Worked Estimates and Checklists
How to read a dental treatment estimate in Canada: codes, fees, lab charges and predeterminations
A line-by-line guide to a Canadian dental treatment estimate, from procedure codes and lab fees to predetermination results, with a worked example and checklist.
A Canadian dental treatment estimate lists each planned service with a procedure code, a description, the tooth number, the dentist's fee and often a separate lab fee. To read it, check four things: that every stage of treatment is listed, that each line has a code you can give your insurer, which lines are fees your plan will consider and which are extras, and what the estimate leaves out. Then send it to your insurer as a predetermination, whose reply shows the eligible amount, the percentage paid, any alternate benefit and your remaining annual maximum. The difference between the total and the plan's reply is what you will pay.
This is the overview for the Worked Estimates and Checklists section. Every guide in this section uses illustrative numbers: replace them with the ones on your own estimate.
The parts of an estimate
| Column | What it means | What to check |
|---|---|---|
| Procedure code | Standard code used across Canada for dental billing (Quebec uses its own nomenclature) | Every line has one |
| Tooth number | The tooth involved, using the international two-digit system (for example 46 is the lower right first molar) | Matches the tooth you discussed |
| Description | Short name of the service | Understandable to you |
| Professional fee | The dentist's fee for the service | Compared with the fee guide if you can |
| Lab fee | Charged by the dental laboratory for crowns, bridges, dentures, implant parts | Listed separately or included |
| Units | For time-based services such as scaling | Number of units matches the plan |
| Total | Sum of fees | Includes taxes only if any service is taxable |
About tax: basic dental services provided by licensed dental professionals are generally exempt from GST/HST, while purely cosmetic services can be taxable. If you see tax on an estimate, ask which line it applies to.
Worked example: reading an implant estimate (illustrative)
| Line | Description | Tooth | Fee | Lab |
|---|---|---|---|---|
| 1 | Cone-beam CT, limited field | 36 | $250 | — |
| 2 | Surgical extraction | 36 | $380 | — |
| 3 | Bone graft at extraction site | 36 | $650 | — |
| 4 | Implant placement, surgical stage | 36 | $2,300 | — |
| 5 | Custom abutment | 36 | $450 | $350 |
| 6 | Implant-supported crown, zirconia | 36 | $1,100 | $450 |
| Total | $5,130 | $800 |
Grand total = $5,130 + $800 = $5,930.
What to ask about this estimate:
- Is a temporary tooth included? It is not listed.
- Are follow-up visits and suture removal included in line 4?
- Is sedation planned? It is not listed.
- Will lines 1 to 4 be billed by a different office than lines 5 and 6?
- When is each line paid: at booking, at surgery or at delivery of the crown?
What a predetermination tells you
A predetermination is a pre-treatment estimate you or your dental office send to your insurer before treatment. The reply usually shows:
- Eligible amount per line. Possibly lower than the fee if the plan uses a fee guide or previous-year guide.
- Coverage percentage. For example 80% basic, 50% major.
- Alternate benefit. "Benefit based on" a different procedure, such as a bridge or partial denture.
- Exclusions. Lines with zero payment and a reason.
- Remaining maximum. How much of your annual maximum is left.
Continuing the example (illustrative plan): the plan excludes implants, covers extraction at 80% and the graft not at all, and the CT scan at 80%.
- CT: 80% × $250 = $200
- Extraction: 80% × $380 = $304
- Graft, implant, abutment, crown: $0
- Plan total: $504
- You pay: $5,930 − $504 = $5,426
If the same plan instead covered implants at 50% subject to a $1,500 maximum, the implant insurance annual maximum example shows how splitting stages over two benefit years changes the result.
Red flags and fair questions
- No codes. You cannot get a predetermination or compare without them.
- A total with no breakdown. Ask for the itemised version.
- Pressure to decide on the day. Larger treatment can usually wait for a predetermination and, if you want, a second opinion.
- Deposits for lab work before you consented. Ask what is refundable.
- Discount for paying everything upfront. It may be legitimate, but ask what happens to the prepaid money if treatment stops.
None of these alone means something is wrong; they are prompts for questions.
Guides in this section
- Single implant from extraction to crown
- Full-arch implant options compared
- Splitting an implant across two benefit years
- Crown and root canal estimate
- Dental financing and payment plans
- Timing payments for the medical expense tax credit
- Implant consultation checklist
FAQ
Is an estimate a binding price?
Usually it is an estimate, not a contract price. Ask the office how and when it would change and to tell you in advance if it does.
My insurer's reply shows less than the plan percentage. Why?
The percentage applies to the eligible amount, which may be a fee guide figure, an alternate treatment or limited by your remaining maximum.
Do I need a predetermination for small treatment?
Not usually. It is most useful for crowns, bridges, implants, dentures and anything over a few hundred dollars.
Can I ask for the estimate in French?
In Quebec, the Charter of the French Language generally gives you the right to be served in French. Elsewhere, ask the office.
Sources
- Canada Revenue Agency: GST/HST — tax status of health care services
- Royal College of Dental Surgeons of Ontario — fees and informed consent
- OmbudService for Life and Health Insurance — help if a dental claim is disputed
- Canadian Dental Care Plan — preauthorization for CDCP members
