ontario Dental Fee Guide

What is the Ontario Dental Fee Guide?

The ODA Fee Guide is a reference for suggested fees for dental services. The list is updated annually by the Ontario Dental Association. 

The ODA Suggested Fee Guide helps dentists derive fees, but this is only a guide, and the fees are only suggested. A dentist may use this guide to formulate a fee for their dental services. Once a dentist has established a fee for a certain service, with notable exceptions, he/she will charge that fee to all patients, regardless of whether or not the patient has a dental plan.

The Ontario Dental Association publishes The ODA Suggested Fee Guide for General Practitioners.  The Guide is based on the provision of dental services that are performed under normal conditions.  It is intended to serve only as a reference for the general practitioner to develop a structure of fees that is fair and reasonable to the patient and the practitioner.  

The Guide is not obligatory. Each practitioner is expected to independently determine the fees charged for the services performed, which means that fees will vary both above and below the Guide.  The Guide is issued merely for professional information purposes, without any intention or expectation that a practitioner will adopt the suggested fees.

The Guide is not available on the ODA website. However, copies have been placed in the reference section of many public libraries so that members of the public can access this document. 

Why is the dental fee guide essential?

While dentists are not obligated to follow the dental fee guide when setting the prices for their services, such a document is essential because it:

• Regulates the price of dentistry within a province
• Allows for more educated and informed consumers
• Ensures individuals receive good value for their money when it comes to oral treatments.
• Makes it easier and more affordable for Canadians to access quality dental care
• Increases transparency, reigning in dentistry costs over time
  

How to use the dental fee guide?

The fees in the dental guide are recommended but are not mandatory. Dentists continue to set the fees they charge for services. Some will charge more than the fee guide; some will charge less.

Because dentists charge different prices, you may wish to shop around. 

To help you compare, the guide includes:

• A list and description of dental procedures
• Codes dentists use to identify procedures.
• Suggested fees

To avoid unexpected costs:

• Compare your dentist's fees with the dental fee guide.
• Ask your dentist to send a pre-authorization to your insurance company.
• Contact your insurance company to determine the amount covered and how much you'll be required to pay.

Ontario Dental Fee Guide 2020

Each year the Ontario Dental Association (ODA) sets its dental fee guide for the coming year.  This guide is used by many dentists to set their prices (though they can charge above or below this). Insurers tend to use these numbers as the “reasonable & customary” limitation for claims.

Last year the Ontario increase was 4.19% on average, which was the highest we’d seen in well over a decade.  The average over that period was about 2.2%/ year.  The 1.27% increase for 2020 is a nice break and much lower than what was expected.

Almost all dentists in Ontario follow the current Ontario Dental Association Fee Guide because most dental insurance companies reimburse based on the ODA fee guide. This is true for procedures typically covered by dental insurance such as dental cleanings, x-rays, fillings, extractions, root canals, crowns and dentures.

The Ontario Dental Association Fee Guide:

• It is about 80 pages long!
• It contains about 1,300 dental procedures!
• Identifies each dental procedure by a five-digit number: the dental code
• Many dental treatments are a combination of multiple codes.
• It is written in “dentist language”; words like cleaning, check-up and filling are NOT used.
• Is NOT available online
• Copies are AVAILABLE in the reference section of many public libraries.
• Although the Fee Guide is “suggested,” almost all dentists in Ontario follow it.

Dentist prices do differ significantly between dentists for procedures typically NOT covered by insurance:

• Cosmetic procedures such as teeth whitening, veneers, braces
• Expensive procedures that insurance companies do not cove, such as dental implants.

Frequently Asked QuestionsHow Are Fees Determined?

Dentists are obligated to adhere to a high standard of dental care and must comply with strict statutory requirements designed to ensure the highest level of patient safety. Dentists are responsible for the costs related to operating a dental office.

• Specialized equipment, products and materials used in dental treatment; 
• The complexity of the treatment; 
• Sterilization and safety protocols, 
• Hiring trained and licensed staff and 
• Ongoing continuing education for the dental team, 
• Practice location and other overhead costs 

These all factor into the cost of providing dental care.
Dentists have to consider all these factors when determining their fees. Operating costs will vary between dental offices as well as provincially.

Are Dentists Required to Follow the Provincial Fee Guide?

No. While many dentists will follow some fees within the guide, there is no requirement to do so. Dental offices consider several variables when determining costs for their office.

Why are specialist fees higher?

Dental specialists receive additional training in the field of dentistry. General practice dentists will refer patients where a specialist's care is required.

Treatment provided within specialty fields is often highly technical and complex. It can involve specialized equipment, materials required for treatment, additional staffing needs and ongoing education. All of these factors are considered by specialists when determining treatment costs.

Why Does My Dentist Charge More than the Provincial Fee Guide?

There is no requirement for dentists to charge the suggested fees outlined in the dental fee guides. Dentists determine costs for their office based on the factors influencing their practice.

Do All Dentists Charge the Same Fees?

Dentists in Ontario are not required to charge the fee guide’s fees, as the manual is only intended to provide an idea of what to charge. Each dentist’s office has its own set of costs that determine how much they charge for a particular treatment type.

This can include highly trained and licensed staff, the office’s size, the office’s location, lab fees, and specialized equipment, just to name a few. Dentists’ fees vary, and as small business owners, they find their profit margins to be one of the most significant factors in their service fee structure.

Can Dentists Bill My Insurance Company?

Yes, provided the dentists have previously confirmed applicable insurance coverage is in place. Contact your insurance provider for a comprehensive description of covered services and claim processes.

Can The Dentist Get My Insurance Information For Me?

No. The privacy laws governing both the dental practice and insurance providers limit your dentist’s ability to access or request specific details about your policy coverage. Insurance companies do not have a legal obligation to provide us with thorough or accurate information about a patient’s coverage. 

Any information your dentist receives from insurance companies is provided in general terms as a courtesy only. Contact your insurance provider for a comprehensive description of covered services, fee schedules, deductibles, and claim processes. We can send off for estimates and pre-authorization for your recommended dental treatments.

Why Do Dentists Provide/Offer Procedures That Are Not Covered?

Dentists are responsible for providing you with the best clinical care and treatment options with your health concerns in mind. Dentists do not know with complete certainty which procedures will be covered. If dentists base their treatment options on the limitations of insurance coverage, they will not be able to provide you with the quality dental care you deserve.

Should I Talk to My Dentist About the ODA Fee Guide?

The best way to determine how you’re charged for a procedure is to ask your dentist. Dental offices receive an updated fee guide every year from ODA, and most dentists will familiarize themselves with its contents when setting prices for a new fiscal year. 
However, dentists routinely use this guide as a reference for dental fees, a tool to assist in billing patients’ plans, and a communication guide to discuss various treatment options for a particular ailment.

Can I Get An Estimate For Treatment Before Going To The Dentist?

After reviewing your medical history and discussing any symptoms or concerns you might have, a dentist will conduct a thorough oral examination of the mouth to identify and diagnose any dental disease. If your dentist identifies an issue in your mouth, they will discuss this with you, along with their treatment recommendations.

Any treatment provided by a dentist is always patient-specific, based on individual patient requirements due to the dentist’s examination and diagnosis. Oral health needs vary greatly between individuals, and therefore, there is no average treatment.

Your dentist will work with you to review treatment alternatives and provide a cost estimate for the treatment plan before proceeding. The calculation can be influenced by the specific treatment options presented, further discussions related to materials, the extent of the care required, whether or not laboratory fees factor into care, etc. Note: A dentist can only estimate costs, and patients should be made aware that costs may change when the actual treatment is performed. As with any medical-based procedure, treatment planning can change throughout the treatment, influencing the price. 

Can I get a second opinion; the cost estimate seems high?

It is essential that you feel comfortable in proceeding with any dental treatment. Your dentist is there to support your health and answer any questions you may have, including why they recommend the treatment presented and/or related to cost.  

If you are concerned with any factors relating to a proposed treatment plan, you are welcome to seek a second opinion. It is essential to understand that there will be an additional cost associated with this. 
The second dentist will need to conduct an examination and consult with you to develop treatment options. 

Why can't a Dentist Provide a Second Opinion Without an Examination?

To provide an opinion related to dental care, a dentist must understand all the factors influencing a patient's health. A crucial part of this is an examination of the mouth to identify and diagnose any dental disease.

For more frequently asked questions, please refer to the Your Oral Health ODA Guide Lines.

A few points to keep in mindAs a dental consumer, you have the right to:

• Tell your dentist that your plan pays according to the 2020 or the latest ODA fee guide.
• Ask your dentist if they charge according to the 2020 or the latest ODA dental fee guide. This will give you an idea of whether your dentist is invoicing according to your plan’s payment basis.
• Request your dentist's rates for specific procedures and compare them with the rates in the dental fee guide
• If you have another cover or additional protection plans, make sure to check if you can use those as well.
• Contact a couple of dentists to compare prices.
• Shop around. Because dentists charge different fees, this can save you significantly.

Questions you might ask your dentist:  

• Why are they recommending the treatment options presented—what is/are the benefit/s to your oral/overall health?
• Are there alternative treatment options available?
• What are the implications of refusing or delaying treatment?
• Is there anything you can change in your mouth care to prevent similar issues in the future?
• What is required on my part to maintain the dental treatment recommended?

Our Dental Fees

At 24/7 Emergency Dental, our goal is to offer the best service, yet remain competitive by providing fair and reasonable dental fees to our patients and their families. That is why we follow the Latest 2020 Ontario Dental Association (ODA) Fee Guide.

We routinely review our dental fees compared to other dental practices within Ontario. With the release of the 2020 Ontario Dental Association (ODA) Fee Guide, we are completely open with our clients about our dental fees and how they compare to the NEW fee guide.

Please be aware that not all procedures are listed as professional fees.

These services’ cost varies based on the associated lab costs and depends upon the complexity of the treatment required. We encourage you to call our office to arrange a visit with one of our dentists to evaluate your oral health and your teeth’ condition so that we can provide a more accurate estimate.

At 24/7 Emergency Dental, we feel it is essential to understand your own specific dental insurance policy. Also, we ask that you are aware that not all procedures are necessarily covered based on your own particular dental insurance coverage. Our Dental Administration Team is here to help you understand and get the most from your insurance coverage! Please contact us with any questions you may have about our services or dental fees in Ontario.