- <>84 - Abortion 
- <>CG - Mental Health Facility - Inpatient 
- <>51 - Hospital - Emergency Accident 
- <>73 - Diagnostic Medical 
- <>15 - Alternate Method Dialysis 
- <>37 - Dental Accident 
- <>A5 - Psychiatric - Room and Board 
- <>48 - Hospital - Inpatient 
- <>RN - Renal 
- <>AE - Physical Medicine 
- <>BN - Gastrointestinal 
- <>61 - In-vitro Fertilization 
- <>BU - Obstetrical 
- <>AN - Routine Exam 
- <>DS - Diabetic Supplies 
- <>96 - Professional (Physician) 
- <>BE - Massage Therapy 
- <>7 - Anesthesia 
- <>CL - Screening laboratory 
- <>TC - Transitional Care 
- <>NI - Neonatal Intensive Care 
- <>25 - Restorative 
- <>78 - Chemotherapy 
- <>43 - Home Health Prescriptions 
- <>BX - Mail Order Prescription Drug: Generic 
- <>AC - Rehabilitation - Outpatient 
- <>BH - Pediatric 
- <>82 - Family Planning 
- <>C1 - Coronary Care 
- <>CA - Private Duty Nursing - Inpatient 
- <>TN - Transitional Nursery Care 
- <>28 - Adjunctive Dental Services 
- <>57 - Air Transportation 
- <>75 - Prosthetic Device 
- <>13 - Ambulatory Service Center Facility 
- <>CQ - Case Management 
- <>A3 - Professional (Physician) Visit - Home 
- <>31 - Benefit Disclaimer 
- <>14 - Renal Supplies in the Home 
- <>MH - Mental Health 
- <>36 - Dental Crowns 
- <>A4 - Psychiatric 
- <>49 - Hospital - Room and Board 
- <>AD - Occupational Therapy 
- <>85 - AIDS 
- <>CF - Mental Health Provider - Outpatient 
- <>50 - Hospital - Outpatient 
- <>72 - Inhalation Therapy 
- <>CK - Screening X-ray 
- <>22 - Social Work 
- <>B2 - Brand Name Prescription Drug - Formulary 
- <>19 - Pneumonia Vaccine 
- <>A9 - Rehabilitation 
- <>44 - Home Health Visits 
- <>66 - Pathology 
- <>BR - Eye 
- <>AI - Substance Abuse 
- <>91 - Brand Name Prescription Drug 
- <>BB - Partial Hospitalization (Psychiatric) 
- <>88 - Pharmacy 
- <>83 - Infertility 
- <>56 - Medically Related Transportation 
- <>74 - Private Duty Nursing 
- <>CP - Eyewear and Eyewear Accessories 
- <>12 - Durable Medical Equipment Purchase 
- <>30 - Health Benefit Plan Coverage 
- <>A2 - Professional (Physician) Visit - Skilled Nursing Facility 
- <>AR - Experimental Drug Therapy 
- <>BY - Physician Visit - Office: Sick 
- <>AB - Rehabilitation - Inpatient 
- <>BI - Nursery 
- <>BL - Cardiac 
- <>86 - Emergency Services 
- <>CE - Mental Health Provider - Inpatient 
- <>53 - Hospital - Ambulatory Surgical 
- <>71 - Audiology Exam 
- <>17 - Pre-Admission Testing 
- <>35 - Dental Care 
- <>A7 - Psychiatric - Inpatient 
- <>UC - Urgent Care 
- <>68 - Well Baby Care 
- <>AG - Skilled Nursing Care 
- <>45 - Hospice 
- <>67 - Smoking Cessation 
- <>BS - Invasive Procedures 
- <>AH - Skilled Nursing Care - Room and Board 
- <>GN - Generic Prescription Drug - Non-Formulary 
- <>90 - Mail Order Prescription Drug 
- <>BC - Day Care (Psychiatric) 
- <>89 - Free Standing Prescription Drug 
- <>1 - Medical Care 
- <>CJ - Substance Abuse Facility - Outpatient 
- <>23 - Diagnostic Dental 
- <>B3 - Brand Name Prescription Drug - Non-Formulary 
- <>18 - Durable Medical Equipment Rental 
- <>A8 - Psychiatric - Outpatient 
- <>PT - Physical Therapy 
- <>40 - Oral Surgery 
- <>62 - MRI/CAT Scan 
- <>BV - Obstetrical/Gynecological 
- <>AM - Frames 
- <>95 - Podiatry - Nursing Home Visits 
- <>BF - Pulmonary Rehabilitation 
- <>4 - Diagnostic X-Ray 
- <>CO - Flu Vaccination 
- <>26 - Endodontics 
- <>59 - Licensed Ambulance 
- <>52 - Hospital - Emergency Medical 
- <>70 - Transplants 
- <>16 - Chronic Renal Disease (CRD) Equipment 
- <>34 - Chiropractic Office Visits 
- <>A6 - Psychotherapy 
- <>69 - Maternity 
- <>AF - Speech Therapy 
- <>BM - Lymphatic 
- <>87 - Cancer 
- <>CD - Surgical Benefits - Facility 
- <>B - Non-escrow or Non-impound Service 
- <>2 - Surgical 
- <>CI - Substance Abuse Facility - Inpatient 
- <>20 - Second Surgical Opinion 
- <>IC - Intensive Care 
- <>39 - Prosthodontics 
- <>46 - Respite Care 
- <>64 - Acupuncture 
- <>BP - Endocrine 
- <>AK - Drug Addiction 
- <>93 - Podiatry 
- <>94 - Podiatry - Office Visits 
- <>BG - Cardiac Rehabilitation 
- <>5 - Diagnostic Lab 
- <>CN - Mammogram, Low Risk Patient 
- <>58 - Cabulance 
- <>27 - Maxillofacial Prosthetics 
- <>PU - Pulmonary 
- <>41 - Routine (Preventive) Dental 
- <>63 - Donor Procedures 
- <>BW - Mail Order Prescription Drug: Brand Name 
- <>AL - Vision (Optometry) 
- <>BZ - Physician Visit - Office: Well 
- <>AA - Rehabilitation - Room and Board 
- <>99 - Professional (Physician) Visit - Inpatient 
- <>BJ - Skin 
- <>80 - Immunizations 
- <>8 - Surgical Assistance 
- <>CC - Surgical Benefits - Professional (Physician) 
- <>55 - Major Medical 
- <>77 - Otological Exam 
- <>11 - Used Durable Medical Equipment 
- <>33 - Chiropractic 
- <>A1 - Professional (Physician) Visit - Nursing Home 
- <>AQ - Nonmedically Necessary Physical 
- <>38 - Orthodontics 
- <>47 - Hospital 
- <>DG - Dermatology 
- <>65 - Newborn Care 
- <>BQ - Neurology 
- <>AJ - Alcoholism 
- <>92 - Generic Prescription Drug 
- <>BA - Independent Medical Evaluation 
- <>C - Escrow or Impound Service 
- <>3 - Consultation 
- <>CH - Mental Health Facility - Outpatient 
- <>21 - Third Surgical Opinion 
- <>B1 - Burn Care 
- <>24 - Periodontics 
- <>79 - Allergy Testing 
- <>42 - Home Health Care 
- <>60 - General Benefits 
- <>BT - Gynecological 
- <>AO - Lenses 
- <>RT - Residential Psychiatric Treatment 
- <>97 - Anesthesiologist 
- <>BD - Cognitive Therapy 
- <>GY - Allergy 
- <>6 - Radiation Therapy 
- <>CM - Mammogram, High Risk Patient 
- <>9 - Other Medical 
- <>CB - Private Duty Nursing - Home 
- <>54 - Long Term Care 
- <>76 - Dialysis 
- <>ON - Oncology 
- <>10 - Blood Charges 
- <>A0 - Professional (Physician) Visit - Outpatient 
- <>32 - Plan Waiting Period 
- <>DM - Durable Medical Equipment 
- <>GF - Generic Prescription Drug - Formulary 
- <>98 - Professional (Physician) Visit - Office 
- <>BK - Orthopedic 
- <>81 - Routine Physical