Dental Treatment Pricing Sheet.xlsx
XLSX spreadsheet 21 KB Posted
- Solicitation number
- W9124X26QA016
About this file
This is a Dental Treatment Pricing Sheet containing fixed-price fee schedules for dental services to be provided to Nevada Army National Guard soldiers across three geographic locations. The pricing sheet establishes rates for comprehensive dental procedures across two regions: Carson City/Reno Area (estimated 22 soldiers with a fixed office fee of $570.00) and Las Vegas Area (estimated 43 soldiers). An additional section references dental treatments for the Carson City/Reno area with an estimated 40 soldiers and a separate Las Vegas section with an estimated 90 soldiers, though these sections contain placeholder pricing of $0.00 per treatment.
The active pricing schedules specify fixed fees for 45 distinct dental service codes (using standard ADA dental nomenclature D-codes) covering diagnostic services, restorative treatments, endodontic procedures, periodontal care, prosthodontics, oral surgery, and sedation/anesthesia administration. Carson City/Reno office fees range from $76.00 for panoramic radiographs to $1,330.00 for crowns and periodontal scaling, while Las Vegas office fees similarly range from $95.00 for cone beam CT to $1,330.00 for crowns and root canal molar therapy. The pricing sheet is associated with RFQ W9124X26QA016 issued by the Nevada Army National Guard for dental treatment services using a commercial item procurement approach under FAR Part 12.
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Other files
| File | Type | Posted |
|---|---|---|
| SF1449 - W9124X26QA016.pdf | ||
| 20260526 Dental Treatment Performance Work Statement.docx | DOCX document |
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Text version
Dental Treatments Carson Reno
| Dental Code | Description | Cost Per Treatment |
| D0140 | Limited Oral Evaluation | $0.00 |
| D0150 | Comprehensive Exam | $0.00 |
| D0274 | Bitewings – Four Radiographic Images | $0.00 |
| D0330 | Panoramic Radiographic Image | $0.00 |
| D0364 | Cone Beam CT | $0.00 |
| D2140 | Amalgam - One Surface | $0.00 |
| D2150 | Amalgam - Two Surfaces | $0.00 |
| D2160 | Amalgam - Three Surfaces | $0.00 |
| D2330 | Anterior Composite - One Surface | $0.00 |
| D2331 | Anterior Composite - Two Surfaces | $0.00 |
| D2332 | Anterior Composite - Three Surfaces | $0.00 |
| D2335 | Anterior Composite - Four or More Surfaces | $0.00 |
| D2391 | Posterior Composite - One Surface | $0.00 |
| D2392 | Posterior Composite - Two Surfaces | $0.00 |
| D2393 | Posterior Composite - Three Surfaces | $0.00 |
| D2750 | Crown - Porcelain Fused to High Noble Metal | $0.00 |
| D2799 | Crown - Provisional Crown Full Cast (unspecified) | $0.00 |
| D2931 | Crown - Prefabricated Stainless Steel | $0.00 |
| D2950 | Core Buildup, including pins | $0.00 |
| D2952 | Indirectly Fabricated Post & Core in Addition to Crown | $0.00 |
| D2954 | Prefabricated Post & Core in Addition to Crown | $0.00 |
| D3110 | Pulp cap direct (excluding final restoration) | $0.00 |
| D3120 | Pulp cap indirect (excluding final restoration) | $0.00 |
| D3310 | Anterior Root Canal Therapy | $0.00 |
| D3320 | Bicuspid Root Canal Therapy | $0.00 |
| D3330 | Molar Root Canal Therapy | $0.00 |
| D3348 | Retreatment of a Previous Root Canal on a Molar Tooth | $0.00 |
| D4341 | Periodontal Scaling & Root Planing - Four or More Teeth Per Quadrant | $0.00 |
| D4355 | Full Mouth Debridement | $0.00 |
| D5820 | Interim Maxillary Partial Denture | $0.00 |
| D5821 | Interim Mandibular Partial Denture | $0.00 |
| D7140 | Extraction, Erupted Tooth or Exposed Root | $0.00 |
| D7210 | Surgical Removal of Erupted Tooth | $0.00 |
| D7220 | Removal of Impacted Tooth, Soft Tissue | $0.00 |
| D7230 | Removal of Impacted Tooth, Partial Bony | $0.00 |
| D7240 | Removal of Impacted Tooth, Completely Bony | $0.00 |
| D7285 | Biopsy of Oral Tissue (Soft) | $0.00 |
| D7953 | Bone Graft | $0.00 |
| D9222 | Deep Sedation or General Anesthesia - First 15 Minutes | $0.00 |
| D9223 | Deep Sedation or General Anesthesia - Each 15 Minute Increment | $0.00 |
| D9230 | Administration of Nitrous Oxide/Anxiolysis, Analgesia | $0.00 |
| D9239 | Intravenous Moderate (Conscious) Sedation/Analgesia- First 15 Minutes | $0.00 |
| D9243 | Intravenous Moderate (Conscious) Sedation/Analgesia – Each 15 Minute Increment | $0.00 |
| D9610 | Therapeutic Parenteral Drug, Single Administration | $0.00 |
| Carson City/ Reno Area | Estimated 40 Soldiers |
Dental Treatments Las Vegas
| Dental Code | Description | Cost Per Treatment |
| D0140 | Limited Oral Evaluation | $0.00 |
| D0150 | Comprehensive Exam | $0.00 |
| D0274 | Bitewings – Four Radiographic Images | $0.00 |
| D0330 | Panoramic Radiographic Image | $0.00 |
| D0364 | Cone Beam CT | $0.00 |
| D2140 | Amalgam - One Surface | $0.00 |
| D2150 | Amalgam - Two Surfaces | $0.00 |
| D2160 | Amalgam - Three Surfaces | $0.00 |
| D2330 | Anterior Composite - One Surface | $0.00 |
| D2331 | Anterior Composite - Two Surfaces | $0.00 |
| D2332 | Anterior Composite - Three Surfaces | $0.00 |
| D2335 | Anterior Composite - Four or More Surfaces | $0.00 |
| D2391 | Posterior Composite - One Surface | $0.00 |
| D2392 | Posterior Composite - Two Surfaces | $0.00 |
| D2393 | Posterior Composite - Three Surfaces | $0.00 |
| D2750 | Crown - Porcelain Fused to High Noble Metal | $0.00 |
| D2799 | Crown - Provisional Crown Full Cast (unspecified) | $0.00 |
| D2931 | Crown - Prefabricated Stainless Steel | $0.00 |
| D2950 | Core Buildup, including pins | $0.00 |
| D2952 | Indirectly Fabricated Post & Core in Addition to Crown | $0.00 |
| D2954 | Prefabricated Post & Core in Addition to Crown | $0.00 |
| D3110 | Pulp cap direct (excluding final restoration) | $0.00 |
| D3120 | Pulp cap indirect (excluding final restoration) | $0.00 |
| D3310 | Anterior Root Canal Therapy | $0.00 |
| D3320 | Bicuspid Root Canal Therapy | $0.00 |
| D3330 | Molar Root Canal Therapy | $0.00 |
| D3348 | Retreatment of a Previous Root Canal on a Molar Tooth | $0.00 |
| D4341 | Periodontal Scaling & Root Planing - Four or More Teeth Per Quadrant | $0.00 |
| D4355 | Full Mouth Debridement | $0.00 |
| D5820 | Interim Maxillary Partial Denture | $0.00 |
| D5821 | Interim Mandibular Partial Denture | $0.00 |
| D7140 | Extraction, Erupted Tooth or Exposed Root | $0.00 |
| D7210 | Surgical Removal of Erupted Tooth | $0.00 |
| D7220 | Removal of Impacted Tooth, Soft Tissue | $0.00 |
| D7230 | Removal of Impacted Tooth, Partial Bony | $0.00 |
| D7240 | Removal of Impacted Tooth, Completely Bony | $0.00 |
| D7285 | Biopsy of Oral Tissue (Soft) | $0.00 |
| D7953 | Bone Graft | $0.00 |
| D9222 | Deep Sedation or General Anesthesia - First 15 Minutes | $0.00 |
| D9223 | Deep Sedation or General Anesthesia - Each 15 Minute Increment | $0.00 |
| D9230 | Administration of Nitrous Oxide/Anxiolysis, Analgesia | $0.00 |
| D9239 | Intravenous Moderate (Conscious) Sedation/Analgesia- First 15 Minutes | $0.00 |
| D9243 | Intravenous Moderate (Conscious) Sedation/Analgesia – Each 15 Minute Increment | $0.00 |
| D9610 | Therapeutic Parenteral Drug, Single Administration | $0.00 |
| Las Vegas Area | Estimated 90 Soldiers |
Carson City- Office Fees
| Dental Code | Description | Fixed Price Per Treatment |
| D0110 | Comprehensive Exam | $102.60 |
| D0140 | Limited Oral Evaluation | $102.60 |
| D0150 | Comprehensive Exam | $99.75 |
| D0274 | Bitewings – Four Radiographic Images | $99.75 |
| D0330 | Panoramic Radiographic Image | $76.00 |
| D0364 | Cone Beam CT | $95.00 |
| D2140 | Amalgam - 1 surface | $427.50 |
| D2150 | Amalgam - 2 surfaces | $133.00 |
| D2160 | Amalgam - 3+ surfaces | $166.25 |
| D2330 | Anterior Composite - 1 surface | $190.00 |
| D2331 | Anterior Composite - 2 surfaces | $214.70 |
| D2332 | Anterior Composite - 3 surfaces | $261.25 |
| D2335 | Anterior Composite - 4+ surfaces | $285.00 |
| D2391 | Posterior Composite - 1 surface | $332.50 |
| D2392 | Posterior Composite - 2 surfaces | $237.50 |
| D2393 | Posterior Composite - 3 surfaces | $261.25 |
| D2750 | Crown - Porcelain Fused to High Noble Metal | $285.00 |
| D2799 | Crown - Full Cast (unspecified) | $1,330.00 |
| D2950 | Core Buildup, including pins | $1,330.00 |
| D3110 | Pulp cap direct (excluding final restoration) | $190.00 |
| D3120 | Pulp cap indirect (excluding final restoration) | $190.00 |
| D3310 | Root Canal - Anterior | $237.50 |
| D3320 | Root Canal - Bicuspid | $950.00 |
| D3330 | Root Canal - Molar | $1,140.00 |
| D4341 | Periodontal Scaling (4+ teeth/quad) | $1,330.00 |
| D4355 | Full Mouth Debridement | $380.00 |
| D5821 | Interim Partial Denture (Mandibular) | $285.00 |
| D5820 | Interim Partial Denture | $617.50 |
| D7140 | Simple Extraction | $617.50 |
| D7210 | Surgical Removal of Erupted Tooth | $168.15 |
| D7220 | Removal of Impacted Tooth - Soft Tissue | $237.50 |
| D7230 | Removal of Impacted Tooth - Partial Bony | $308.75 |
| D7240 | Complete Bony Impaction Extraction | $475.00 |
| D7285 | Biopsy of Oral Tissue (Soft) | $665.00 |
| D7953 | Bone Graft | $213.75 |
| D9230 | Administration of Nitrous Oxide/Anxiolysis, Analgesia | $233.42 |
| D9239 | Intravenous Moderate (Conscious) Sedation/Analgesia- First 15 Minutes | $104.50 |
| D9243 | Intravenous Moderate (Conscious) Sedation/Analgesia – Each 15 Minute Increment | $427.50 |
| Reno / Carson City Area | $570.00 | |
| Estimated 22 Soldiers |
Vegas - Office Fees
| Dental Code | Description | Fixed Price Per Treatment |
| D0110 | Comprehensive Exam | $102.60 |
| D0140 | Limited Oral Evaluation | $99.75 |
| D0150 | Comprehensive Exam | $102.60 |
| D0274 | Bitewings – Four Radiographic Images | $76.00 |
| D0330 | Panoramic Radiographic Image | $95.00 |
| D0364 | Cone Beam CT | $380.00 |
| D2140 | Amalgam - 1 surface | $142.50 |
| D2150 | Amalgam - 2 surfaces | $190.00 |
| D2160 | Amalgam - 3+ surfaces | $237.50 |
| D2330 | Anterior Composite - 1 surface | $164.35 |
| D2331 | Anterior Composite - 2 surfaces | $196.65 |
| D2332 | Anterior Composite - 3 surfaces | $237.50 |
| D2335 | Anterior Composite - 4+ surfaces | $304.95 |
| D2391 | Posterior Composite - 1 surface | $182.40 |
| D2392 | Posterior Composite - 2 surfaces | $231.80 |
| D2393 | Posterior Composite - 3 surfaces | $257.45 |
| D2750 | Crown - Porcelain Fused to High Noble Metal | $1,330.00 |
| D2799 | Crown - Full Cast (unspecified) | $1,140.00 |
| D2950 | Core Buildup, including pins | $116.85 |
| D3110 | Pulp cap direct (excluding final restoration) | $190.00 |
| D3120 | Pulp cap indirect (excluding final restoration) | $209.00 |
| D3310 | Root Canal - Anterior | $950.00 |
| D3320 | Root Canal - Bicuspid | $1,140.00 |
| D3330 | Root Canal - Molar | $1,330.00 |
| D4341 | Periodontal Scaling (4+ teeth/quad) | $380.00 |
| D4355 | Full Mouth Debridement | $285.00 |
| D5821 | Interim Partial Denture (Mandibular) | $617.50 |
| D5820 | Interim Partial Denture | $617.50 |
| D7140 | Simple Extraction | $104.50 |
| D7210 | Surgical Removal of Erupted Tooth | $190.00 |
| D7220 | Removal of Impacted Tooth - Soft Tissue | $285.00 |
| D7230 | Removal of Impacted Tooth - Partial Bony | $475.00 |
| D7240 | Complete Bony Impaction Extraction | $665.00 |
| D7285 | Biopsy of Oral Tissue (Soft) | $190.00 |
| D7953 | Bone Graft | $233.42 |
| D9230 | Administration of Nitrous Oxide/Anxiolysis, Analgesia | $95.00 |
| D9239 | Intravenous Moderate (Conscious) Sedation/Analgesia- First 15 Minutes | $380.00 |
| D9243 | Intravenous Moderate (Conscious) Sedation/Analgesia – Each 15 Minute Increment | $522.50 |
| Las Vegas Area | Estimated 43 Soldiers |
File details come from the government source that posted it. Updated .