Dental Treatment Prices Example .xlsx
XLSX spreadsheet 13 KB Posted
- Attached to
- VAARNG Dental Services BPA
- Solicitation number
- W912LQ26QA016
About this file
This file is a pricing template that lists dental procedures and services organized by category for the Virginia Army National Guard (VAARNG) Dental Services BPA solicitation. The template includes over 100 dental procedures spanning two main categories: Dental Evaluation (preventive and diagnostic services such as annual exams, x-rays, and biopsies) and Dental Treatment (restorative, surgical, and therapeutic procedures including extractions, fillings, dentures, root canals, anesthesia, and oral surgery). Each procedure is assigned a unique procedure code (prefixed with O for evaluations and P for treatments) and includes a line for estimated cost, though specific pricing amounts are not populated in this template. This pricing structure is designed to support the BPA's requirement that individual calls include statements of work or performance work statements, with pricing submissions due by the dates specified in the solicitation (April 24, May 15, or June 11, 2026, depending on amendment cycle). Vendors responding to the solicitation must populate the estimated cost column for each applicable procedure to establish their pricing rates for the 60-month ordering period with a maximum call ceiling of $350,000 and individual call limits ranging from $1.00 to $10,000.
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Text version
Sheet1
| Category | Procedure No | Service Description | Estimated Cost |
| Dental Treatment | P78 | Adjust complete denture - mandibular | |
| Dental Treatment | P9 | Amalgam, Four or More Surfaces, Permanent | |
| Dental Treatment | P6 | Amalgam, One Surface, Permanent | |
| Dental Treatment | P8 | Amalgam, Three Surfaces, Permanent | |
| Dental Treatment | P7 | Amalgam, Two Surfaces, Permanent | |
| Dental Treatment | P35 | Analgesic Nitrous | |
| Dental Evaluation | O2 | Annual Dental Exam (Comprehensive Oral Examination) | |
| Dental Evaluation | O1 | Annual Dental Exam (Periodic Oral Examination) | |
| Dental Treatment | P22 | Anterior (excluding final restoration) | |
| Dental Treatment | P158 | Appliance removal (not by dentist who placed it) includes removal of archbar | |
| Dental Treatment | P23 | Bicuspid (excluding final restoration) | |
| Dental Treatment | P99 | Biopsy of oral tissue (hard) | |
| Dental Treatment | P98 | Biopsy of oral tissue (soft) | |
| Dental Treatment | P86 | Complete denture mandibular | |
| Dental Treatment | P85 | Complete denture maxillary | |
| Dental Evaluation | O7 | Complete series x-ray | |
| Dental Treatment | P164 | Cone beam CT, limited | |
| Dental Treatment | P165 | Cone beam CT, mandible | |
| Dental Treatment | P166 | Cone beam CT, maxilla | |
| Dental Treatment | P1 | Consultation Dental Exam | |
| Dental Treatment | P25 | Core build up including pins | |
| Dental Treatment | P41 | Deep Sedation / general anesthesia each additional 15 minutes | |
| Dental Treatment | P186 | Deep Sedation / general anesthesia first 15 minutes | |
| Dental Evaluation | O6 | Dental bitewing, set of four films as indicated | |
| Dental Evaluation | O4 | Dental bitewing, set of two films | |
| Dental Evaluation | O3 | Dental bitewing, single film | |
| Dental Treatment | P4 | Detailed and extensive oral evaluation | |
| Dental Treatment | P108 | Excision of benign lesion - lesion diameter less than 1.25 cm | |
| Dental Treatment | P29 | Extraction deciduous tooth | |
| Dental Treatment | P27 | Extraction, single tooth | |
| Dental Treatment | P48 | Full mouth debridement | |
| Dental Treatment | P174 | Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth | |
| Dental Treatment | P62 | Immediate denture mandibular | |
| Dental Treatment | P61 | Immediate denture maxillary | |
| Dental Treatment | P152 | Incision and drainage of abscess-soft tissue | |
| Dental Treatment | P75 | Interim partial denture (maxillary) | |
| Dental Evaluation | O10 | Intraoral periapical x-ray | |
| Dental Treatment | P173 | Intraoral-periapical each additional radiographic image | |
| Dental Treatment | P37 | IV anesthesia each additional 15 minutes | |
| Dental Treatment | P187 | IV anesthesia first 15 minutes | |
| Dental Treatment | P88 | Mandibular partial denture - cast metal | |
| Dental Treatment | P24 | Molar (excluding final restoration) | |
| Dental Treatment | P45 | Oral antibiotics (given at the office) | |
| Dental Treatment | P140 | Oroantral fistula closure | |
| Dental Treatment | P156 | Osseous, osteoperiosteal, or cartilage graft of the mandible or facial bone - autogenous or nonautogenous | |
| Dental Treatment | P44 | Palliative treatment of dental pain | |
| Dental Evaluation | O11 | Panographic x-ray | |
| Dental Treatment | P64 | Partial denture mandibular (resin base) | |
| Dental Treatment | P63 | Partial denture maxillary (resin base) | |
| Dental Treatment | P47 | Period scaling and root planing per quadrant | |
| Dental Treatment | P52 | Pin retention in addition to filling | |
| Dental Treatment | P26 | Prefab post & core | |
| Dental Treatment | P134 | Provisional crown | |
| Dental Treatment | P57 | Pulpal debridement | |
| Dental Treatment | P93 | Rebase complete mandibular denture | |
| Dental Treatment | P129 | Recement crown | |
| Dental Treatment | P117 | Removal of benign odontogenic cyst or tumor (lesion diameter greater than 1.25 cm) | |
| Dental Treatment | P34 | Removal of impacted tooth partial bony | |
| Dental Treatment | P33 | Removal of impacted tooth soft tissue | |
| Dental Treatment | P32 | Removal of impacted tooth-completely bony | |
| Dental Treatment | P181 | Removal of impacted tooth-completely bony, with unusual surgical complications | |
| Dental Treatment | P18 | Resin (1) one surface posterior | |
| Dental Treatment | P19 | Resin (2) two surface posterior | |
| Dental Treatment | P20 | Resin (3) three surface posterior | |
| Dental Treatment | P21 | Resin (4) four or more posterior | |
| Dental Treatment | P131 | Resin based composite crown, anterior | |
| Dental Treatment | P17 | Resin Based Composite, four surface | |
| Dental Treatment | P14 | Resin Based Composite, one surface | |
| Dental Treatment | P16 | Resin Based Composite, three surfaces | |
| Dental Treatment | P15 | Resin Based Composite, two surfaces | |
| Dental Treatment | P60 | Retreatment of molar endo | |
| Dental Treatment | P138 | Retreatment of previous RCT - anterior | |
| Dental Treatment | P139 | Retreatment of previous RCT - bicuspid | |
| Dental Treatment | P130 | Stainless steel crown | |
| Dental Treatment | P31 | Surgical removal of erupted tooth | |
| Dental Treatment | P96 | Surgical removal of residual root tips | |
| Dental Treatment | P43 | Therapeutic drug injection - includes antibiotic or injection of sedative | |
| Dental Treatment | P147 | Treatment of root canal obstruction - non surgical |
File details come from the government source that posted it. Updated .