[1] Along its route, PTH 23 passes through the communities of Elgin, Ninette, Baldur, Miami, Lowe Farm, and Morris.

The highway heads due east for several kilometres, crossing several creeks to pass through the town of Elgin along Main Street, having an intersection with PR 448 here.

As it leaves Elgin, it has a junction with PTH 22 on the north side of Whitewater Recreation Park, before heading east through farmland for the next several kilometres, passing just north of Fairfax (where it has an intersection with PR 444) to come to an intersection and become concurrent (overlap) with PTH 10 (John Bracken Highway) for the next several kilometres.

PTH 23 leaves Ninette and travels along the southern edge of Belmont, passing through several switchbacks along the way, where it has a junction with PR 458 before crossing into the Rural Municipality of Argyle.

The highway then goes through a switchback and has a junction with PR 342 at the community of Greenway before crossing into the Rural Municipality of Lorne.

They head south through a business district, where PTH 23 splits off along Montreal Avenue to pass through neighbourhoods and cross a bridge over the Red River.

Provincial Road 444 (PR 444) is a 11.5-kilometre-long (7.1 mi) north-south spur of PTH 23 mostly within the Municipality of Grassland, providing access to the hamlet of Fairfax.

In is entirely a two-lane road with the portion between Fairfax and PTH 23 being paved, where it is known as North Avenue, while the rest is composed of gravel.