Dental Fee Schedule
Dental Fees, Insurance & Payment Options in Toronto
At Dupont Dentalworks, we believe patients should understand the cost of their dental care, how their dental insurance works and what payment options may be available before moving forward with treatment.
Our Toronto dental team is happy to help you understand treatment estimates, dental insurance claims, co-payments, deductibles and other costs associated with your care. As a courtesy, we can also assist with submitting eligible insurance claims and help explain the information provided by your insurance company.
Does Dupont Dentalworks Follow the ODA Fee Guide?
Yes. Dupont Dentalworks bases our dental fees on the current Ontario Dental Association (ODA) Suggested Fee Guide, which is updated annually. The ODA Suggested Fee Guide provides suggested fees and procedure codes for dental treatments performed in Ontario. Your actual treatment cost will depend on the dental services you require, the complexity of your treatment and your individual treatment plan.
Before proceeding with more extensive dental care, our team can review your recommended treatment and provide an estimate so you have a clearer understanding of the anticipated cost.
If you are new to our practice, an oral exam and new patient exam can help our team assess your oral health and determine which treatments, if any, may be recommended.
How Does Dental Insurance Work at Dupont Dentalworks?
Dental insurance is an agreement between the patient, their employer or plan sponsor, and the insurance company. Dupont Dentalworks does not determine your dental coverage and does not have control over what your insurance plan approves, excludes or reimburses.
As a courtesy to our patients, we can submit eligible dental claims electronically to insurance companies on your behalf. Where permitted by the insurance plan, we may also collect the insured portion directly from the insurance company.
We can help you understand the information your insurer provides, but decisions regarding coverage are made by your insurance company according to the terms of your specific plan.
Dental plans can vary considerably and may include differences in:
- The percentage of treatment covered
- Annual maximums
- Deductibles
- Treatment frequency limitations
- Eligible dental procedures
- Orthodontic or major restorative coverage
- Coverage based on a previous year’s dental fee guide
Any co-payment, deductible or portion of treatment that is not covered by your dental insurance remains the patient’s responsibility.
Your Dental Treatment Is Based on Your Oral Health, Not Your Insurance Coverage
Our responsibility as your dental care provider is to recommend treatment based on your oral health, wellbeing and individual clinical needs. Dental insurance plans are designed to provide financial assistance toward dental care, but the treatment covered by an insurance plan may not always align with the treatment that is most appropriate for a patient’s oral health.
For this reason, our dentists will recommend the care they believe is clinically appropriate for you, regardless of whether a particular service is fully covered, partially covered or not covered by your insurance plan.
We will always do our best to explain your treatment options, anticipated costs and available insurance information so you can make an informed decision about your care.
What Is a Dental Insurance Deductible?
A deductible is an amount that you may be required to pay before your dental insurance plan begins contributing toward eligible treatment costs. For example, if your insurance plan has an annual deductible, you may need to pay that amount yourself before the insurer begins reimbursing covered dental services.
Deductibles vary by insurance plan. Some plans have no deductible, while others may apply a deductible once per year or under specific circumstances. Your insurance company determines whether a deductible applies and how much it is.
What Is a Dental Claim Acknowledgement?
After a dental claim or predetermination is submitted electronically, the insurance company may provide a claim acknowledgement.
A claim acknowledgement primarily confirms that the insurance company has received the submitted information. In many cases, the acknowledgement does not provide detailed information about reimbursement, the amount the insurer will pay or the patient’s final out-of-pocket cost.
Depending on the insurance company, an acknowledgement may indicate that a claim or predetermination has been received or processed, and in some cases it may indicate that a submission has been rejected. However, it should not be relied upon as a detailed explanation of insurance coverage or reimbursement.
More detailed information about how a claim or predetermination has been assessed is generally provided through an Explanation of Benefits or other documentation issued by the insurance company.
If you have questions about an acknowledgement received after a claim or predetermination is submitted, our team can help explain the information that has been provided. Questions about coverage decisions or reimbursement may need to be directed to your insurance company.
What Is an Explanation of Benefits?
An Explanation of Benefits, often referred to as an EOB, is information provided by your insurance company explaining how a dental claim or predetermination has been assessed under your plan.
Unlike a claim acknowledgement, which may simply confirm that information has been received, an Explanation of Benefits may provide more detailed information about the insurer’s assessment.
Depending on your insurance provider and plan, this may include:
- The dental services submitted
- The amount submitted to the insurance company
- The amount considered eligible under your plan
- The amount covered or reimbursed by the insurer
- Any deductible that has been applied
- The amount that may remain the patient’s responsibility
- Reasons why a service or portion of a claim was not covered
- Information about a predetermination or treatment estimate
The information provided will vary depending on the insurance company and the terms of your individual dental plan.
Our team can help you understand the information contained in an Explanation of Benefits. However, your insurance company ultimately determines your coverage and can provide additional clarification regarding its decisions.
What Is a Dental Insurance Predetermination?
For certain dental treatments, Dupont Dentalworks can submit a predetermination or treatment estimate to your insurance provider before treatment begins.
A predetermination allows your insurance company to review the proposed treatment and provide information about what may be covered under your plan. This can help you better understand your estimated out-of-pocket cost before deciding how to proceed.
A predetermination is not a guarantee of payment. Final coverage is determined by your insurance provider according to the terms of your plan and your available benefits when the treatment is completed.
Predeterminations can be particularly helpful when considering more extensive treatments such as Invisalign treatment in Toronto or dental implants in Toronto.
What Is a Dental Insurance Co-Payment?
A co-payment is the portion of your dental treatment cost that your insurance plan does not cover and that you are responsible for paying.
For example, if your insurance plan reimburses a percentage of an eligible procedure, you are responsible for the remaining amount, along with any deductible or charges that are not covered by your plan. The amount you are responsible for depends on your individual dental insurance policy.
Dupont Dentalworks can assist with submitting your eligible claim and help explain the response received from your insurer, but we cannot change the level of coverage established by your insurance plan.
Does Dupont Dentalworks Accept the Canadian Dental Care Plan (CDCP)?
Yes. Dupont Dentalworks accepts patients covered under the Canadian Dental Care Plan (CDCP).
The CDCP helps eligible Canadians pay for certain dental services. The amount covered can vary depending on the services provided, CDCP-established fees and the patient’s applicable co-payment.
Dupont Dentalworks submits eligible CDCP claims on behalf of patients. Patients are responsible for paying any remaining balance not covered by the CDCP, including applicable co-payments or other amounts that fall outside CDCP coverage.
Our team can review the anticipated cost of your dental treatment with you and explain any estimated balance that may remain after CDCP coverage. As with private dental insurance, treatment recommendations are based on your oral health and clinical needs rather than solely on what the CDCP covers.
Does Dupont Dentalworks Offer Payment Plans?
Yes. Payment plan options are available for qualifying larger treatment plans.
We understand that some dental treatments represent a significant investment in your oral health. Depending on your treatment plan, payment options may be available for services such as:
- Invisalign clear aligners
- Dental implants
- Other qualifying larger treatment plans
If you are considering a larger dental treatment, speak with our team about available payment arrangements. We can review the treatment plan, anticipated costs and available options with you before treatment begins.
What If I Don't Have Dental Insurance?
You don’t need dental insurance to become a patient at Dupont Dentalworks.
Patients without insurance are welcome at our Toronto dental clinic. Our team will explain your recommended treatment and associated fees so you can make an informed decision about your dental care.
For qualifying larger treatment plans, payment options may also be available. If you are due for a checkup or have a dental concern, you can begin with a comprehensive oral exam so our team can assess your oral health and discuss any treatment that may be recommended.
Frequently Asked Questions
Does Dupont Dentalworks submit dental insurance claims?
Yes. As a courtesy, Dupont Dentalworks can submit eligible dental insurance claims electronically on behalf of our patients. Your insurance coverage is determined by your insurance company according to the terms of your individual plan.
Does Dupont Dentalworks determine what my dental insurance covers?
No. Your dental insurance plan is an agreement between you, your employer or plan sponsor, and your insurance company. Dupont Dentalworks does not determine or control the level of coverage provided by your plan.
Does Dupont Dentalworks use the Ontario Dental Association Fee Guide?
Yes. Dupont Dentalworks bases its dental fees on the current Ontario Dental Association Suggested Fee Guide, which is updated annually.
What is a dental insurance deductible?
A deductible is an amount you may be required to pay before your dental insurance begins contributing toward eligible treatment costs. Whether a deductible applies and the amount charged depend on your individual insurance plan.
What is a dental claim acknowledgement?
A claim acknowledgement primarily confirms that an insurance company has received information submitted for a dental claim or predetermination. It generally does not provide complete details about reimbursement or the patient’s final cost, although it may sometimes indicate that a submission has been rejected.
What is an Explanation of Benefits?
An Explanation of Benefits provides more detailed information from your insurance company about how a dental claim or predetermination has been assessed. Depending on your plan, it may show eligible amounts, insurance reimbursement, deductibles, the patient’s remaining portion and reasons for coverage decisions.
Will Dupont Dentalworks recommend treatment based on what my insurance covers?
No. Our dentists recommend treatment based on your oral health, wellbeing and individual clinical needs. Insurance coverage can help with the cost of care, but it does not determine which treatment is most appropriate for you.
Can you tell me how much my insurance will cover before treatment?
For certain treatments, our team can submit a predetermination to your insurance provider. This may provide an estimate of what your plan will cover, although it is not a guarantee of payment and final reimbursement is determined by your insurer.
Does Dupont Dentalworks accept CDCP?
Yes. Dupont Dentalworks accepts patients covered through the Canadian Dental Care Plan and submits eligible CDCP claims on their behalf. Patients are responsible for any applicable co-payment or remaining balance not covered by the CDCP.
Do you offer payment plans for dental treatment?
Payment plan options are available for qualifying larger treatment plans, including treatments such as Invisalign and dental implants. Speak with our team about the options that may be available for your specific treatment.
Can I visit Dupont Dentalworks without dental insurance?
Yes. Patients without dental insurance are welcome. We will explain your recommended treatment and associated fees before moving forward.
Have Questions About Dental Insurance, CDCP or Treatment Costs?
Dental insurance terminology and coverage can sometimes be confusing. Our team is happy to help make the process easier to understand.
If you have questions about an insurance claim, deductible, claim acknowledgement, Explanation of Benefits, predetermination, CDCP coverage, treatment estimate or available payment options, contact Dupont Dentalworks.
While we can help explain the information supplied by your insurer, questions about why a particular service is or is not covered should ultimately be directed to your insurance company.
Schedule Your Appointment
Call 416-536-9535 or contact our Toronto dental clinic to schedule an appointment.