Code | Display | Comments |
---|
1 | Medical Care | |
2 | Surgical | |
3 | Consultation | |
4 | Diagnostic XRay | |
5 | Diagnostic Lab | |
14 | Renal Supplies | |
23 | Diagnostic Dental | |
24 | Periodontics | |
25 | Restorative | |
26 | Endodontics | |
27 | Maxillofacial Prosthetics | |
28 | Adjunctive Dental Services | |
30 | Health Benefit Plan Coverage | |
35 | Dental Care | |
36 | Dental Crowns | |
37 | Dental Accident | |
49 | Hospital Room and Board | |
55 | Major Medical | |
56 | Medically Related Transportation | |
61 | In-vitro Fertilization | |
62 | MRI Scan | |
63 | Donor Procedures | |
69 | Maternity | |
76 | Renal Dialysis | |
F1 | Medical Coverage | |
F3 | Dental Coverage | |
F4 | Hearing Coverage | |
F6 | Vision Coverage | |