't have dental insurance, there's no doubt that in Canada, having dental insurance coverage is a must. But there are tons of options to choose from, and the plan you pick will significantly impact what you finally end up paying.

If you're worried about paying unexpected out-of-pocket costs at the dentist, look for a plan that has high monthly coverage. A bargain plan costs less upfront, but may not fully cover your costs. Especially if you expect to have dental expenses in the future, such as aligners, choose a plan that will defray your costs.

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