Getting Extra Scaling Units Approved Under the CDCP: What Works and What Does Not
Extra scaling units are one of the most common preauthorization requests I see, and one of the most commonly rejected. The frustrating part is that most of the rejections have nothing to do with whether the patient needs the treatment. They come down to what was in the envelope when the request went out.
Here is what I have learned about getting these approved, and the two tools I put together to make it easier.
First, know when you actually need a preauthorization
Scaling and root planing are covered up to a yearly maximum with no preauthorization at all. For age 17 and up, that is 4 units in any 12 months in combination with root planing. The maximums are lower for younger patients: half a unit for ages 0 to 11, and one unit for ages 12 to 16.
Anything beyond that maximum needs preauthorization. If the patient has not reached the yearly maximum yet, there is nothing to request. Submit the treatment and move on. A surprising number of preauthorizations get sent in for units that were already covered.
What works
A dated complete periodontal chart from the last 12 months. Six measurements per tooth. This is the single most important document in the request, and it is the one most often missing or stale. A chart from two years ago is not current documentation. If you genuinely cannot provide a complete chart, write out why. A clear written rationale for a missing or incomplete chart is part of the criteria, not an excuse for skipping it.
Documentation that actually shows severity. The severity of the periodontal disease is the main factor in the decision. That means recent clinical notes, a stated diagnosis and prognosis, the complete periodontal charting, and radiographs, all working together to show disease serious enough to need more than the standard units. Higher staging (I to IV) and grading (A to C) support the need, but only when the chart substantiates them. A stage asserted in the notes and nowhere else is just a word. The stage is worth something to the reviewer when the measurements behind it are sitting in the same envelope. If you are not confident where a case lands, the stage and grade quiz in the checklist tool will help you gauge it before you write the request.
A rationale that connects the condition to the units requested. Do not make the reviewer infer it. Say plainly why this patient’s condition requires units beyond the standard limit. The notes and the request should tell one story.
Here is the difference in practice. A weak rationale:
Patient has periodontal disease and requires additional scaling beyond the yearly maximum. Please approve 4 additional units.
A strong one, same patient:
Patient presents with generalized Stage III, Grade B periodontitis, with probing depths of 5 to 7mm across 18 sites and radiographic bone loss to the middle third on the posterior sextants. The 4 standard units are insufficient to debride the affected sites in this dentition. 4 additional units are required to complete non-surgical therapy across all four quadrants. Without full debridement the patient remains at continued risk of attachment loss and eventual tooth loss.
The weak version names a condition but never a severity. It never connects the number of units to anything measurable, and it gives the reviewer nothing to check against the chart. The strong version states the stage and grade, cites the specific findings that justify them, and explains why the standard allotment does not cover the work. Every claim in it can be verified against the chart travelling with the request. That is the whole difference.
Relevant medical conditions and prescribed medications. If there is a medical condition affecting the patient’s periodontal disease, including any prescribed medication, include it. This is a supporting factor rather than a requirement. It can strengthen a request, and leaving it out will not count against you, but including it costs nothing.
What does not work
Sending the request with no chart and no explanation. This is the most common reason for a rejection I see. The chart is the evidence. Without it, and without a reason for its absence, there is nothing to evaluate.
Assuming the reviewer will fill in the blanks. They will not. If the diagnosis is implied by the numbers but never written down, it is not in the request.
Requesting extra units before the standard maximum is used. See above. Check the date of the last scaling and count the units first.
Treating urgency as evidence. The patient needing the treatment and the file demonstrating the need are two different things. The file is what gets reviewed.
Reusing narrative from a previous patient. Generic rationale reads as generic. It should be specific to the case in front of you.
Use the checklist before you submit
I built the CDCP Approval Checklist to walk through this one question at a time. The Extra Scaling Units category runs through each criterion and tells you which points passed, which failed, and which still need confirming before you send anything. It covers crowns and root canal retreatment too, and includes a stage and grade quiz built on the 2017 classification.
No patient data goes into it. It is tickboxes only.
The blank request form is there to give the request a consistent structure so nothing gets left out.
Submit it electronically
Send the preauthorization through your practice management software using the ITRANS digital claim system, and send the supporting attachments electronically the same way. The perio chart, the radiographs, and the clinical notes should travel with the request rather than separately.
Every practice management system handles attachments a little differently, and the steps are not always where you would expect to find them. I am not going to tell you where the button is in your software, because I would get it wrong for most of you. Your vendor is the right people to ask, and they will not guess.
If you are not sure who that is or how to reach them, ITRANS publishes a list of ITRANS Ready software vendors with a link out to each one. ABELDent, Dentrix Canada, Open Dental, EagleSoft and MacPractice are all on it. Most vendors offer training on electronic claim and attachment submission, so ask for that rather than a one-off answer. If your vendor points you back at ITRANS, ITRANS support is at 866-788-1212 or support@goitrans.com, weekdays 9am to 5pm.
It is worth the phone call once, because the documentation reaching the reviewer intact is the entire point of the work above.
How long the decision takes
Every preauthorization I have submitted has gone electronically, so that is the only turnaround I can speak to. In my experience the decision comes back within about a month at the longest, and often sooner. I cannot tell you how paper submissions compare because I have never sent one.
That number is my own observation rather than a published service standard, so treat it as a rough expectation and not a guarantee. The practical use of it is knowing when the wait has stopped being normal. If a month has passed with nothing, that is the point to pick up the phone rather than keep waiting.
When it comes back rejected
Most people reading this arrived after a rejection, so here is what I actually do.
Call the Sun Life CDCP hotline and speak to an agent. Do not guess at what went wrong and do not immediately fire off a corrected request. The point of the call is to find out where the gap is, because it is not always on your end. Sometimes something was missed in the submission. Sometimes something was missed on the CDCP side. You cannot tell which from the rejection alone, and the agent can.
What happens next depends on what the call turns up. If something was missing from your submission, correct that specific thing and resubmit. If the request is already in appeal and review, the work is to wait for that to process rather than submit anything new on top of it. The agent will tell you which situation you are in and give you a new timeline for it. That timeline is the one to work from, since it is specific to your file in a way that nothing in this article can be.
The reason the call comes first is the same reason the documentation matters. Resubmitting blind means guessing at the reason for the rejection, and a corrected request that corrects the wrong thing gets rejected again.
An honest note on approvals
Neither the form nor the checklist approves anything. Nothing does except the CDCP itself, and only after a legitimate claim has been submitted by an oral health provider. Final approval is always subject to that submission and to the CDCP’s own review. A clean checklist means the request looks like it meets the published criteria. It is not a decision and it is not a promise.
These approvals are not a trick or a workaround. They come from following the published guidelines carefully and making sure the documentation supporting a request is complete and current before it goes out. That is the whole method. The criteria here come from the CDCP Dental Benefits Guide (scaling policy 6.5.1) and the 2026 CDCP Dental Benefit Grid for Ontario. If Health Canada or Sun Life update the policies, the guidance changes with them.
When patients genuinely need the treatment and the file shows it clearly, approvals follow far more often than not. Most of the work is in the file.