The ODA suggested fee guide, explained
Many Ontario patients hear about the fee guide when they read an insurance statement. Here's what it is and how it affects you.
The Ontario Dental Association publishes a suggested fee guide for general dentists every year. It lists treatments by code with a suggested fee for each. Dentists may choose to follow it, and many insurers use it to set what they reimburse. Your plan may pay a percentage, or an older year's amount, so you may owe a balance.
What the fee guide is
The Ontario Dental Association (ODA) is the professional association for dentists in Ontario. Each year, it publishes a suggested fee guide for general practitioners. The guide assigns a code to each procedure, such as an exam, a set of X-rays or a filling on a certain number of tooth surfaces, along with a suggested fee.
The guide is a reference point. It's not a law, and each dentist decides what to charge. At our office, our fees follow the ODA suggested fee guide.
How insurance uses it
Many insurance plans in Ontario base what they pay on the ODA fee guide. Your employer and insurer agree on the details, so two people with the same insurer can have different coverage. Common differences include:
- The percentage covered for each type of service, such as basic, major or preventive
- Which year's fee guide the plan uses; some plans pay based on a previous year
- Time units for scaling, which are billed in units of time
- Frequency limits, such as how often exams or X-rays are covered
- Annual or lifetime maximums
Why you might owe a balance
If your plan pays a percentage of the current fee guide amount, you'll owe the remaining percentage. If your plan reimburses based on an older fee guide, there may be a gap between what the office charges and what the plan considers eligible, even for services covered at 100%.
Treatment that uses a different material or approach from what your plan allows may also be paid at a lower, alternative rate.
Reading a dental estimate
A dental estimate usually lists each planned procedure with a five-digit code from the fee guide, the tooth number and surfaces involved, and the fee. Some procedures, such as scaling, are listed in time units, so the number of units affects the total.
If you're comparing estimates between offices, compare the codes as well as the totals. Two plans for the same tooth may use different procedures or materials. Ask the office to explain any code you don't recognize. Your insurer can also tell you how a particular code is covered under your plan.
How to avoid surprises
- Ask for a written treatment estimate that lists each procedure code
- For larger treatment, ask the office to submit a predetermination to your insurer
- Check your plan booklet for coverage percentages, maximums and frequency limits
- Ask whether your plan uses the current fee guide or an older one
- If you have the Canadian Dental Care Plan, ask about co-payments and any balance before treatment
Frequently asked questions
Is the fee guide the same as what I'll pay?
Not necessarily. Your share depends on the office's fees, your plan's coverage and which fee guide year your insurer uses. We explain costs and coverage before treatment.
Where can I see the fee guide?
The ODA makes the guide available to its members and insurers. Your dental office can tell you the codes and fees for the treatment you need.
Does the CDCP use the ODA fee guide?
The CDCP has its own fee schedule set by the federal government. If an office's fee is higher than what the plan pays, the difference may be charged to you. We explain any balance in advance.
Can I ask for an estimate before every visit?
Yes. You can ask for an estimate for any treatment, and for larger work we can send a predetermination to your insurer.
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Trusted health information
General information only; not a substitute for an exam. Reviewed by Dr. Sayeh Maralani, DDS, general dentist. Last updated 2026-11-05.
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