Dental Treatment Prices Example .xlsx

XLSX spreadsheet 13 KB Posted

Attached to
VAARNG Dental Services BPA
Solicitation number
W912LQ26QA016
Issued by

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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Sheet1

CategoryProcedure NoService DescriptionEstimated Cost
Dental TreatmentP78Adjust complete denture - mandibular
Dental TreatmentP9Amalgam, Four or More Surfaces, Permanent
Dental TreatmentP6Amalgam, One Surface, Permanent
Dental TreatmentP8Amalgam, Three Surfaces, Permanent
Dental TreatmentP7Amalgam, Two Surfaces, Permanent
Dental TreatmentP35Analgesic Nitrous
Dental EvaluationO2Annual Dental Exam (Comprehensive Oral Examination)
Dental EvaluationO1Annual Dental Exam (Periodic Oral Examination)
Dental TreatmentP22Anterior (excluding final restoration)
Dental TreatmentP158Appliance removal (not by dentist who placed it) includes removal of archbar
Dental TreatmentP23Bicuspid (excluding final restoration)
Dental TreatmentP99Biopsy of oral tissue (hard)
Dental TreatmentP98Biopsy of oral tissue (soft)
Dental TreatmentP86Complete denture mandibular
Dental TreatmentP85Complete denture maxillary
Dental EvaluationO7Complete series x-ray
Dental TreatmentP164Cone beam CT, limited
Dental TreatmentP165Cone beam CT, mandible
Dental TreatmentP166Cone beam CT, maxilla
Dental TreatmentP1Consultation Dental Exam
Dental TreatmentP25Core build up including pins
Dental TreatmentP41Deep Sedation / general anesthesia each additional 15 minutes
Dental TreatmentP186Deep Sedation / general anesthesia first 15 minutes
Dental EvaluationO6Dental bitewing, set of four films as indicated
Dental EvaluationO4Dental bitewing, set of two films
Dental EvaluationO3Dental bitewing, single film
Dental TreatmentP4Detailed and extensive oral evaluation
Dental TreatmentP108Excision of benign lesion - lesion diameter less than 1.25 cm
Dental TreatmentP29Extraction deciduous tooth
Dental TreatmentP27Extraction, single tooth
Dental TreatmentP48Full mouth debridement
Dental TreatmentP174Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth
Dental TreatmentP62Immediate denture mandibular
Dental TreatmentP61Immediate denture maxillary
Dental TreatmentP152Incision and drainage of abscess-soft tissue
Dental TreatmentP75Interim partial denture (maxillary)
Dental EvaluationO10Intraoral periapical x-ray
Dental TreatmentP173Intraoral-periapical each additional radiographic image
Dental TreatmentP37IV anesthesia each additional 15 minutes
Dental TreatmentP187IV anesthesia first 15 minutes
Dental TreatmentP88Mandibular partial denture - cast metal
Dental TreatmentP24Molar (excluding final restoration)
Dental TreatmentP45Oral antibiotics (given at the office)
Dental TreatmentP140Oroantral fistula closure
Dental TreatmentP156Osseous, osteoperiosteal, or cartilage graft of the mandible or facial bone - autogenous or nonautogenous
Dental TreatmentP44Palliative treatment of dental pain
Dental EvaluationO11Panographic x-ray
Dental TreatmentP64Partial denture mandibular (resin base)
Dental TreatmentP63Partial denture maxillary (resin base)
Dental TreatmentP47Period scaling and root planing per quadrant
Dental TreatmentP52Pin retention in addition to filling
Dental TreatmentP26Prefab post & core
Dental TreatmentP134Provisional crown
Dental TreatmentP57Pulpal debridement
Dental TreatmentP93Rebase complete mandibular denture
Dental TreatmentP129Recement crown
Dental TreatmentP117Removal of benign odontogenic cyst or tumor (lesion diameter greater than 1.25 cm)
Dental TreatmentP34Removal of impacted tooth partial bony
Dental TreatmentP33Removal of impacted tooth soft tissue
Dental TreatmentP32Removal of impacted tooth-completely bony
Dental TreatmentP181Removal of impacted tooth-completely bony, with unusual surgical complications
Dental TreatmentP18Resin (1) one surface posterior
Dental TreatmentP19Resin (2) two surface posterior
Dental TreatmentP20Resin (3) three surface posterior
Dental TreatmentP21Resin (4) four or more posterior
Dental TreatmentP131Resin based composite crown, anterior
Dental TreatmentP17Resin Based Composite, four surface
Dental TreatmentP14Resin Based Composite, one surface
Dental TreatmentP16Resin Based Composite, three surfaces
Dental TreatmentP15Resin Based Composite, two surfaces
Dental TreatmentP60Retreatment of molar endo
Dental TreatmentP138Retreatment of previous RCT - anterior
Dental TreatmentP139Retreatment of previous RCT - bicuspid
Dental TreatmentP130Stainless steel crown
Dental TreatmentP31Surgical removal of erupted tooth
Dental TreatmentP96Surgical removal of residual root tips
Dental TreatmentP43Therapeutic drug injection - includes antibiotic or injection of sedative
Dental TreatmentP147Treatment of root canal obstruction - non surgical

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