Attachment 1 - Quote Sheet.xlsx
XLSX spreadsheet 472 KB Posted
- Solicitation number
- 36C10G23Q0005
About this file
This document is a request for quotations (RFQ) for dental laboratory products and services under a follow-on multiple award indefinite delivery indefinite quantity contract with the Department of Veterans Affairs. The solicitation seeks quotations for items such as crowns, bridges, dentures, and implants prosthetics to be provided over a one year base period and four one-year options. Prospective offerors may submit questions by May 5th and must submit quotations by May 22nd. Awards are anticipated to support the VA SAC National Dental Laboratory.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10G23Q0005 0001.docx | DOCX document | |
| RFQ Questions - Dental Laboratory Follow-On Solicitation Number 36C10G23Q0005.pdf | ||
| Copy of NATIONAL CONTRACT SLA Fee Quote Sheet Version 2023.xlsx | XLSX spreadsheet | |
| Attachment 2 - Quarterly Reporting Tool.xlsx | XLSX spreadsheet | |
| 36C10G23Q0005 - Solicitation SAC Dental Labs.pdf | ||
| Attachment 3 - Pay.gov Vendor Submittal Instructions.docx | DOCX document |
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Text version
Action Line Item Information
| Action Type Name | Primary ID | Secondary ID | Mod Number | Title | Order Discount Type Name | Order Discount Type | Order Discount |
| RFQ | 36C10G23Q0005 | RFQ | FOLLOW-ON VA NATIONAL DENTAL LABORATORY PRODUCTS & SERVICES | Percent | 0 |
KB Version: FY23.02A
Items
| Item Number | SLIN | Description | Ref CLIN | Comment | Include Comments in Document | Contract Period | Pop Begin | Pop End | Quantity | Unit of Measure | Packaging Multiple | Receipt Type | Line Item Is | Unit Price | Item Discount Type Name | Item Discount | Date Updated | Address1 | Address2 | Address3 | City | State | Zip | Zip4 | Country | Mark For | Contact Name | Contact Phone | Contact Email | Delivery Date | FOB | Special Instructions | Include Instructions/Comments in Document | PRINCIPAL NAICS CODE | PRODUCT/SERVICE CODE | UNSPSC | SIC CODE | MANUFACTURER PART NUMBER (MPN) | NATIONAL STOCK NUMBER | LOCAL STOCK NUMBER | DM DOC ID | DELIVERY REF. COUNTER | UNIT TEXT/DESCRIPTION | DELIVERY REFERENCE | ITEM MASTER FILE NUMBER | EXPENDABLE/NON-EXPENDABLE | QUANTITY REQUESTED | UNIT OF PURCHASE CODE | UNIT OF PURCHASE TEXT/DESC. |
| 0001 | PFM Crown (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0001 | ||||||||||||||||||||||||||||||||||||
| 0002 | PFM Crowns (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0002 | ||||||||||||||||||||||||||||||||||||
| 0003 | PFM FPD (Bridge units - Retainer and pontics) (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0003 | ||||||||||||||||||||||||||||||||||||
| 0004 | PFM FPD (Bridge units - Retainer and pontics) (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0004 | ||||||||||||||||||||||||||||||||||||
| 0005 | Porcelain Application Only | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0005 | ||||||||||||||||||||||||||||||||||||
| 0006 | Full Metal Crowns (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0006 | ||||||||||||||||||||||||||||||||||||
| 0007 | Full Metal Crowns (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0007 | ||||||||||||||||||||||||||||||||||||
| 0008 | Full Metal FPD (bridge units) (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0008 | ||||||||||||||||||||||||||||||||||||
| 0009 | Full Metal FPD (bridge units) (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0009 | ||||||||||||||||||||||||||||||||||||
| 0010 | Resin-bonded bridges (Maryland Bridge) (Ceramic) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0010 | ||||||||||||||||||||||||||||||||||||
| 0011 | Resin-bonded bridges (Maryland Bridge) (Metal Ceramic) | CROWN AND BRIDGE METAL BASED | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0011 | ||||||||||||||||||||||||||||||||||||
| 0012 | Porcelain Laminate Veneer | CROWN AND BRIDGE METAL FREE | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0012 | ||||||||||||||||||||||||||||||||||||
| 0013 | All-Ceramic inlay-Onlay-3/4 Crown | CROWN AND BRIDGE METAL FREE | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0013 | ||||||||||||||||||||||||||||||||||||
| 0014 | Pressed Lithium Disilicate/Silicate Crown/Full Contour | CROWN AND BRIDGE METAL FREE | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0014 | ||||||||||||||||||||||||||||||||||||
| 0015 | Pressed Lithium Disilicate/Silicate Crown/Layered | CROWN AND BRIDGE METAL FREE | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0015 | ||||||||||||||||||||||||||||||||||||
| 0016 | Milled Lithium Disilicate/Silicate Crown/Full Contour | CROWN AND BRIDGE METAL FREE | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0016 | ||||||||||||||||||||||||||||||||||||
| 0017 | Milled Lithium Disilicate/Silicate Crown/Layered | CROWN AND BRIDGE METAL FREE | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0017 | ||||||||||||||||||||||||||||||||||||
| 0018 | Porcelain-to-Zirconia Layered Crown | CROWN AND BRIDGE METAL FREE | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0018 | ||||||||||||||||||||||||||||||||||||
| 0019 | Monolithic Zirconia Crown | CROWN AND BRIDGE METAL FREE | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0019 | ||||||||||||||||||||||||||||||||||||
| 0020 | Metal-free 3-unit bridge w/Zirconia Understructure | CROWN AND BRIDGE METAL FREE | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0020 | ||||||||||||||||||||||||||||||||||||
| 0021 | Processed Acrylic Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0021 | ||||||||||||||||||||||||||||||||||||
| 0022 | Milled Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0022 | ||||||||||||||||||||||||||||||||||||
| 0023 | 3D-Printed Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0023 | ||||||||||||||||||||||||||||||||||||
| 0024 | 3D-Printed Model from Intraoral Scan (Per Arch) | CROWN AND BRIDGE OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0024 | ||||||||||||||||||||||||||||||||||||
| 0025 | Diagnostic Wax-up (Per tooth) | CROWN AND BRIDGE OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0025 | ||||||||||||||||||||||||||||||||||||
| 0026 | Cast Post and Core | CROWN AND BRIDGE OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0026 | ||||||||||||||||||||||||||||||||||||
| 0027 | Special Ceramics Addition (Pink Porcelain) | CROWN AND BRIDGE OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0027 | ||||||||||||||||||||||||||||||||||||
| 0028 | Cement-retained PFM Crown | IMPLANTS PROSTHETICS (Single Unit) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0028 | ||||||||||||||||||||||||||||||||||||
| 0029 | Cement-retained Metal Crown | IMPLANTS PROSTHETICS (Single Unit) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0029 | ||||||||||||||||||||||||||||||||||||
| 0030 | Cement-retained Zirconia Crown | IMPLANTS PROSTHETICS (Single Unit) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0030 | ||||||||||||||||||||||||||||||||||||
| 0031 | Cement-retained Lithium Disilicate/Silicate Crown | IMPLANTS PROSTHETICS (Single Unit) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0031 | ||||||||||||||||||||||||||||||||||||
| 0032 | Screw-retained PFM Crown | IMPLANTS PROSTHETICS (Single Unit) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0032 | ||||||||||||||||||||||||||||||||||||
| 0033 | Screw-retained Metal Crown | IMPLANTS PROSTHETICS (Single Unit) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0033 | ||||||||||||||||||||||||||||||||||||
| 0034 | Screw-retained Zirconia Crown | IMPLANTS PROSTHETICS (Single Unit) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0034 | ||||||||||||||||||||||||||||||||||||
| 0035 | Screw-retained Lithium Disilicate/Silicate Crown | IMPLANTS PROSTHETICS (Single Unit) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0035 | ||||||||||||||||||||||||||||||||||||
| 0036 | Titanium CAD/CAM abutment (OEM) | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0036 | ||||||||||||||||||||||||||||||||||||
| 0037 | Titanium CAD/CAM abutment (Aftermarket) | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0037 | ||||||||||||||||||||||||||||||||||||
| 0038 | Zirconia CAD/CAM abutment (OEM) | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0038 | ||||||||||||||||||||||||||||||||||||
| 0039 | Zirconia CAD/CAM abutment (Aftermarket) | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0039 | ||||||||||||||||||||||||||||||||||||
| 0040 | Custom Abutment | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0040 | ||||||||||||||||||||||||||||||||||||
| 0041 | Ti Base abutment (OEM) | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0041 | ||||||||||||||||||||||||||||||||||||
| 0042 | Ti Base abutment (Aftermarket) | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0042 | ||||||||||||||||||||||||||||||||||||
| 0043 | All on 4, Fixed Hybrid Denture | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0043 | ||||||||||||||||||||||||||||||||||||
| 0044 | Full arch removable overdenture, titanium bar with attachments | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0044 | ||||||||||||||||||||||||||||||||||||
| 0045 | Titanium Bar | IMPLANTS PROSTHETICS (Abutments) | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0045 | ||||||||||||||||||||||||||||||||||||
| 0046 | Complete Denture Setup (Premium Teeth / IPN Equivalent) | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0046 | ||||||||||||||||||||||||||||||||||||
| 0047 | Complete Denture Process and Finish (Packing Technique) | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0047 | ||||||||||||||||||||||||||||||||||||
| 0048 | Complete Denture Process and Finish (Injection Technique) | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0048 | ||||||||||||||||||||||||||||||||||||
| 0049 | Complete Denture CAD-CAM Milled | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0049 | ||||||||||||||||||||||||||||||||||||
| 0050 | Complete Denture 3D Printed | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0050 | ||||||||||||||||||||||||||||||||||||
| 0051 | Rebase | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0051 | ||||||||||||||||||||||||||||||||||||
| 0052 | Reline | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0052 | ||||||||||||||||||||||||||||||||||||
| 0053 | Repair add Tooth | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0053 | ||||||||||||||||||||||||||||||||||||
| 0054 | Repair Simple Fracture | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0054 | ||||||||||||||||||||||||||||||||||||
| 0055 | Repair Complex Fracture | REMOVABLE PROSTHETICS | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0055 | ||||||||||||||||||||||||||||||||||||
| 0056 | Custom Tray | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0056 | ||||||||||||||||||||||||||||||||||||
| 0057 | Model | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0057 | ||||||||||||||||||||||||||||||||||||
| 0058 | Model 3D Printed | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0058 | ||||||||||||||||||||||||||||||||||||
| 0059 | Bite Blocks | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0059 | ||||||||||||||||||||||||||||||||||||
| 0060 | Nightguard Hard Heat Cured | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0060 | ||||||||||||||||||||||||||||||||||||
| 0061 | Nightguard Vacuum-formed | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0061 | ||||||||||||||||||||||||||||||||||||
| 0062 | Nightguard Dual-laminate | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0062 | ||||||||||||||||||||||||||||||||||||
| 0063 | Nightguard Talon | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0063 | ||||||||||||||||||||||||||||||||||||
| 0064 | Nightguard 3D Printed | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0064 | ||||||||||||||||||||||||||||||||||||
| 0065 | Nightguard 3D Milled | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0065 | ||||||||||||||||||||||||||||||||||||
| 0066 | Surgical Stent | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0066 | ||||||||||||||||||||||||||||||||||||
| 0067 | Additional Clasp Wire Surcharge (Each) | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0067 | ||||||||||||||||||||||||||||||||||||
| 0068 | Additional Clasp Clear/Tooth Surcharge (Each) | REMOVABLE PROSTHETICS OTHER | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0068 | ||||||||||||||||||||||||||||||||||||
| 0069 | Framework Cast | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0069 | ||||||||||||||||||||||||||||||||||||
| 0070 | Framework CAD/CAST | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0070 | ||||||||||||||||||||||||||||||||||||
| 0071 | Framework CAD/Laser-Sintered/SLM | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0071 | ||||||||||||||||||||||||||||||||||||
| 0072 | Framework Milled Polymer Tooth Shade | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0072 | ||||||||||||||||||||||||||||||||||||
| 0073 | Framework Milled Polymer Clear Shade | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0073 | ||||||||||||||||||||||||||||||||||||
| 0074 | Reline Partial Denture | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0074 | ||||||||||||||||||||||||||||||||||||
| 0075 | Acrylic Transitional Partial Denture w/ 2 Clasps | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0075 | ||||||||||||||||||||||||||||||||||||
| 0076 | Acrylic Transitional Partial Denture from Setup | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0076 | ||||||||||||||||||||||||||||||||||||
| 0077 | Partial Denture Setup (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0077 | ||||||||||||||||||||||||||||||||||||
| 0078 | Partial Denture Setup and Process (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0078 | ||||||||||||||||||||||||||||||||||||
| 0079 | Partial Denture Process & Finish | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0079 | ||||||||||||||||||||||||||||||||||||
| 0080 | Flexible Partial Denture Setup (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0080 | ||||||||||||||||||||||||||||||||||||
| 0081 | Flexible Partial Denture Setup and Process (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0081 | ||||||||||||||||||||||||||||||||||||
| 0082 | Flexible Partial Denture Process & Finish | PARTIAL DENTURES | Base | 08/16/23 | 08/15/24 | 1 | EA | 1 | 8/15/2024 | Destination | 339116 | 6520 | 0082 | ||||||||||||||||||||||||||||||||||||
| 1001 | PFM Crown (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1001 | ||||||||||||||||||||||||||||||||||||
| 1002 | PFM Crowns (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1002 | ||||||||||||||||||||||||||||||||||||
| 1003 | PFM FPD (Bridge units - Retainer and pontics) (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1003 | ||||||||||||||||||||||||||||||||||||
| 1004 | PFM FPD (Bridge units - Retainer and pontics) (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1004 | ||||||||||||||||||||||||||||||||||||
| 1005 | Porcelain Application Only | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1005 | ||||||||||||||||||||||||||||||||||||
| 1006 | Full Metal Crowns (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1006 | ||||||||||||||||||||||||||||||||||||
| 1007 | Full Metal Crowns (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1007 | ||||||||||||||||||||||||||||||||||||
| 1008 | Full Metal FPD (bridge units) (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1008 | ||||||||||||||||||||||||||||||||||||
| 1009 | Full Metal FPD (bridge units) (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1009 | ||||||||||||||||||||||||||||||||||||
| 1010 | Resin-bonded bridges (Maryland Bridge) (Ceramic) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1010 | ||||||||||||||||||||||||||||||||||||
| 1011 | Resin-bonded bridges (Maryland Bridge) (Metal Ceramic) | CROWN AND BRIDGE METAL BASED | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1011 | ||||||||||||||||||||||||||||||||||||
| 1012 | Porcelain Laminate Veneer | CROWN AND BRIDGE METAL FREE | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1012 | ||||||||||||||||||||||||||||||||||||
| 1013 | All-Ceramic inlay-Onlay-3/4 Crown | CROWN AND BRIDGE METAL FREE | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1013 | ||||||||||||||||||||||||||||||||||||
| 1014 | Pressed Lithium Disilicate/Silicate Crown/Full Contour | CROWN AND BRIDGE METAL FREE | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1014 | ||||||||||||||||||||||||||||||||||||
| 1015 | Pressed Lithium Disilicate/Silicate Crown/Layered | CROWN AND BRIDGE METAL FREE | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1015 | ||||||||||||||||||||||||||||||||||||
| 1016 | Milled Lithium Disilicate/Silicate Crown/Full Contour | CROWN AND BRIDGE METAL FREE | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1016 | ||||||||||||||||||||||||||||||||||||
| 1017 | Milled Lithium Disilicate/Silicate Crown/Layered | CROWN AND BRIDGE METAL FREE | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1017 | ||||||||||||||||||||||||||||||||||||
| 1018 | Porcelain-to-Zirconia Layered Crown | CROWN AND BRIDGE METAL FREE | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1018 | ||||||||||||||||||||||||||||||||||||
| 1019 | Monolithic Zirconia Crown | CROWN AND BRIDGE METAL FREE | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1019 | ||||||||||||||||||||||||||||||||||||
| 1020 | Metal-free 3-unit bridge w/Zirconia Understructure | CROWN AND BRIDGE METAL FREE | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1020 | ||||||||||||||||||||||||||||||||||||
| 1021 | Processed Acrylic Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1021 | ||||||||||||||||||||||||||||||||||||
| 1022 | Milled Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1022 | ||||||||||||||||||||||||||||||||||||
| 1023 | 3D-Printed Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1023 | ||||||||||||||||||||||||||||||||||||
| 1024 | 3D-Printed Model from Intraoral Scan (Per Arch) | CROWN AND BRIDGE OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1024 | ||||||||||||||||||||||||||||||||||||
| 1025 | Diagnostic Wax-up (Per tooth) | CROWN AND BRIDGE OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1025 | ||||||||||||||||||||||||||||||||||||
| 1026 | Cast Post and Core | CROWN AND BRIDGE OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1026 | ||||||||||||||||||||||||||||||||||||
| 1027 | Special Ceramics Addition (Pink Porcelain) | CROWN AND BRIDGE OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1027 | ||||||||||||||||||||||||||||||||||||
| 1028 | Cement-retained PFM Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1028 | ||||||||||||||||||||||||||||||||||||
| 1029 | Cement-retained Metal Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1029 | ||||||||||||||||||||||||||||||||||||
| 1030 | Cement-retained Zirconia Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1030 | ||||||||||||||||||||||||||||||||||||
| 1031 | Cement-retained Lithium Disilicate/Silicate Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1031 | ||||||||||||||||||||||||||||||||||||
| 1032 | Screw-retained PFM Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1032 | ||||||||||||||||||||||||||||||||||||
| 1033 | Screw-retained Metal Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1033 | ||||||||||||||||||||||||||||||||||||
| 1034 | Screw-retained Zirconia Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1034 | ||||||||||||||||||||||||||||||||||||
| 1035 | Screw-retained Lithium Disilicate/Silicate Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1035 | ||||||||||||||||||||||||||||||||||||
| 1036 | Titanium CAD/CAM abutment (OEM) | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1036 | ||||||||||||||||||||||||||||||||||||
| 1037 | Titanium CAD/CAM abutment (Aftermarket) | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1037 | ||||||||||||||||||||||||||||||||||||
| 1038 | Zirconia CAD/CAM abutment (OEM) | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1038 | ||||||||||||||||||||||||||||||||||||
| 1039 | Zirconia CAD/CAM abutment (Aftermarket) | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1039 | ||||||||||||||||||||||||||||||||||||
| 1040 | Custom Abutment | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1040 | ||||||||||||||||||||||||||||||||||||
| 1041 | Ti Base abutment (OEM) | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1041 | ||||||||||||||||||||||||||||||||||||
| 1042 | Ti Base abutment (Aftermarket) | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1042 | ||||||||||||||||||||||||||||||||||||
| 1043 | All on 4, Fixed Hybrid Denture | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1043 | ||||||||||||||||||||||||||||||||||||
| 1044 | Full arch removable overdenture, titanium bar with attachments | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1044 | ||||||||||||||||||||||||||||||||||||
| 1045 | Titanium Bar | IMPLANTS PROSTHETICS (Abutments) | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1045 | ||||||||||||||||||||||||||||||||||||
| 1046 | Complete Denture Setup (Premium Teeth / IPN Equivalent) | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1046 | ||||||||||||||||||||||||||||||||||||
| 1047 | Complete Denture Process and Finish (Packing Technique) | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1047 | ||||||||||||||||||||||||||||||||||||
| 1048 | Complete Denture Process and Finish (Injection Technique) | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1048 | ||||||||||||||||||||||||||||||||||||
| 1049 | Complete Denture CAD-CAM Milled | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1049 | ||||||||||||||||||||||||||||||||||||
| 1050 | Complete Denture 3D Printed | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1050 | ||||||||||||||||||||||||||||||||||||
| 1051 | Rebase | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1051 | ||||||||||||||||||||||||||||||||||||
| 1052 | Reline | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1052 | ||||||||||||||||||||||||||||||||||||
| 1053 | Repair add Tooth | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1053 | ||||||||||||||||||||||||||||||||||||
| 1054 | Repair Simple Fracture | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1054 | ||||||||||||||||||||||||||||||||||||
| 1055 | Repair Complex Fracture | REMOVABLE PROSTHETICS | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1055 | ||||||||||||||||||||||||||||||||||||
| 1056 | Custom Tray | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1056 | ||||||||||||||||||||||||||||||||||||
| 1057 | Model | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1057 | ||||||||||||||||||||||||||||||||||||
| 1058 | Model 3D Printed | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1058 | ||||||||||||||||||||||||||||||||||||
| 1059 | Bite Blocks | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1059 | ||||||||||||||||||||||||||||||||||||
| 1060 | Nightguard Hard Heat Cured | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1060 | ||||||||||||||||||||||||||||||||||||
| 1061 | Nightguard Vacuum-formed | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1061 | ||||||||||||||||||||||||||||||||||||
| 1062 | Nightguard Dual-laminate | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1062 | ||||||||||||||||||||||||||||||||||||
| 1063 | Nightguard Talon | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1063 | ||||||||||||||||||||||||||||||||||||
| 1064 | Nightguard 3D Printed | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1064 | ||||||||||||||||||||||||||||||||||||
| 1065 | Nightguard 3D Milled | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1065 | ||||||||||||||||||||||||||||||||||||
| 1066 | Surgical Stent | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1066 | ||||||||||||||||||||||||||||||||||||
| 1067 | Additional Clasp Wire Surcharge (Each) | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1067 | ||||||||||||||||||||||||||||||||||||
| 1068 | Additional Clasp Clear/Tooth Surcharge (Each) | REMOVABLE PROSTHETICS OTHER | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1068 | ||||||||||||||||||||||||||||||||||||
| 1069 | Framework Cast | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1069 | ||||||||||||||||||||||||||||||||||||
| 1070 | Framework CAD/CAST | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1070 | ||||||||||||||||||||||||||||||||||||
| 1071 | Framework CAD/Laser-Sintered/SLM | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1071 | ||||||||||||||||||||||||||||||||||||
| 1072 | Framework Milled Polymer Tooth Shade | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1072 | ||||||||||||||||||||||||||||||||||||
| 1073 | Framework Milled Polymer Clear Shade | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1073 | ||||||||||||||||||||||||||||||||||||
| 1074 | Reline Partial Denture | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1074 | ||||||||||||||||||||||||||||||||||||
| 1075 | Acrylic Transitional Partial Denture w/ 2 Clasps | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1075 | ||||||||||||||||||||||||||||||||||||
| 1076 | Acrylic Transitional Partial Denture from Setup | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1076 | ||||||||||||||||||||||||||||||||||||
| 1077 | Partial Denture Setup (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1077 | ||||||||||||||||||||||||||||||||||||
| 1078 | Partial Denture Setup and Process (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1078 | ||||||||||||||||||||||||||||||||||||
| 1079 | Partial Denture Process & Finish | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1079 | ||||||||||||||||||||||||||||||||||||
| 1080 | Flexible Partial Denture Setup (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1080 | ||||||||||||||||||||||||||||||||||||
| 1081 | Flexible Partial Denture Setup and Process (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1081 | ||||||||||||||||||||||||||||||||||||
| 1082 | Flexible Partial Denture Process & Finish | PARTIAL DENTURES | Option 1 | 08/16/24 | 08/15/25 | 1 | EA | 1 | 8/15/2025 | Destination | 339116 | 6520 | 1082 | ||||||||||||||||||||||||||||||||||||
| 2001 | PFM Crown (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2001 | ||||||||||||||||||||||||||||||||||||
| 2002 | PFM Crowns (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2002 | ||||||||||||||||||||||||||||||||||||
| 2003 | PFM FPD (Bridge units - Retainer and pontics) (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2003 | ||||||||||||||||||||||||||||||||||||
| 2004 | PFM FPD (Bridge units - Retainer and pontics) (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2004 | ||||||||||||||||||||||||||||||||||||
| 2005 | Porcelain Application Only | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2005 | ||||||||||||||||||||||||||||||||||||
| 2006 | Full Metal Crowns (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2006 | ||||||||||||||||||||||||||||||||||||
| 2007 | Full Metal Crowns (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2007 | ||||||||||||||||||||||||||||||||||||
| 2008 | Full Metal FPD (bridge units) (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2008 | ||||||||||||||||||||||||||||||||||||
| 2009 | Full Metal FPD (bridge units) (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2009 | ||||||||||||||||||||||||||||||||||||
| 2010 | Resin-bonded bridges (Maryland Bridge) (Ceramic) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2010 | ||||||||||||||||||||||||||||||||||||
| 2011 | Resin-bonded bridges (Maryland Bridge) (Metal Ceramic) | CROWN AND BRIDGE METAL BASED | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2011 | ||||||||||||||||||||||||||||||||||||
| 2012 | Porcelain Laminate Veneer | CROWN AND BRIDGE METAL FREE | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2012 | ||||||||||||||||||||||||||||||||||||
| 2013 | All-Ceramic inlay-Onlay-3/4 Crown | CROWN AND BRIDGE METAL FREE | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2013 | ||||||||||||||||||||||||||||||||||||
| 2014 | Pressed Lithium Disilicate/Silicate Crown/Full Contour | CROWN AND BRIDGE METAL FREE | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2014 | ||||||||||||||||||||||||||||||||||||
| 2015 | Pressed Lithium Disilicate/Silicate Crown/Layered | CROWN AND BRIDGE METAL FREE | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2015 | ||||||||||||||||||||||||||||||||||||
| 2016 | Milled Lithium Disilicate/Silicate Crown/Full Contour | CROWN AND BRIDGE METAL FREE | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2016 | ||||||||||||||||||||||||||||||||||||
| 2017 | Milled Lithium Disilicate/Silicate Crown/Layered | CROWN AND BRIDGE METAL FREE | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2017 | ||||||||||||||||||||||||||||||||||||
| 2018 | Porcelain-to-Zirconia Layered Crown | CROWN AND BRIDGE METAL FREE | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2018 | ||||||||||||||||||||||||||||||||||||
| 2019 | Monolithic Zirconia Crown | CROWN AND BRIDGE METAL FREE | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2019 | ||||||||||||||||||||||||||||||||||||
| 2020 | Metal-free 3-unit bridge w/Zirconia Understructure | CROWN AND BRIDGE METAL FREE | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2020 | ||||||||||||||||||||||||||||||||||||
| 2021 | Processed Acrylic Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2021 | ||||||||||||||||||||||||||||||||||||
| 2022 | Milled Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2022 | ||||||||||||||||||||||||||||||||||||
| 2023 | 3D-Printed Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2023 | ||||||||||||||||||||||||||||||||||||
| 2024 | 3D-Printed Model from Intraoral Scan (Per Arch) | CROWN AND BRIDGE OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2024 | ||||||||||||||||||||||||||||||||||||
| 2025 | Diagnostic Wax-up (Per tooth) | CROWN AND BRIDGE OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2025 | ||||||||||||||||||||||||||||||||||||
| 2026 | Cast Post and Core | CROWN AND BRIDGE OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2026 | ||||||||||||||||||||||||||||||||||||
| 2027 | Special Ceramics Addition (Pink Porcelain) | CROWN AND BRIDGE OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2027 | ||||||||||||||||||||||||||||||||||||
| 2028 | Cement-retained PFM Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2028 | ||||||||||||||||||||||||||||||||||||
| 2029 | Cement-retained Metal Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2029 | ||||||||||||||||||||||||||||||||||||
| 2030 | Cement-retained Zirconia Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2030 | ||||||||||||||||||||||||||||||||||||
| 2031 | Cement-retained Lithium Disilicate/Silicate Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2031 | ||||||||||||||||||||||||||||||||||||
| 2032 | Screw-retained PFM Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2032 | ||||||||||||||||||||||||||||||||||||
| 2033 | Screw-retained Metal Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2033 | ||||||||||||||||||||||||||||||||||||
| 2034 | Screw-retained Zirconia Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2034 | ||||||||||||||||||||||||||||||||||||
| 2035 | Screw-retained Lithium Disilicate/Silicate Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2035 | ||||||||||||||||||||||||||||||||||||
| 2036 | Titanium CAD/CAM abutment (OEM) | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2036 | ||||||||||||||||||||||||||||||||||||
| 2037 | Titanium CAD/CAM abutment (Aftermarket) | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2037 | ||||||||||||||||||||||||||||||||||||
| 2038 | Zirconia CAD/CAM abutment (OEM) | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2038 | ||||||||||||||||||||||||||||||||||||
| 2039 | Zirconia CAD/CAM abutment (Aftermarket) | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2039 | ||||||||||||||||||||||||||||||||||||
| 2040 | Custom Abutment | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2040 | ||||||||||||||||||||||||||||||||||||
| 2041 | Ti Base abutment (OEM) | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2041 | ||||||||||||||||||||||||||||||||||||
| 2042 | Ti Base abutment (Aftermarket) | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2042 | ||||||||||||||||||||||||||||||||||||
| 2043 | All on 4, Fixed Hybrid Denture | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2043 | ||||||||||||||||||||||||||||||||||||
| 2044 | Full arch removable overdenture, titanium bar with attachments | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2044 | ||||||||||||||||||||||||||||||||||||
| 2045 | Titanium Bar | IMPLANTS PROSTHETICS (Abutments) | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2045 | ||||||||||||||||||||||||||||||||||||
| 2046 | Complete Denture Setup (Premium Teeth / IPN Equivalent) | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2046 | ||||||||||||||||||||||||||||||||||||
| 2047 | Complete Denture Process and Finish (Packing Technique) | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2047 | ||||||||||||||||||||||||||||||||||||
| 2048 | Complete Denture Process and Finish (Injection Technique) | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2048 | ||||||||||||||||||||||||||||||||||||
| 2049 | Complete Denture CAD-CAM Milled | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2049 | ||||||||||||||||||||||||||||||||||||
| 2050 | Complete Denture 3D Printed | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2050 | ||||||||||||||||||||||||||||||||||||
| 2051 | Rebase | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2051 | ||||||||||||||||||||||||||||||||||||
| 2052 | Reline | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2052 | ||||||||||||||||||||||||||||||||||||
| 2053 | Repair add Tooth | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2053 | ||||||||||||||||||||||||||||||||||||
| 2054 | Repair Simple Fracture | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2054 | ||||||||||||||||||||||||||||||||||||
| 2055 | Repair Complex Fracture | REMOVABLE PROSTHETICS | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2055 | ||||||||||||||||||||||||||||||||||||
| 2056 | Custom Tray | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2056 | ||||||||||||||||||||||||||||||||||||
| 2057 | Model | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2057 | ||||||||||||||||||||||||||||||||||||
| 2058 | Model 3D Printed | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2058 | ||||||||||||||||||||||||||||||||||||
| 2059 | Bite Blocks | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2059 | ||||||||||||||||||||||||||||||||||||
| 2060 | Nightguard Hard Heat Cured | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2060 | ||||||||||||||||||||||||||||||||||||
| 2061 | Nightguard Vacuum-formed | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2061 | ||||||||||||||||||||||||||||||||||||
| 2062 | Nightguard Dual-laminate | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2062 | ||||||||||||||||||||||||||||||||||||
| 2063 | Nightguard Talon | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2063 | ||||||||||||||||||||||||||||||||||||
| 2064 | Nightguard 3D Printed | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2064 | ||||||||||||||||||||||||||||||||||||
| 2065 | Nightguard 3D Milled | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2065 | ||||||||||||||||||||||||||||||||||||
| 2066 | Surgical Stent | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2066 | ||||||||||||||||||||||||||||||||||||
| 2067 | Additional Clasp Wire Surcharge (Each) | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2067 | ||||||||||||||||||||||||||||||||||||
| 2068 | Additional Clasp Clear/Tooth Surcharge (Each) | REMOVABLE PROSTHETICS OTHER | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2068 | ||||||||||||||||||||||||||||||||||||
| 2069 | Framework Cast | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2069 | ||||||||||||||||||||||||||||||||||||
| 2070 | Framework CAD/CAST | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2070 | ||||||||||||||||||||||||||||||||||||
| 2071 | Framework CAD/Laser-Sintered/SLM | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2071 | ||||||||||||||||||||||||||||||||||||
| 2072 | Framework Milled Polymer Tooth Shade | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2072 | ||||||||||||||||||||||||||||||||||||
| 2073 | Framework Milled Polymer Clear Shade | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2073 | ||||||||||||||||||||||||||||||||||||
| 2074 | Reline Partial Denture | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2074 | ||||||||||||||||||||||||||||||||||||
| 2075 | Acrylic Transitional Partial Denture w/ 2 Clasps | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2075 | ||||||||||||||||||||||||||||||||||||
| 2076 | Acrylic Transitional Partial Denture from Setup | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2076 | ||||||||||||||||||||||||||||||||||||
| 2077 | Partial Denture Setup (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2077 | ||||||||||||||||||||||||||||||||||||
| 2078 | Partial Denture Setup and Process (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2078 | ||||||||||||||||||||||||||||||||||||
| 2079 | Partial Denture Process & Finish | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2079 | ||||||||||||||||||||||||||||||||||||
| 2080 | Flexible Partial Denture Setup (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2080 | ||||||||||||||||||||||||||||||||||||
| 2081 | Flexible Partial Denture Setup and Process (Premium Teeth / IPN Equivalent) | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2081 | ||||||||||||||||||||||||||||||||||||
| 2082 | Flexible Partial Denture Process & Finish | PARTIAL DENTURES | Option 2 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2026 | Destination | 339116 | 6520 | 2082 | ||||||||||||||||||||||||||||||||||||
| 3001 | PFM Crown (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/25 | 08/15/26 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3001 | ||||||||||||||||||||||||||||||||||||
| 3002 | PFM Crowns (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3002 | ||||||||||||||||||||||||||||||||||||
| 3003 | PFM FPD (Bridge units - Retainer and pontics) (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3003 | ||||||||||||||||||||||||||||||||||||
| 3004 | PFM FPD (Bridge units - Retainer and pontics) (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3004 | ||||||||||||||||||||||||||||||||||||
| 3005 | Porcelain Application Only | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3005 | ||||||||||||||||||||||||||||||||||||
| 3006 | Full Metal Crowns (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3006 | ||||||||||||||||||||||||||||||||||||
| 3007 | Full Metal Crowns (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3007 | ||||||||||||||||||||||||||||||||||||
| 3008 | Full Metal FPD (bridge units) (Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3008 | ||||||||||||||||||||||||||||||||||||
| 3009 | Full Metal FPD (bridge units) (High Noble Alloy) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3009 | ||||||||||||||||||||||||||||||||||||
| 3010 | Resin-bonded bridges (Maryland Bridge) (Ceramic) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3010 | ||||||||||||||||||||||||||||||||||||
| 3011 | Resin-bonded bridges (Maryland Bridge) (Metal Ceramic) | CROWN AND BRIDGE METAL BASED | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3011 | ||||||||||||||||||||||||||||||||||||
| 3012 | Porcelain Laminate Veneer | CROWN AND BRIDGE METAL FREE | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3012 | ||||||||||||||||||||||||||||||||||||
| 3013 | All-Ceramic inlay-Onlay-3/4 Crown | CROWN AND BRIDGE METAL FREE | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3013 | ||||||||||||||||||||||||||||||||||||
| 3014 | Pressed Lithium Disilicate/Silicate Crown/Full Contour | CROWN AND BRIDGE METAL FREE | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3014 | ||||||||||||||||||||||||||||||||||||
| 3015 | Pressed Lithium Disilicate/Silicate Crown/Layered | CROWN AND BRIDGE METAL FREE | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3015 | ||||||||||||||||||||||||||||||||||||
| 3016 | Milled Lithium Disilicate/Silicate Crown/Full Contour | CROWN AND BRIDGE METAL FREE | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3016 | ||||||||||||||||||||||||||||||||||||
| 3017 | Milled Lithium Disilicate/Silicate Crown/Layered | CROWN AND BRIDGE METAL FREE | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3017 | ||||||||||||||||||||||||||||||||||||
| 3018 | Porcelain-to-Zirconia Layered Crown | CROWN AND BRIDGE METAL FREE | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3018 | ||||||||||||||||||||||||||||||||||||
| 3019 | Monolithic Zirconia Crown | CROWN AND BRIDGE METAL FREE | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3019 | ||||||||||||||||||||||||||||||||||||
| 3020 | Metal-free 3-unit bridge w/Zirconia Understructure | CROWN AND BRIDGE METAL FREE | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3020 | ||||||||||||||||||||||||||||||||||||
| 3021 | Processed Acrylic Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3021 | ||||||||||||||||||||||||||||||||||||
| 3022 | Milled Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3022 | ||||||||||||||||||||||||||||||||||||
| 3023 | 3D-Printed Provisional Restoration (Per Unit) | CROWN AND BRIDGE OTHER | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3023 | ||||||||||||||||||||||||||||||||||||
| 3024 | 3D-Printed Model from Intraoral Scan (Per Arch) | CROWN AND BRIDGE OTHER | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3024 | ||||||||||||||||||||||||||||||||||||
| 3025 | Diagnostic Wax-up (Per tooth) | CROWN AND BRIDGE OTHER | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3025 | ||||||||||||||||||||||||||||||||||||
| 3026 | Cast Post and Core | CROWN AND BRIDGE OTHER | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3026 | ||||||||||||||||||||||||||||||||||||
| 3027 | Special Ceramics Addition (Pink Porcelain) | CROWN AND BRIDGE OTHER | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3027 | ||||||||||||||||||||||||||||||||||||
| 3028 | Cement-retained PFM Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3028 | ||||||||||||||||||||||||||||||||||||
| 3029 | Cement-retained Metal Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3029 | ||||||||||||||||||||||||||||||||||||
| 3030 | Cement-retained Zirconia Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3030 | ||||||||||||||||||||||||||||||||||||
| 3031 | Cement-retained Lithium Disilicate/Silicate Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3031 | ||||||||||||||||||||||||||||||||||||
| 3032 | Screw-retained PFM Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3032 | ||||||||||||||||||||||||||||||||||||
| 3033 | Screw-retained Metal Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3033 | ||||||||||||||||||||||||||||||||||||
| 3034 | Screw-retained Zirconia Crown | IMPLANTS PROSTHETICS (Single Unit) | Option 3 | 08/16/26 | 08/15/27 | 1 | EA | 1 | 8/15/2027 | Destination | 339116 | 6520 | 3034 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .