Scribd Logo
Carica

Benvenuto in Scribd!

  • Health Claims With Cause WORKINGS

    Caricato da

    Bobby Ganessingh
    18 visualizzazioni2.495 pagine
    This document contains claims data for various beneficiaries with details including beneficiary ID, claim number, cause of claim, and sequence. There are over 150 claims listed spanning multiple beneficiaries and covering a variety of medical issues such as glaucoma, vision care, prostate exams, skin conditions, dental care, deviated nasal septum, and more. The level of detail provided in the claims data includes beneficiary ID, claim number, cause or reason for the claim, and claim sequence number.

    Descrizione originale:

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Formati disponibili

    XLS, PDF, TXT o leggi online da Scribd

    Hai trovato utile questo documento?

    Questo contenuto è inappropriato?

    Segnala questo documento
    This document contains claims data for various beneficiaries with details including beneficiary ID, claim number, cause of claim, and sequence. There are over 150 claims listed spanning multiple beneficiaries and covering a variety of medical issues such as glaucoma, vision care, prostate exams, skin conditions, dental care, deviated nasal septum, and more. The level of detail provided in the claims data includes beneficiary ID, claim number, cause or reason for the claim, and claim sequence number.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Scarica in formato XLS, PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    18 visualizzazioni2.495 pagine

    Health Claims With Cause WORKINGS

    Caricato da

    Bobby Ganessingh
    This document contains claims data for various beneficiaries with details including beneficiary ID, claim number, cause of claim, and sequence. There are over 150 claims listed spanning multiple beneficiaries and covering a variety of medical issues such as glaucoma, vision care, prostate exams, skin conditions, dental care, deviated nasal septum, and more. The level of detail provided in the claims data includes beneficiary ID, claim number, cause or reason for the claim, and claim sequence number.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Scarica in formato XLS, PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    di 2495

    Claims Data

    Beneficiary ID

    CLAIM #
    1 06994
    2 05140
    2 05140
    3 03489
    3 03729
    3 03729
    3 03729.1
    3 03730
    3 03814
    3 03814
    3 03814.1
    3 04368
    3 04883
    3 05104
    3 05365
    3 05365
    3 05365
    3 05365
    3 05369
    3 05369
    3 05672
    3 05816
    3 05816
    3 06025
    3 06025.1
    3 06214
    3 06214
    3 06405
    3 06632
    3 06888
    3 06888
    3 06888
    3 06889
    3 07098
    3 07099
    3 07402
    3 07402
    3 07480
    3 08634
    3 08635
    3 08636
    3 08636.1
    4 04070
    4 04070
    4 05676
    4 05676
    4 05676
    4 05676
    4 05676

    Seq

    CAUSE DESCRIPTION
    1 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    1 PROSTATE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 SKIN - ECZEMA
    1 GLAUCOMA
    1
    2
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 CATARACT
    1 PROSTATE
    1 HYPERTENSION
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    4 PROSTATE
    1 GLAUCOMA
    2 GLAUCOMA
    1
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 HYPERTENSION
    1 GLAUCOMA
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 PROSTATE
    1 CATARACT
    1 PROSTATE
    2 PROSTATE
    1 BACK PAIN
    1 PROSTATE
    1 GLAUCOMA
    1 BURSITIS
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM

    Page 1

    Claims Data

    4 05676.1
    5 04083
    5 04083
    5 04083
    6 05474
    6 05474
    6 05474
    7 08882
    7 08882
    7 08882
    8 08278
    8 08278
    9 04380
    9 04380
    9 05505
    9 05505.1
    9 06517
    9 06892
    9 06892
    9 06892
    10 04939
    10 04939
    10 04939
    10 04939
    10 06250
    10 08275
    10 08275
    10 08275
    10 08275.1
    10 08275.1
    10 08275.1
    10 08276
    10 08276
    10 08277
    11 04759
    11 08242
    11 08242
    11 08242
    12 05373
    12 05373
    12 05373.1
    12 05373.1
    12 05373.1
    12 05373.1
    12 05373.2
    12 06742
    12 07151
    12 07151
    12 07151
    12 07577

    1 DEVIATED NASAL SEPTUM


    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    1 PROSTATE
    2 PROSTATE
    1 PROSTATE
    1 HYPERTENSION
    1 PROSTATE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    3 FRACTURE - HAND BONES
    4 FRACTURE - HAND BONES
    1 FRACTURE - HAND BONES
    1 THYROID
    2 THYROID
    3 THYROID
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANXIETY
    2 ANXIETY
    1 SKIN - LESION
    1 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 HYPERTENSION
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION

    Page 2

    Claims Data

    12 08741
    12 08894
    12 08894
    12 08894.1
    13 03612
    13 03612
    13 03612
    13 04707
    13 04707
    13 08462
    13 08462
    13 08462.1
    14 06945
    14 06945
    14 06945
    14 07157
    14 07157
    14 07157
    15 04065
    15 04065
    15 04065
    15 04065
    15 05605
    15 05605
    15 09044
    16 07146
    16 07146
    16 07146
    16 07146.1
    16 07146.1
    17 05141
    18 03491
    18 03491
    18 05106
    18 05106
    18 05106
    18 05317
    18 05317
    18 06746
    18 06746
    18 07769
    18 07769
    18 07769.1
    18 07769.1
    19 04228
    19 04228
    19 04228
    20 05103
    20 05103
    20 05103.1

    1 HYPERTENSION
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 HEMORRHOIDS
    1
    2
    3
    1 BACK PAIN
    2 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 HYPERTENSION
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 THYROID
    2 THYROID
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 ARTHRITIS

    Page 3

    Claims Data

    20 05103.2
    20 05103.2
    21 04272
    21 04272
    21 04272.1
    21 07149
    21 07149
    21 07150
    21 07150
    21 08241
    21 08241
    21 08241
    22 03608
    22 03886
    22 05041
    22 07142
    22 07142
    23 05606
    23 05606
    23 05606
    23 05606
    23 05606
    23 06024
    23 06024
    23 06024
    23 06639
    23 06639
    23 06639
    24 04441
    24 04441
    24 04441
    24 05295
    24 05295
    24 05295
    24 05295
    24 06748
    24 06748
    24 07992
    24 07992
    24 08464
    24 08464
    25 07403
    25 07403
    26 03610
    26 05017
    26 06106
    26 08731
    27 03523
    27 04436
    27 05040

    1 SINUSITIS
    2 SINUSITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 JAUNDICE
    1 EYE DISORDER
    2 EYE DISORDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1
    1
    1 DILATION & CURRETAGE
    1 ANXIETY
    2 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    3 PAINFUL HEEL
    4 PAINFUL HEEL
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    1 AMMENORRHOEA
    1 AMMENORRHOEA
    1 AMMENORRHOEA
    1 HYPERTENSION
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM

    Page 4

    Claims Data

    27 05040
    27 05040.1
    27 05612
    27 06406
    27 07501
    27 08240
    27 08240
    27 08240
    27 08405
    28 03672
    28 03672
    28 04361
    28 04361
    28 04362
    28 04362
    28 05917
    28 05917
    28 05917
    28 05917
    28 05918
    28 05918
    28 05918
    28 05918
    28 06845
    28 06845
    28 07585
    28 07585
    28 07585
    28 08260
    29 03531
    29 03531
    29 03531
    29 03531
    29 03531
    29 03531.1
    29 03531.1
    29 03531.2
    29 03531.2
    29 06067
    30 05172
    30 05172.2
    30 05172.2
    30 05172.3
    30 05172.3
    30 08279
    30 08279
    30 08279
    31 06348
    31 06348
    32 07931

    2 DEVIATED NASAL SEPTUM


    1 EAR DYSFUNCTION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    1 BACK PAIN
    2 BACK PAIN
    1 EPILEPSY
    2 EPILEPSY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 BACK PAIN
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    2 FEVER
    1 DENGUE
    2 DENGUE
    1 PAINFUL HEEL
    1 INFECTION THUMB
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER
    1 DENTAL CARE

    Page 5

    Claims Data

    32 07931
    32 08067
    33 06057
    33 06057
    33 06057
    33 06057.1
    34 04437
    34 04437
    34 04437
    34 04437
    34 04437
    34 04437.1
    34 04437.2
    34 04437.2
    34 04758
    34 05503
    34 07100
    34 07100
    34 07100
    34 07451
    34 07451.1
    34 08347
    34 08347
    34 08347.1
    34 08347.1
    35 03524
    35 03525
    35 04366
    35 04366
    35 04366
    35 04367
    35 04367
    35 06007
    35 06007
    35 06007
    35 06546
    35 06547
    35 07927
    35 07928
    35 07928
    35 08638
    35 08639
    36 05366
    36 05367
    36 06645
    36 06844
    36 06844
    36 06844
    36 06844
    36 06844

    2 DENTAL CARE
    1 AMMENORRHOEA
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BARTHOLIN'S CYST
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    5 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 ACUTE ENTERITIS
    1 HEART
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 HEART
    2 HEART
    1 GLAUCOMA
    1 THYROID
    1 THYROID
    2 THYROID
    3 THYROID
    1 CATARACT
    2 CATARACT
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    1 THYROID
    1 GLAUCOMA
    1 THYROID
    1 GLAUCOMA
    2 GLAUCOMA
    1 THYROID
    1 CATARACT
    1 VISION CARE
    1 DILATION & CURRETAGE
    1 MUSCULAR PAIN
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN

    Page 6

    Claims Data

    36 06844.1
    36 07041
    36 07041
    36 07321
    36 07503
    36 07699
    36 07930
    37 06021
    38 04109
    38 04109
    38 04109
    38 04109
    38 04110
    38 04110
    38 04110
    38 04110
    38 05980
    38 05980
    38 05980
    39 03487
    39 03728
    39 04589
    39 04589
    39 04589
    39 05471
    39 05471.1
    39 05471.1
    39 05471.1
    39 06644
    39 06644
    40 03670
    40 03671
    40 04273
    40 04274
    40 05169
    40 05170
    40 06596
    40 06596
    40 06596
    40 06596
    40 06810
    40 08028
    40 08028
    40 08028
    41 05013
    41 05013
    41 05818
    41 05818
    41 05819
    41 05819

    1 HYPERTENSION
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 BACK PAIN
    1 CHOSTOCHRONDITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1
    2
    3
    1 CIRCULATORY DISORDER
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 SKIN - ECZEMA
    1 BARTHOLIN'S CYST
    1 COUGH - AIRWAY OBSTRUCTION
    1 COUGH - AIRWAY OBSTRUCTION
    1 INFECTION - MALE GENITAL
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE

    Page 7

    Claims Data

    41 05819
    41 05819
    42 04178
    42 04178
    42 04178
    42 04660
    42 04660
    43 08144
    43 08144
    43 08144
    44 03883
    44 03883
    44 03883
    44 06840
    44 06840
    44 06840
    44 06841
    44 06841
    45 06351
    45 06351
    45 06351.1
    46 04171
    46 04171
    46 04171
    46 05473
    46 05473
    46 05473
    46 05473
    47 07520
    47 07520
    47 07520.1
    47 07520.1
    48 03530
    48 03530
    48 05042
    48 05042
    48 05042
    48 05042
    48 05042
    48 05042.1
    48 06329
    48 06329
    48 06329
    49 03488
    49 03488
    49 03488
    49 05687
    49 05687
    49 05687
    49 05687

    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 MUSCULAR PAIN
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    5
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1
    2
    3
    4

    Page 8

    Claims Data

    49 06022
    49 06022
    49 06330
    50 04066
    50 04066
    50 04066
    50 04066
    50 04066
    50 04066.1
    50 06808
    50 06808
    51 05105
    51 06248
    51 06253
    51 06253
    51 06347
    51 06347.1
    51 06352
    51 07042
    51 07042
    51 07042
    51 07042
    51 07809
    51 07809
    51 07809
    51 07809
    51 07809
    52 05981
    52 05982
    52 05982
    52 05983
    52 05983
    52 05983
    52 05983
    52 05983.1
    52 08680
    52 08680
    52 08681
    52 08681
    52 08681
    53 08317
    54 04158
    54 04158
    54 04158
    54 04158
    54 04158
    54 04158.1
    54 04158.1
    54 04158.1
    54 04158.1

    1 FRACTURE - HAND BONES


    2 FRACTURE - HAND BONES
    1 FRACTURE - HAND BONES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 SKIN - ATOPIC DERMATITIS
    1 DENTAL CARE
    1
    2
    1
    1
    1
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 HYPERTENSION
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    1 BREAST DISORDERS
    1 HEART- ISCHEMIC HEART DISEASE
    2 HEART- ISCHEMIC HEART DISEASE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MISCARRIAGE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    1 HEART
    2 HEART
    2 HEART

    Page 9

    Claims Data

    54 04158.1
    54 04158.1
    54 04158.2
    54 04158.2
    54 04158.2
    54 05340
    54 05340
    54 05340
    54 05340
    54 05340
    54 05340.1
    54 05340.1
    54 06017
    54 06516
    54 06516
    54 06516
    54 06516
    54 06638
    54 06638.1
    54 06638.1
    54 07399
    54 07399.1
    54 07399.1
    54 08533
    54 08533
    55 08742
    55 08742
    55 08742
    56 05603
    56 05603
    56 05603
    57 06659
    57 06659
    58 07046
    59 03882
    59 03882
    59 03882
    59 03882
    59 03882
    59 06066
    59 06066
    59 06066
    59 06066
    60 07516
    60 07516
    60 07516
    61 07452
    61 07452
    61 07452
    62 04275

    3 HEART
    3 HEART
    1 HEART
    2 HEART
    3 HEART
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    3 HEART- ISCHEMIC HEART
    4 HEART- ISCHEMIC HEART
    5 HEART- ISCHEMIC HEART
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    1 HEART
    1
    2
    3
    4
    1 HEART
    1 HEART
    2 HEART
    1 HEART- ISCHEMIC HEART
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    5 DILATION & CURRETAGE
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE

    Page 10

    DISEASE
    DISEASE
    DISEASE
    DISEASE
    DISEASE
    DISEASE
    DISEASE

    DISEASE
    DISEASE
    DISEASE

    Claims Data

    62 04275
    62 04275
    62 04275
    62 04276
    62 04276
    62 04276
    62 04276
    62 04935
    62 04935
    62 04935
    62 04935
    62 04935
    62 04935.1
    62 04935.1
    62 04936
    62 04936
    62 05493
    62 05494
    62 05494
    62 05494
    62 05494
    62 05494
    62 05496
    62 05496
    62 05496
    62 05496.1
    62 06407.1
    62 06407.1
    62 06407.1
    62 06407.1
    62 06640
    62 06640
    62 06640
    62 07239
    62 07239
    62 08341
    62 08341
    62 08341
    63 08406
    63 08406
    63 08406
    64 08682
    64 08682
    64 08682
    64 08682
    64 08682
    65 06544
    65 06544
    65 06544
    65 07484

    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEART
    2 HEART
    1 BARTHOLIN'S CYST
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 BRONCHITIS

    Page 11

    Claims Data

    65 07484
    65 07484
    66 04107
    66 04108
    66 04108
    66 04108
    66 04225
    66 04225
    66 05814
    66 05814
    66 05815
    66 07326
    66 07326
    66 08340
    66 08340
    67 08321
    67 08321
    68 08532
    68 08532
    68 08532
    68 08532
    69 05314
    69 05314
    70 05288
    71 06280
    72 03533
    72 03533
    72 03533
    73 05335
    73 05335
    73 05335
    73 05335
    73 05866
    73 05866
    73 05866
    73 08342
    73 08342
    73 08343
    73 08343
    73 08343
    73 08343
    73 08343
    74 08900
    74 08900
    74 08900
    75 06055
    75 06055
    75 06055
    75 06350
    75 06350

    2 BRONCHITIS
    3 BRONCHITIS
    1 OVARIAN CYST
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1
    2
    1 OVARIAN CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1
    1
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    3 FEVER
    1
    2
    3
    1 HYPERTENSION
    2 HYPERTENSION

    Page 12

    Claims Data

    75 07148
    75 07148
    75 07148
    75 07972
    75 07972
    75 07972
    75 07972
    75 08349
    75 08349
    75 08350
    75 08350
    75 08351
    76 05677
    76 05677
    76 05677
    76 08145
    76 08145
    77 03613
    77 03613
    77 03951
    77 03951
    77 03951
    77 03989
    77 03989
    77 03989
    77 03990
    77 03990
    77 03990
    77 06747
    77 06747
    77 06747
    77 08463
    77 08463
    78 07481
    78 07482
    78 07482
    79 03733
    79 03733
    79 03733
    79 03733
    79 03734
    79 03734
    79 03734
    79 03734
    79 03736
    79 03736
    79 03736
    79 03736
    79 03736
    79 03736.1

    1
    2
    3
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    3 SOFT TISSUE DISORDERS/DISEASE
    4 SOFT TISSUE DISORDERS/DISEASE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    1 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BACK PAIN
    2 BACK PAIN
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1
    2
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1

    Page 13

    Claims Data

    79 06254
    79 06254
    79 06254
    79 06254
    79 06254.1
    79 06254.1
    79 06254.1
    80 03527
    80 03529
    80 03529
    80 03529
    80 03529
    80 03529
    80 03812
    80 03812
    80 03812
    80 03812
    80 04446
    80 04446
    80 04446
    80 04446
    80 05139
    80 05139
    80 05248
    80 06839
    80 07991
    81 03889
    81 03889
    81 03889
    81 03889
    81 03889
    81 03889.1
    81 03889.1
    81 03889.1
    81 03889.2
    81 03889.2
    81 03889.2
    81 03889.2
    81 03889.2
    81 04891
    81 04891
    81 05740
    81 05740
    81 06518
    81 06518
    81 06518
    81 07263
    81 07263
    81 07264
    82 04859

    1 DEVIATED NASAL SEPTUM


    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    5 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    1 HEART
    1 HEART
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 BACK PAIN
    2 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1
    2
    3
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 RADICULOPATHY INFLAME NERVE ROOT
    1

    Page 14

    Claims Data

    82 04859
    82 04859
    82 04859
    82 04859.1
    82 04859.2
    82 04859.2
    82 04859.2
    82 05387
    82 05387
    82 05387
    82 05387
    82 05387
    82 05387
    82 05387.1
    82 05387.1
    82 05387.2
    82 05387.2
    82 05387.3
    82 05387.3
    82 05387.3
    82 05387.4
    82 05387.5
    82 06174
    83 04071
    83 04071
    83 04071
    83 04605
    83 04605
    83 04605
    83 05881
    83 05881
    83 05881
    83 05921
    83 05921
    83 07523
    83 07523
    83 07523.1
    84 04377
    84 04377
    84 04377
    84 04378
    84 04378
    84 08027.1
    84 08027.1
    84 08027.1
    84 08637
    84 08637
    84 08637
    84 08637
    85 07590

    1
    2
    2
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    3 HYPERTENSION
    1 EAR DYSFUNCTION
    1 EAR DYSFUNCTION
    1 PROSTATE
    1 PROSTATE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 EAR DYSFUNCTION
    1 PROSTATE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER
    1 HYPERTENSION
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 INJURY - OPEN WOUND

    Page 15

    Claims Data

    85 07590
    85 07590
    86 04606
    86 05922
    86 05922
    86 05922
    86 05922
    86 05922
    86 05922.1
    86 05923
    86 05923
    86 05923
    86 05923
    86 05923
    86 06286
    86 07591
    86 07591
    86 07591
    86 07591
    86 08411
    86 08411
    86 08411
    86 08412
    86 08412
    87 03490
    87 03490
    87 03490
    88 04092
    88 04092
    88 04092
    88 06838
    89 04379
    89 04379
    89 05342
    89 05342
    89 06515
    89 06515
    89 08408
    89 08408
    89 08408
    89 08409
    89 08409
    89 08409
    89 08409.1
    90 06026
    90 06027
    90 06027
    90 06027
    90 06027
    90 06027

    2 INJURY - OPEN WOUND


    3 INJURY - OPEN WOUND
    1 VISION CARE
    1 ADENOTONSILLITIS ALLERGIC
    2 ADENOTONSILLITIS ALLERGIC
    3 ADENOTONSILLITIS ALLERGIC
    4 ADENOTONSILLITIS ALLERGIC
    5 ADENOTONSILLITIS ALLERGIC
    1 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND
    4 INJURY - OPEN WOUND
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 INTESTINAL COLIC
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 HYPERTENSION
    1 OVARIAN CYST
    1
    2
    3
    4
    5

    Page 16

    Claims Data

    90 06408
    90 06408
    90 07863
    91 06890
    91 06890
    91 06890
    92 07406
    93 05675
    93 05675
    93 05675
    93 06728
    93 06728
    94 04843
    94 04843
    94 04843
    94 04843.1
    94 06837
    94 06837
    95 03727
    95 03727
    95 03727
    95 03727.1
    95 03884
    95 03884
    95 03884
    95 03884
    95 03885
    95 03885
    95 04226
    95 04226
    95 04226.1
    95 04227
    95 04227.1
    95 04435
    95 04435
    95 05739
    95 06279
    95 07144
    95 08346
    95 08633
    96 04279
    96 04279
    97 07261
    98 08143
    98 08143
    99 07143
    99 07143
    99 07143
    99 07143
    99 07258

    1
    2
    1 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    1 DILATION & CURRETAGE
    1 BACK PAIN
    2 BACK PAIN
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 PROSTATE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 PROSTATE
    2 PROSTATE
    1 HEART
    1 PROSTATE
    1 DIAB'ETES
    1 SINUSITIS
    2 SINUSITIS
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 INJURY - UNSPECIFIED
    2 INJURY - UNSPECIFIED
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 HYPERTENSION

    Page 17

    Claims Data

    100 04440
    100 04440
    100 04440
    100 04442
    100 04442.1
    100 04442.2
    100 04442.3
    100 06545
    101 04290
    101 04290
    101 04290
    101 04290
    101 04290
    101 08743
    102 03887
    102 05044
    102 05044
    102 05138
    102 05470
    102 05470
    102 05470.1
    102 06331
    102 06811
    102 06811
    102 06811
    102 06811
    102 07145
    102 07145
    102 07145
    102 07145.1
    103 04940
    103 04940
    104 04884
    104 04884
    104 04884
    105 03532
    105 03880
    105 03880
    105 03880
    105 05014
    105 05014
    105 05015
    105 05015
    105 05173
    105 05173
    105 05371
    105 05371
    105 06105
    105 06809
    105 08744

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DILATION & CURRETAGE
    1 HYPERTENSION
    1 CYSTITIS
    1 ANAEMIA
    1 MUSCULAR PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 DIAB'ETES
    1 HYPERTENSION
    1 TENDONITIS
    2 TENDONITIS
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 TENDONITIS
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 BACK PAIN
    2 BACK PAIN
    1 DENTAL CARE
    1 DENTAL CARE
    1 SINUSITIS

    Page 18

    Claims Data

    105 08744
    105 08745
    105 08745
    106 04890
    106 04890
    107 05880
    108 03492
    108 03492
    108 03493
    108 03493
    108 03493
    108 04528
    108 04528
    108 05700
    108 05700
    108 05700
    108 06968
    108 06968.1
    108 06968.1
    108 06968.1
    108 06968.1
    108 06968.1
    108 07259
    108 07259
    108 07323
    108 07323
    108 07324
    108 07324
    108 07324.1
    108 07324.1
    108 07324.1
    108 07324.2
    108 07324.2
    108 07522
    108 07522
    108 07522
    108 07522
    109 04106
    109 06641
    110 06660
    110 06660
    110 06660
    110 06660
    111 05984
    111 05984
    111 05984
    111 05984
    111 07586
    111 07586
    111 08029

    2 SINUSITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 LARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 VISION CARE
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    4 INGROWING TOE NAIL
    5 INGROWING TOE NAIL
    1 DENTAL CARE
    2 DENTAL CARE
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1 HEART
    2 HEART
    3 HEART
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 CANCER-BREAST
    1 CANCER-BREAST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    3
    4
    1
    2
    1

    Page 19

    Claims Data

    112 03638
    112 04858
    113 06745
    113 06745
    113 06745
    114 08407
    114 08407
    115 04439
    115 04439
    115 06991
    115 06991
    116 04363
    116 04363
    116 08274
    116 08274
    117 05247
    117 06597
    117 06597
    117 06597
    117 06597.1
    117 06658
    118 05168
    118 05168
    118 05168
    118 05168
    118 05168
    119 07320
    119 07320
    119 07502
    119 07502
    119 07698
    119 08320
    119 08320
    120 04760
    120 04760
    120 04760
    120 04760
    121 03737
    121 03737
    121 03879
    121 03879
    121 03879
    121 05019
    121 05019
    121 05388
    121 05388
    121 05504
    122 06100
    122 06100
    122 06100

    1 DENTAL CARE
    1 DENTAL CARE
    1 ALLERGY
    2 ALLERGY
    3 ALLERGY
    1 VISION CARE
    2 VISION CARE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1 EYE DISORDER
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 PHARYNGITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 THYROID
    2 THYROID
    1 THYROID
    2 THYROID
    1 THYROID
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1
    2
    1 BONE & CARTILAGE DISORDER
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN

    Page 20

    Claims Data

    122 06100
    122 06891
    122 06891
    122 07043
    122 07043
    122 07043.1
    122 07407
    122 08280
    122 08280
    122 08280
    122 08467
    122 08467
    123 03609
    123 03609
    123 03609.1
    123 03609.1
    123 05502
    123 05502
    123 05879
    123 05879
    123 06656
    123 06656
    123 06656.1
    123 07400
    123 07400.1
    123 07400.1
    123 08273
    123 08273
    124 04438
    124 07405
    124 07405
    124 08679
    125 05372
    125 05372
    126 07521
    126 07521
    126 07521
    126 07521
    126 07521.1
    127 07412
    127 07412
    127 07412
    127 07412
    127 07412
    128 08410
    128 08410
    129 06657
    129 06657
    130 06636
    131 07339

    4 MUSCULAR PAIN
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1
    2
    1
    1 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 THYROID
    2 THYROID
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 BURSITIS
    2 BURSITIS
    1 THYROID
    1 BURSITIS
    1 THYROID
    2 THYROID
    1 ARTHRITIS
    2 ARTHRITIS
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 SKIN - ECZEMA
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 BARTHOLIN'S CYST
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 PHIMOSIS
    2 PHIMOSIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    1 VISION CARE

    Page 21

    Claims Data

    131 07339
    132 06339
    132 06339
    132 06339.1
    133 07588
    133 07588
    133 07589
    134 07531
    134 07531
    134 07531
    134 07531.1
    134 08954
    135 04979
    135 04979
    135 04981
    135 04981
    135 05507
    135 05507
    135 05507
    135 05507.1
    135 05507.1
    135 05507.1
    135 05507.2
    135 06077
    135 06077
    135 06077.1
    135 06077.1
    135 07505
    135 07505
    135 08247
    136 04169
    136 04169
    136 04170
    136 04987
    136 04987
    136 04987
    136 05893
    136 05894
    136 06012
    137 08378
    137 08378
    137 08378
    137 08379
    138 04986
    138 04986
    138 04986
    139 04984
    139 04984
    139 04984
    139 04984

    2 VISION CARE
    1 TENDONITIS
    2 TENDONITIS
    1 SINUSITIS
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 SKIN - ECZEMA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 HYPERTENSION
    1 BACK PAIN
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1
    2
    3
    1 ALLERGIC RHINITIS
    1 GLAUCOMA
    2 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    Page 22

    Claims Data

    139 08254
    139 08254
    139 08254
    139 08254
    139 08856
    139 08856
    140 03947
    140 05776
    140 05776
    140 05776
    140 08246
    141 07166
    141 07166
    141 08948
    141 08948
    141 08948.1
    141 08948.1
    141 08949
    141 08949
    141 08949
    141 08950
    141 08950
    141 08950
    141 08951
    141 08951
    142 03811
    142 03811
    142 03811
    142 05777
    142 05777
    142 05777
    142 05777.1
    142 06103
    143 08186
    143 08186
    143 08186
    143 08186
    143 08186
    144 05779
    144 05779
    145 07876
    145 07876
    145 07876
    145 07876
    145 07876
    145 07876.1
    145 07876.1
    146 04167
    146 04167
    146 04167

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 FEVER
    2 FEVER
    1 HEART
    2 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALOPECIA
    2 ALOPECIA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 ALLERGIC REACTION
    1 ALLERGIC REACTION
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    Page 23

    Claims Data

    146 04985
    146 04985
    146 05223
    146 05223
    146 06684
    146 06684
    147 08381
    147 08381
    147 08382
    147 08382
    147 08382
    147 08382
    147 08382
    147 08857
    148 04160
    148 04160
    148 06281.1
    148 06281.1
    148 06281.1
    148 06281.1
    148 06281.1
    148 08248
    148 08248
    148 08248
    148 08248
    149 04159
    149 04159
    150 08728
    150 08729
    150 08729
    151 03944
    151 03944
    151 03944
    151 04164
    151 04164
    151 04164
    151 04164
    151 04164.1
    151 04166
    151 05508
    151 05508
    151 05508
    151 05508
    151 06011
    151 06011
    151 06035
    151 06035
    151 06035
    151 06035
    152 04356

    1 DENTAL CARE
    2 DENTAL CARE
    1 CYST
    2 CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 ABDOMINAL PAINS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1
    2
    3
    4
    5
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 THYROID
    2 THYROID
    3 THYROID
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    1 SKIN - ATOPIC DERMATITIS
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1

    Page 24

    Claims Data

    152 04356
    153 04359
    153 04359.1
    153 04988
    153 04988
    153 04988
    153 07879.1
    153 07879.1
    153 08956
    153 08956.1
    154 08380
    154 08380
    155 03810
    155 03810
    155 05780
    155 05780
    155 05780
    155 08252
    155 08252
    155 08252.1
    155 08252.1
    156 08952
    157 04526
    157 04527
    157 04527.1
    157 08255
    157 08256
    157 08256.1
    158 08375
    158 08375
    158 08375
    158 08375
    158 08375
    158 08375.1
    159 04168
    159 07506
    159 07506
    159 08257
    159 08257
    159 08257
    159 08426
    159 08426
    159 08426
    160 04162
    160 04163
    160 04163
    160 07378
    160 07378
    160 07378
    161 04978

    2
    1
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 SKIN - ECZEMA
    1
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERTENSION
    2 HYPERTENSION
    1 TENDONITIS
    2 TENDONITIS
    1 VISION CARE
    1 OVARIAN CYST
    1 RECTAL ABCESS
    1
    1 FRACTURE - HAND BONES
    1 EAR DYSFUNCTION
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    3
    1
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 RENAL DYSFUNCTION

    Page 25

    Claims Data

    161 04978
    161 04978
    162 06682
    162 06682
    162 06682
    162 06682
    162 06682
    162 06682.1
    163 08953
    163 08953
    163 08953.1
    164 03809
    164 03809
    165 06685
    165 06685
    165 06685
    165 06685
    166 06681
    167 08250
    167 08251
    167 08251
    167 08251
    167 08251
    167 08251
    168 04161
    168 04161
    168 04357
    168 04358
    168 04982
    168 04982
    168 04982.1
    168 04983
    168 04983
    169 06133
    169 06133
    169 06134
    169 06134
    170 07464
    170 07465
    170 07881
    170 07881
    171 05481
    171 05481
    171 05481
    172 05271
    172 05272
    172 05272
    172 05273
    173 03496
    173 03496

    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 BONE & CARTILAGE DISORDER
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 ALLERGIC RHINITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ASTHMA
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DEPRESSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 OTITIS - EAR
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION

    Page 26

    Claims Data

    173 06135
    173 06135
    173 06137
    173 06138
    173 07273
    173 07274
    173 07275
    173 07275.1
    173 07275.1
    174 04627
    174 04627
    174 04627
    174 04627
    174 04627
    174 04721
    174 04721
    174 04721
    175 06036
    175 06036
    175 06036
    175 06036
    175 06036
    176 07656
    176 07656
    176 07656
    177 07487
    177 07487
    177 07487
    177 07487
    178 05270
    178 05270
    178 05270
    178 07655
    178 07655
    178 07655
    178 07655
    178 07655
    179 06976
    179 06976
    179 06976
    179 07880
    179 07880
    179 07880
    179 07880
    179 08159
    179 08159
    180 03619
    180 03619
    180 03619
    180 04628

    1 BEHAVIOURIAL PROBLEMS
    2 BEHAVIOURIAL PROBLEMS
    1 ABDOMINAL PAINS
    1 DEVIATED NASAL SEPTUM
    1 TONSILLITIS
    1 ANAEMIA
    1 ANAEMIA
    1 ANAEMIA
    2 ANAEMIA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    3 FEVER
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 ASTHMA

    Page 27

    Claims Data

    180 04628
    180 04628
    180 04628
    180 04628
    180 06037
    180 06037
    180 06037
    180 06037
    180 06037
    180 06037.1
    181 04463.1
    181 04463.1
    181 04463.1
    181 04464
    182 08213
    182 08213
    182 08213
    183 03699
    183 03699
    183 07193
    183 07193
    184 03680
    184 03680
    184 03681
    184 03681
    184 03681
    184 04449
    184 04449
    184 07170
    184 07170
    185 05954
    185 05954
    185 05954
    186 05109
    186 05109
    186 05109
    186 05110
    186 05110
    187 04448
    187 04448
    187 04448
    187 04448.1
    187 04448.1
    187 07724
    187 07724
    187 07724
    187 07724
    188 04450
    188 04450
    188 05051

    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    5 ASTHMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 HEART
    2 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 ALLERGIC REACTION

    Page 28

    Claims Data

    188 05051
    188 05051
    188 05052
    188 05052
    188 05052
    189 05512
    189 05512
    189 05512
    189 06362
    189 06362
    189 07725
    189 07725
    189 07725
    190 03686
    190 03686
    190 03686.1
    190 03686.1
    190 06758
    190 06758
    190 06758.1
    191 05055
    192 04453
    192 04453
    192 04453
    192 04453
    192 04453.1
    192 04453.1
    192 04453.1
    193 03714
    193 03714
    193 03715
    193 03715
    193 03715
    193 03717
    193 03717
    194 05514
    194 05514
    194 05514
    194 05514
    195 04457
    195 04457
    195 04457
    195 04457
    195 06368
    195 06368
    195 06368
    195 08192
    195 08192
    196 03684
    197 04455

    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    3
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    1 DIAB'ETES
    2 DIAB'ETES
    1
    2
    1 DIAB'ETES
    2 DIAB'ETES
    1 SKIN - ECZEMA
    1 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM

    Page 29

    Claims Data

    197 04455
    197 04455.1
    197 05941
    197 05941
    197 05941
    198 05111
    198 05111
    198 05111
    199 04458
    200 07171
    200 07171
    200 07171
    201 03685
    201 03685.1
    202 03687
    202 04461
    202 05516
    202 06759
    202 06759
    202 06759
    202 06759
    202 06760
    202 06760
    202 06760
    202 06760
    202 08194
    202 08194
    202 08195
    202 08195
    203 05515
    203 05515
    204 05056
    204 05056
    204 05056
    204 05056.1
    205 05948
    205 05948
    205 05948
    205 05948
    205 05948
    205 05948.1
    205 05948.1
    206 05048
    206 05048
    206 05048
    206 05049
    206 05049
    206 05939
    206 05939
    206 05939

    2 DEVIATED NASAL SEPTUM


    1 HYPERTENSION
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 HYPERTENSION
    1 AMMENORRHOEA
    1 SINUSITIS
    1 ALLERGIC RHINITIS
    1 ALLERGY
    1 LACERATION TO FOOT
    2 LACERATION TO FOOT
    3 LACERATION TO FOOT
    4 LACERATION TO FOOT
    1
    2
    3
    4
    1 CHEST PAIN
    2 CHEST PAIN
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 CONSTIPATION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 FEVER
    2 FEVER
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY

    Page 30

    Claims Data

    206 05939
    206 05939
    206 05939.1
    206 06757
    206 06757
    206 06757.1
    206 06757.1
    206 08187
    207 06366
    207 06366
    208 03708
    208 03709
    208 04492
    208 04493
    208 05157
    208 05158
    208 05158
    208 06398
    208 06776
    208 08228
    209 05059
    209 05059
    209 05059
    209 06370
    209 06370
    210 08199
    210 08199.1
    210 08199.2
    211 08197
    211 08197.1
    211 08197.2
    212 07177
    212 07177
    213 05062
    213 05062
    213 05300
    213 05300
    214 04460
    214 04460
    214 04460.1
    214 04460.1
    214 04460.1
    214 04460.2
    214 04460.2
    214 08193
    214 08193
    215 03701
    215 03701
    215 03701.1
    215 03702

    4 HORMONE REPLACMENT THERAPY


    5 HORMONE REPLACMENT THERAPY
    1 HORMONE REPLACMENT THERAPY
    1 BACK PAIN
    2 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 AMMENORRHOEA
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 OVARIAN CYST
    1 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    1 FEVER
    1 OTITIS - EAR
    1 RENAL DYSFUNCTION
    1 FEVER
    1 PAIN-BACK/SHOULDER
    1 EYE DISORDER
    2 EYE DISORDER
    1 SINUSITIS
    2 SINUSITIS
    1 BACK PAIN
    2 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HYPERTENSION
    2 HYPERTENSION
    1 BONE & CARTILAGE DISORDER
    1 DENTAL CARE

    Page 31

    Claims Data

    215 05531
    215 05531
    216 05528
    216 05528
    216 05528
    216 07191
    216 07739
    216 07739
    216 07739
    216 08212
    217 07176
    217 07176
    218 05050
    218 05050
    218 05050
    218 05937
    218 05937
    218 05938.1
    218 05938.1
    218 06756
    218 06756
    218 07167
    218 07167
    218 07167
    218 07167
    218 07168
    218 07168
    218 07168
    218 07168
    218 08188
    218 08188
    219 05455
    219 05455
    219 05455.1
    219 06374
    219 06374.1
    219 06374.1
    220 04462
    220 04462
    220 06369
    220 06369
    220 06369
    220 06369.1
    220 06369.1
    220 07728
    221 06360
    221 06360
    221 06360
    222 03621
    222 03621

    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 VARICOSE
    2 VARICOSE
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 VARICOSE
    2 VARICOSE
    1
    2
    3
    4
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    1 VARICOSE
    2 VARICOSE
    1
    2
    1 TONSILLITIS
    1 HYPERTENSION
    1
    2
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 ENDOMETROSIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION

    Page 32

    Claims Data

    222 03621
    222 03621
    222 03621.1
    222 03621.1
    223 04490
    223 04490
    223 04490
    223 05156
    223 05156
    223 06774
    223 06774
    223 06774
    223 07756
    223 07756
    223 08226
    223 08226
    224 03705
    224 03705
    224 03705
    225 06761
    225 06761
    225 06762
    226 05161
    226 05161
    226 05161
    226 05161
    227 03691
    227 03691
    227 03691
    228 05112
    228 05113
    228 05114
    228 05114
    228 05114
    228 05114
    228 05114
    228 05114.1
    229 03694
    230 05148
    230 05148
    230 05148
    231 07179
    231 07179
    231 07179
    232 05153
    232 05153
    232 05153
    232 05538
    232 05538
    233 07172

    2 HEADACHE- MIGRAINE TENSION


    2 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 CHEST PAIN
    2 CHEST PAIN
    1 HEART- ISCHEMIC HEART DISEASE
    2 HEART- ISCHEMIC HEART DISEASE
    3 HEART- ISCHEMIC HEART DISEASE
    1 TONSILLITIS
    2 TONSILLITIS
    1 HEART
    2 HEART
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 ALLERGIC REACTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 OTITIS - EAR
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 URTICARIA
    2 URTICARIA
    1 DEPRESSION

    Page 33

    Claims Data

    234 05956
    235 03692
    235 03692
    235 03692
    235 07183
    235 07183
    235 07183
    235 07183
    235 07183
    235 07183.1
    235 07186
    235 07186
    236 06375
    236 06375
    236 06375
    237 06765
    237 06765
    238 06769
    238 06769
    238 06769
    238 06769
    239 03711
    239 03711
    240 05061
    240 07175
    240 07175
    240 07175
    241 07734
    241 07734
    242 04483
    242 04484
    242 04484
    242 05537
    242 05537
    243 08198
    243 08198
    243 08198
    244 08206
    244 08206
    245 05942
    245 05942
    245 07174
    245 07174
    245 07174
    245 07730
    245 07730
    245 07730
    245 07730
    245 07730
    246 03718

    1
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    4 INGROWING TOE NAIL
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 GLAUCOMA
    1 FEVER
    2 FEVER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE

    Page 34

    Claims Data

    246 03719
    246 04500
    246 04500
    246 04500
    247 06387
    247 06387
    247 06387
    247 06486
    247 07182
    247 07182
    248 06775
    248 06775
    248 06775
    249 05053
    249 05511
    249 05511
    249 06361
    249 06361
    250 05943
    250 05943
    250 05943
    251 03690
    251 03690
    251 03690.1
    251 08200
    251 08200
    251 08200
    251 08201
    251 08201
    251 08201
    252 06377
    252 06377
    253 04482
    253 04482
    253 04482
    253 04482
    253 04482.1
    253 04482.1
    254 05522
    254 05522
    254 05522
    255 07198
    255 07198
    256 07192
    256 07192
    257 08227
    257 08227
    257 08227
    257 08227
    257 08227.1

    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    3 CERVICAL STRAIN
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABSCESS
    2 ABSCESS
    1 HYPERTENSION
    1
    2
    3
    1
    2
    3
    1 DIAB'ETES
    2 DIAB'ETES
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 CYSTITIS
    2 CYSTITIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 HYPERTENSION

    Page 35

    Claims Data

    258 05517
    258 05517
    259 03693
    259 03693
    260 03712
    260 03712
    260 03712
    260 04497
    260 04497
    260 04497
    260 04497
    260 04497
    260 04497.1
    260 04499
    260 05542
    260 07211
    260 07212
    260 07212
    260 07212
    260 07212
    260 07757
    260 08229
    260 08229
    261 03706
    261 03706
    261 04478
    261 04478
    261 04478
    262 07732
    262 07732
    262 07732
    263 05960
    263 05960
    263 05960
    263 05961
    263 05961
    263 05961
    263 07205
    263 07205.1
    263 07205.1
    264 07761
    264 07761
    265 05959
    265 05959
    265 05959
    265 05959
    266 04468
    267 08205
    267 08205
    268 03700

    1 HEARING LOSS
    2 HEARING LOSS
    1 DENTAL CARE
    2 DENTAL CARE
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 LARYNGITIS
    2 LARYNGITIS
    3 LARYNGITIS
    4 LARYNGITIS
    5 LARYNGITIS
    1 LARYNGITIS
    1 DENTAL CARE
    1 CONSTIPATION
    1 ALLERGIC RHINITIS
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    1 ENDOCRINE DISORDERS
    1 CONSTIPATION
    2 CONSTIPATION
    1 FEVER
    2 FEVER
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1

    Page 36

    Claims Data

    269 04489
    269 04489
    269 04489
    270 06365
    270 06365
    270 06365
    270 06365
    271 05121
    271 05121
    271 05121
    272 03688
    272 03688
    272 03688
    273 06766
    274 04486
    274 04486
    274 05154
    274 05154
    274 05154
    274 05154.1
    274 05539
    274 05539
    274 05539
    274 07755
    274 07755
    274 07755
    275 05953
    276 05957
    276 05957
    277 04909
    277 06385
    277 06386
    277 06978
    277 06978
    277 06978
    277 06978
    277 06978
    277 07882
    277 07882
    277 07882
    277 07882
    278 05525
    278 05525
    278 05525
    279 05521
    279 05521
    279 05521
    280 04472
    280 04472
    281 07190

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    3 CERVICAL STRAIN
    4 CERVICAL STRAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 SKIN - ECZEMA
    1 BACK PAIN
    2 BACK PAIN
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 BACK PAIN
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    1 GLAUCOMA
    1 DIAB'ETES
    2 DIAB'ETES
    1 OTITIS - EAR
    1 VISION CARE
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1
    2
    3
    4
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 CERVICAL SPONDYLOSIS

    Page 37

    Claims Data

    281 07190
    281 07190
    281 07190
    281 08208
    282 06379
    282 06379
    282 06379
    283 06384
    283 06384.1
    283 06384.1
    284 07208
    284 07208
    285 07203
    285 07203
    285 07203
    285 07203
    286 05952
    286 05952
    286 05952
    286 05952
    286 06383
    287 07754
    287 07754
    287 07754
    288 06392
    288 06392
    288 06392
    289 07206
    289 07206
    290 06363
    291 05117
    291 05117
    291 05117
    291 06770
    292 06764
    292 06764
    292 06764
    292 06764.1
    293 05054.1
    293 05054.1
    293 05054.1
    293 06364
    293 06364
    293 06364
    294 06763
    294 06763
    295 05115
    295 05115
    295 05526
    295 05526

    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    1 SKIN - LESION
    2 SKIN - LESION
    1 HYPERTENSION
    2 HYPERTENSION
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 CHEST PAIN
    2 CHEST PAIN
    1 BONE & CARTILAGE DISORDER
    1 INFECTION - MALE GENITAL
    2 INFECTION - MALE GENITAL
    3 INFECTION - MALE GENITAL
    1 BARTHOLIN'S CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 OTITIS - EAR
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 CHlCKEN POX
    2 CHlCKEN POX
    1 VISION CARE
    2 VISION CARE

    Page 38

    Claims Data

    295 05526
    296 05060
    296 05060
    296 06372
    296 06372
    296 06372
    296 06373
    296 06373
    296 06373
    297 05940
    298 03689
    298 03689
    298 03689
    299 06367
    299 06367
    299 06367
    300 05524
    300 05524
    301 05155
    301 06773
    302 07188
    302 07188
    302 07188
    303 04466
    303 04466
    303 04466
    303 04467
    303 05518
    303 05944
    304 05520
    304 05520
    305 05541
    305 05541
    306 06380
    306 06380.1
    306 06380.1
    306 06381
    306 06381.1
    307 05872
    307 05872
    307 07187
    307 07187
    308 07748
    308 07748
    308 07748
    309 05955
    310 04488
    310 04488
    310 04488
    310 04488

    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    1
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BLOOD DISORDER
    2 BLOOD DISORDER
    1 HYPERTENSION
    1 HYPERTENSION
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 GLAUCOMA
    1 EYE DISORDER
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 BURSITIS
    2 BURSITIS
    1 FEVER
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    1 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER

    Page 39

    Claims Data

    310 06772
    310 06772
    310 06772
    311 04476
    311 04476
    311 04476
    312 07758
    312 07758
    312 07758
    313 05963
    314 06777
    314 07204
    314 07204
    314 07204
    314 07204
    315 04469
    316 07194
    316 07194
    317 04473
    317 04473
    317 04473
    317 04473
    317 04473
    317 04473.1
    317 04473.1
    317 04473.1
    317 04473.1
    318 07729
    318 07729
    318 07729
    318 07729
    319 03695
    319 03695
    319 03695
    319 03695
    319 03864
    319 03864
    319 03864
    319 03864
    319 03864
    319 06977
    319 06977
    320 05118
    320 05118
    321 05119
    321 05119
    321 07740
    321 07740
    322 04474
    322 05120

    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGY
    2 ALLERGY
    3 ALLERGY
    1 ARTHRITIS
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    5 VARICOSE
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 DIAB'ETES
    2 DIAB'ETES
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1
    1 VISION CARE

    Page 40

    Claims Data

    322 05120
    322 05120
    323 05124
    323 05124
    323 05124
    323 07197
    323 07197
    324 05532
    324 05532
    324 05532
    324 07726
    324 07727
    324 07727
    325 07743
    325 07743
    325 07743
    325 07743
    325 07743
    325 07743.1
    325 07743.1
    325 07743.1
    326 07745
    326 07745
    326 07746
    326 07746
    326 07746
    326 07746.1
    327 07747
    327 07747
    327 07747
    327 07747
    327 07747
    327 07747.1
    328 06771
    328 06771
    328 06771
    329 07199
    329 07199
    329 07749
    329 07749
    330 05534
    330 05534
    330 05534
    330 05534
    330 05535
    330 05535
    330 05535
    330 05535
    330 05535.1
    330 05536

    2 VISION CARE
    3 VISION CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 SINUSITIS
    1 FATIGUE
    2 FATIGUE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 OTITIS - EAR
    1 HORMONE REPLACMENT
    2 HORMONE REPLACMENT
    3 HORMONE REPLACMENT
    4 HORMONE REPLACMENT
    5 HORMONE REPLACMENT
    1 HORMONE REPLACMENT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 STROKE
    2 STROKE
    1 STROKE
    2 STROKE
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 CHOSTOCHRONDITIS
    1 MUSCULAR PAIN

    Page 41

    THERAPY
    THERAPY
    THERAPY
    THERAPY
    THERAPY
    THERAPY

    Claims Data

    330 05536
    330 05536
    330 05536
    330 07751
    330 07751
    330 07751
    331 04494
    332 05152
    332 05152
    332 05152
    332 05958
    332 05958
    332 08220
    332 08220
    333 03707
    333 03707
    333 05540
    333 05540
    334 04491
    334 04491
    334 04491
    334 04491
    334 06391
    334 06391
    335 04471
    335 04471
    335 05116
    335 05116
    336 08189
    336 08189
    336 08189
    336 08189
    336 08189
    336 08189.1
    336 08189.1
    336 08190
    337 05162
    337 05162
    337 05162
    337 05162
    338 07243
    338 07243
    339 05163
    339 05163
    339 05163
    339 05163
    340 06399
    340 06399
    341 06779
    341 06779

    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 PSORIASIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER
    1
    2
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 SKIN - LESION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    4 OTITIS - EAR
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    2 DENTAL CARE

    Page 42

    Claims Data

    341 06779
    341 06779
    342 04501
    342 04501
    343 04722
    343 04722
    343 04723
    343 04723
    343 04723
    343 04723.1
    344 07752
    344 07752
    344 07753
    344 07753
    344 07753
    345 07189
    345 07189
    345 07189
    346 06376
    346 06376
    347 05513
    347 05513
    347 05513
    347 05513
    348 08224
    349 04844
    349 04844
    349 04844
    349 04844
    349 05057
    349 05057
    349 05057
    349 05057
    350 05058
    350 05058
    350 05058.1
    351 03696
    351 03696
    352 06371
    352 06371
    352 06371
    353 05510
    353 05510
    353 05510
    354 03622
    354 03622
    354 06388
    354 06388
    354 07242
    354 07242

    3 DENTAL CARE
    4 DENTAL CARE
    1 BURSITIS
    2 BURSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 FATIGUE
    2 FATIGUE
    3 FATIGUE
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 DIAB'ETES
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 FEVER
    2 FEVER
    1 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 FEVER
    2 FEVER
    1 DIAB'ETES
    2 DIAB'ETES
    1 FEVER
    2 FEVER

    Page 43

    Claims Data

    354 07242
    355 03683
    355 03683
    356 05302
    356 05302
    357 05108
    357 05108
    357 05523
    357 05523
    357 05523
    357 05523
    358 05945
    359 04475
    359 04475
    359 04475.1
    359 04475.1
    359 04475.2
    359 05122
    359 05122
    359 05123
    359 05123
    359 07195
    359 07195.1
    359 07195.1
    359 07195.1
    359 07195.1
    359 07241
    359 07241
    359 07741
    359 07742
    359 08214
    359 08214
    359 08214
    359 08892
    359 08892
    359 08892
    359 08892
    359 08893
    359 08893
    359 08893
    359 08893
    360 05519
    360 05519
    360 05519
    361 05063
    361 05063
    361 05947
    361 07280
    361 08204
    361 08204

    3 FEVER
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    1 URTICARIA
    2 URTICARIA
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DIAB'ETES
    1 FEVER
    2 FEVER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 ASTHMA
    2 ASTHMA
    1 BACK PAIN
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 VISION CARE
    1 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1
    1 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS

    Page 44

    Claims Data

    362 06378
    362 06378
    362 06378
    363 03703
    363 03703
    363 03703
    364 07738
    364 07738
    364 07738
    364 07738
    365 07733
    365 07733
    365 07733
    366 07759
    367 08211
    368 07380
    368 07380
    368 07380
    368 07380
    368 07380
    369 04364
    369 04364
    369 04364
    369 06964
    369 06964
    369 06964
    369 06964
    369 06966
    369 06966
    369 06966
    370 04465
    370 04465
    370 04465
    371 03697
    371 03697
    371 03697
    371 03698
    371 03698
    371 03698
    371 03698
    371 03698.1
    371 04208
    371 04208
    371 04208
    371 04208
    371 07737
    371 07737
    371 07737
    371 07737
    372 08209

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BACK PAIN
    1 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    1 HYPERTENSION
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE

    Page 45

    Claims Data

    372 08210
    373 05530
    373 05530
    373 05530.1
    374 04487
    374 04487
    374 04487
    374 04487
    374 04487
    375 08207
    375 08207
    375 08207
    375 08207
    376 05946
    377 07731
    377 07731
    378 04470
    378 04470
    378 04470
    378 05527
    378 05527
    378 05527
    378 05949
    378 05949
    378 05949
    378 07735
    378 07735
    378 07735
    379 06767
    379 06767
    380 07750
    380 07750
    380 07750
    381 04479
    381 04479
    381 04479
    381 04479.1
    381 04479.2
    381 04479.2
    381 05149
    381 05149
    381 05149
    381 05149
    381 08217
    381 08217
    381 08217
    381 08217
    381 08217
    381 08218
    381 08218

    1 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERTENSION
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 LARYNGITIS
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    1 DIAB'ETES
    2 DIAB'ETES
    1 HEMORRHOIDS
    2 HEMORRHOIDS
    3 HEMORRHOIDS
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 ARTHRITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1
    2
    3
    4
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VARICOSE
    2 VARICOSE

    Page 46

    Claims Data

    381 08218
    381 08218
    381 08218.1
    382 05150
    382 05150
    382 05151
    382 05151
    382 05151
    382 05159
    382 05159
    382 05159
    382 06389
    382 06389
    382 06390
    382 06390
    382 07202
    382 07202
    383 08219
    383 08219
    384 07201
    384 07201
    384 07201
    385 05533
    385 05533
    386 06393
    386 06393
    386 06393
    386 06393
    386 06393
    386 06395
    386 06395
    386 06397
    386 06397
    386 06397
    387 05160
    387 05160
    388 04495
    388 04495
    388 05962
    388 05962
    388 07207
    389 05303
    389 05303.1
    389 05304
    389 05304
    389 05304
    389 05304
    390 04405
    390 04405
    390 04405

    3 VARICOSE
    4 VARICOSE
    1 GASTRIC - PEPTIC ULCER/GERD
    1 DIAB'ETES
    2 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ILL DEFINED - FAINTING
    2 ILL DEFINED - FAINTING
    1 TENDONITIS
    2 TENDONITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1
    2
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    5 VARICOSE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HEMATURIA
    2 HEMATURIA
    1 STROKE
    2 STROKE
    1 STROKE
    2 STROKE
    1 EYE DISORDER
    1 RENAL DYSFUNCTION
    1
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    Page 47

    Claims Data

    390 04405
    390 05069
    390 05069
    390 05069
    391 06780
    391 06780
    391 06781
    391 06781
    391 06781
    391 06781
    392 04809
    392 04809
    392 04809
    392 07490
    392 07492
    393 03507
    393 03507
    393 03507
    393 03507
    393 03507
    393 03507.1
    393 03507.1
    393 03507.1
    393 03507.2
    393 03507.2
    393 03507.2
    393 03507.2
    393 03774
    393 03774
    393 04638
    393 04638
    393 05028
    393 05028
    393 05459
    393 05459
    393 05459
    393 05459
    393 07493
    393 07493
    393 08121
    393 08121
    393 08121
    393 08121
    394 04077
    394 04077
    394 04077
    394 05027
    394 05275
    394 05684
    394 06243

    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 VISION CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    5 SINUSITIS
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 THYROID
    2 THYROID
    3 THYROID
    1
    1 AMMENORRHOEA
    1 CANCER-BREAST
    1

    Page 48

    Claims Data

    394 08386
    394 08386
    394 08387
    395 04639
    395 04639
    395 04639
    395 04640
    395 05280
    395 05280
    395 05280
    395 06577
    395 06577
    395 08388
    396 05276
    396 05276
    397 04132
    397 04132
    397 06692
    398 06695
    398 06695
    398 06695
    398 06695.1
    398 06695.1
    399 06140
    399 06140
    400 04138
    400 04138
    400 04138
    400 04281
    400 04281
    400 04281
    400 04281
    400 04281
    400 04923
    400 04923
    400 04923
    400 04923
    400 04923
    400 04923.1
    400 05460
    400 05460
    400 05460
    400 05460
    400 05460
    400 05685
    400 05685
    400 05685
    400 06081
    400 06081
    400 06081

    1 THYROID
    2 THYROID
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DEVIATED NASAL SEPTUM
    1 THYROID
    2 THYROID
    1 ANAEMIA
    2 ANAEMIA
    1 ANAEMIA
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 PROSTATE
    2 PROSTATE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION

    Page 49

    Claims Data

    400 06081
    400 06081
    400 06081.1
    400 06081.1
    400 06081.1
    400 06081.2
    400 08122
    400 08122
    400 08122
    400 08122
    400 08122
    400 08122.1
    401 04133
    401 08541
    401 08541
    401 08541
    401 08542
    401 08543
    401 08544
    401 08544
    401 08544
    402 04135
    402 04135
    402 04135
    402 04135
    402 04135
    402 04136
    402 04136
    402 04136
    402 05278
    402 05278
    403 03652
    403 03652
    403 03652
    403 03652
    403 03652.1
    403 04874
    403 04874
    403 04874
    403 04874
    403 04875
    403 04875
    403 05713
    403 05713
    404 04134
    404 05277.1
    404 06139
    404 06139
    404 06139
    404 06139

    4 ALLERGIC REACTION
    5 ALLERGIC REACTION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 HYPERTENSION
    1
    2
    3
    4
    5
    1 HYPERTENSION
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 SINUSITIS
    2 SINUSITIS
    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    4 CANDIDIASIS
    1 CANDIDIASIS
    1
    2
    3
    4
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 PAINFUL LEGS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    Page 50

    Claims Data

    404 06696
    404 06696
    404 06696
    404 06696
    404 06823
    404 06823
    405 03654
    405 03654
    405 03654
    405 03654
    405 05714
    405 05714
    405 05714
    405 05850
    405 05850
    405 07283
    405 07283
    405 07283
    405 07283
    405 07283
    405 07283.1
    406 03655
    406 03655
    406 03656
    406 05282
    406 05715
    406 05715
    406 05715
    406 07541
    407 04873
    407 05306
    407 05306
    407 05306.1
    407 05306.1
    407 05306.1
    407 05711
    407 05711
    407 05711
    407 05711
    407 08164
    407 08164
    408 04869
    408 04869
    408 04869
    408 04869
    408 04869
    408 04869.1
    408 05544
    408 05544
    408 05544

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABSCESS
    2 ABSCESS
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    4 COUGH - AIRWAY OBSTRUCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    3 KIDNEY DISEASE
    4 KIDNEY DISEASE
    5 KIDNEY DISEASE
    1 KIDNEY DISEASE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 HYPERTENSION
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    1 BURSITIS
    1 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 HEART
    2 HEART
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL

    Page 51

    Claims Data

    408 05544
    408 07797
    408 07797
    408 07797
    408 07797
    408 07797
    408 07797.1
    408 07797.2
    408 07797.2
    408 07797.2
    408 07797.2
    409 07537
    409 07537
    410 03649
    410 03649
    410 03649
    410 03649
    410 07533
    410 07533
    410 07533.1
    410 07533.2
    410 07533.2
    411 07538
    411 07538
    411 07538
    411 07538
    411 07538
    411 07538.1
    411 07538.1
    411 07538.1
    411 08165
    411 08165
    411 08165.1
    411 08165.1
    411 08165.2
    411 08165.2
    411 08166
    412 04871
    412 04871
    412 04872
    412 04872
    413 04131
    413 04131
    413 04131
    413 08540
    413 08540
    414 05708
    415 05710
    415 05710
    415 06697

    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    4 HEADACHE- MIGRAINE TENSION
    5 HEADACHE- MIGRAINE TENSION
    1
    1
    2
    3
    4
    1 VISION CARE
    2 VISION CARE
    1 TENDONITIS
    2 TENDONITIS
    3 TENDONITIS
    4 TENDONITIS
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANAEMIA
    2 ANAEMIA
    1 BACK PAIN
    1 ANXIETY
    2 ANXIETY
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE

    Page 52

    Claims Data

    415 06697
    415 06697
    415 06697
    415 07534
    415 07534
    415 07534
    415 07534
    415 07534
    415 08163
    415 08163
    416 03653
    416 04139
    416 04139
    416 04876
    416 04876
    416 04876
    416 05281
    416 05281
    416 07535
    416 07535
    416 07535
    416 08167
    417 04137
    417 04137
    418 04866
    418 04866
    418 04866
    418 04866
    418 04867
    418 04867
    418 04867
    418 04867
    418 04867
    418 04867.1
    418 04868
    418 04868
    418 04868
    419 06693
    419 06693
    419 06693
    419 06694
    419 06694
    419 06694
    419 06694
    419 06822
    419 08545
    419 08545
    420 05709
    421 03578
    421 04210

    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    5 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 STROKE
    2 STROKE
    3 STROKE
    1 PAINFUL LEGS
    1 FEVER
    2 FEVER
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 FEVER

    Page 53

    Claims Data

    421 04210
    421 04210
    421 04210.1
    421 04210.1
    421 04210.1
    421 04210.1
    421 04210.1
    421 04264
    421 04264
    421 04264
    421 04264
    421 04725
    421 04725
    421 04725
    421 04878
    421 04878
    421 04878
    421 04878
    421 04878
    421 04878.1
    421 04878.1
    421 07507
    421 07507
    421 07507
    421 07507
    421 07507
    421 07507.1
    421 08032.1
    421 08032.1
    421 08032.1
    421 08032.1
    421 08032.1
    421 08172
    421 08172
    421 08172
    421 08438
    421 08884
    422 05656
    422 05656
    422 05656
    422 05656.1
    423 04418
    423 04418
    423 04418
    423 04418
    423 04810
    423 04810
    423 05227
    423 05227
    423 05227

    2 FEVER
    3 FEVER
    1
    2
    3
    4
    5
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    Page 54

    Claims Data

    423 05227
    423 05227
    423 05228
    423 05228
    424 07027
    424 07027
    424 07027
    425 05897
    425 05897
    425 05897
    425 06825
    425 06825
    425 06825
    426 05896
    426 06039
    426 06039.1
    426 06039.2
    427 03721
    427 06578
    428 03720
    428 03720
    428 04259
    428 04260
    428 05785
    428 05785
    429 03722
    429 03722.1
    429 05659
    429 05659
    429 05659
    429 05659
    429 06541
    429 06541
    429 06541
    429 07664
    429 07664
    429 07664
    429 07664
    429 07664
    430 03576
    430 03576.1
    430 03577
    430 03577
    430 03577
    430 04261
    430 04261
    430 05071
    430 05071
    430 05071.1
    430 05071.2

    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    1 BACK PAIN
    1 FEVER
    2 FEVER
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 VISION CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 PNEUMONIA
    2 PNEUMONIA
    3 PNEUMONIA
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    5 DENGUE
    1 DEVIATED NASAL SEPTUM
    1
    1 DENGUE
    2 DENGUE
    3 DENGUE
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    1

    Page 55

    Claims Data

    430 06185
    430 06185
    430 06186
    430 06186
    430 07382
    430 07382
    430 07382
    430 07382.1
    430 07384
    430 07384
    430 07385
    430 07385
    430 08170
    430 08170.1
    431 04727
    431 04727
    431 04727
    431 05079
    431 05079
    431 05426
    431 05426
    431 05426
    431 07891
    431 07891
    431 07891
    432 05070
    433 05084
    433 05084
    434 06537
    435 04726
    435 04726
    435 07434
    436 05072
    436 05072
    436 05073
    436 05073
    436 05073
    436 05074
    436 05074
    436 05075
    436 05075
    436 05076
    436 05076
    436 05077
    436 05077
    436 05781
    436 05782
    436 05782
    436 05783
    436 05783

    1 SINUSITIS
    2 SINUSITIS
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 HEART
    1 SINUSITIS
    2 SINUSITIS
    1
    2
    1 HYPERTENSION
    1 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 CERVICAL SPONDYLOSIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    Page 56

    Claims Data

    437 07286
    437 07286
    438 04417
    438 04417
    438 04417.1
    438 04646
    438 04646
    438 04646
    439 06532
    439 06532
    439 08603
    440 07431
    441 04641
    441 04641
    441 07285
    441 07285
    441 07285
    442 07509
    443 05423
    443 05423
    443 05423
    443 05423
    443 05423
    444 03919
    444 03919
    445 04033
    445 06535
    445 06535.1
    445 08231
    445 08231
    445 08231
    445 09154
    445 04033,1
    446 03580
    446 03580
    446 03581
    446 03581
    446 03581
    446 03582
    446 03582
    446 03582
    446 03582
    446 04408
    446 04409
    446 04410
    446 04411
    446 04412
    446 04412
    446 04645
    446 05653

    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1
    2
    1 THYROID
    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 VISION CARE
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1
    1 ALOPECIA
    1
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 GASTRIC - PEPTIC ULCER/GERD
    1
    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    3 BREAST DISORDERS
    4 BREAST DISORDERS
    1 DENTAL CARE
    1
    1
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 RENAL DYSFUNCTION

    Page 57

    Claims Data

    446 05653
    446 05653
    446 05653
    446 05654
    446 05654
    446 05654
    446 05654.1
    446 05655
    446 07026
    446 07386
    446 07386
    446 07386
    446 07885
    446 07886
    446 07886
    446 07886
    447 05078
    447 05078
    447 05078
    448 04487
    448 04487
    448 04487
    449 07387
    449 07662
    449 07662
    449 07662
    450 07245
    450 07245
    450 07245
    450 07246
    450 07246
    450 07246.1
    450 07246.1
    450 07887
    450 07887
    450 07887
    450 07888
    450 07890
    451 04142
    451 04142
    451 04142
    451 04142
    451 04142.1
    451 04142.1
    451 04142.1
    451 04142.1
    451 04142.1
    451 04142.2
    451 04142.2
    451 08604

    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 PAINFUL HEEL
    1 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MUSCULAR PAIN
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    3
    1 THYROID
    2 THYROID
    1
    2
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 SINUSITIS
    1 THYROID
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    5 ASTHMA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 ASTHMA

    Page 58

    Claims Data

    451 08604
    451 08604
    451 08604
    451 08604
    451 08604.1
    451 08604.1
    452 04422
    452 09006
    453 03579
    453 03579
    454 04140
    454 04140
    454 04140
    454 06531
    454 06531
    454 06531
    454 06531
    455 05081
    455 06188
    455 06188
    455 06539
    455 07389
    456 05127
    457 04266
    458 03918
    458 03918
    458 03918
    458 03918
    458 03918
    458 04263
    458 04263
    459 04419
    459 04419
    459 05657
    459 07510
    459 07510
    459 07510
    459 07510
    459 07510
    459 07510.1
    460 04423
    460 04424
    460 04424
    460 04647
    460 04648
    460 05786
    460 05786.1
    461 04407
    461 04407
    461 04407

    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    5 ASTHMA
    1 ASTHMA
    2 ASTHMA
    1 MISCARRIAGE
    1 DENTAL CARE
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1
    2
    3
    4
    1 DENTAL CARE
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 DENTAL CARE
    1 EYE DISORDER
    1 DENTAL CARE
    1 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 JAUNDICE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 MISCARRIAGE
    1 CERVICAL SPONDYLOSIS
    1 CONSTIPATION
    1
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS

    Page 59

    Claims Data

    461 04407
    462 06530
    462 07661
    463 05126
    463 05126
    464 04031
    465 04649
    465 04649
    466 03658
    466 03658
    466 03658.1
    467 04032
    467 04032
    467 04032
    467 08879
    467 08879
    467 08879
    467 08879
    467 08879
    468 04141
    468 04141
    468 04141
    468 04141
    468 06533
    468 06533
    468 06533
    468 06533
    468 08497
    468 08497
    468 08497
    468 08497
    469 03659
    469 03659
    469 03659
    469 03659
    469 06534
    470 07388
    470 07388
    471 05869
    472 07543
    472 07543
    472 08304
    472 08304
    472 08304
    472 08304
    473 04642
    473 04642
    473 04642
    473 04642
    473 04642

    4 SINUSITIS
    1
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 BASAL CELL CARCINOMA
    2 BASAL CELL CARCINOMA
    1 OVARIAN CYST
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 TENDONITIS
    2 TENDONITIS
    3 TENDONITIS
    4 TENDONITIS
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 SKIN - LESION
    1 VISION CARE
    2 VISION CARE
    1
    2
    3
    4
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    Page 60

    Claims Data

    474 05492
    474 05492
    474 05492
    474 05492
    474 05492
    474 05492.1
    475 04420
    475 05424
    475 05425
    475 07834
    475 07834
    476 04644
    476 06824
    476 06824
    476 06824
    476 06824
    476 06824
    476 07542
    477 07894
    478 03657
    478 03657
    478 03657
    478 03657
    478 03657
    478 07432
    479 06187
    479 06187
    479 06187
    480 06190
    480 06190
    480 06937
    480 06937
    480 06937
    480 07544
    480 07544
    481 05658
    481 05658
    482 03583
    482 03583
    482 03583
    482 03583
    482 03583
    482 04421
    482 04421
    482 07287
    482 07287
    482 07435
    483 04084
    483 08885
    484 05080

    1
    2
    3
    4
    5
    1
    1 MISCARRIAGE
    1 CONSTIPATION
    1 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    1 FEVER
    1 EYE DISORDER

    Page 61

    Claims Data

    484 05080
    484 06936
    484 06936
    484 06936
    484 07893
    484 07893
    484 07893
    484 07893
    484 07893
    484 08880
    485 06191
    485 06191
    485 08389
    485 08389
    485 08389
    485 08389
    486 03866
    486 03866
    486 03866
    486 05082
    486 05082
    486 05229
    486 05229
    486 05229
    486 05229
    486 08232
    486 08232
    486 08232
    486 08232
    486 08886
    486 08886
    487 05784
    487 05784
    487 09004
    487 09004
    487 09004
    488 04406
    488 04406
    488 06184
    489 06579
    489 06579
    489 06579
    489 06580
    489 06580
    490 04643
    490 04643
    491 03865
    492 06536
    492 06536
    492 06536

    2 EYE DISORDER
    1 FEVER
    2 FEVER
    3 FEVER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    4 HEADACHE- MIGRAINE TENSION
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 FEVER
    2 FEVER
    3 FEVER
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    1 CIRCUMCISION
    2 CIRCUMCISION
    3 CIRCUMCISION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    Page 62

    Claims Data

    493 05226
    493 05226
    493 05226
    493 08883
    493 08883
    494 08957
    494 08957
    494 08957
    494 08957
    494 08957
    495 04879
    495 04879
    495 04879
    495 05686
    495 05686
    495 05686
    495 05717
    495 05717
    495 05787
    495 07762
    495 07895
    495 07895
    496 08174
    497 03585
    498 06793
    498 06794
    498 06794
    499 08175
    499 08175
    499 08175
    499 08175
    500 04511
    500 04511
    501 05001.1
    501 05001.1
    501 05001.1
    502 03594
    502 03594
    502 03594
    502 05725
    502 05725
    502 05725
    502 05725
    503 05726
    503 05726
    503 05726.1
    503 07443
    503 07443.1
    503 07901
    503 07901

    1 HEADACHE- MIGRAINE TENSION


    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    1 EYE DISORDER
    2 EYE DISORDER
    1 SKIN - ATOPIC DERMATITIS
    1 HORMONE REPLACMENT THERAPY
    1
    2
    1 CHEST PAIN
    1
    1 ARTHRITIS
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 CYST
    2 CYST
    3 CYST
    4 CYST
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    1 ASTHMA
    2 ASTHMA
    1 HEART
    1 BRONCHITIS - ACUTE
    1 HEART
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD

    Page 63

    Claims Data

    503 07901
    504 03586
    505 04509
    505 07897
    505 07897
    505 08958
    505 08958
    505 08958
    505 08958
    506 04512
    506 04512
    507 04034
    507 04034
    507 04034.1
    507 04034.1
    507 04514
    507 05002
    507 05002
    507 05002
    507 06796
    507 06796
    507 06796
    507 07028
    507 07900
    508 06044
    508 06044
    508 06044
    508 06044
    508 07440
    508 07440
    508 07440
    508 07441
    508 07441
    508 07441
    509 07898
    509 07898
    509 07898
    509 07898.1
    510 05724
    510 06046
    511 05000
    511 05000
    511 06791
    511 06792
    511 06792
    511 07437
    511 07437
    512 06045
    512 06045
    512 06045

    3 GASTRIC - PEPTIC ULCER/GERD


    1 COUGH - AIRWAY OBSTRUCTION
    1 CERVICITIS
    1 CERVICITIS
    2 CERVICITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 TENDONITIS
    2 TENDONITIS
    1
    2
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1
    1 HEART
    1 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1
    2
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    Page 64

    Claims Data

    512 06045.1
    513 03593
    513 03593
    513 03593
    513 03593
    513 05722
    513 05722
    513 05722
    513 05722
    514 06041
    514 06041
    514 06041
    514 06041
    514 06042
    514 06042
    514 06042
    514 06042
    514 06043
    515 07438
    515 07438
    515 07438
    516 05718
    516 05718
    516 05718
    516 05718
    516 05718
    516 05718.1
    517 07439
    517 07439
    517 07439
    518 04999
    518 04999
    518 04999
    519 03584
    519 03584
    519 08173
    519 08173
    520 03589
    520 03590
    520 04508
    520 04508
    520 04508
    521 06782
    521 06782
    521 06782
    521 06783
    521 06783
    521 06783
    521 06783
    521 06783

    1 HYPERTENSION
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 TONSILLITIS
    2 TONSILLITIS
    1 VISION CARE
    1 VISION CARE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    Page 65

    Claims Data

    522 06797
    522 06797
    522 07442
    523 05720
    524 04507
    524 04507
    524 04507
    524 04507
    524 04507
    524 04507.1
    524 08503
    524 08503
    525 05870
    525 05870
    525 05870
    525 05870
    525 06795
    525 06795
    525 06795
    525 06795
    525 06795
    526 08959
    526 08959
    526 08959
    527 05721
    527 05721
    527 05721
    528 04506
    528 04506
    528 04997
    528 04997
    529 03587
    529 03588
    529 04504
    529 04505
    529 04505
    529 04505
    529 04505
    529 05307
    529 05307
    529 05307
    529 06786
    529 06787
    529 06787
    529 06789
    529 06789
    529 06789
    529 08501
    529 08501
    529 08501

    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1
    2
    1 DENTAL CARE
    1 VISION CARE
    1 EPILEPSY
    1 TENDONITIS
    2 TENDONITIS
    3 TENDONITIS
    4 TENDONITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 EPILEPSY
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER

    Page 66

    Claims Data

    529 08501.1
    529 08502
    529 08502
    529 08502
    530 05308
    530 05308
    530 05308
    531 04513
    531 04513
    531 04513
    531 04513
    531 04513
    531 04998
    531 04998
    531 04998
    531 04998
    531 04998
    531 04998.1
    531 06040
    531 06040
    531 07896
    531 07896
    531 07896
    532 06790
    532 06790
    533 03591
    533 03591
    533 03591.1
    533 04510
    533 04510
    533 04510
    533 08960
    533 08960
    533 08960
    534 08499
    534 08499
    535 07899
    535 07899
    535 07899
    536 04502
    536 04502
    536 04502
    536 04996
    536 04996
    536 06784
    536 06784
    536 06785
    536 07436
    536 07436
    536 07436

    1 EPILEPSY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1
    2
    3
    4
    5
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    2 DIAB'ETES
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 RENAL DYSFUNCTION
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    1
    2
    1 THROMBOSIS
    2 THROMBOSIS
    1 CANCER-BREAST
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST

    Page 67

    Claims Data

    536 07436.1
    536 07436.1
    537 06165
    537 06165
    537 06165
    537 06165
    537 06165
    538 05582
    538 05582
    539 04054
    539 04054
    539 04054
    539 04054
    539 04054
    539 04751
    539 04751
    540 06615
    540 06615
    540 06616
    540 06617
    541 08315
    542 06875
    542 06875
    542 06875
    542 06875
    542 07468
    542 07468
    542 07468
    543 04744
    543 04744
    543 04744
    543 04744
    543 04744
    543 04744.1
    544 05545
    544 05545
    544 05545
    544 06491
    544 06491
    544 06491
    545 06881
    546 07666
    547 03783
    547 03783
    547 05232
    547 05232
    547 05232
    547 05232
    548 05236
    548 05236

    1 CANCER-BREAST
    2 CANCER-BREAST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 INFECTION THUMB
    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS

    Page 68

    Claims Data

    549 07133
    549 07133
    549 07133
    549 07134
    549 07134
    549 07134
    549 07134
    549 07134
    549 07134.1
    549 07134.1
    549 07134.1
    549 07134.1
    549 07134.1
    549 07134.2
    550 05794
    550 05794
    550 05970
    551 08511
    551 08511.1
    551 08511.1
    551 08511.1
    552 04150
    552 04330
    552 04330
    552 07840
    553 04151
    553 05806
    553 07088
    554 05971
    554 05971
    554 05971
    554 05971
    554 05971
    554 05973
    554 05973
    554 07672
    554 07672
    554 07672
    555 04817
    555 04817
    555 04817
    555 04817
    555 04818
    555 04818
    555 04818.1
    555 04818.1
    555 04818.2
    556 03777
    556 05789
    556 05789

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 ARTHRITIS
    1 PROSTATE
    1 PROSTATE
    1 PROSTATE
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    4 CHOSTOCHRONDITIS
    5 CHOSTOCHRONDITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 CYSTITIS
    2 CYSTITIS
    1 DIAB'ETES
    1
    1 DENTAL CARE
    2 DENTAL CARE

    Page 69

    Claims Data

    556 05789
    556 05790
    556 05790
    556 05790
    556 05790.1
    557 07680
    557 07680
    558 04035
    558 04035
    558 04035
    559 06584
    559 06584
    559 06584
    559 06584
    560 05977
    561 03867
    561 03867
    561 03867
    561 03867
    561 03867
    561 03867.1
    561 05486
    561 05486
    561 05486
    561 05486
    562 05231
    562 05231
    562 05231
    562 05231
    562 05231
    563 05233
    563 05233.1
    563 05798
    563 05798
    563 05798
    563 05799
    563 05799
    563 06145
    563 06145
    563 06145
    563 06145
    563 07676
    563 07676
    564 04828
    564 04828
    564 04828.1
    565 05796
    565 05797
    566 08611
    566 08612

    3 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DILATION & CURRETAGE
    1 EYE DISORDER
    2 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 EYE DISORDER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ABDOMINAL PAINS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 BACK PAIN
    2 BACK PAIN
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 INTESTINAL COLIC
    1 PAINFUL HEEL
    1 PSORIASIS
    1 DEVIATED NASAL SEPTUM
    1

    Page 70

    Claims Data

    567 03778
    568 05230
    568 05230
    568 05230
    569 05792
    569 05792
    569 05792
    569 05792.1
    570 07675
    570 07675
    570 07675
    570 07675
    570 07675
    571 04823
    571 04823
    572 05805
    572 05805
    572 07683
    572 08517
    573 07079
    573 07079
    573 07079
    573 07080
    573 07080
    574 05801
    574 05801
    575 06583
    576 04816
    576 04816
    576 04816
    576 04816
    576 04816
    577 04812
    577 04812
    577 04812
    577 04812
    577 07837
    577 07837
    577 08505
    577 08505
    577 08505
    577 08505
    577 08505
    578 08514
    578 08514
    578 08514
    578 08514.1
    578 08514.1
    579 06305
    579 06305

    1 PAIN-BACK/SHOULDER
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 PROSTATE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 ANXIETY
    2 ANXIETY
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 EYE DISORDER
    2 EYE DISORDER
    1 PAIN-BACK/SHOULDER
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    5 CANCER-BREAST
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE

    Page 71

    Claims Data

    579 06305
    579 06305
    579 06305
    579 06305.1
    579 06306
    579 06306
    579 06306
    579 06307
    579 06307
    580 06144
    580 06304
    580 06304
    580 06304
    580 06304.1
    580 07085
    580 07085
    580 07085
    580 07085
    580 07085
    580 07085.1
    580 07085.1
    581 04825
    581 04825
    581 05975
    581 07678
    581 07678
    582 05234
    582 05234
    582 05235
    582 05235
    582 05235.1
    582 05235.1
    582 05235.1
    583 03787
    583 03787
    583 03787
    583 07679
    583 07679
    583 08395
    583 08395
    583 08395
    584 03788
    584 03788
    584 03788
    585 03775
    585 03775
    585 03775
    585 03775
    585 03775
    585 05788

    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 SOFT TISSUE DISORDERS/DISEASE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERTENSION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1
    2
    1 ANXIETY
    2 ANXIETY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 CHEST PAIN
    2 CHEST PAIN
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    5 CATARACT
    1 CATARACT

    Page 72

    Claims Data

    585 05788
    586 05974
    587 05791
    587 05791
    587 05791
    587 05791
    588 03925
    588 05803
    588 05978
    589 07084
    590 03789
    590 04827
    590 05804
    590 05804
    591 07677
    591 07677
    591 07677
    592 04328
    592 04328
    592 04328
    592 04328
    592 05795
    592 07082
    592 07082
    592 07082
    592 07082
    592 07082
    593 06142
    593 07670
    593 07670
    593 07670
    593 07670
    593 07839
    594 04821
    594 04821
    594 04821
    594 04821
    594 07081
    594 07081
    595 08613
    596 07682
    596 07682
    596 07682
    596 07682
    597 04822
    597 08393
    598 07684
    598 07684
    598 07685
    598 07685

    2 CATARACT
    1 EYE DISORDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 SKIN - LOCAL INFECTION
    1 BONE & CARTILAGE DISORDER
    1
    1
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 STONE - URETER
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    5 TONSILLITIS
    1 SKIN - ATOPIC DERMATITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PAINFUL HEEL
    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    4 CANDIDIASIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 RENAL DYSFUNCTION
    1 CONSTIPATION
    1 SINUSITIS
    2 SINUSITIS
    1 OVARIAN CYST
    2 OVARIAN CYST

    Page 73

    Claims Data

    598 07685
    598 07685
    599 03921
    599 03921
    599 03921
    599 06582
    599 06582
    599 06582
    599 06582
    600 06141
    600 06141
    600 06141
    601 03920
    601 03920
    602 03923
    603 06622
    604 04148
    604 04148
    604 04148
    604 04148.1
    604 04148.1
    604 04149
    604 04149
    604 04149
    604 04811
    604 04811
    604 06618
    604 06618
    604 06618
    604 06619
    604 06619
    604 07078
    604 07078
    605 07687
    605 07687
    605 07687
    605 07687
    606 06621
    606 06621
    607 04813
    607 04813
    607 04813
    607 04813
    607 07669
    608 03922
    608 03922
    609 03782
    610 04829
    610 04829
    610 04829

    3 OVARIAN CYST
    4 OVARIAN CYST
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    3
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    1 MUSCULAR PAIN
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 DEVIATED NASAL SEPTUM
    1
    2
    3

    Page 74

    Claims Data

    611 04830
    611 04830
    611 04830
    612 08516
    612 08516
    612 08516
    612 08516
    613 06699
    613 06699
    614 05793
    614 05969
    614 07671
    614 08392
    615 05851
    615 08606
    615 08606
    615 08606
    616 04577
    616 04577
    616 04577
    617 04924
    617 04924
    617 04924
    617 05998
    617 05998
    618 06698
    618 06698
    618 06698
    618 06698
    618 07838
    618 07838
    618 07838
    618 07838
    618 07838
    619 04578
    619 04578
    619 04652
    619 04653
    619 04654
    619 07135
    619 08009
    619 08009
    620 05727
    620 05852
    620 05852
    620 05852
    620 08610
    620 08610
    620 08610.1
    620 08610.1

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CYST
    2 CYST
    3 CYST
    4 CYST
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1 BACK PAIN
    1 ALLERGIC REACTION
    1 PHIMOSIS
    2 PHIMOSIS
    3 PHIMOSIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CATARACT
    2 CATARACT
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 SKIN - LOCAL INFECTION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 TENDONITIS
    2 TENDONITIS
    1 DIAB'ETES
    2 DIAB'ETES

    Page 75

    Claims Data

    621 07763
    621 07763
    621 07763
    622 05283
    622 05283
    622 07136
    622 07136
    623 05728
    623 05728
    623 05728
    624 07466
    624 07466
    625 07512
    625 07512
    625 07512
    625 07512
    626 07514
    626 07514
    626 07514
    626 07514
    626 07514.1
    626 07514.1
    626 08614
    626 08614
    627 05856
    628 06798
    628 06798
    629 04581
    629 05666
    629 05857
    629 05857
    629 06000
    629 06000
    629 06623
    629 06980
    629 06980
    629 07446
    630 05329
    631 04658
    631 04658
    631 04658.1
    631 04658.1
    632 04728
    632 04728
    632 05330
    632 05330
    632 05330
    632 05330
    632 05330
    633 05171

    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEART- ISCHEMIC HEART DISEASE
    2 HEART- ISCHEMIC HEART DISEASE
    1 HEART- ISCHEMIC HEART DISEASE
    2 HEART- ISCHEMIC HEART DISEASE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PROSTATE
    2 PROSTATE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 EYE DISORDER
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1 SKIN - ATOPIC DERMATITIS
    1 PAIN-BACK/SHOULDER
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    1 BONE & CARTILAGE DISORDER
    1
    2
    1 CERVICAL SPONDYLOSIS
    1 HYPERTENSION
    1 GLAUCOMA
    2 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 CANCER-BREAST

    Page 76

    Claims Data

    633 05171
    633 05171
    633 05171
    634 04580
    634 04580
    634 05284
    634 05284
    634 06700
    634 06700
    634 06700
    635 06620
    635 06620
    636 04211
    637 05665
    637 08010
    638 04579
    638 04579
    638 07445
    638 07445
    638 07445
    639 05662
    639 05662
    639 05662
    639 05662
    639 05662
    640 07029
    640 07029
    641 03874
    641 03874
    641 03874
    641 03874.1
    641 03874.1
    641 07139
    641 07139
    641 07139
    641 07139
    641 07513
    641 07513
    641 07513
    641 07513
    641 07513.1
    642 05331
    642 05331
    643 03873
    643 03873
    643 03873
    643 03873
    644 05663
    644 05663
    644 05663

    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    1 CHEST PAIN
    1
    1 GASTRIC - PEPTIC ULCER/GERD
    1 TONSILLITIS
    2 TONSILLITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    1 DILATION & CURRETAGE
    1 GLAUCOMA
    2 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE

    Page 77

    Claims Data

    644 05663
    644 05663
    644 05663.1
    645 05858
    645 07841
    646 06084
    647 05999
    647 05999
    648 07444
    648 07444
    648 07444
    649 03604
    650 07511
    650 07511
    650 07511
    651 04655
    652 05854
    652 05854
    653 07836
    653 07836
    654 04925
    654 08607
    654 08607
    654 08607
    654 08609
    654 08609
    655 05855
    655 06085
    656 04656
    656 04656
    656 04656
    656 04656
    656 04656
    656 06270
    657 07835
    657 07835
    658 04329
    658 04329
    658 06143
    659 03779
    659 03779
    659 03779
    659 03780
    659 03780
    659 03781
    659 03781
    660 04327
    660 04327
    660 04327
    660 04327.1

    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    1 MISCARRIAGE
    1 EAR DYSFUNCTION
    1 FEVER
    1 GLAUCOMA
    2 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HEMORRHOIDS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGIC REACTION
    1 EYE DISORDER
    2 EYE DISORDER
    1 CHEST PAIN
    2 CHEST PAIN
    1 BACK PAIN
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DILATION & CURRETAGE
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 HYPERTENSION

    Page 78

    Claims Data

    660 05968
    660 05968
    660 05968
    661 03776
    661 03776
    662 06581
    663 06148
    664 05976
    665 05802
    665 05802
    665 05802
    665 05802
    666 03784
    666 03784
    666 03784
    666 03784
    666 06147
    666 07087
    666 07087
    666 07087
    667 04819
    667 04819
    667 04819
    667 04820
    667 04820
    667 04820
    667 08513
    667 08513
    667 08513
    667 08513
    668 03793
    668 03793
    668 03793
    668 08019
    668 08019
    669 03790
    670 08018
    670 08018
    670 08018
    671 03792
    671 03792
    671 03792
    671 03792
    672 08016
    672 08016
    672 08017
    673 03791
    673 03791
    674 08258
    674 08258

    1 FEVER
    2 FEVER
    3 FEVER
    1
    2
    1 STONE - URETER
    1
    1 EYE DISORDER
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    4 CIRCULATORY DISORDER
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    3 SKIN - LOCAL INFECTION
    4 SKIN - LOCAL INFECTION
    1 OVARIAN CYST
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE

    Page 79

    Claims Data

    674 08258
    674 08258
    675 04152
    675 04152
    675 04152
    676 08259
    676 08259
    677 06871
    677 06871
    678 08306
    678 08306
    678 08306
    679 03986
    680 06244
    680 06244
    680 06244
    681 06802
    681 06802
    681 06802
    682 06803.1
    682 06803.1
    682 06803.1
    682 06803.1
    682 06803.1
    683 07338
    684 08519
    684 08519
    684 08519
    684 08519
    685 04282
    685 04282
    685 04282
    686 06272
    686 06272
    686 06272
    686 06273
    686 06273
    686 06273
    687 03806
    687 03807
    687 03807
    687 04215
    687 04216
    687 06246
    688 04591
    689 04214
    689 04214
    689 04214
    689 06593
    689 06593

    3 DENTAL CARE
    4 DENTAL CARE
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    5 DILATION & CURRETAGE
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1
    2
    1 FRACTURE - HAND BONES
    1 FRACTURE - HAND BONES
    1 KNEE INTERNAL DERANGEMENT
    1 DIAB'ETES
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY

    Page 80

    Claims Data

    689 06593.1
    689 06594
    689 06594
    689 06594.1
    690 03513
    690 07999
    690 07999
    690 07999
    691 06592
    691 06592
    692 08624
    692 08624
    693 05362
    693 05362.1
    693 05362.1
    693 05362.2
    693 05362.2
    694 05871
    694 05871
    694 05871
    694 05871
    694 05871
    694 05871.1
    695 03805.2
    695 03805.2
    695 03805.2
    695 03805.2
    695 03805.2
    695 03805.3
    695 03805.3
    695 04156
    695 04156
    695 04156.1
    695 04156.2
    695 04521
    695 04521
    696 06245
    697 04522
    698 07449
    698 07449
    698 07449
    698 07449.1
    699 03936
    699 03936
    699 03936
    699 03936
    699 03937
    699 03937
    699 03937
    699 03938

    1
    1 VARICOSE
    2 VARICOSE
    1 HORMONE REPLACMENT THERAPY
    1 FEVER
    1
    2
    3
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 ASTHMA
    2 ASTHMA
    1
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    1 APPENDICITIS
    2 APPENDICITIS
    3 APPENDICITIS
    4 APPENDICITIS
    5 APPENDICITIS
    1 APPENDICITIS
    2 APPENDICITIS
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    1
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DENTAL CARE

    Page 81

    Claims Data

    699 03938
    700 03519
    700 03519
    700 03519
    700 03519
    700 03519
    700 03519.1
    700 03519.1
    700 03519.1
    700 04697
    700 04697
    700 04697
    700 04697
    700 04698
    700 04698
    700 04698
    700 04698
    700 04699
    700 04699
    700 04699
    700 04699
    700 04700
    700 04700
    700 04700
    700 04700
    700 04700
    700 04701
    700 04701
    700 04701
    700 04701
    700 04701
    700 06705
    700 06705
    700 06705
    700 06705
    700 06705
    700 06705.1
    701 04080
    701 04080
    701 04080
    701 04080
    701 08967
    701 08967
    701 08967
    701 08968
    701 08968
    702 04702
    702 04702
    702 04702
    702 04702

    2 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    5 OVARIAN CYST
    1 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    Page 82

    Claims Data

    702 04703
    702 04703
    702 04703
    702 04703
    702 04703
    703 04704
    703 04704
    703 04704
    703 04704
    704 06711
    704 06711
    704 06711
    704 07215
    704 07216
    704 07216
    704 07217
    704 07217
    705 07034
    705 07034
    705 07034
    706 08037
    706 08037
    706 08037.1
    706 08038
    707 04082
    707 04082
    707 04082
    707 04082
    707 05312
    707 05312
    707 05312
    707 05312
    707 05312
    708 07035
    708 07035
    708 07036
    708 07036
    708 07036
    708 08969
    709 05310
    709 05310
    709 05311
    709 05311
    709 05311
    710 07033
    710 07033
    710 07033
    710 08039
    710 08039
    710 08039

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 ARTHRITIS
    1 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 AMMENORRHOEA
    1
    2
    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    Page 83

    Claims Data

    711 08520
    711 08520
    711 08520
    712 04696
    712 04696
    713 04079
    713 04079
    713 04079
    713 04079
    714 04081
    714 04081
    714 04081
    714 04081.1
    714 04081.1
    714 06709
    714 06709
    714 06709
    714 06710
    715 04705
    715 04706
    715 04706
    715 04706
    716 05091
    716 05091
    716 05091
    716 08562
    716 08562
    717 08556
    717 08556
    718 04218
    718 04218
    718 04218
    718 04218
    718 04219
    718 04219
    718 04219
    718 06322
    718 06322
    718 06322
    718 06323
    718 06323
    718 07317
    719 07309
    719 07309
    720 06325
    720 06325
    720 06325.1
    720 06325.1
    720 06325.1
    720 06325.1

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 ANAEMIA
    2 ANAEMIA
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    1 DENTAL CARE
    1 DENTAL CARE
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 HEMORRHOIDS
    2 HEMORRHOIDS
    3 HEMORRHOIDS
    1 TONSILLITIS
    2 TONSILLITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD

    Page 84

    Claims Data

    720 06325.2
    721 06986
    721 06986
    722 06987
    722 06987
    722 06987
    722 06987
    722 06988
    722 06988
    722 06989
    722 06989
    722 06989
    722 06989
    723 05431
    723 07315
    723 07315
    723 07315
    723 07316
    723 07316
    723 07316
    723 08561
    723 08561.1
    724 06317
    724 07848
    724 07848
    724 07848
    724 07848
    725 05429
    725 05429
    725 05429
    725 05429
    725 05429
    725 05429.1
    725 05430
    726 06320
    726 06320
    726 06320
    727 03607
    727 03607
    727 05090
    727 07312
    727 07312
    727 07313
    727 07314
    728 07318
    728 07318
    728 07318
    728 07319
    728 07319
    728 07319

    1 DEVIATED NASAL SEPTUM


    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    1
    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 DENTAL CARE
    1
    2
    1 VISION CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST

    Page 85

    Claims Data

    728 07851
    729 05088
    729 05088
    729 05089
    729 05089
    729 05089
    729 08555
    729 08555
    729 08555
    730 05010
    730 05010
    730 05010
    730 05010
    730 05010
    731 06319
    731 06319
    731 06319
    732 05810
    732 05810
    732 05811
    732 05811
    732 06098
    732 06098
    732 06098
    732 07390
    732 07390
    732 07390
    732 07391
    732 07391
    732 07391
    733 08563
    734 07849
    734 07849
    734 07849
    734 07849
    735 04222
    735 04222
    735 04222
    735 04222
    736 05092
    737 06984
    737 06984
    737 06984
    737 06984
    737 07311
    737 07311
    738 08554
    738 08554
    738 08554
    738 08554

    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    5 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    Page 86

    Claims Data

    739 06313
    739 06313
    739 06313
    739 06313
    739 06313
    740 04217
    740 05087
    740 05087
    740 05087
    740 06315
    740 06982
    740 07308
    740 08558
    740 08558
    740 08558
    741 04220
    741 04220
    741 04220
    741 04220
    741 04221
    741 04221
    741 04221
    741 04221
    742 04223
    742 04223
    743 06321
    743 06321
    743 06321
    743 06321
    743 06321
    744 06316
    744 06316
    744 06316
    745 04224
    745 04224
    745 05094
    745 06324
    745 06324
    745 06324
    745 06324
    745 06324
    746 05093
    746 05093
    747 07850
    747 07850
    747 07850
    747 07850
    748 06627.2
    748 06627.2
    748 06627.2

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CHEST PAIN
    2 CHEST PAIN
    1 ALLERGIC REACTION
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART

    Page 87

    Claims Data

    748 06627.2
    748 06627.2
    748 06627.3
    748 06627.3
    748 06627.3
    748 06627.3
    748 06627.3
    749 05734
    749 05734
    749 05734
    750 05735
    750 05735
    750 05735
    750 07037
    751 05736
    751 05736
    751 05736
    752 06629
    752 06629
    752 06629
    753 07552
    753 07552
    753 07552
    754 08125
    754 08307
    754 08307
    754 08307
    755 05558
    755 05558
    755 05558
    755 05558
    755 05558
    755 05558.1
    755 05560
    755 05560
    755 05560
    755 05561
    755 05561
    755 05561
    755 07852
    755 07852
    755 07852
    755 07852
    756 04044
    756 04044
    756 04044
    756 04044
    756 04044
    756 04588
    756 04588.1

    4 HEART
    5 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    5 CANCER-BREAST
    1 PROSTATE
    1 PROSTATE

    Page 88

    Claims Data

    756 04588.1
    756 04739
    756 04740
    756 05562
    756 05562
    756 05562
    756 05562
    756 05562
    756 05562.1
    756 05564
    756 05565
    756 06502
    756 06503
    756 06713.1
    756 06713.1
    756 06713.1
    756 06713.1
    756 08041
    756 08042
    756 08043
    756 08043
    756 08043
    756 08308
    756 08308
    756 08308.1
    757 07224
    757 07224
    757 07224
    757 07224
    757 07224
    758 05566
    758 05566
    758 05566
    758 05567
    758 05567
    758 08702
    758 08704
    758 08704
    759 04046
    759 04046
    759 04047
    759 04048
    759 04048
    759 04742
    759 05571
    759 06152
    759 06878
    759 07228
    759 07229
    759 07229

    2 PROSTATE
    1 CANCER-BREAST
    1 HYPERTENSION
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    5 CANCER-BREAST
    1 CANCER-BREAST
    1 HYPERTENSION
    1 HYPERTENSION
    1 SKIN - ECZEMA
    1 CANCER-BREAST
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    3 FRACTURE - HAND BONES
    4 FRACTURE - HAND BONES
    5 FRACTURE - HAND BONES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    1 VISION CARE
    2 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 PAIN-BACK/SHOULDER
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS

    Page 89

    Claims Data

    759 07469
    759 08309
    760 05579
    760 05579
    761 04744.2
    761 04744.2
    761 04744.2
    761 04744.2
    761 04744.2
    761 04744.3
    761 04744.3
    761 04744.3
    761 04744.3
    761 05580
    761 05580
    761 05580
    761 06715
    761 06715
    761 06716
    761 06716
    761 08310
    761 08310
    761 08310
    761 08310
    762 05584
    762 05584
    763 05585.1
    763 05585.1
    763 05585.1
    763 05585.1
    763 05585.1
    764 05587
    764 05587
    764 05588
    764 05588
    764 06879
    764 06879
    764 07856
    764 07856
    764 07856
    764 07856
    764 08706
    764 08706
    765 06505
    765 06505
    765 06505
    765 06505
    765 06505.1
    766 06507
    766 06507

    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ALOPECIA
    2 ALOPECIA
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 BACK PAIN
    2 BACK PAIN
    1 SINUSITIS
    2 SINUSITIS
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    1 CHlCKEN POX
    2 CHlCKEN POX
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1
    1 CERVICITIS
    2 CERVICITIS

    Page 90

    Claims Data

    766 06507
    766 08709
    766 08709
    767 04053
    767 04053
    767 06718
    767 06718
    767 06881.1
    767 06881.1
    767 07397
    767 07397
    767 07397
    767 07397
    768 05037
    768 05037.1
    768 05037.1
    768 05037.2
    768 05037.2
    768 05037.3
    768 05037.4
    768 05037.5
    768 05592
    768 05592
    768 05592
    768 05592
    768 05593
    768 05593
    768 05593
    768 05593
    768 05594
    768 05594
    768 05594
    768 05594
    768 05812
    768 05812
    768 06882
    768 06882
    768 06882
    768 06882
    768 08311
    768 08311
    768 08311.1
    769 04750
    769 04750
    769 04750
    770 04054.1
    770 04054.1
    770 04054.1
    770 04054.1
    770 04054.1

    3 CERVICITIS
    1
    2
    1 EYE DISORDER
    2 EYE DISORDER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 CANDIDIASIS
    1 ANAEMIA
    2 ANAEMIA
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 BREAST DISORDERS
    1 CERVICAL SPONDYLOSIS
    1 LIVER CIRRHOSIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 THYROID
    2 THYROID
    3 THYROID
    4 THYROID
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    Page 91

    Claims Data

    770 04054.2
    770 04054.2
    770 04054.2
    770 04055
    770 04055
    770 04055
    770 04055.1
    770 04751.1
    770 04751.1
    770 04751.1
    770 04751.1
    770 08712
    770 08712
    771 04931
    771 04931
    771 04932
    771 04932
    771 04932
    771 05595
    771 06161
    771 06161
    771 06990
    771 06990
    771 06990
    771 06990
    771 08044
    772 08713
    772 08714
    773 06165.1
    773 06165.1
    773 06165.1
    773 06165.1
    773 06165.1
    773 06165.2
    773 07471
    773 07471
    774 06883
    774 06883
    774 06884
    774 06884
    774 06885
    774 06885
    774 06886
    774 06887
    774 06887
    774 08973
    774 08973
    774 08973
    775 04064
    775 08315.1

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 CERVICAL SPONDYLOSIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 EYE DISORDER
    2 EYE DISORDER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    2
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DILATION & CURRETAGE
    1 DENTAL CARE

    Page 92

    Claims Data

    775 08315.1
    775 08974
    776 06169
    776 06169
    777 04737
    777 04737
    777 04737
    778 06875.1
    778 06875.1
    778 06875.1
    778 07468.1
    778 07468.1
    778 07468.1
    778 07468.1
    778 07468.1
    779 05130
    779 05130
    779 05130
    779 07038
    779 07038
    779 07038
    779 07038
    779 07038
    779 07038.1
    779 07038.1
    780 05581
    780 05582.1
    780 05582.1
    780 05582.1
    780 07854
    780 07854
    780 07854
    781 04056
    781 04057
    781 04057
    781 04057
    781 06162
    781 06162
    781 06162.1
    782 07234
    782 07234
    782 07234
    782 07234
    783 04062
    783 04062
    783 04063
    783 05598
    783 07859
    783 07859
    783 07859

    2 DENTAL CARE
    1 AMMENORRHOEA
    1 BURSITIS
    2 BURSITIS
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1 EYE DISORDER
    2 EYE DISORDER
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    1 HYPERTENSION
    1
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    Page 93

    Claims Data

    783 07859
    783 07859
    784 05557
    785 02244
    785 02244
    785 02244
    786 07470
    786 07470
    786 07470
    787 03521
    787 03521
    787 03521
    787 04049
    787 04049
    787 04049
    787 04049
    787 04049
    787 04050
    787 04746
    787 05583
    787 06717
    788 04747
    788 04747
    788 04747
    788 04747
    788 04747
    788 04747.1
    788 06880
    788 06880.1
    788 08707
    788 08707
    788 08707
    789 04045
    789 04045
    789 07222
    789 07222
    789 07222
    789 07222
    790 04432
    790 04432
    790 04432
    790 06154
    790 06154
    790 06154
    790 06155
    790 06155
    790 06157
    791 05556
    791 05556.1
    791 05556.2

    4 HYPERTENSION
    5 HYPERTENSION
    1 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 CONJUNCTIVITIS - EYE
    1 ALLERGIC REACTION
    1 FEVER
    1 ABDOMINAL PAINS
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    2
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICITIS
    2 CERVICITIS
    3 CERVICITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 FEVER
    1 CERVICAL SPONDYLOSIS
    1 DEVIATED NASAL SEPTUM
    1

    Page 94

    Claims Data

    791 06874
    791 06874
    791 07221
    792 05572
    792 05572
    792 05572
    792 05572
    792 06153
    792 06153
    793 03878
    793 03878
    793 03878
    793 04052
    793 04052
    794 06712
    794 06712
    794 06712
    795 04058
    795 04752
    795 05596
    795 06508
    795 08045
    796 08128
    796 08128
    796 08128
    796 08129
    796 08129
    796 08129
    796 08129
    796 08129
    796 08130
    797 08314
    797 08314
    797 08314
    797 08314
    798 04749
    799 08701
    800 06158
    800 06158
    800 06158
    801 06511
    802 04059
    802 04059
    802 04059
    802 04059
    802 04060
    802 04060
    803 06167
    803 06167
    803 06167

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1
    2
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ANXIETY
    1 HEART- ISCHEMIC HEART DISEASE
    1 ANXIETY
    1 DEPRESSION
    1 DEPRESSION
    1 JAUNDICE
    2 JAUNDICE
    3 JAUNDICE
    1 PHIMOSIS
    2 PHIMOSIS
    3 PHIMOSIS
    4 PHIMOSIS
    5 PHIMOSIS
    1 OTITIS - EAR
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 VISION CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    Page 95

    Claims Data

    803 06167
    803 08715
    804 04061
    804 04061
    804 06720
    804 06720
    804 08716
    804 08716
    805 06160
    805 06160
    805 06160
    806 07800
    806 07800
    806 07800
    806 08453
    806 08453
    806 08453
    806 08453
    807 04051
    807 04051.1
    807 05597
    807 05597.1
    807 06719
    807 06719
    807 06719
    807 06719
    807 07857
    807 07857
    808 08316
    808 08719
    808 08719
    809 05599
    809 05599
    809 05599.1
    809 05599.1
    809 06168
    809 06168
    809 06168
    810 04748
    810 04748
    811 08050
    811 08050
    811 08050
    812 08046
    812 08046
    812 08046
    812 08046
    812 08046
    812 08046.1
    812 08046.1

    4 DIAB'ETES
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 HEMORRHOIDS
    2 HEMORRHOIDS
    1 FEVER
    2 FEVER
    3 FEVER
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    3 SKIN - LOCAL INFECTION
    4 SKIN - LOCAL INFECTION
    1 EYE DISORDER
    1 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1
    1 VISION CARE
    2 VISION CARE
    1 THYROID
    2 THYROID
    1 DEPRESSION
    2 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ANXIETY
    2 ANXIETY
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    Page 96

    Claims Data

    812 08046.1
    812 08048
    813 08313
    813 08313
    813 08313
    814 04741
    814 04741
    814 04741
    814 06714
    814 06714
    814 08705
    814 08705
    815 04753
    815 04753
    815 08717
    815 08717
    815 08717
    816 07232
    816 07232
    816 07232
    816 07233
    816 07233
    816 07233
    816 07233
    817 06166
    818 06151
    818 06151
    818 06151
    818 06151
    819 07855
    819 07855
    820 04738
    820 04738
    820 04738
    820 07467
    820 07467
    820 07467
    821 08708
    821 08708
    821 08708
    821 08708
    822 06149
    822 06150
    823 06504
    823 06504
    823 06504
    823 06504
    824 05600
    824 05600
    824 05600

    3 DENTAL CARE
    1 DENTAL CARE
    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 NASAL POLYP
    2 NASAL POLYP
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    3 HYPERLIPIDERMIA
    4 HYPERLIPIDERMIA
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL

    Page 97

    Claims Data

    825 06163
    825 06163
    825 06164
    825 06509
    825 06509
    825 06510
    826 07231
    826 07231
    826 07231
    826 07231
    827 07223
    827 07223
    827 07853
    828 08972
    828 08972
    828 08972
    828 08972
    829 04103
    829 04103
    830 04104
    830 04104
    830 04104
    830 07473
    830 07473
    831 04934
    831 04934
    832 06199
    832 06199
    832 08721
    832 08721
    832 08721
    832 08722
    832 08723
    832 08723
    833 05131
    833 05131
    833 05131
    833 05131
    833 05131
    833 05131.1
    833 05131.1
    834 07576
    834 07576
    835 04433
    835 04433
    835 04433
    835 04592
    835 04592
    835 04592.1
    835 04593

    1 HEADACHE- MIGRAINE TENSION


    2 HEADACHE- MIGRAINE TENSION
    1 HEMORRHOIDS
    1 TONSILLITIS
    2 TONSILLITIS
    1 RENAL DYSFUNCTION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 HERPES ZOSTER
    2 HERPES ZOSTER
    1 VARICOSE
    2 VARICOSE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC RHINITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 TENDONITIS
    2 TENDONITIS
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 CONJUNCTIVITIS - EYE
    1

    Page 98

    Claims Data

    835 06326
    835 06326
    835 06806
    835 06806
    835 07235
    835 07235
    835 07235
    835 07236
    835 07236
    835 07236
    835 07236
    835 07236
    836 06200
    836 06200
    837 07040
    837 07040
    837 07040
    837 07040
    838 06327
    838 06327
    838 06327
    838 07860
    838 07860
    838 07860
    839 05132
    839 05132
    839 08176
    839 08176
    840 04105
    840 04105
    841 05177
    841 05177
    841 05177
    841 05179
    841 05179
    841 05179
    841 07363
    841 07363
    841 07363
    841 08646
    841 08646
    841 08646
    841 08647
    841 08647
    842 05251
    842 05251
    843 03548
    843 03548
    843 03548
    843 03996

    1 SKIN - LOCAL INFECTION


    2 SKIN - LOCAL INFECTION
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    3 EAR DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1 LUNG DISEASE
    2 LUNG DISEASE
    3 LUNG DISEASE
    1 LUNG DISEASE
    2 LUNG DISEASE
    3 LUNG DISEASE
    1
    2
    3
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 VISION CARE
    2 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 OTITIS - EAR

    Page 99

    Claims Data

    843 03996
    843 03996
    843 03996
    843 03996
    843 03996.1
    843 03996.1
    843 06897
    843 06897
    843 06898
    843 06898
    843 06898
    844 04000
    844 04000
    845 03537
    845 03537
    845 03537
    845 03537
    846 06409
    846 06409
    846 08415
    846 08415
    846 08415
    847 05255
    847 05255.1
    847 05255.1
    847 05256
    847 05256
    847 05256
    847 05256
    847 05256
    847 05256.1
    847 05256.1
    847 07298
    847 07298
    847 07299
    847 07299
    848 05635
    848 05635
    849 03992
    849 03992
    849 03992
    849 05252
    849 05252
    849 05252
    849 05987
    849 05987
    849 05987
    849 05987
    849 06415
    849 06415

    2 OTITIS - EAR
    3 OTITIS - EAR
    4 OTITIS - EAR
    5 OTITIS - EAR
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 HEART
    2 HEART
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    5 OVARIAN CYST
    1 HEART
    2 HEART
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS

    Page 100

    Claims Data

    849 06415
    849 07296
    849 07296
    849 07296
    850 07301
    850 07301
    851 04293
    851 04293
    851 04293
    851 07561
    851 07561
    851 07561
    852 04291
    852 04291
    853 03550
    853 03550
    853 03550
    854 05988
    854 05988
    855 06903
    855 06903
    855 06903.1
    855 06903.1
    856 07294
    857 05989
    857 05989
    857 05989
    858 04762
    858 04762
    859 07559
    860 07557
    860 07557
    860 07557
    861 04299
    861 04299
    862 08416
    862 08416
    863 05615
    863 05615
    864 05260
    864 05260
    864 05260
    864 06460
    864 06460
    864 06460
    865 02467.1
    865 02467.1
    865 02467.1
    866 03616
    866 03616

    3 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 CATARACT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 HYPERTENSION
    2 HYPERTENSION
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    3
    1 DIAB'ETES
    2 DIAB'ETES

    Page 101

    Claims Data

    867 06445
    867 06445
    867 07558
    867 07558
    868 04292
    868 04292
    869 06900
    869 06900
    869 06900
    869 06901
    869 06902
    870 04767
    870 04767
    870 05261
    870 05633
    870 05991
    870 06462
    870 06462
    871 03999
    871 03999
    871 03999
    872 06444
    872 06444
    872 06444
    873 03536
    873 03536
    873 03536
    873 03536
    873 03536
    874 03993
    874 03993
    874 03993
    875 03822
    875 03822
    875 03822
    875 03822
    875 05253
    875 05253
    875 05253
    875 05253
    875 05506
    875 05506
    875 05506
    875 06033
    875 06033
    875 06033
    875 06033
    875 06033
    875 07554
    876 07293

    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 BONE & CARTILAGE DISORDER
    1 VISION CARE
    1 TRAUMA
    2 TRAUMA
    1 BREAST DISORDERS
    1 INJURY - UNSPECIFIED
    1
    1 CYST
    2 CYST
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    5 ANAEMIA
    1 VISION CARE
    1 FEVER

    Page 102

    Claims Data

    876 07293
    876 07293
    876 08413
    876 08413
    876 08413
    876 08414
    876 08414
    876 08414
    877 06414
    877 06414
    878 05990
    878 05990
    879 05254
    879 05254.1
    879 07705
    879 07705
    879 07705
    879 07705
    879 07705
    879 07705.1
    880 03543
    880 04764
    880 04764
    880 04764
    880 05257
    880 05257
    881 03546
    881 03546
    882 05985
    882 05985
    883 03544
    883 03544
    884 03541
    884 03541
    884 03542
    884 03542
    884 05627
    884 06442
    885 06412
    885 06412
    885 06412
    886 04298
    886 04298
    886 04298
    886 05262
    886 05262
    886 05262
    886 05634
    887 03540
    887 03540

    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 TENDONITIS
    1 DIAB'ETES
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 AMMENORRHOEA
    1 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 URTICARIA
    2 URTICARIA
    1 HYPERTENSION
    1 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 VISION CARE
    1 OVARIAN CYST
    2 OVARIAN CYST

    Page 103

    Claims Data

    887 07556
    887 07556
    887 07556.1
    887 07556.1
    887 07556.1
    888 05986
    888 05986
    889 06896
    889 06896
    890 04763
    890 07297
    890 07297
    890 07297
    891 03553
    891 03553
    891 06473
    891 06473
    891 06473
    891 06473
    891 06473.1
    891 06473.1
    891 06473.1
    892 03539
    892 03539
    892 03539
    892 03539
    892 06068
    892 06068
    892 06068
    892 06068
    893 07555
    893 07555
    893 07555
    894 03994
    894 03994
    894 03994
    894 06439
    894 06439
    894 06439
    894 06440
    894 06440
    895 04766
    895 04766
    895 04766
    895 04766
    895 06899
    895 06899
    895 07300
    895 07300
    895 07300

    1 OVARIAN CYST
    2 OVARIAN CYST
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 TONSILLITIS
    2 TONSILLITIS
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 CERVICITIS
    2 CERVICITIS
    3 CERVICITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 ANAEMIA
    2 ANAEMIA
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS

    Page 104

    Claims Data

    895 07300
    896 05258
    896 05258
    897 04761
    897 04761
    897 04761
    898 06999
    898 06999
    898 06999
    898 06999
    898 06999
    898 06999.1
    898 06999.1
    898 06999.1
    898 06999.1
    898 06999.1
    898 06999.2
    898 06999.2
    899 06019
    899 06019
    899 06019
    899 06020
    899 06020
    899 06020
    899 06020
    899 06020
    899 06020.1
    899 06020.1
    900 04381
    900 04381
    900 04381
    900 04381.1
    900 04381.1
    900 04382
    900 04382.1
    900 06729
    900 06729
    900 07413
    900 07413
    900 07413
    900 07413
    900 07413
    901 03830
    901 04184
    901 04947
    901 04947.1
    901 04948
    901 05182
    901 05182
    901 05182

    4 BRONCHITIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 ABSCESS
    2 ABSCESS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 LACERATION TO FOOT
    2 LACERATION TO FOOT
    1 VISION CARE
    1 EYE DISORDER
    1
    2
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1 ABDOMINAL PAINS
    1 GLAUCOMA
    1 HYPERTENSION
    1 HYPERTENSION
    1 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    Page 105

    Claims Data

    901 05322
    901 05322.1
    901 06432
    901 06432.1
    901 06432.2
    901 06997
    901 06997
    901 07603
    901 08282
    901 08282.1
    901 08648
    901 08648
    901 08649
    901 08649
    902 05875
    902 05875.1
    902 05875.1
    902 05875.2
    902 07458
    902 07458.1
    902 07458.2
    903 08653
    903 08653
    903 08653
    904 07610
    904 07610
    905 04203
    905 04203
    905 04962
    906 06678
    906 06678
    907 06413
    907 06413
    908 05323
    908 05323
    909 03836
    909 03836
    909 03836
    909 07107
    909 07108
    909 07108
    909 07109
    910 05744
    910 05744
    910 05744
    910 06452
    910 06452
    910 06452
    910 06452
    910 06453

    1 HYPERTENSION
    1 ASTHMA
    1 GLAUCOMA
    1 HYPERTENSION
    1 ASTHMA
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 HYPERTENSION
    1 THYROID
    1 HYPERTENSION
    2 HYPERTENSION
    1 BACK PAIN
    2 BACK PAIN
    1 PROSTATE
    1
    2
    1 SKIN - LOCAL INFECTION
    1 PROSTATE
    1 COUGH - AIRWAY OBSTRUCTION
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DILATION & CURRETAGE
    1 VISION CARE
    2 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 GLAUCOMA
    1 HYPERTENSION
    2 HYPERTENSION
    1 CATARACT
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    4 URTICARIA
    1 CERVICAL SPONDYLOSIS

    Page 106

    Claims Data

    910 06453
    910 06453
    910 06453
    910 06453
    910 06453.1
    910 06454
    910 06455
    910 06455
    910 06455
    910 06455
    910 06455
    910 07004
    910 07004
    910 07004
    910 07004
    910 07004
    910 07005
    910 07005
    910 07005
    910 07005
    910 07006
    910 07006
    910 07006
    910 07009
    910 07009
    910 07009
    910 07009
    910 07009
    910 07009.1
    911 04607
    911 04607
    911 04607
    911 04608
    911 04943
    911 04943
    911 04944
    911 04944
    911 05434
    911 05434
    911 05434
    911 05434
    911 05435
    911 05435
    911 05435
    911 05435
    911 05435
    911 05435.1
    911 06995
    911 06995
    911 06995

    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 FEVER
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    4 URTICARIA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1
    2
    3
    4
    5
    1
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    5 CONSTIPATION
    1 FEVER
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA

    Page 107

    Claims Data

    911 07596
    912 06436
    912 06436
    912 06436
    913 03838
    913 03838
    913 03839
    913 03839
    913 03839
    913 03840
    913 04186
    913 04186
    913 04186.1
    913 04548
    913 05439
    913 05440
    913 05440
    913 06443
    913 06443
    913 06443
    913 06443
    913 06857
    913 06857
    913 06858
    913 06858
    913 06858
    913 06858
    913 06858
    913 06858.1
    913 06858.1
    913 06858.1
    913 07365
    913 07366
    914 03820
    914 03820
    914 03820
    914 04609
    914 04610
    914 05613
    914 05613
    914 05613
    914 05613
    914 05613
    914 05613.1
    914 07864
    914 07864
    914 07864
    914 07864
    914 08640
    914 08641

    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    1 OTITIS - EAR
    1 DIAB'ETES
    1 DIAB'ETES
    1 BACK PAIN
    2 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    5 SKIN - ATOPIC DERMATITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    1 HYPERTENSION
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 FEVER
    1 DENTAL CARE
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    5 CATARACT
    1 CATARACT
    1 HEARING LOSS
    2 HEARING LOSS
    3 HEARING LOSS
    4 HEARING LOSS
    1 DENTAL CARE
    1 DENTAL CARE

    Page 108

    Claims Data

    914 08642
    914 08642
    914 08643
    914 08643
    914 08643
    915 04192
    915 04192
    915 04192
    915 04193
    915 04193
    915 04193.1
    915 04193.2
    915 05632
    915 05632
    915 05632.1
    915 07012
    915 07012.1
    915 07012.1
    915 07013
    915 07953
    915 07953
    915 07953
    915 07953
    915 07953
    915 07953.1
    915 07953.1
    916 04554
    916 04554
    916 04554
    916 04554
    916 04554
    916 04845
    916 04845.1
    916 04845.2
    916 04956
    916 04956
    916 06449
    916 06675
    916 06675
    916 07002
    916 07608
    916 07608
    916 07608
    917 04185
    917 04185
    917 07993
    917 07993
    918 04360
    918 04360.1
    918 04365

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 ANXIETY
    1 ABDOMINAL PAINS
    1 HYPERTENSION
    2 HYPERTENSION
    1 PROSTATE
    1 SKIN - ECZEMA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERTENSION
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    3 PAINFUL HEEL
    4 PAINFUL HEEL
    5 PAINFUL HEEL
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    5 TONSILLITIS
    1 HEART
    1 HEART
    1 HEART
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 AMMENORRHOEA
    1 EYE DISORDER
    2 EYE DISORDER
    1 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA
    1 DIAB'ETES
    1 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS

    Page 109

    Claims Data

    918 05892
    918 05892
    918 06104
    918 06104.1
    918 06213
    918 06213.1
    918 06328
    918 06946
    918 07251
    918 07251
    918 07251.1
    918 07251.2
    918 07578
    918 07578.1
    918 08237
    918 08821
    918 08822
    918 08822
    918 08899
    918 08899.1
    919 04180
    919 04180
    919 05622
    919 05622
    919 05622
    919 05622
    919 05622
    919 05623
    919 05623
    919 07354
    919 07354
    919 07355
    919 07355
    919 07355
    919 07355
    919 07355
    919 07355.1
    919 07355.1
    919 07357
    919 07357
    919 07357
    920 03813
    920 04246
    920 05446
    920 05747
    920 06247
    920 06247
    920 06851
    920 07612
    920 07612

    1 ABSCESS
    2 ABSCESS
    1 DIAB'ETES
    1 INTESTINAL COLIC
    1 CERVICAL STRAIN
    1 DIAB'ETES
    1 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 CERVICAL SPONDYLOSIS
    1 PROSTATE
    1 CERVICAL SPONDYLOSIS
    1 DIAB'ETES
    1 HYPERTENSION
    1 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 DIAB'ETES
    1 INTESTINAL COLIC
    1 FEVER
    2 FEVER
    1
    2
    3
    4
    5
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    5 STONE - URETER
    1 STONE - URETER
    2 STONE - URETER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    1 DIAB'ETES
    1 DIAB'ETES
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION

    Page 110

    Claims Data

    920 08281
    920 08645
    921 04955
    921 04955
    921 04955
    921 04955
    921 04955.1
    921 04955.1
    921 04955.1
    921 06671
    921 06671
    921 06859
    921 06859
    922 05436
    922 06423
    922 06423
    922 06423
    922 06423
    922 06424
    922 06424
    922 06424
    922 06849
    922 06850
    922 06850
    922 07358
    922 07359
    922 07359
    922 07359.1
    922 07600
    922 07600
    923 05920
    923 05920
    923 05920
    923 05920
    923 05920
    924 04967
    924 04967
    924 04967
    925 06456.1
    925 06456.1
    925 06456.1
    925 06456.1
    925 06456.1
    925 06457.1
    925 07011
    925 07950
    925 07950
    925 07950
    925 07951
    925 07951

    1 HYPERTENSION
    1 DIAB'ETES
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    1 CATARACT
    2 CATARACT
    3 CATARACT
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 INTESTINAL COLIC
    1 BACK PAIN
    2 BACK PAIN
    1 HEART
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    2 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 PAINFUL LEGS
    1 HEART
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    Page 111

    Claims Data

    925 07952
    925 08654
    925 08655
    925 08655.1
    926 08089
    926 08089
    926 08089
    926 08089
    926 08089
    927 04258.1
    927 04258.1
    927 06472
    927 06472
    928 04443
    928 04937
    928 05134
    928 05134
    928 05134
    928 05134
    928 05296
    928 05296
    928 05368
    928 06078
    928 06101
    928 07994
    928 07994
    928 07994
    928 07994
    928 08178
    928 08730
    929 04550
    929 04550
    929 04551
    929 04551
    929 04552
    929 04552
    929 05189
    929 05189.1
    929 05629
    929 05630
    929 05630
    929 06447
    929 06447
    929 06863
    929 06863
    929 06863
    929 06864
    929 06864
    929 07939
    929 07939

    1 HEART
    1 PROSTATE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 CONSTIPATION
    1 CONSTIPATION
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 SINUSITIS
    1 DENTAL CARE
    1 SINUSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CONSTIPATION
    1 CONSTIPATION
    1 RECTAL BLEEDING
    2 RECTAL BLEEDING
    1 TONSILLITIS
    2 TONSILLITIS
    1
    2
    1 OTITIS - EAR
    1 EYE DISORDER
    1 FEVER
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    Page 112

    Claims Data

    929 07939
    929 07940
    929 07940
    929 07940
    929 07941
    929 07941
    929 07941
    929 07941
    929 07942
    929 07942
    929 07942
    929 07942
    929 07942
    929 07943
    929 07943
    929 07944
    929 07944
    929 07945
    929 07945
    929 07946
    929 07946
    930 04244
    930 04244
    930 04244
    930 06418
    930 06418
    930 06418
    930 06418
    930 06418
    930 06418.1
    930 07599
    931 05181
    931 05181
    932 08352
    932 08352
    932 08352
    933 04537
    933 04539
    933 04539
    933 04539
    933 04541
    933 04541
    933 04541
    933 05616
    933 05616
    933 05617
    933 05617
    933 05617.1
    933 05618
    933 05618

    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 TONSILLITIS
    2 TONSILLITIS
    1
    2
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1 EYE DISORDER
    1
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE

    Page 113

    Claims Data

    933 05619
    933 05619
    933 05620
    933 05621
    933 05621
    933 06996
    933 07348
    933 07350
    933 07350
    933 07351
    933 07352
    933 07353
    934 06861
    934 06861
    934 06861
    935 03892.1
    935 03896.1
    935 03896.1
    935 03896.1
    935 03896.1
    935 03897.1
    935 04073
    935 04073
    935 04073
    935 04073.1
    935 04073.2
    935 04968
    935 04969
    935 04969
    935 04969
    935 04971
    935 04971
    935 04971
    935 04971
    935 04971.1
    935 04972
    935 04975
    935 04975
    935 04975
    935 04975
    935 04975
    935 04976
    935 04976
    935 04976
    935 04976
    935 04977
    935 04977
    935 06251
    935 06251
    935 06251

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERTENSION
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 SINUSITIS
    1
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    1
    2
    3
    4
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 HEADACHE- MIGRAINE TENSION
    1 ALLERGY
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 HEADACHE- MIGRAINE TENSION
    1 DENTAL CARE
    1 EPIDIDMYITIS
    2 EPIDIDMYITIS
    3 EPIDIDMYITIS
    4 EPIDIDMYITIS
    5 EPIDIDMYITIS
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1 RECTAL BLEEDING
    2 RECTAL BLEEDING
    3 RECTAL BLEEDING

    Page 114

    Claims Data

    935 06251
    935 06251
    935 06251.1
    935 06252
    935 06598
    935 06598
    935 06599
    935 06599
    935 06607
    935 06607
    935 06607
    935 06749
    935 06749
    935 06749
    935 07044
    935 07408
    935 07408
    935 07409
    935 07409
    935 07409
    935 07410
    935 07524
    935 07524
    935 08096
    935 08096
    935 08096
    935 08181
    936 06464
    936 06465
    936 06465
    936 06465
    936 06467
    936 06467
    936 06470
    936 06470
    936 06470
    936 06471
    936 06471
    936 06471
    936 08093
    936 08093
    936 08094
    936 08095
    936 08095
    937 03837
    937 03837
    937 03837
    937 05628
    937 05628
    937 08650

    4 RECTAL BLEEDING
    5 RECTAL BLEEDING
    1 OTITIS - EAR
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 PAIN-BACK/SHOULDER
    1 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    1 HYPERTENSION
    1 BURSITIS
    2 BURSITIS
    1 ENDOMETROSIS
    2 ENDOMETROSIS
    3 ENDOMETROSIS
    1 SKIN - LESION
    2 SKIN - LESION
    1 DENTAL CARE

    Page 115

    Claims Data

    937 08651
    937 08651
    937 08651
    937 08651
    938 04953
    938 04953
    938 04953
    938 04953
    938 06441
    938 06441
    938 06441
    939 07949
    939 07949
    940 03842
    940 03842
    940 03842
    940 05389
    940 05389
    940 05389
    940 06672
    940 06672
    940 06672
    940 07000
    940 07000
    940 07000
    940 07000
    940 07104
    940 07104
    940 07104
    940 07105
    940 07105
    940 07106
    940 07106.1
    940 07106.1
    940 07106.1
    940 07367
    940 08283
    940 08283
    941 04949
    941 04949
    941 04949
    941 06667
    941 06667
    942 03821
    942 03821
    942 03821
    942 05742
    942 05742
    943 08108.1
    943 08108.1

    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    4 CIRCULATORY DISORDER
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 DEVIATED NASAL SEPTUM
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 VISION CARE
    1
    2
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 AMMENORRHOEA
    2 AMMENORRHOEA

    Page 116

    Claims Data

    943 05756
    943 05756
    943 05756
    943 05756
    943 05756.1
    943 05756.1
    943 06474
    944 04187
    944 04187
    944 06446
    944 06446
    944 06446
    944 06446
    945 06854
    946 04249
    946 04249
    946 04249
    946 04249
    946 04249
    946 05186
    946 05186
    946 05186
    946 05186
    946 05441
    946 05441
    946 05441
    946 06673
    946 06673
    946 06674
    946 06674
    946 07936
    946 07936
    946 07937
    946 07937
    946 07937
    946 08073
    946 08073
    946 08073
    946 08073
    946 08073
    946 08074
    946 08075
    946 08075
    946 08075
    946 08076
    946 08076
    946 08076
    947 03829
    947 04545
    947 04546

    1
    2
    3
    4
    1
    2
    1 ANAEMIA
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    1 VISION CARE
    1 DIAB'ETES

    Page 117

    Claims Data

    947 05625
    947 06430
    947 07602.1
    947 07932
    948 03678
    948 03679
    948 03679
    948 03679
    948 03679
    948 04765
    948 06812
    948 07485
    948 07486
    949 03850
    949 03850
    949 03850
    949 07615
    949 07615
    949 07615
    949 08290
    949 08290
    949 08290
    950 05318
    951 04196
    951 04196
    951 04196
    951 04197
    951 04197
    951 04198
    951 04198
    951 04199
    951 04199
    951 04280
    951 04280
    951 04280
    951 04280
    951 04961
    951 04961
    951 05437
    951 05437
    951 05437
    951 05751
    951 05751
    951 05752
    951 05752
    951 05752
    951 06459
    951 06459
    951 08085
    951 08086

    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 HYPERTENSION
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 FATIGUE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 THYROID
    2 THYROID
    3 THYROID
    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    1
    1
    2
    3
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 SKIN - LESION
    2 SKIN - LESION
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1
    2
    1
    2
    3
    1 EYE DISORDER
    2 EYE DISORDER
    1 SKIN - ATOPIC DERMATITIS
    1 ALLERGIC RHINITIS

    Page 118

    Claims Data

    951 08656
    951 08656
    952 06437
    952 06437
    952 06437
    952 06437
    952 06437
    952 06437
    953 03828
    953 06428
    953 06428
    954 04179
    954 04179
    954 04860
    954 04860.1
    954 04860.1
    954 05741
    954 05741
    954 07347
    954 07597
    954 07597
    954 07702
    954 07702
    954 07702
    955 03841
    955 03841
    955 05442
    955 05442
    955 07604
    955 07604
    955 07605
    955 07605
    955 07605
    955 07938
    955 07938
    955 08285
    955 08286
    956 04617
    956 04617
    956 04618
    956 04618
    956 04618
    956 05107
    956 05107
    956 05107
    956 05748
    956 05748
    956 05748
    956 05749
    956 05749

    1 EYE DISORDER
    2 EYE DISORDER
    1 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    3 PSORIASIS
    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1
    1 CERVICITIS
    2 CERVICITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    1
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 BACK PAIN
    2 BACK PAIN

    Page 119

    Claims Data

    956 05749
    956 05749
    956 05749
    956 05750
    956 05750
    956 05750
    956 05750
    956 05750
    956 06458
    956 06458
    956 07014
    956 07014
    956 07014
    957 05636
    958 05326
    958 05326
    958 05326
    959 04544
    959 04544
    959 04544
    960 08652
    960 08652
    961 04557
    961 04557
    961 04557
    961 04557
    962 04542
    962 04542
    962 04542
    962 04543
    962 04543
    962 04543
    962 04543
    962 04543
    962 04543.1
    962 04543.1
    962 06416
    962 06416
    962 06417
    962 06417
    962 06417
    963 08644
    963 08644
    963 08644
    964 04189
    964 04189
    964 04190
    964 04190
    964 04190
    964 06450

    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    4 INGROWING TOE NAIL
    5 INGROWING TOE NAIL
    1 FEVER
    2 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    3 FRACTURE - HAND BONES
    4 FRACTURE - HAND BONES
    5 FRACTURE - HAND BONES
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    3 FRACTURE - HAND BONES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 ALLERGIC REACTION

    Page 120

    Claims Data

    964 06450
    964 06450
    964 06451
    965 03831
    965 03831
    965 03831
    965 03831
    965 03832
    965 04547
    965 04547
    965 04547
    965 04547
    965 04547
    965 04547.1
    965 04547.1
    965 04547.1
    965 04614
    965 04614
    965 06433
    965 06433
    965 06433
    965 06433
    965 06433
    965 07933
    965 07933
    965 07933
    965 07933
    965 07933
    966 06448
    967 03834
    967 03834
    967 03834
    968 06664
    968 06664
    968 06664
    969 07954
    969 07954
    969 07954
    970 08287
    971 06668
    971 06668
    971 06668
    971 08072
    971 08072
    971 08072
    971 08072
    972 06435
    972 06435
    972 06435
    972 06998.1

    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 INTESTINAL COLIC
    1
    2
    3
    4
    1 LIVER CIRRHOSIS
    1
    2
    3
    4
    5
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    5
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE

    Page 121

    Claims Data

    972 06998.3
    972 06998.3
    972 06998.3
    972 06998.3
    972 07934
    972 07934
    973 08097
    973 08097
    973 08185
    973 08185
    973 08185
    974 08084
    974 08084
    975 04001
    975 04001
    975 04001
    975 06971
    975 06971
    975 06971
    975 06971.1
    975 06971.1
    975 06971.1
    976 03995
    976 04718
    976 04718
    976 04719
    976 05919
    976 06642
    976 06643
    976 06643
    976 06643
    976 06643
    976 07147
    976 08147
    977 04243
    977 04243
    978 04896
    978 04896.1
    978 04896.1
    978 05045
    978 05045
    978 05325
    978 05325
    978 05325
    978 05679
    978 05679
    978 07327
    978 07327
    978 07327
    978 07327.1

    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    1 CONSTIPATION
    2 CONSTIPATION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 DIAB'ETES
    1 ARTHRITIS
    2 ARTHRITIS
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1

    Page 122

    Claims Data

    978 07560
    978 07560
    979 04615
    979 04615
    980 05443
    980 05443
    980 05443
    980 05443
    981 03891
    981 03891
    981 03891
    981 07459
    982 03552
    982 04897
    982 06970
    982 06970
    982 06970
    983 07015
    983 07015
    983 07015.1
    983 07015.1
    983 07015.1
    983 07015.2
    983 07015.2
    983 07015.2
    984 05447
    985 05184
    985 05184
    985 06852
    985 06852
    985 06852
    985 06852
    985 06852
    986 04250
    986 04250
    986 04250
    986 04616
    986 04616
    987 07368
    987 07368
    988 03847
    988 03847
    988 03848
    988 03848
    988 03849
    988 03849
    988 03849
    988 04963
    988 04963
    988 04964

    1 OVARIAN CYST
    2 OVARIAN CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1
    2
    3
    4
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 BACK PAIN
    1 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BLOOD DISORDER
    2 BLOOD DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 HEART
    2 HEART
    3 HEART
    1 HEART
    2 HEART
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION

    Page 123

    Claims Data

    988 04964
    988 05327
    988 05327
    988 05327
    988 07613
    988 07613
    988 07614
    988 07614
    988 07614
    988 07614.1
    988 07614.1
    989 04253
    989 04253
    989 04253
    989 04253
    989 04966
    989 04966
    989 05328
    989 06463
    989 07370
    989 07370
    989 07371
    989 07371
    989 07371
    989 07371
    990 04191
    990 04191
    990 04191
    990 04553
    990 04553
    990 05191
    990 05745
    990 05746
    990 05746
    990 05746
    990 05746
    990 05746
    990 07010
    990 07010
    990 07010.1
    991 03823
    991 03823
    991 03823
    991 04183
    991 04183.1
    991 05432
    991 05433
    991 05433
    992 03844
    992 03845

    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 VISION CARE
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 PAIN-BACK/SHOULDER
    1 BARTHOLIN'S CYST
    1 THYROID
    1 FATIGUE
    2 FATIGUE
    1 DENTAL CARE
    1 DENTAL CARE

    Page 124

    Claims Data

    992 04201
    992 04201
    992 04201
    992 04201.1
    992 06865
    992 06865.1
    992 08088
    992 08088
    992 08088
    992 08088
    993 04965
    994 04535
    994 04535
    994 04535
    994 04535
    994 04535
    995 06662
    995 06662
    995 06662
    995 06662
    995 06662.1
    995 06663
    995 06663
    995 06663
    995 07598
    996 03846
    996 03846
    996 04202
    996 04202
    996 04202.1
    996 06461
    996 06461
    996 06461
    996 06461
    997 04182
    997 04182
    997 04182
    998 03825
    998 03825
    998 03826
    998 03826
    998 04613
    998 04613
    998 06427
    998 06666
    998 06666
    998 06666
    998 06666
    999 04195
    1000 06855

    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    1
    1 DIAB'ETES
    1 AMMENORRHOEA
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    4 SKIN - ECZEMA
    1 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART
    1 ALOPECIA
    1 DIAB'ETES
    2 DIAB'ETES
    1 HEMORRHOIDS
    2 HEMORRHOIDS
    1 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1
    2
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    1 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 FEVER
    1 OVARIAN CYST

    Page 125

    Claims Data

    1000 06855
    1000 06855
    1000 06855.1
    1000 06855.1
    1000 06855.1
    1001 07595
    1002 06679
    1002 06679
    1003 06676
    1003 06676
    1003 06677
    1004 04181
    1004 04181
    1004 04181
    1004 04181
    1005 05631
    1005 05631
    1005 05631
    1005 05631.1
    1005 05631.2
    1005 05631.2
    1005 05631.2
    1006 05626
    1007 05678
    1007 05678
    1007 06669
    1007 06669
    1008 05324
    1008 05324
    1009 05319
    1009 05319
    1009 05319
    1009 05321
    1009 06411
    1009 06411
    1009 06411
    1009 07346
    1009 07346
    1009 07346
    1009 07592
    1010 07369
    1011 03890
    1011 03890
    1011 03890
    1011 04444
    1011 04444
    1011 04444
    1011 04444
    1011 07404
    1011 07404

    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ALLERGIC REACTION
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    4 ALLERGIC RHINITIS
    1
    2
    3
    1 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 MISCARRIAGE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DENTAL CARE
    1
    2
    3
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DENTAL CARE
    1
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 GLAUCOMA
    2 GLAUCOMA

    Page 126

    Claims Data

    1011 07404
    1011 07404
    1012 08468
    1012 08468
    1012 08468
    1012 08468
    1012 08468
    1013 04549
    1013 04549
    1013 04549.1
    1013 06860
    1013 06860
    1013 06860.1
    1013 06860.1
    1013 06860.2
    1013 07606
    1013 07606
    1013 07607
    1013 07607
    1014 03534
    1014 03534
    1014 03534
    1014 04941
    1014 04941
    1014 04941
    1014 06519
    1014 06519
    1014 06520
    1014 06520
    1014 06521
    1014 06521
    1014 06521.1
    1014 08070
    1014 08070
    1015 03640
    1015 04251.1
    1015 04251.1
    1015 04251.1
    1015 04251.1
    1015 04252.1
    1015 04252.1
    1015 04252.1
    1015 05390
    1015 05390
    1015 05754
    1015 05754
    1015 05754
    1015 05754
    1015 05755
    1016 03494

    3 GLAUCOMA
    4 GLAUCOMA
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1
    2
    1 PROSTATE
    1 VISION CARE
    2 VISION CARE
    1
    2
    1 EYE DISORDER
    1
    2
    1 HYPERTENSION
    2 HYPERTENSION
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 HEARING LOSS
    2 HEARING LOSS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 HEADACHE- MIGRAINE TENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 PAIN-BACK/SHOULDER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    4 SKIN - LESION
    1 DIAB'ETES
    1 BACK PAIN

    Page 127

    Claims Data

    1016 03494
    1016 03494
    1016 03494
    1016 03494.1
    1016 03494.1
    1016 03494.1
    1016 03494.1
    1016 03494.2
    1016 03494.2
    1016 03494.3
    1016 03494.3
    1016 03494.3
    1016 04093
    1016 04093.1
    1016 04093.1
    1016 04093.1
    1016 05020
    1016 05020
    1016 05020
    1016 05020
    1016 05020
    1016 05020.1
    1016 05020.1
    1016 06176
    1016 07001
    1016 08077
    1016 08077
    1016 08077
    1016 08078
    1016 08078
    1016 08078
    1016 08079
    1016 08079.1
    1016 08079.1
    1017 06109
    1017 06109
    1017 06109.1
    1017 06109.1
    1017 06109.2
    1017 06109.2
    1017 06109.3
    1017 06109.3
    1017 08146
    1017 08146.1
    1017 08146.1
    1018 04241
    1018 04241
    1018 04241
    1018 04241
    1018 04241

    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 DIAB'ETES
    2 DIAB'ETES
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 DIAB'ETES
    1 CERVICAL STRAIN
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1
    2
    3
    1 ACUTE ENTERITIS
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 THYROID
    2 THYROID
    1
    2
    3
    4
    5

    Page 128

    Claims Data

    1018 04241.1
    1018 04241.1
    1018 04241.1
    1018 04241.1
    1018 04942
    1018 04942
    1018 04942
    1018 04942
    1019 07723
    1019 07723
    1020 07717
    1020 07717
    1020 07717
    1021 03549
    1022 04676
    1023 06224
    1023 06224
    1023 07714
    1023 07715
    1024 03961
    1024 03961
    1024 03961
    1025 05185
    1025 05185
    1025 05185
    1025 06220
    1025 06220
    1025 06221
    1025 06221
    1025 06222
    1025 06222
    1025 06222
    1026 05194
    1026 05194
    1026 05194
    1027 08071
    1027 08071
    1027 08071
    1028 05438
    1029 07593
    1029 07593
    1029 07593
    1029 07594
    1029 07594.1
    1029 07594.1
    1029 07594.1
    1029 07594.1
    1030 04256
    1030 04257
    1030 06236

    1
    2
    3
    4
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 DENTAL CARE
    1 ACUTE ENTERITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 MUSCULAR PAIN
    1 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 FEVER
    2 FEVER
    3 FEVER
    1 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DIAB'ETES
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 EYE DISORDER
    1 HYPERTENSION
    1 EYE DISORDER

    Page 129

    Claims Data

    1030 06236
    1030 06525
    1030 06969
    1030 06969
    1030 06969
    1030 08289
    1031 03962
    1031 03962
    1031 04960
    1031 04960
    1031 04960.1
    1031 07164
    1031 07164
    1031 07164.1
    1032 04675
    1032 06233
    1032 06233
    1032 06233
    1032 07720
    1032 07720
    1032 07720
    1033 03957
    1033 03957
    1033 03957
    1033 03957
    1033 03957
    1033 03957.1
    1033 03957.1
    1034 03547
    1034 03547
    1034 03547
    1034 07160
    1034 07161
    1034 07161
    1034 07161
    1035 04717
    1035 05820
    1035 06856
    1035 06856
    1035 06856
    1036 03952
    1036 03952
    1036 03953
    1036 03953
    1037 04670
    1037 04670
    1037 04670.1
    1037 04670.2
    1037 04945
    1038 03538

    2 EYE DISORDER
    1 EYE DISORDER
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1
    1
    2
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 GASTRIC - PEPTIC ULCER/GERD
    1 FATIGUE
    2 FATIGUE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1
    2
    3
    4
    5
    1
    2
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    3 SOFT TISSUE DISORDERS/DISEASE
    1 BARTHOLIN'S CYST
    1 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 INTESTINAL COLIC
    1 ABDOMINAL PAINS
    1 GASTRIC - PEPTIC ULCER/GERD
    1 RADICULOPATHY INFLAME NERVE ROOT

    Page 130

    Claims Data

    1038 03538
    1038 03538
    1038 03955
    1038 03955
    1038 03955
    1038 03956
    1038 03956
    1038 03956
    1038 04247
    1038 04247
    1038 05183
    1038 05183
    1038 05183
    1038 05183.1
    1038 06522
    1038 06522
    1038 06523
    1038 06523
    1038 06523
    1038 07706
    1038 07706
    1038 07706
    1038 07707
    1038 07707
    1038 07707
    1039 03965
    1039 03965
    1039 03965
    1040 04200
    1040 04200
    1040 04245
    1040 04245
    1040 06034
    1040 06034
    1040 06034
    1040 06034
    1040 06175
    1040 06175
    1040 06175.1
    1040 06175.1
    1040 06175.1
    1040 06175.2
    1040 06175.2
    1040 06175.3
    1040 06175.3
    1040 06175.3
    1040 06175.3
    1040 06175.3
    1040 06175.4
    1040 06219

    2 RADICULOPATHY INFLAME NERVE ROOT


    3 RADICULOPATHY INFLAME NERVE ROOT
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 TONSILLITIS
    2 TONSILLITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    2
    3
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1
    2
    3
    1
    2
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    3 EAR DYSFUNCTION
    4 EAR DYSFUNCTION
    5 EAR DYSFUNCTION
    1 EAR DYSFUNCTION
    1 DEVIATED NASAL SEPTUM

    Page 131

    Claims Data

    1040 07362
    1040 07362
    1040 07704
    1040 07704
    1041 04248
    1041 04248
    1041 04248
    1042 06217
    1043 07716
    1044 03551
    1044 03551
    1044 03551
    1045 04672
    1045 04673
    1045 05188
    1045 05188
    1045 05188
    1045 05188
    1045 05188
    1046 03991
    1046 03991
    1046 03991
    1047 05174
    1047 05174
    1047 05174
    1048 04254
    1048 04254
    1048 04254
    1048 04254
    1048 04254
    1048 04255
    1048 04255
    1048 06235
    1048 06235
    1048 06235
    1048 06235
    1048 06235
    1048 06235.1
    1049 07158
    1049 07158
    1049 07700
    1050 05187
    1050 06223
    1050 06524
    1050 06524
    1050 06524
    1050 07709
    1050 07709
    1050 07709
    1050 07709

    1 OTITIS - EAR
    2 OTITIS - EAR
    1 INJURY - UNSPECIFIED
    2 INJURY - UNSPECIFIED
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 MISCARRIAGE
    1 DIAB'ETES
    1 CHlCKEN POX
    2 CHlCKEN POX
    3 CHlCKEN POX
    1 DIAB'ETES
    1 ACUTE ENTERITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1 EYE DISORDER
    1 STROKE
    2 STROKE
    1 STROKE
    1
    1 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST

    Page 132

    Claims Data

    1051 06234
    1051 06234
    1051 06234
    1052 03954
    1052 03954
    1052 03954
    1052 04671
    1053 05175
    1053 05175
    1053 05176
    1053 05176
    1053 06215
    1053 06215
    1053 06215
    1053 06215
    1053 06216
    1053 07701
    1054 04895.1
    1054 04895.1
    1054 04895.1
    1054 04895.1
    1055 03963
    1055 03963
    1055 03964
    1055 03964
    1055 03964
    1055 03964
    1055 03964
    1055 07721
    1055 07721
    1055 07721
    1055 08090
    1055 08091
    1055 08091
    1056 06357
    1056 06357
    1056 07935
    1056 07935
    1057 03959
    1057 03959
    1057 03960
    1057 03960
    1057 04957
    1057 04957
    1057 04958
    1057 04959
    1057 04959
    1057 04959
    1057 06229
    1057 06229

    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1
    1 INJURY - UNSPECIFIED
    1 THYROID
    2 THYROID
    3 THYROID
    4 THYROID
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    2 FEVER
    1 VISION CARE
    2 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 HYPERTENSION
    2 HYPERTENSION

    Page 133

    Claims Data

    1057 06230
    1057 06230
    1057 07162
    1057 07162
    1057 07163
    1057 07163
    1057 08080
    1057 08080
    1057 08081
    1057 08081
    1058 02813.4
    1058 02813.5
    1058 02813.5
    1058 06225
    1058 06225
    1058 06225
    1058 06225
    1059 03545.1
    1059 03545.1
    1059 08284
    1059 08284
    1059 08284
    1060 04946
    1060 04946
    1060 04946
    1061 04072
    1061 04072
    1061 04072
    1061 06226
    1061 06226
    1061 06226
    1061 06226
    1062 03535
    1062 03535
    1062 03535
    1063 07703
    1063 07703
    1064 07159
    1065 06231
    1065 06231
    1065 06231
    1065 07719
    1065 07719.1
    1065 07719.1
    1066 05190
    1066 05190
    1067 04950.1
    1067 04951
    1067 04951
    1067 04951

    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEART
    2 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEART
    1 HEART
    1 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 MISCARRIAGE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    Page 134

    Claims Data

    1067 07454
    1067 07454
    1067 07454
    1067 07455
    1067 07455
    1067 07455
    1067 07455
    1067 07455
    1067 07455.1
    1068 03863
    1068 03863
    1068 03863
    1068 03863
    1068 03863
    1068 03863.1
    1068 04901
    1068 04901
    1068 05451
    1068 05451
    1068 06613
    1068 06613
    1069 03641.1
    1069 03641.1
    1070 04388
    1070 04388
    1070 04388
    1070 04388
    1070 04388
    1070 05640
    1070 05640
    1070 08149
    1070 08149
    1070 08149
    1071 08005
    1071 08005
    1072 06255
    1072 06255
    1073 05216
    1073 05216
    1073 05216
    1073 05216
    1073 05216
    1073 05216.1
    1073 06076
    1073 06076
    1073 06738
    1073 06738
    1073 06975
    1073 06975
    1073 06975

    1 HORMONE REPLACMENT THERAPY


    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 HYPERTENSION
    2 HYPERTENSION
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    3 SKIN - LOCAL INFECTION
    4 SKIN - LOCAL INFECTION
    5 SKIN - LOCAL INFECTION
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 ARTHRITIS
    2 ARTHRITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY

    Page 135

    Claims Data

    1073 06975
    1073 06975
    1073 06975.1
    1073 06975.1
    1074 05706
    1074 05706
    1074 05706
    1074 07377
    1074 07377
    1074 07377
    1074 08156
    1074 08156
    1074 08156
    1074 08156.1
    1074 08156.1
    1075 05826
    1075 05826
    1075 05826
    1076 04391
    1077 04558
    1077 06904
    1077 06905
    1078 04623
    1079 05891
    1079 05891
    1079 05891
    1079 05891
    1079 06239
    1079 06239
    1079 06239
    1079 06239
    1079 06483
    1079 06483
    1079 06483
    1079 07025
    1079 07240
    1079 07240
    1079 07240
    1079 07240
    1079 07240
    1080 03554
    1080 03554
    1080 06477
    1080 06477
    1080 06732
    1080 06732
    1080 06732
    1080 06732
    1080 06732
    1080 06732.1

    4 HORMONE REPLACMENT THERAPY


    5 HORMONE REPLACMENT THERAPY
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 BACK PAIN
    2 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 GLAUCOMA
    1 HYPERTENSION
    1 EYE DISORDER
    1 EYE DISORDER
    1 HEART
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    4 SKIN - ECZEMA
    1 INFECTION THUMB
    2 INFECTION THUMB
    3 INFECTION THUMB
    4 INFECTION THUMB
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    5 SKIN - ATOPIC DERMATITIS
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 BURSITIS

    Page 136

    Claims Data

    1081 06737
    1081 06737
    1082 04115
    1082 04115.1
    1082 05197
    1082 05197
    1082 05637
    1082 05638
    1082 05701
    1082 05702
    1082 05702
    1082 05821
    1082 05821.1
    1082 06475
    1082 06608
    1082 06608
    1082 08580
    1083 03555
    1083 03555
    1083 03555
    1083 04120
    1083 04120
    1083 04625
    1083 05641
    1083 05641
    1083 05641
    1083 05641
    1083 05641
    1083 05642
    1083 05642
    1083 05642
    1083 06072
    1083 06072
    1083 06073
    1083 06073
    1083 06569
    1083 06569
    1083 06569
    1083 06569
    1083 06569.1
    1083 06569.2
    1083 07866
    1083 07866
    1084 04112
    1084 04112
    1084 04112
    1084 04112
    1084 04113
    1084 04113.1
    1084 04114

    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DIAB'ETES
    1 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 PROSTATE
    1 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 DEPRESSION
    1 EYE DISORDER
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 EPILEPSY
    2 EPILEPSY
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 EPILEPSY
    1 HEART
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    1 HYPERTENSION
    1 RENAL DYSFUNCTION

    Page 137

    Claims Data

    1084 05448
    1084 05448
    1084 05449
    1084 05449
    1084 05884
    1084 05884
    1084 05884
    1084 05884
    1084 05884
    1084 05884.1
    1084 05889
    1084 05889
    1084 07019
    1084 07019
    1085 06238
    1086 04622
    1087 03851
    1087 03851
    1087 03851
    1087 03851
    1087 03852
    1087 03852
    1087 03853
    1087 03853
    1087 03853
    1087 05703
    1087 05703
    1087 05703
    1087 07628
    1087 07628
    1087 07629
    1087 07629
    1088 07376
    1088 07376
    1088 07376
    1088 07646
    1088 07646
    1089 05452
    1089 05452
    1089 05452
    1089 05823
    1089 06237
    1089 06735
    1089 06735
    1089 06735
    1089 06735
    1090 06556
    1090 06730
    1090 06731
    1090 07814

    1 ANXIETY
    2 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    4 ANXIETY
    5 ANXIETY
    1 ANXIETY
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 BARTHOLIN'S CYST
    1 BONE & CARTILAGE DISORDER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 HERPES ZOSTER
    2 HERPES ZOSTER
    3 HERPES ZOSTER
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INTESTINAL COLIC
    1 GASTRIC - PEPTIC ULCER/GERD
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 CHEST PAIN
    1 DENTAL CARE
    1 DENTAL CARE
    1 EAR DYSFUNCTION

    Page 138

    Claims Data

    1090 07814
    1090 07815
    1090 07816
    1090 08354
    1091 03854
    1091 03854
    1091 03854
    1091 03856
    1091 03856
    1091 04624
    1091 04624
    1091 07462
    1091 07462
    1091 07463
    1091 07463
    1091 08001
    1091 08001
    1091 08001.1
    1091 08002
    1092 05822
    1093 04390
    1093 04390
    1093 04900
    1093 04900
    1093 04900.1
    1093 04900.2
    1093 06074
    1093 06074
    1093 06074.1
    1093 06479
    1093 06479
    1093 06479.1
    1093 06479.1
    1093 07374
    1093 07374.1
    1094 08003
    1094 08003
    1094 08004
    1095 03557
    1095 03557
    1095 03557
    1095 03557
    1096 04121
    1096 04121
    1096 04121
    1096 04121
    1096 04121
    1096 04121.1
    1097 04395
    1097 04395

    2 EAR DYSFUNCTION
    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1
    2
    1 ARTHRITIS
    2 ARTHRITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 HEART
    2 HEART
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    1
    1 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 SINUSITIS
    2 SINUSITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ARTHRITIS
    1 BACK PAIN
    2 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    2 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 URTICARIA
    2 URTICARIA
    1 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    Page 139

    Claims Data

    1097 04395
    1098 05453
    1098 05453
    1098 05453
    1098 05453
    1098 05454
    1098 05454
    1098 05890
    1098 05890
    1098 05890
    1098 08153
    1098 08153
    1098 08153
    1098 08153
    1098 08153
    1099 04385
    1099 04385
    1099 04385
    1099 05825
    1099 05825
    1099 05825
    1099 05825
    1099 05825
    1099 05825.1
    1099 05825.1
    1099 05825.1
    1099 05825.1
    1100 03860
    1100 03860
    1100 03860
    1100 03860
    1100 03861
    1100 03861
    1100 03861
    1100 03861
    1100 03861
    1100 04389
    1100 05704
    1100 05704
    1100 05704.1
    1100 05704.1
    1100 05704.1
    1100 05704.1
    1100 06071
    1100 06071
    1100 07021
    1100 07021
    1100 07504
    1100 07865
    1100 07865

    3 RENAL DYSFUNCTION
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    1 BACK PAIN
    2 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 EPILEPSY
    2 EPILEPSY
    3 EPILEPSY
    4 EPILEPSY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 REMOVAL OF MOLE
    1
    2
    1
    2
    3
    4
    1 EPILEPSY
    2 EPILEPSY
    1 EPILEPSY
    2 EPILEPSY
    1 HEART
    1 EPILEPSY
    2 EPILEPSY

    Page 140

    Claims Data

    1100 07865.1
    1100 08148
    1100 08148
    1100 08148
    1100 08148
    1100 08148.1
    1100 08148.1
    1100 08585
    1101 04384
    1101 04384
    1101 04384
    1101 04384
    1101 04384
    1101 04384.1
    1101 04384.1
    1101 04384.1
    1101 07460
    1101 07460
    1101 08000
    1102 03857
    1102 03857
    1102 03857
    1102 06973
    1102 06973
    1102 06973
    1102 06973
    1103 05450
    1103 05450
    1104 06549
    1104 06550
    1105 04904
    1106 04392
    1106 04393
    1106 04393
    1106 04393
    1106 04393.1
    1106 04559
    1107 04394
    1107 04394
    1108 05207
    1108 05207
    1108 07022
    1108 07022
    1108 07023
    1108 08586
    1108 08586
    1108 08587
    1108 08587
    1108 08587
    1109 04129

    1 DEVIATED NASAL SEPTUM


    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 RETINOPATY
    2 RETINOPATY
    1 BONE & CARTILAGE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    4 URTICARIA
    1 VISION CARE
    2 VISION CARE
    1 ABDOMINAL PAINS
    1 OVARIAN CYST
    1 DEVIATED NASAL SEPTUM
    1 OTITIS - EAR
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    1 OTITIS - EAR
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 SKIN - LOCAL INFECTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION

    Page 141

    Claims Data

    1109 04129.1
    1110 06481
    1110 06481
    1110 06481
    1110 06570
    1110 06570
    1110 06570
    1110 06570
    1110 06570
    1110 06736
    1111 03556
    1111 03556
    1111 07375
    1111 07375
    1111 07375
    1111 08152
    1111 08152
    1112 07372
    1112 07372
    1112 07372
    1112 07372
    1112 07372
    1113 04620
    1113 04620
    1113 04621
    1114 08155
    1115 07373
    1115 07373
    1115 07373
    1116 06069
    1116 06069
    1116 06069
    1116 06478
    1116 06478
    1117 03754
    1117 03754
    1117 03754
    1117 05771
    1117 05771
    1117 07824
    1117 07824
    1118 03747
    1118 03747
    1118 03747
    1118 03747
    1119 06291
    1119 06291
    1119 06291
    1119 06291
    1119 06292

    1 THYROID
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 FEVER
    2 FEVER
    1 SKIN - LOCAL INFECTION
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 BARTHOLIN'S CYST

    Page 142

    Claims Data

    1119 06292
    1119 06292
    1119 06293
    1120 08364
    1120 08364
    1120 08364
    1120 08364
    1120 08364
    1120 08364.1
    1120 08364.1
    1120 08364.1
    1121 04006
    1121 04006
    1121 05705
    1122 07527
    1122 07527
    1122 07527
    1122 07527
    1122 07527
    1122 07527.1
    1123 08355
    1123 08355
    1123 08355.1
    1124 07020
    1124 07020
    1124 07020.1
    1124 07020.1
    1125 07641
    1125 07641
    1125 07641
    1125 07642
    1125 07642
    1125 07642
    1125 07643
    1126 06294
    1126 06294
    1126 06294
    1127 05770
    1127 05770
    1127 05770
    1128 07653
    1129 07631
    1129 07631
    1129 07631
    1129 08360
    1129 08360
    1129 08360
    1130 05046
    1130 05639
    1130 05680

    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 HYPERTENSION
    2 HYPERTENSION
    1 BEHAVIOURIAL PROBLEMS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 VISION CARE
    1 HEART
    2 HEART
    1
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 HEADACHE- MIGRAINE TENSION
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BLOOD DISORDER
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 DEPRESSION
    1 OVARIAN CYST
    1 DEPRESSION

    Page 143

    Claims Data

    1130 06476.1
    1130 06821
    1130 06821.1
    1130 07116
    1131 07076
    1132 04009
    1132 04009
    1132 04009.1
    1133 07645
    1133 07645
    1134 08362
    1134 08363
    1134 08363
    1134 08363
    1134 08363
    1135 04204
    1135 04204
    1135 04204
    1135 04204
    1135 04204
    1135 04898
    1135 04898
    1135 06359
    1135 06359
    1135 06359
    1135 06359
    1135 07525
    1135 07525
    1135 07525
    1136 04796
    1136 04796
    1136 04796
    1137 03755
    1137 03755
    1137 03756
    1137 07072
    1137 07072
    1138 04772
    1138 04772
    1138 04772
    1138 05760
    1138 05760
    1138 06557
    1138 06557
    1138 06557
    1138 06557.1
    1138 06557.1
    1138 06557.1
    1138 06557.2
    1138 06557.3

    1 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    1
    1 ANAEMIA
    1
    1 DIAB'ETES
    2 DIAB'ETES
    1 PROSTATE
    1 VISION CARE
    2 VISION CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HEART
    2 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ENDOCRINE DISORDERS
    2 ENDOCRINE DISORDERS
    1 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    1 GASTRIC - PEPTIC ULCER/GERD
    1 ANAEMIA

    Page 144

    Claims Data

    1138 06557.3
    1138 06557.3
    1138 06557.3
    1138 06557.3
    1138 06557.4
    1138 07617
    1138 07617
    1138 07617
    1138 07618
    1138 07618
    1138 07618
    1138 07619
    1138 07619
    1138 07619
    1138 08476
    1138 08476
    1138 08476
    1138 08476
    1138 08476
    1139 07616
    1139 07616
    1139 07616
    1139 08474
    1139 08474
    1139 08474
    1140 04314
    1140 04314
    1140 04314
    1140 04315
    1140 04315
    1140 04315
    1141 07640
    1141 07640
    1141 07640
    1141 07640
    1142 03745
    1142 03745
    1142 05763
    1142 05763
    1142 05763
    1142 06563
    1142 06564
    1142 06564
    1142 06564
    1142 08359
    1142 08359
    1143 04010
    1143 04010
    1143 04010
    1143 04788

    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    5 ANAEMIA
    1 ANAEMIA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 ANXIETY
    2 ANXIETY
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 HEART
    2 HEART
    1
    2
    3
    1 VISION CARE

    Page 145

    Claims Data

    1143 04788
    1143 05772
    1143 05772
    1143 07648
    1143 07648
    1143 08367
    1144 05933
    1145 05206
    1145 05206
    1145 07637
    1146 08361
    1146 08361
    1147 03746
    1147 07820
    1148 04303
    1148 04303
    1148 04303
    1148 04303
    1148 04304
    1148 04304
    1148 05209
    1148 05209
    1148 05209
    1148 06124
    1148 06124
    1148 06124
    1148 06124
    1149 05215
    1149 05215
    1149 05215
    1150 04720
    1150 04720
    1150 04720
    1150 04720
    1150 04720
    1151 07111
    1151 07111
    1151 07111
    1151 07111
    1151 07111
    1151 07112
    1151 07112.1
    1151 07112.1
    1151 07112.1
    1151 07113
    1151 07113.1
    1151 07113.1
    1151 07113.1
    1151 07114
    1152 04005

    2 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 OTITIS - EAR
    1
    1 VISION CARE
    2 VISION CARE
    1 SKIN - LESION
    1 ABSCESS
    2 ABSCESS
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1
    2
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    3 PAINFUL LEGS
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    3 PAINFUL LEGS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 INSECT STING
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 SKIN - LESION
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 FEVER
    1 DIAB'ETES

    Page 146

    Claims Data

    1153 08486
    1153 08487
    1153 08487
    1153 08487
    1154 05926
    1154 05926
    1154 05926
    1154 06560
    1154 06560
    1155 04117
    1155 04117
    1155 07620
    1155 08581
    1155 08581
    1156 07819
    1156 07819
    1156 07819
    1157 06568
    1158 03617
    1158 03617
    1158 03617
    1158 03617
    1158 03617
    1159 07639
    1159 07639
    1159 07639
    1160 05212
    1160 05213
    1160 05213
    1160 05213
    1160 05213.1
    1160 05213.1
    1160 05769
    1160 05769
    1160 06125
    1160 06125
    1160 07644
    1161 06562
    1161 06562.1
    1161 06562.2
    1161 07772
    1161 07772
    1162 04125
    1162 04125
    1162 05932
    1162 05932
    1162 05932
    1162 06290
    1162 06290
    1162 06290

    1 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HEART
    2 HEART
    3 HEART
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HEART
    2 HEART
    3 HEART
    1 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 GLAUCOMA
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 GLAUCOMA
    2 GLAUCOMA
    1 HYPERTENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 PROSTATE
    1 CHOSTOCHRONDITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1
    2
    1 HEART
    2 HEART
    3 HEART
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA

    Page 147

    Claims Data

    1162 06290
    1162 06290.1
    1162 06290.1
    1162 06290.1
    1163 03862
    1163 03862
    1163 04003
    1163 04004
    1163 04004
    1163 04118
    1163 04899
    1163 04899
    1163 04899
    1163 04899
    1163 04899
    1163 06118
    1163 06118
    1163 06119
    1163 06119
    1163 06120
    1163 06120
    1163 06178
    1163 06178
    1163 06178.1
    1163 06178.1
    1163 06178.1
    1163 06178.1
    1163 06178.1
    1163 06178.2
    1163 06178.2
    1163 06974
    1163 06974
    1163 06974
    1163 06974
    1163 06974
    1163 06974.1
    1163 06974.1
    1163 06974.1
    1163 07528
    1163 07528
    1163 07528
    1163 07528
    1163 07528
    1164 04312
    1164 05217
    1164 05217
    1164 05217
    1164 07071
    1164 07071
    1164 07071

    4 ANAEMIA
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 CATARACT
    2 CATARACT
    1
    1 GLAUCOMA
    2 GLAUCOMA
    1 HYPERTENSION
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 DIAB'ETES
    2 DIAB'ETES
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    5 DEPRESSION
    1 DEPRESSION
    2 DEPRESSION
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    3 HEART
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    5 DEPRESSION
    1 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    Page 148

    Claims Data

    1165 07062
    1166 03904
    1166 03904
    1166 03904
    1166 04778
    1166 06123
    1166 06123
    1166 07065
    1166 07065
    1166 07635
    1166 07636
    1166 07636
    1166 08480
    1166 08481
    1166 08481
    1166 08482
    1166 08482
    1167 02057.1
    1167 03741
    1167 03741
    1167 03741
    1167 04774
    1167 07622
    1167 07623
    1167 07623
    1167 07624
    1168 03740
    1168 03740
    1168 03740
    1168 03740
    1168 03740
    1168 04300
    1168 06558
    1168 06558
    1168 06558
    1168 06612
    1168 07049
    1168 07049
    1169 04116
    1169 04116
    1169 04116
    1170 07634
    1170 07634
    1171 06117
    1171 06117
    1172 05766
    1172 05766
    1172 05766
    1172 07066
    1172 07066

    1 INTESTINAL COLIC
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 ABDOMINAL PAINS
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    1 VISION CARE
    2 VISION CARE
    1 DEPRESSION
    1 EYE DISORDER
    2 EYE DISORDER
    1 ENDOMETROSIS
    2 ENDOMETROSIS
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 BRONCHITIS - ACUTE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 DEPRESSION
    2 DEPRESSION
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 VISION CARE
    2 VISION CARE
    1 FEVER
    2 FEVER
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION

    Page 149

    Claims Data

    1173 03764
    1173 06680
    1173 06680
    1174 04776
    1174 04777
    1174 04777
    1174 06295
    1175 06554
    1175 06554
    1176 04780
    1176 04780
    1177 04313
    1178 06113
    1178 06113
    1178 06113
    1178 06116
    1178 06116
    1179 05018
    1179 05214
    1179 05214
    1179 06614
    1179 06614
    1179 06614
    1179 06614
    1179 06614
    1180 06112
    1180 06112
    1180 06112
    1181 05297
    1181 05297
    1181 05297
    1181 07868
    1181 07868
    1182 03757
    1182 03757
    1182 03757
    1183 03750
    1183 03750
    1183 03751
    1183 03751
    1183 05203
    1183 05927
    1183 05927
    1183 05927
    1183 05928
    1184 04305
    1184 04305
    1184 04305
    1184 04305
    1184 04306

    1 ABDOMINAL PAINS
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HORMONE REPLACMENT THERAPY
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART
    1
    2
    1 HYPERTENSION
    1 SINUSITIS
    2 SINUSITIS
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE

    Page 150

    Claims Data

    1184 04306
    1184 04306
    1184 04306
    1184 04306
    1184 04306.1
    1184 04308
    1184 04308
    1184 04308
    1184 04308
    1184 04309
    1184 05768
    1184 05768
    1184 05768
    1184 07067
    1185 08472
    1185 08472
    1186 03742
    1186 03742
    1186 03901
    1186 04775
    1187 04119
    1187 04119
    1187 04119
    1188 03905
    1188 03905
    1188 04781
    1188 04781
    1188 05765
    1188 08484
    1188 08484
    1189 05221
    1189 05221
    1189 07649
    1189 07649
    1189 07649
    1189 08368
    1189 08369
    1190 03752
    1190 03752
    1190 08493
    1190 08493
    1191 05195
    1191 05757
    1191 05757
    1192 06565
    1192 06565
    1192 06565
    1193 04316
    1194 07632
    1194 07632

    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    1 BEHAVIOURIAL PROBLEMS
    2 BEHAVIOURIAL PROBLEMS
    3 BEHAVIOURIAL PROBLEMS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    1
    2
    1
    1
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1 DENTAL CARE
    1 THYROID
    2 THYROID
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 MISCARRIAGE
    1 ANAEMIA
    2 ANAEMIA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL STRAIN
    1 VISION CARE
    2 VISION CARE

    Page 151

    Claims Data

    1194 07632
    1195 07817
    1195 07817
    1195 07817
    1196 03739
    1196 03739
    1196 06551
    1196 06551
    1196 06551
    1196 06551
    1196 06551
    1196 06552
    1196 06552
    1196 06552
    1196 06552
    1197 04768
    1197 04768
    1197 04768
    1197 04768
    1197 04768
    1197 04769.1
    1197 04769.1
    1197 08470
    1197 08470
    1198 06566
    1198 06567
    1198 06567
    1198 06567
    1199 05924
    1199 05924
    1200 07823
    1200 07823
    1200 07823
    1200 07823
    1201 05196
    1201 05196.1
    1201 05196.1
    1202 06111
    1202 07047
    1203 03759
    1203 03760
    1203 03760
    1203 03761
    1203 05774
    1203 05775
    1203 05775
    1203 05775
    1204 04773
    1204 04773
    1204 05925

    3 VISION CARE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    1 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 CERVICAL STRAIN
    1 BACK PAIN
    1 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    1 BONE & CARTILAGE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 THYROID
    2 THYROID
    1

    Page 152

    Claims Data

    1204 05925
    1205 05147
    1205 05147
    1205 05147
    1205 08588
    1205 08588
    1205 08589
    1206 04383
    1206 04383
    1206 04383
    1206 07265
    1206 07265
    1206 07265
    1206 07265
    1206 07266
    1206 07267
    1206 07267
    1206 07267
    1206 07267
    1206 07268
    1206 07268
    1207 07269
    1208 04386
    1209 05145
    1209 05145
    1209 05145
    1209 05145
    1209 05146
    1209 05146
    1209 05146
    1210 04094
    1211 06572
    1211 06572
    1212 04096
    1213 07272
    1213 07272
    1213 07272
    1213 07272
    1214 03899
    1214 03899
    1214 04770
    1214 04770
    1214 04771
    1214 04771
    1215 07050
    1215 08357
    1215 08357
    1215 08357
    1216 06289
    1216 06289

    2
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 ASTHMA
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 ASTHMA
    2 ASTHMA
    1 BACK PAIN
    1 FATIGUE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    3
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 HORMONE REPLACMENT THERAPY
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE

    Page 153

    Claims Data

    1217 08483
    1217 08483
    1217 08483
    1218 09860.1
    1218 09860.1
    1218 09860.1
    1218 09860.1
    1218 09860.1
    1218 09860.2
    1218 06131
    1218 06131
    1218 06575
    1218 06575
    1218 07073
    1218 07073
    1218 07073
    1219 04310
    1219 04310
    1219 04310
    1219 04310
    1219 04310
    1219 06126
    1219 06126
    1220 07627
    1220 07627
    1221 06571
    1221 06571
    1221 06571
    1221 06571
    1221 06571
    1221 07638
    1221 07638
    1221 07638
    1221 07638
    1221 08485
    1221 08485
    1222 05761
    1222 05761
    1222 05761
    1222 05761
    1222 05762
    1222 05762
    1222 08353
    1222 08353
    1223 08475
    1223 08475
    1223 08475
    1224 05201
    1224 05201
    1224 05201

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    5 DILATION & CURRETAGE
    1 DILATION & CURRETAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CANCER-BREAST
    2 CANCER-BREAST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS

    Page 154

    Claims Data

    1224 05201
    1224 06297
    1224 06297
    1224 06561
    1224 06561
    1224 06561
    1224 06561
    1224 07055
    1224 07055
    1224 07055
    1224 07055
    1224 07055.1
    1224 07625
    1224 08479
    1224 08479
    1224 08479
    1225 04122
    1225 04122
    1225 04122
    1225 04122
    1225 04122
    1225 04783
    1225 04783
    1225 04783
    1225 04783
    1225 04783
    1225 04784
    1225 04784
    1225 05021
    1225 05021
    1225 05021
    1225 05021
    1225 05021
    1225 05021.1
    1225 05021.1
    1225 05022
    1225 05022
    1225 05022
    1225 06482
    1225 06482
    1225 06482
    1225 06482
    1225 07068
    1225 07068
    1225 07068
    1225 07068
    1225 07068
    1226 04795
    1226 04795
    1227 06574

    4 PHARYNGITIS
    1 RETINOPATY
    2 RETINOPATY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 THYROID
    1 THYROID
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HEART
    2 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    1 DENTAL CARE

    Page 155

    Claims Data

    1227 06574
    1228 03907
    1228 03907
    1228 03907
    1228 05931
    1228 05931
    1228 05931
    1228 05931
    1228 05931
    1228 06128
    1228 06128
    1228 06128
    1228 06128
    1228 06128
    1228 06128.1
    1228 06129
    1228 06129
    1228 06129
    1228 06130
    1228 06130
    1228 06130
    1228 06130
    1229 05200
    1229 05200
    1230 04317
    1230 04317
    1231 07654
    1231 07654
    1231 07654
    1231 08371
    1231 08371
    1231 08371
    1231 08371
    1231 08371.1
    1231 08371.2
    1232 04782
    1232 06075
    1232 06075
    1232 06075
    1233 07822
    1233 07822
    1233 08591
    1234 03900
    1234 03900
    1234 03900
    1235 07053
    1235 07053.1
    1235 07053.1
    1235 07053.1
    1235 07053.1

    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    5 CHEST PAIN
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 THYROID
    2 THYROID
    3 THYROID
    4 THYROID
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 DENTAL CARE
    2 DENTAL CARE
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 RENAL DYSFUNCTION
    1 THYROID
    1 URTICARIA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    1 DEVIATED NASAL SEPTUM
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 BONE & CARTILAGE DISORDER
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL

    Page 156

    Claims Data

    1235 07053.2
    1235 07053.2
    1235 07053.2
    1235 07053.2
    1235 07053.2
    1235 07053.3
    1235 07053.4
    1235 07053.4
    1235 07053.5
    1235 07053.6
    1235 07053.6
    1236 04792
    1236 04792
    1236 04794
    1236 04794
    1237 04785
    1237 04785
    1237 04785
    1237 04785
    1238 03758
    1238 03758
    1238 08291
    1238 08291
    1238 08291
    1238 08291
    1238 08291
    1238 08291.1
    1238 08291.1
    1238 08291.1
    1238 08291.1
    1238 08291.1
    1239 06121
    1239 06121
    1240 03738
    1240 03738
    1240 03738
    1240 07810
    1240 07810
    1240 07810
    1240 07810
    1240 07810
    1240 07812
    1240 07812
    1241 07821
    1241 07821
    1241 07821
    1242 03748
    1242 03748
    1242 03748.1
    1242 03749

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1
    2
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 THYROID
    1 BREAST DISORDERS

    Page 157

    Claims Data

    1242 07064
    1243 03908
    1243 03908
    1243 03908
    1244 04311
    1244 04786
    1244 04786
    1244 04786
    1244 04787
    1244 04787
    1244 04787
    1245 05218
    1245 05218
    1245 05218.1
    1245 05219
    1245 05219
    1245 05219
    1245 05220
    1245 05220
    1245 05220
    1245 05220
    1245 06573
    1245 06573
    1245 06573
    1245 06573
    1246 07110
    1246 07110
    1247 07626
    1247 07626
    1247 07626
    1247 07626
    1247 07818
    1247 07818
    1248 06288
    1248 07048
    1248 07048
    1248 07048
    1248 07048
    1249 05929
    1249 05929
    1249 05929
    1249 05929
    1249 08492
    1249 08492
    1250 05210
    1250 05210
    1250 05210
    1250 05210
    1250 05211
    1250 05211

    1 FATIGUE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1
    2
    3
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 GASTRIC - PEPTIC ULCER/GERD
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    Page 158

    Claims Data

    1250 05211
    1250 05211
    1250 05211
    1250 05211.1
    1251 04128
    1251 04128
    1251 04128
    1251 04128.1
    1251 04128.1
    1251 07074
    1251 07074
    1251 07650
    1251 07650
    1251 07651
    1251 07825
    1252 04302
    1252 04302
    1252 04302
    1252 04302
    1252 04302
    1252 04302.1
    1253 05773
    1253 05773
    1253 05773
    1253 07652
    1253 07652
    1253 07652
    1254 07061
    1255 05202
    1255 05202
    1256 05198
    1256 05198
    1256 05198
    1256 05198
    1257 06559
    1257 07621
    1257 07621
    1258 03763
    1258 03763
    1258 05222
    1258 06132
    1258 06132
    1258 06287
    1258 06287
    1258 06287
    1259 07075
    1259 07075
    1259 07075
    1260 08370
    1260 08370

    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1
    2
    3
    1
    2
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 VISION CARE
    2 VISION CARE
    1 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 OTITIS - EAR
    1 ENDOMETROSIS
    2 ENDOMETROSIS
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA
    1 PROSTATE
    2 PROSTATE

    Page 159

    Claims Data

    1261 07063
    1261 07063
    1262 05758
    1262 05758
    1262 05758.1
    1262 07813
    1263 05759
    1263 05759
    1263 05759
    1263 06555
    1263 06555
    1263 06555
    1263 06611
    1264 08473
    1265 05767
    1265 05767
    1266 04126
    1266 04126
    1266 04126
    1266 04127
    1266 04127
    1267 04007
    1267 04007
    1267 04008
    1267 04008
    1267 04008
    1267 07070
    1267 07070
    1267 07070
    1267 07070
    1267 08366
    1267 08366
    1267 08366
    1267 08366.1
    1268 03903
    1268 03903
    1268 04002
    1268 04002
    1268 04002
    1269 06296
    1269 06296
    1269 06296
    1269 07633
    1269 07633
    1269 07633
    1269 07633
    1270 04560
    1270 04561
    1270 04561
    1270 04561

    1 VISION CARE
    2 VISION CARE
    1 INGROWING TOE NAIL
    1 INGROWING TOE NAIL
    1 OVARIAN CYST
    1 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 FEVER
    2 FEVER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 HEMORRHOIDS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    Page 160

    Claims Data

    1270 05263
    1270 05263
    1270 05263
    1270 05263
    1270 05263
    1270 05263.1
    1270 05263.1
    1270 05263.1
    1270 05264
    1270 05264
    1270 05475
    1270 05475
    1270 07117
    1270 07117
    1270 07117
    1271 06906
    1271 06906
    1271 06906
    1272 04564
    1272 04564
    1272 04564
    1273 03646
    1273 03646
    1273 03646
    1273 03647
    1273 03647
    1273 03647
    1274 04397
    1274 04397
    1274 04397
    1274 07873
    1274 07873
    1274 07873
    1275 04398
    1275 04398
    1275 04398
    1275 04399
    1275 05996
    1275 05996
    1275 05996
    1275 05996
    1275 05996
    1275 08105
    1275 08105
    1276 03618
    1276 03618
    1276 03618
    1276 03618
    1276 03618
    1276 03618.1

    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 TENDONITIS
    2 TENDONITIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    1
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    4 PROSTATE
    5 PROSTATE
    1
    2
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    4 KNEE INTERNAL DERANGEMENT
    5 KNEE INTERNAL DERANGEMENT
    1 KNEE INTERNAL DERANGEMENT

    Page 161

    Claims Data

    1276 03618.1
    1276 03618.1
    1276 03618.1
    1277 04563
    1277 04563
    1277 04563
    1277 04563
    1277 05477
    1277 05477
    1277 05477
    1277 05478
    1277 05478
    1277 05478
    1277 05478
    1277 05478
    1277 07329
    1277 07329
    1277 07329
    1277 07329
    1277 07869
    1277 07869
    1277 07869
    1278 05994
    1278 05994
    1278 05994
    1278 05994
    1278 05994
    1279 06753
    1279 06753
    1280 04562
    1280 04562
    1280 04562
    1280 04562
    1280 04562
    1280 04562.1
    1280 04562.1
    1280 05476
    1280 05476
    1281 03648
    1281 03648
    1281 04396
    1281 04396
    1281 04396
    1282 03558
    1282 03558
    1282 03558
    1282 03558.1
    1282 03558.1
    1282 03558.1
    1282 03558.1

    2 KNEE INTERNAL DERANGEMENT


    3 KNEE INTERNAL DERANGEMENT
    4 KNEE INTERNAL DERANGEMENT
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    5 BRONCHITIS - ACUTE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    4 PROSTATE
    5 PROSTATE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 FEVER
    2 FEVER
    3 FEVER
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    4 KNEE INTERNAL DERANGEMENT

    Page 162

    Claims Data

    1282 04626
    1282 04626
    1282 04626
    1282 04626
    1282 07870
    1282 07870
    1282 07870
    1282 07870.1
    1283 04677
    1283 04677
    1283 04677
    1283 04677
    1283 04677
    1283 04677.1
    1283 04678
    1283 04678
    1283 04679
    1283 04679
    1283 05266
    1283 05266
    1283 07119
    1283 07119
    1283 07119
    1283 07119
    1283 07120
    1283 07120
    1284 05298
    1284 05298
    1284 05298
    1284 05298.1
    1284 05298.1
    1284 05298.1
    1285 06866
    1285 06866
    1286 04680
    1286 04680
    1287 06010
    1287 06257
    1287 06257
    1287 07330
    1287 07330
    1288 06484
    1288 06484
    1289 08321.1
    1289 08321.1
    1289 08321.1
    1289 08321.1
    1290 03911
    1291 08102
    1291 08102

    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1
    2
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 ALOPECIA
    2 ALOPECIA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    2 HEART
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DEPRESSION
    2 DEPRESSION
    1
    1 VISION CARE
    2 VISION CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1
    1 VISION CARE
    2 VISION CARE

    Page 163

    Claims Data

    1291 08102
    1292 08098
    1292 08098
    1292 08099
    1292 08099
    1292 08099
    1292 08099
    1293 07871
    1293 07872
    1293 07872
    1294 05480
    1294 05480
    1294 05480
    1294 05995
    1294 05995
    1294 05995
    1295 05268
    1295 05268
    1295 05268
    1296 03559
    1296 03559
    1296 04565
    1296 04565
    1296 04565
    1296 04566
    1296 04566
    1296 04566
    1296 05479
    1296 08103
    1296 08103
    1296 08103
    1296 08104
    1296 08104
    1296 08104
    1297 05993
    1297 05993
    1298 06009
    1299 03910
    1299 03910
    1299 03910
    1299 03910
    1299 03910
    1299 05269
    1299 05269
    1300 04906
    1300 04906
    1300 04906
    1300 04906
    1300 07414
    1300 07414

    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 BACK PAIN
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 BONE & CARTILAGE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 EYE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1
    2
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL

    Page 164

    Claims Data

    1301 03912
    1301 05682
    1302 05023
    1302 07529
    1302 08006
    1302 08006
    1302 08006.1
    1302 08006.1
    1303 03495
    1303 03495
    1303 03495
    1303 03909
    1303 03909
    1303 03909
    1303 06752
    1303 06752
    1303 06752
    1304 04318
    1304 04907
    1304 07077
    1304 07077
    1304 07077
    1305 06867
    1305 06867.1
    1305 06867.2
    1305 06867.2
    1306 04447
    1306 04447
    1306 04447
    1306 06750
    1306 06751
    1306 06751
    1307 08374
    1307 08374
    1307 08374
    1308 08008
    1309 05299
    1309 05299
    1309 05299
    1309 05299.1
    1309 05299.1
    1310 04097
    1311 05827
    1311 05827
    1311 05827
    1311 05828
    1311 05829
    1311 05829
    1311 05829
    1311 05829

    1
    1 SKIN - ATOPIC DERMATITIS
    1 ARTHRITIS
    1 BACK PAIN
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 RECTAL ABCESS
    2 RECTAL ABCESS
    3 RECTAL ABCESS
    1
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 DIAB'ETES
    1 CANDIDIASIS
    1 ANXIETY
    2 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1
    2
    3
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1
    2
    3
    4

    Page 165

    Claims Data

    1312 05267
    1312 05681
    1312 06526
    1312 06527
    1312 06527
    1312 06527
    1312 06527
    1312 06527.1
    1312 06527.1
    1312 07562
    1312 07563
    1313 06528
    1313 06528
    1313 06528
    1313 06528
    1313 06528
    1314 05997
    1314 05997
    1314 05997
    1315 08158
    1315 08158
    1316 03561
    1316 06241
    1317 06242
    1317 06242
    1317 06242
    1318 04681
    1318 04681
    1319 03560
    1319 03560
    1319 03560
    1319 03560
    1319 04682
    1319 04682
    1319 04682
    1319 04991
    1319 04991
    1319 04991
    1319 08292
    1319 08292
    1319 08292
    1320 03563
    1320 03563
    1320 03563.1
    1320 03564
    1320 03564
    1320 03564
    1320 03564.1
    1320 03564.1
    1320 03564.1

    1 INTESTINAL COLIC
    1 INTESTINAL COLIC
    1 GASTRIC - PEPTIC ULCER/GERD
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 DIAB'ETES
    2 DIAB'ETES
    1 MISCARRIAGE
    1 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 SKIN - ATOPIC DERMATITIS
    1
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 CHOSTOCHRONDITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS

    Page 166

    Claims Data

    1320 03564.1
    1320 03564.2
    1321 04801
    1321 04802
    1321 04802
    1321 04802
    1321 07128
    1321 07128
    1321 07128
    1322 05645
    1322 05645
    1322 05645
    1322 05645
    1322 05645
    1322 05645.1
    1322 05645.1
    1322 05645.1
    1322 05645.1
    1322 05645.1
    1322 07122
    1322 07122
    1322 07123
    1322 07123
    1322 07123
    1322 05645,2
    1322 05645,2
    1323 03967
    1323 07124
    1323 07124
    1323 07124
    1323 07125
    1324 05393
    1324 05393
    1324 05393
    1324 05393.1
    1324 05393.1
    1324 05393.2
    1324 05393.2
    1324 05393.2
    1324 05393.2
    1324 05393.23
    1324 05393.23
    1325 05392
    1325 05392
    1325 05392
    1325 08108
    1325 08108
    1326 03562
    1326 03562
    1326 04797

    4 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 INFECTION THUMB
    2 INFECTION THUMB
    3 INFECTION THUMB
    1 DIAB'ETES
    2 DIAB'ETES
    1 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 GLAUCOMA
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    1 HYPERTENSION
    2 HYPERTENSION
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    4 ANXIETY
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FATIGUE
    2 FATIGUE
    1 HYPERTENSION
    2 HYPERTENSION
    1

    Page 167

    Claims Data

    1326 04798
    1326 04798
    1326 04798
    1326 08106
    1326 08106
    1326 08106
    1326 08106
    1326 08107
    1326 08107
    1326 08107
    1327 03567
    1327 03567
    1328 07126
    1328 07126
    1328 07126
    1329 08113
    1329 08113
    1329 08113
    1330 04076
    1330 04076
    1330 04076
    1331 03620
    1331 03620
    1331 04074
    1331 04074
    1331 04800
    1331 04800
    1331 07127
    1331 07276
    1331 07276
    1331 07276
    1332 03568
    1332 03569
    1332 03569
    1332 03569
    1332 03569
    1333 04075
    1333 04075
    1333 04075.1
    1333 04804
    1333 04804
    1333 04804
    1333 05650
    1333 05650
    1333 05651
    1333 05651
    1333 07279
    1333 07279
    1333 08117
    1333 08117

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 OVARIAN CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1
    2
    1 HEARING LOSS
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    1 CANDIDIASIS
    2 CANDIDIASIS
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS

    Page 168

    Claims Data

    1333 08118
    1333 08119
    1334 05395
    1334 05395
    1335 08120
    1335 08120
    1335 08120
    1336 05401
    1336 05401
    1336 05401
    1337 03566
    1337 03566
    1337 03566
    1337 03566
    1338 08299
    1339 03968
    1339 03968
    1339 03968
    1339 03968
    1340 06485
    1340 06485
    1340 06485
    1340 06485
    1340 06485
    1341 03970
    1341 03970
    1341 05396
    1341 05396
    1341 05396
    1341 05396
    1341 05396.1
    1341 05396.1
    1341 08494
    1341 08494
    1341 08494
    1342 03570
    1342 03570
    1343 05648
    1343 05648
    1343 05648
    1343 05648
    1343 05648
    1343 05648.1
    1343 08293
    1343 08293
    1343 08293
    1343 08293
    1343 08294
    1343 08294
    1343 08295

    1 SKIN - LOCAL INFECTION


    1 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    4 HEADACHE- MIGRAINE TENSION
    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    4 CANDIDIASIS
    5 CANDIDIASIS
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    1 HYPERTENSION
    2 HYPERTENSION
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 HERPES ZOSTER
    2 HERPES ZOSTER
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    3 SOFT TISSUE DISORDERS/DISEASE
    4 SOFT TISSUE DISORDERS/DISEASE
    5 SOFT TISSUE DISORDERS/DISEASE
    1 SOFT TISSUE DISORDERS/DISEASE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 HYPERTENSION

    Page 169

    Claims Data

    1343 08295
    1343 08295
    1343 08295
    1343 08295.1
    1343 08295.1
    1344 03573
    1344 08112
    1344 08112
    1344 08112
    1345 07121
    1345 07121
    1346 03966
    1346 03966
    1346 03966
    1346 03966
    1347 03976
    1347 03977
    1347 03977
    1347 03977
    1347 03977.1
    1347 03977.1
    1347 05402
    1347 08300
    1347 08300
    1347 08300
    1348 05643
    1348 05643
    1348 05643
    1349 03571
    1349 03571
    1349 03571
    1349 03571
    1350 03574
    1350 03575
    1350 03575
    1350 03971
    1350 03971
    1350 03971.1
    1350 03973
    1350 03974
    1350 03975
    1350 03975
    1350 04803
    1350 04803
    1350 04803
    1350 05397
    1350 05397
    1350 05397
    1350 05397.1
    1350 05397.1

    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 ASTHMA
    2 ASTHMA
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    1 THYROID
    2 THYROID
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BREAST DISORDERS
    1 SKIN - LOCAL INFECTION
    1 FEVER
    2 FEVER
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 THYROID
    2 THYROID

    Page 170

    Claims Data

    1350 05649
    1350 05649
    1350 07129
    1350 07129
    1350 08114
    1350 08115
    1350 08115
    1350 08115.1
    1351 05391
    1352 04799
    1352 04799
    1352 04799
    1353 08109
    1354 05047
    1354 05047
    1354 05509
    1354 05509
    1354 05509
    1354 05509
    1354 07278
    1354 07379
    1354 08116
    1354 08116
    1355 06079
    1356 04319
    1356 04319
    1356 04319
    1356 04319
    1356 04319
    1356 04319.1
    1356 07416
    1356 07416
    1356 07416
    1356 07416
    1356 07416
    1357 03765
    1357 03765
    1357 03766
    1357 03766
    1357 04320
    1357 04805
    1357 07883
    1358 04993
    1358 04993
    1358 04993
    1358 04993
    1358 04994
    1358 04994
    1358 04994
    1358 04994

    1 THYROID
    2 THYROID
    1 THYROID
    2 THYROID
    1 THYROID
    1 FEVER
    2 FEVER
    1 DEVIATED NASAL SEPTUM
    1 CHOSTOCHRONDITIS
    1 FEVER
    2 FEVER
    3 FEVER
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    4 HEADACHE- MIGRAINE TENSION
    1 DENTAL CARE
    1 LARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 GLAUCOMA
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1
    2
    1 SKIN - LOCAL INFECTION
    1 DIAB'ETES
    1 DIAB'ETES
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION

    Page 171

    Claims Data

    1358 04994
    1359 03916
    1359 03916
    1359 03916
    1359 03917
    1359 03917
    1359 03917
    1360 05024
    1360 05024
    1360 05024
    1360 05024
    1360 05024
    1360 05025
    1360 05025
    1360 05025
    1360 05025
    1360 05025
    1360 05025.1
    1360 05125
    1360 05125
    1360 05125
    1360 05125
    1361 03913.1
    1361 03913.1
    1362 03914
    1362 03914
    1362 03914
    1362 03915
    1362 03915
    1362 04321
    1362 04321
    1362 06341
    1362 06341
    1362 06907
    1362 06907
    1362 06907
    1363 03767
    1363 03767
    1363 03767
    1364 07419
    1365 03501
    1365 03501
    1365 03501
    1365 03501
    1365 03502
    1365 03502
    1365 03502
    1365 03502
    1365 03502
    1365 06913

    5 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 LARYNGITIS
    2 LARYNGITIS
    3 LARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1
    2
    3
    4
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1
    2
    3
    1 RENAL DYSFUNCTION
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HYPERTENSION

    Page 172

    Claims Data

    1365 06913.1
    1365 06913.2
    1366 04590
    1366 04590
    1366 04590.1
    1366 04590.1
    1366 06179
    1366 06179
    1366 06179
    1366 06179
    1366 07995
    1366 07995
    1367 06868
    1368 08536
    1369 03505
    1369 03505
    1369 03505
    1369 06488
    1369 06488.2
    1369 06488.2
    1369 06488.3
    1370 04571
    1370 04571
    1370 04571
    1371 05964
    1371 05964
    1371 05964
    1372 07787
    1372 07787
    1373 04922
    1373 04922
    1373 05967
    1373 05967
    1373 05967
    1373 05967
    1374 04012
    1374 04012
    1374 04012
    1374 04012.1
    1374 04012.2
    1374 04012.3
    1374 07418
    1374 07418
    1374 07418
    1374 07418
    1375 04913
    1375 04913
    1375 04913
    1375 05543
    1375 05543

    1 HYPERTENSION
    1 ARTHRITIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANAEMIA
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1
    1 ENDOCRINE DISORDERS
    2 ENDOCRINE DISORDERS
    3 ENDOCRINE DISORDERS
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 HYPERTENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 KIDNEY DISEASE
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    3 KIDNEY DISEASE
    4 KIDNEY DISEASE
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 HYPERTENSION
    2 HYPERTENSION

    Page 173

    Claims Data

    1375 06979
    1375 06979
    1375 07421
    1375 07421
    1375 07421
    1375 07422
    1375 07422
    1375 07779
    1376 04017
    1376 04017
    1376 04017.1
    1376 04017.1
    1376 04914
    1376 04914
    1376 04914
    1376 04914
    1376 04914
    1376 06921.1
    1376 06921.1
    1376 06921.1
    1376 06922.1
    1376 06922.1
    1377 05835
    1377 05836
    1377 05836
    1377 05836
    1377 05837
    1377 05837
    1378 07796
    1378 07796
    1378 07796
    1378 07796
    1379 03497
    1379 03497
    1379 03497
    1379 03497
    1379 05707
    1379 05707
    1379 05707
    1379 05707
    1379 05707
    1379 06038
    1379 06038
    1379 06038.1
    1379 06038.1
    1379 06038.2
    1379 06038.2
    1379 06908
    1379 06908
    1379 07776

    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 CHEST PAIN
    2 CHEST PAIN
    1 ARTHRITIS
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1
    2
    1 THROMBOSIS
    2 THROMBOSIS
    3 THROMBOSIS
    4 THROMBOSIS
    5 THROMBOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 LARYNGITIS
    2 LARYNGITIS
    1 EYE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    4 SKIN - ECZEMA
    5 SKIN - ECZEMA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE

    Page 174

    Claims Data

    1379 07776
    1379 07776
    1379 08031
    1379 08031
    1379 08031
    1379 08031.1
    1379 08031.1
    1379 08597
    1379 08597
    1379 08597
    1379 08597
    1379 08597.1
    1380 04011
    1380 04011
    1380 04011
    1381 07788.2
    1381 07788.2
    1381 07788.2
    1381 07788.3
    1381 07788.3
    1382 05965
    1382 08301
    1383 04568
    1383 04568
    1384 04567
    1384 04567
    1384 05403
    1384 05403
    1384 05403
    1384 06909
    1384 06909
    1384 06909
    1384 07417
    1384 07417
    1384 07417.1
    1384 07955
    1384 08566
    1384 08566
    1385 05407
    1385 05407
    1385 05407
    1385 05407
    1386 04572
    1386 04572
    1386 04572
    1386 04572
    1386 04572
    1386 05415
    1386 07425
    1386 07425

    2 VISION CARE
    3 VISION CARE
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    1 SKIN - ATOPIC DERMATITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 CATARACT
    2 CATARACT
    3 CATARACT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    2 EYE DISORDER
    2 EYE DISORDER
    1 ANAEMIA
    2 ANAEMIA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DIAB'ETES
    1 CATARACT
    2 CATARACT

    Page 175

    Claims Data

    1387 05417
    1388 04020
    1388 04020
    1388 04020
    1389 04919
    1389 04919
    1390 04019
    1390 04019
    1390 04019
    1391 03082
    1391 03082
    1391 03082
    1391 03082
    1391 03082
    1391 03082.1
    1391 06893
    1391 06893.1
    1392 06925
    1392 06925
    1392 06926
    1392 06926
    1393 03500
    1393 03500
    1393 04013
    1393 04014
    1393 04912
    1393 06260
    1393 06911
    1393 07420
    1393 07778
    1393 07778
    1394 07828
    1394 07828
    1394 07828
    1394 07828.1
    1394 07828.1
    1394 07828.1
    1394 07828.1
    1395 07429
    1395 07430
    1395 07430
    1395 07430
    1395 08537
    1396 05419
    1396 05419
    1396 05419
    1396 05419
    1396 05419
    1396 05419.1
    1396 05419.1

    1 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    3
    4
    5
    1
    2 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    1 VISION CARE
    1 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    4 CIRCULATORY DISORDER
    5 CIRCULATORY DISORDER
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER

    Page 176

    Claims Data

    1396 05419.1
    1396 05419.1
    1396 05844
    1396 05844
    1396 05844
    1396 05844
    1396 05844
    1396 05844.1
    1396 05844.1
    1396 05844.1
    1396 05844.1
    1396 05844.1
    1397 03504
    1398 04918
    1398 04918
    1398 04918
    1398 04918
    1398 04918
    1398 04918.1
    1398 05839
    1398 05839
    1398 05839
    1398 05839
    1398 05839.1
    1398 06263
    1398 06263
    1398 06263
    1398 07830
    1398 07830.1
    1398 07830.2
    1398 07830.2
    1399 05410
    1399 05411
    1399 06261
    1399 06261
    1399 07884
    1399 07884
    1399 07884
    1399 07884
    1399 07884
    1399 07884.1
    1400 04910
    1400 04910
    1400 04910
    1400 04910
    1400 05405
    1400 06259
    1400 06259
    1401 06927
    1401 06927

    3 CIRCULATORY DISORDER
    4 CIRCULATORY DISORDER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 OTITIS - EAR
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 DIAB'ETES
    1
    2
    3
    4
    1 DIAB'ETES
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 MUSCULAR PAIN
    1 BURSITIS
    1 DIAB'ETES
    2 DIAB'ETES
    1 DILATION & CURRETAGE
    1 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    2 FEVER

    Page 177

    Claims Data

    1401 06927
    1401 06927
    1402 04016
    1403 05414
    1403 05414
    1403 05414
    1403 06264
    1403 06264
    1404 05830
    1405 05833
    1405 05833
    1405 05833
    1406 03498
    1406 03499
    1406 03499
    1406 03499
    1407 05843
    1408 04921
    1408 04921
    1409 04569
    1409 04569
    1410 04025
    1410 04025
    1410 04025
    1410 06928
    1411 04015
    1411 04015
    1412 07423
    1412 07423
    1412 07423
    1413 05404
    1413 05404
    1413 07775
    1414 04576
    1414 04576
    1415 07780
    1415 07780
    1416 06269
    1417 06919
    1417 06919
    1417 06919
    1417 06919
    1417 06919
    1418 05832
    1419 04023
    1419 05416
    1419 05416
    1419 07786
    1419 07786
    1420 04920

    3 FEVER
    4 FEVER
    1 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 ARTHRITIS
    2 ARTHRITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 MISCARRIAGE
    1 BACK PAIN
    2 BACK PAIN
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 HEART
    2 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1
    1 EYE DISORDER
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE

    Page 178

    Claims Data

    1420 04920
    1420 07785
    1421 07795
    1421 07795
    1422 05418
    1422 05418
    1423 06258
    1423 06258
    1423 06258
    1424 06918
    1424 06918
    1424 06918
    1425 03506
    1425 04209
    1425 04209
    1425 04209
    1425 04209
    1425 04209.1
    1425 04209.1
    1425 04209.1
    1425 04401
    1425 04401
    1425 04401
    1425 04401
    1425 04402
    1425 04402
    1425 04402
    1425 04402
    1425 05482
    1425 05482
    1425 05483
    1425 05484
    1425 06267
    1425 06268
    1425 06298
    1425 06298
    1425 07532
    1425 07532
    1425 07532
    1425 07532.1
    1425 07791
    1425 07791
    1425 07791.1
    1425 07791.1
    1425 07791.2
    1425 07793
    1425 07794
    1425 08303
    1426 03768
    1426 03768

    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BEHAVIOURIAL PROBLEMS
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DILATION & CURRETAGE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 PROSTATE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    Page 179

    Claims Data

    1426 03768
    1427 05225
    1427 05225
    1428 05840
    1428 05840
    1429 04573
    1429 04573
    1429 04573
    1429 04574
    1429 04755
    1429 04755
    1429 07426
    1429 07426
    1429 07426
    1429 07426
    1429 07426
    1429 07426.1
    1429 07426.1
    1429 07427
    1429 07427
    1429 07427
    1430 06923
    1430 06923
    1430 06923
    1431 06910
    1431 06910
    1432 07424
    1433 04911
    1434 04018
    1434 04018
    1434 04018
    1434 04018
    1435 04862
    1435 04862
    1435 04862.1
    1435 05412
    1435 05412
    1435 05412.1
    1436 06912
    1436 06912
    1437 05831
    1437 05831
    1437 05831
    1437 05831
    1438 04024
    1438 04024
    1438 04630
    1438 04630
    1438 04630
    1438 05841

    3 DENTAL CARE
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEART
    2 HEART
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    5 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE
    1 ABSCESS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEPRESSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ANXIETY

    Page 180

    Claims Data

    1438 05841
    1438 05841.1
    1438 05841.1
    1438 05842
    1438 05842
    1438 06688
    1439 07783
    1439 07783
    1440 05966
    1440 05966
    1440 06487
    1440 06487
    1440 06487
    1440 06487
    1441 07826
    1441 07826
    1441 08030
    1441 08030
    1441 08030
    1441 08030
    1441 08030
    1441 08030.1
    1442 06686
    1442 06686
    1442 06686
    1443 06924
    1443 07957
    1443 07957
    1444 04864
    1444 04864
    1444 04864
    1445 05406
    1445 05406
    1445 05406
    1446 05224
    1446 05224
    1447 06687
    1447 07781
    1448 03769
    1448 04570
    1448 04570
    1448 04683
    1448 04683
    1448 04683
    1448 04684
    1448 04684
    1448 04684
    1448 04861
    1448 05408
    1448 05408

    2 ANXIETY
    1 DIAB'ETES
    2 DIAB'ETES
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    4 GLAUCOMA
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    5 BRONCHITIS - ACUTE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    1 HYPERTENSION
    1 DEPRESSION
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEPRESSION
    1 DEPRESSION
    2 DEPRESSION

    Page 181

    Claims Data

    1448 06917
    1449 03770
    1449 03770
    1449 03770
    1449 03770
    1449 03770
    1449 03770.1
    1449 04400
    1449 04400
    1449 04400
    1449 04400
    1450 04629
    1450 04629
    1450 04629
    1451 06266
    1451 06266
    1451 06266
    1452 04130
    1452 04130
    1452 04130
    1452 04130
    1453 07784
    1453 08538
    1454 05413
    1454 05413
    1455 04863
    1456 04636
    1456 04636
    1456 04636
    1456 04636
    1456 04637
    1456 04637
    1456 06932
    1456 06932
    1456 06932
    1456 06933
    1456 06933
    1456 06933
    1456 06933
    1457 04806
    1457 04806
    1457 05066
    1457 07658
    1457 07996
    1457 07996
    1457 08160
    1457 08160
    1458 04807
    1458 04807
    1458 04807

    1 DEPRESSION
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1
    2
    3
    4
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 MISCARRIAGE
    1 MISCARRIAGE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    1 INGROWING TOE NAIL
    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    Page 182

    Claims Data

    1458 04807
    1458 07489
    1459 04635
    1459 04635
    1459 04635
    1459 05164
    1459 05164
    1459 05164
    1459 05164
    1459 05849
    1459 05849
    1459 06014
    1459 06014
    1459 06014
    1459 06014
    1459 06014
    1459 06689
    1459 06689
    1459 06689
    1459 06691
    1459 06691
    1459 06691
    1459 06691
    1459 06934
    1459 06934
    1459 06934
    1459 06934
    1459 07660
    1459 07660
    1459 07660
    1459 07833
    1459 07833
    1459 07997
    1459 07997
    1459 08601
    1459 08601
    1460 05067
    1460 05067
    1460 05067
    1460 05067
    1461 05345
    1461 05345
    1461 05345
    1461 05345
    1462 05343
    1462 05343
    1462 05343
    1462 05344
    1462 05344
    1462 05344

    4 BACK PAIN
    1 DENTAL CARE
    1
    2
    3
    1 INFECTION - MALE GENITAL
    2 INFECTION - MALE GENITAL
    3 INFECTION - MALE GENITAL
    4 INFECTION - MALE GENITAL
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1
    2
    3
    4
    5
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    1 GENERAL PAIN
    2 GENERAL PAIN
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    Page 183

    Claims Data

    1463 04026
    1463 04026
    1463 04027
    1463 04027
    1463 04027
    1463 04029
    1463 04029
    1463 04029
    1463 04029
    1463 04631
    1463 04631
    1463 04631
    1463 04631.1
    1463 04631.1
    1463 04631.1
    1463 04631.2
    1463 04631.2
    1463 04631.2
    1463 04724
    1463 04724
    1463 04724
    1463 04724
    1463 04724
    1463 04724.1
    1463 04724.1
    1463 05458
    1463 05458
    1463 05458
    1463 05458
    1464 04865
    1464 04865
    1464 04865
    1464 04865
    1464 04865
    1464 05026
    1464 05026
    1464 05026
    1464 05026
    1464 05026
    1464 05457
    1464 05457
    1464 06301
    1464 06301
    1464 06301
    1464 06301
    1464 06931
    1464 07381
    1464 08272
    1465 03773
    1465 03773

    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    5 TONSILLITIS
    1 SINUSITIS
    2 SINUSITIS
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    5 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 DENTAL CARE
    1 DENTAL CARE
    1 DIAB'ETES
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    Page 184

    Claims Data

    1465 03773
    1465 03773
    1465 06013
    1465 06013
    1465 06013
    1465 06739
    1465 06739
    1465 06739
    1465 06739
    1465 06739
    1466 04322
    1466 04324
    1466 04324
    1466 06302
    1466 06302
    1466 06302
    1466 07130
    1466 07130
    1466 07130
    1466 07130
    1466 07131
    1466 07131
    1466 07131
    1466 07131
    1467 05346
    1467 05346
    1467 05346
    1467 05346
    1467 05346
    1467 05346.1
    1467 05346.2
    1467 07132
    1467 07659
    1468 04995
    1468 04995
    1468 05274
    1468 05274
    1468 05274
    1468 07832
    1468 07832
    1468 07832
    1468 07832
    1468 07832
    1468 07832.1
    1469 04632
    1469 04632
    1469 04632
    1469 04632
    1469 04633
    1469 04633

    3 DEVIATED NASAL SEPTUM


    4 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 OBESITY
    1 HEMATURIA
    2 HEMATURIA
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 OBESITY
    2 OBESITY
    3 OBESITY
    4 OBESITY
    1
    2
    3
    4
    5
    1
    1 DIAB'ETES
    1
    1 HYPERTENSION
    1 HERPES ZOSTER
    2 HERPES ZOSTER
    1 PNEUMONIA
    2 PNEUMONIA
    3 PNEUMONIA
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER

    Page 185

    Claims Data

    1469 04633
    1469 04634
    1469 04634
    1469 04634
    1469 05848
    1469 05848
    1469 05848
    1469 08161
    1469 08162
    1470 04030
    1470 04030
    1470 04030
    1470 04030
    1470 06741
    1470 06741
    1470 06741
    1471 05068
    1471 05068
    1471 05068
    1472 05064
    1472 05064
    1472 05064
    1473 05065
    1473 05065
    1473 05065
    1473 05456
    1473 05456
    1473 05456
    1474 06299
    1474 06299
    1474 06299
    1474 06299
    1474 06935
    1474 06935
    1474 06935
    1475 07657
    1475 07657
    1475 07657
    1475 07657
    1476 05846
    1476 05846
    1476 05846
    1477 08600
    1477 08600
    1477 08600
    1478 07488
    1478 07488
    1479 07831
    1479 07831
    1479 07831

    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ASTHMA
    1 SINUSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    3
    4
    1 NASAL POLYP
    2 NASAL POLYP
    3 NASAL POLYP
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 FEVER
    2 FEVER
    3 FEVER

    Page 186

    Claims Data

    1479 07831
    1480 03771
    1481 07331
    1481 07331
    1481 07331
    1482 03599
    1482 03599
    1482 03599
    1483 05354
    1483 05354
    1483 07336
    1483 07336
    1483 08391
    1483 08391
    1484 05352
    1484 05352
    1484 05352
    1485 04651
    1485 04651
    1486 04325
    1486 04325
    1486 04325
    1486 05351
    1486 05351
    1486 05351
    1486 05351
    1487 08033
    1487 08033
    1487 08033
    1487 08033
    1488 04144
    1488 04144
    1488 04144
    1488 06826
    1488 06827
    1488 06827
    1488 06827
    1488 08390
    1489 05353
    1490 06082
    1490 06082
    1491 04146
    1491 04146
    1491 04146
    1491 04146
    1492 03601
    1492 03601
    1492 03601
    1492 07247
    1492 07247

    4 FEVER
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 VISION CARE
    2 VISION CARE
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 HORMONE REPLACMENT THERAPY
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    1 MISCARRIAGE
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 TONSILLITIS
    2 TONSILLITIS

    Page 187

    Claims Data

    1492 07248
    1492 07248
    1492 07248
    1492 07248
    1492 07334
    1492 07334
    1492 07334
    1492 07334
    1492 07334.1
    1492 07334.1
    1492 07334.1
    1493 04326
    1493 04326
    1493 04326
    1493 07332
    1493 07332
    1493 07333
    1493 07333
    1493 07333
    1493 07333
    1494 06830
    1494 06830
    1494 06830
    1495 04650
    1495 04650
    1495 04650
    1496 05349
    1496 05349
    1496 05350
    1496 05350
    1496 05350
    1496 05350
    1497 03602
    1498 03603
    1498 03603
    1498 03603
    1498 03603
    1498 06083
    1499 04147
    1499 04147
    1499 04147
    1499 04147
    1499 04147
    1499 07337
    1499 07337
    1500 03597
    1500 03597
    1500 03597
    1500 03598
    1500 03598

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1
    2

    Page 188

    Claims Data

    1500 06489
    1500 06489
    1500 06489
    1500 06490
    1500 06490
    1500 06490
    1501 03595
    1501 03595
    1501 03596
    1501 03596
    1501 03596
    1502 05485
    1502 05485
    1502 05485
    1502 05485
    1503 04926
    1503 04926
    1503 04926
    1503 04926
    1503 04926.1
    1503 04926.1
    1504 04832
    1504 04832
    1504 04832
    1505 03926
    1505 03926
    1505 06309
    1505 06309
    1505 06310
    1505 06310
    1505 06310
    1505 06310
    1505 06310
    1505 07302
    1505 07303
    1505 07303
    1505 07303
    1506 07304
    1506 07304
    1506 07304
    1506 07304
    1506 08015
    1506 08015
    1507 05333
    1507 05333
    1508 03660
    1508 03660
    1508 03660
    1508 03660
    1508 03661

    1 CYSTITIS
    2 CYSTITIS
    3 CYSTITIS
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    3
    4
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 HEART
    2 HEART
    1 CHEST PAIN
    2 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    5 CHEST PAIN
    1 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART
    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    4 SKIN - LESION
    1 EYE DISORDER
    2 EYE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE

    Page 189

    Claims Data

    1508 03661
    1508 03662
    1508 03662
    1509 06585
    1509 06585
    1509 06585
    1509 06585
    1509 06588
    1509 06588
    1509 06588
    1509 06588
    1509 07564
    1509 07564
    1509 07564
    1509 07564
    1509 07564
    1509 07564.1
    1509 07564.1
    1509 07564.1
    1509 07564.1
    1510 08011
    1510 08012
    1510 08012
    1510 08012
    1510 08012
    1510 08012.1
    1510 08012.1
    1511 05030
    1511 05031
    1511 05031
    1512 06590
    1512 06590
    1512 06590
    1512 06590
    1512 06590
    1512 06590.1
    1512 08014
    1512 08014
    1512 08014
    1513 03663
    1513 04834
    1513 04834
    1513 04834
    1513 06308
    1513 07799
    1514 04078
    1514 04078
    1514 07305
    1515 07288
    1515 07288

    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    4 KNEE INTERNAL DERANGEMENT
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    3 PAINFUL LEGS
    4 PAINFUL LEGS
    5 PAINFUL LEGS
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    3 PAINFUL LEGS
    4 PAINFUL LEGS
    1 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 BASAL CELL CARCINOMA
    2 BASAL CELL CARCINOMA
    1 CONJUNCTIVITIS - EYE
    1 VISION CARE
    2 VISION CARE
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 BONE & CARTILAGE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE

    Page 190

    Claims Data

    1515 07288.1
    1515 07288.1
    1516 03664
    1516 03664
    1516 03664
    1517 06002
    1517 06002
    1517 06002
    1517 06002
    1517 06002
    1518 03509
    1518 03509
    1518 03927
    1518 03927
    1518 03927
    1518 03927
    1518 03927
    1518 03928
    1518 03928
    1518 03928
    1518 03928
    1518 05332
    1518 05332
    1518 05332
    1519 03930
    1519 04833
    1519 06311
    1519 07798
    1520 05029
    1520 05029
    1521 04426
    1522 06801
    1523 06001
    1523 06001
    1523 06001
    1523 06800
    1523 06800
    1523 06800
    1523 06800
    1524 03508
    1524 04425
    1525 04333
    1525 04333
    1525 04334
    1525 04334
    1525 04334
    1525 04334
    1526 05355
    1526 06086
    1527 05669

    1
    2
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 PROSTATE
    2 PROSTATE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    1 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 CANCER-BREAST
    1 CANCER-BREAST
    1 HYPERLIPIDERMIA - CHOLESTEROL

    Page 191

    Claims Data

    1527 05669
    1528 05907
    1528 05907
    1529 03794
    1529 04331
    1529 04331
    1529 05667
    1529 05668
    1529 05668
    1529 05668
    1529 05668
    1530 05902
    1530 05902
    1531 06192
    1531 06192
    1532 05085
    1532 05085
    1533 05309
    1533 05309
    1534 07567
    1534 07567
    1534 07567
    1534 07567
    1534 07568
    1534 07568
    1534 07568
    1534 07568
    1534 07568
    1534 07568.1
    1534 07568.1
    1534 07568.1
    1534 07568.1
    1534 07568.1
    1534 07568.2
    1535 03932
    1535 03932
    1535 03932
    1535 06091
    1535 06091
    1535 06091
    1536 03801
    1536 03801
    1536 03801
    1536 03801
    1536 03801
    1537 07904
    1537 07904
    1538 05356
    1539 03931
    1539 03931

    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    1 STONE - URETER
    1
    2
    1 STONE - URETER
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 HEART
    2 HEART
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    Page 192

    Claims Data

    1539 03931
    1539 04335
    1539 04335
    1539 04335
    1539 04335
    1540 05670
    1540 05670.1
    1540 05670.1
    1540 05670.1
    1540 07249
    1540 07249
    1540 07249
    1540 07250
    1540 07250
    1540 07250
    1540 07250
    1540 07250
    1540 07250.1
    1540 07250.1
    1541 04837
    1541 06942
    1542 05909
    1543 05359
    1543 05359
    1543 05359
    1544 07572
    1544 07572
    1545 03798
    1545 03798
    1545 03798
    1545 03798
    1545 03798
    1545 03800
    1545 03980
    1545 03980
    1545 04835
    1545 04836
    1545 05903
    1545 05903
    1545 06938
    1545 06938
    1545 06938
    1545 06938
    1545 06938
    1545 06939
    1545 06939
    1545 07843
    1545 07843
    1546 06088
    1547 03796

    3 DEVIATED NASAL SEPTUM


    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    4 COUGH - AIRWAY OBSTRUCTION
    1 CATARACT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CYSTITIS
    2 CYSTITIS
    3 CYSTITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1
    1 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1
    1 HEART
    2 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 DIAB'ETES
    1 HEART
    2 HEART
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 HEART
    2 HEART
    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    1 VISION CARE

    Page 193

    Claims Data

    1547 03796
    1547 03796
    1547 06343
    1547 06343
    1547 06343
    1547 07905
    1547 07905
    1547 07905
    1547 07905
    1547 07905
    1547 07905.1
    1548 07844
    1548 07844
    1548 07844
    1548 07844
    1549 08618
    1549 08618
    1549 08618
    1550 04344
    1550 04344
    1550 04345
    1550 04345
    1550 04345
    1550 04345
    1550 04345
    1550 04345.1
    1550 05360
    1550 05360
    1550 05361
    1550 05361
    1550 07575
    1550 07575
    1551 04659
    1551 04659
    1551 04659
    1551 04659
    1551 04659
    1551 04659.1
    1552 06090
    1552 06090
    1552 06090
    1552 06090
    1553 03978
    1553 03978
    1553 03979
    1554 07573
    1554 07573
    1554 07573
    1554 07573
    1554 07573

    2 VISION CARE
    3 VISION CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    1
    2
    3
    1 HEART
    2 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEART
    2 HEART
    1
    2
    3
    4
    5
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ALLERGIC RHINITIS
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    5 VARICOSE

    Page 194

    Claims Data

    1555 03983
    1555 03983
    1555 03983.1
    1555 03983.1
    1555 05908
    1555 05908
    1555 05908.1
    1556 03982
    1556 03982
    1557 07571
    1557 07571
    1557 07571
    1558 03795
    1558 03795
    1558 03795
    1558 03795
    1558 03795
    1558 03795.1
    1558 05899
    1558 05899
    1558 05899
    1558 05899
    1558 05899
    1558 05899.1
    1558 05899.1
    1558 05900
    1558 05900
    1558 05900
    1558 05901
    1558 05901
    1558 05901
    1558 05901
    1559 03803
    1559 03803
    1559 03803
    1559 03804
    1559 03804
    1559 03804
    1559 04348
    1559 04348
    1559 04348
    1559 04348
    1559 04349
    1559 04349
    1559 04349
    1559 04349
    1559 04350
    1559 04350
    1559 04350
    1559 04351

    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 OTITIS - EAR
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    4 PSORIASIS
    5 PSORIASIS
    1 PSORIASIS
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    5 ANAEMIA
    1 DEPRESSION
    2 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 BACK PAIN

    Page 195

    Claims Data

    1559 04351
    1559 04351
    1559 04351
    1559 04352
    1559 04352
    1559 04352
    1559 04838
    1559 04838
    1559 04838
    1559 05086
    1559 05086
    1559 05086
    1559 06543
    1559 06543
    1559 06543
    1560 03797
    1561 04685
    1561 04685
    1561 07515
    1561 07515
    1562 07912
    1562 07912
    1562 07912.1
    1563 04336
    1563 04336
    1563 04336
    1563 04336
    1563 04337
    1563 04337
    1563 04337
    1563 04337
    1563 07306
    1563 07306
    1563 07306
    1563 07306
    1563 07306.1
    1563 07306.2
    1563 07306.2
    1563 07306.2
    1564 03510
    1564 03510
    1564 03510
    1564 03510
    1564 04427
    1564 04427
    1564 04427
    1564 04427
    1564 06400
    1564 06400
    1564 06400

    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 VISION CARE
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 CHEST PAIN
    1 FATIGUE
    2 FATIGUE
    3 FATIGUE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS

    Page 196

    Claims Data

    1564 07448
    1564 07448
    1564 07448
    1564 07448
    1565 06087
    1565 06087
    1566 07574
    1566 07574
    1566 07574
    1567 05898
    1567 05898
    1567 05898
    1568 04339
    1568 04339
    1568 06089
    1568 06089
    1569 05906
    1569 05906.1
    1569 05906.1
    1569 05906.1
    1569 05906.1
    1569 07447
    1569 07447
    1569 07447
    1569 07447
    1569 07447
    1570 05357
    1570 05357
    1570 05357
    1570 05357
    1570 05357
    1570 05604
    1570 05604
    1570 05604
    1570 05604
    1571 04343
    1572 04341
    1573 03802
    1573 03802
    1573 03802
    1573 04342
    1573 04342
    1573 04342
    1573 04342
    1573 04342
    1574 04927
    1575 03511
    1575 03511
    1575 03511.1
    1575 04729

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 SINUSITIS
    2 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 HEART
    2 HEART
    1 VISION CARE
    1 RETINOPATY
    2 RETINOPATY
    3 RETINOPATY
    4 RETINOPATY
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1
    2
    3
    4
    5
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 BACK PAIN
    1 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    5 STONE - URETER
    1 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 EAR DYSFUNCTION
    1 GLAUCOMA

    Page 197

    Claims Data

    1575 04730
    1575 05490
    1575 05490
    1575 05491
    1575 05491
    1575 05491
    1575 05491.1
    1575 06492
    1575 06947
    1575 06947
    1575 07916
    1575 07916
    1576 04428
    1577 06003
    1577 06003
    1577 06003
    1577 06003
    1578 08621
    1578 08621
    1578 08621
    1578 08621
    1578 08621
    1578 08621.1
    1579 05285
    1579 05285
    1580 06869
    1580 06869
    1580 06869
    1580 06869
    1580 06870
    1580 06870
    1580 06870
    1580 06870
    1580 06870
    1580 06870.1
    1580 06870.1
    1581 05286
    1581 05286
    1582 07140
    1582 07140
    1583 03665
    1583 03665
    1583 03665
    1583 03665
    1583 03665
    1583 04583
    1583 04583
    1583 04583
    1583 04583
    1583 04584

    1 BONE & CARTILAGE DISORDER


    1 GLAUCOMA
    2 GLAUCOMA
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 DIAB'ETES
    1 GLAUCOMA
    1 HYPERTENSION
    2 HYPERTENSION
    1 GLAUCOMA
    2 GLAUCOMA
    1 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    3
    4
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 ANAEMIA
    1 HYPERTENSION
    2 HYPERTENSION
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    5 ALLERGIC REACTION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ALLERGIC RHINITIS

    Page 198

    Claims Data

    1583 04584
    1583 04584
    1583 04584
    1583 05034
    1583 05034
    1583 05034
    1583 05034
    1583 05034
    1583 05034.1
    1583 05034.1
    1583 05034.1
    1583 05034.1
    1583 05034.1
    1583 05034.2
    1583 05034.2
    1583 05034.2
    1583 05034.2
    1583 05034.2
    1583 05034.3
    1583 05487
    1583 05487
    1583 05487
    1583 06271
    1583 06271.1
    1583 06493
    1583 06493
    1583 07917
    1583 07917
    1584 05239
    1584 07845
    1585 05807
    1585 05807
    1585 05807
    1585 05807
    1586 05237
    1586 05237
    1586 05237.1
    1586 05237.1
    1586 05237.1
    1586 06494
    1586 06494.1
    1586 06494.1
    1586 08549
    1586 08549
    1586 08549.1
    1587 07289
    1587 07289
    1587 07289
    1588 04690
    1588 06701

    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    4 ALLERGIC RHINITIS
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    1 VISION CARE
    2 VISION CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 DIAB'ETES
    1 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 ASTHMA
    2 ASTHMA
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ASTHMA
    2 ASTHMA
    1 ASTHMA
    2 ASTHMA
    1 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    1 VISION CARE

    Page 199

    Claims Data

    1588 06701
    1588 06701
    1589 04267
    1589 04267.1
    1590 04734
    1590 04734
    1590 04734
    1590 04734
    1590 04734
    1590 04734.1
    1590 06194
    1590 06194.1
    1590 06194.1
    1590 06495
    1590 06495
    1591 03667
    1591 03667
    1591 03667
    1591 03668
    1591 03668
    1591 03668
    1591 03668
    1591 04268
    1591 04268
    1591 04268
    1591 04268
    1591 04268
    1591 04268.1
    1591 04353
    1591 04353
    1591 04353
    1591 04353.1
    1591 04354
    1591 04354
    1591 04354.1
    1591 04354.2
    1591 04518
    1591 04518
    1591 05240
    1591 05240
    1591 05240.1
    1591 05241
    1591 05241
    1591 05461
    1591 05461
    1591 05461.1
    1591 05461.2
    1591 05462
    1591 05462
    1591 06835

    2 VISION CARE
    3 VISION CARE
    1 GLAUCOMA
    1 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 DIAB'ETES
    1 ARTHRITIS
    2 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    3 HEART- ISCHEMIC HEART
    4 HEART- ISCHEMIC HEART
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 DEPRESSION
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 HYPERTENSION
    1 DEPRESSION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DIAB'ETES
    2 DIAB'ETES
    1 ASTHMA
    1 HYPERTENSION
    2 HYPERTENSION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 ALLERGIC RHINITIS
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION

    Page 200

    DISEASE
    DISEASE
    DISEASE
    DISEASE

    Claims Data

    1591 06835
    1591 06835
    1591 06835.1
    1591 06835.1
    1591 06835.1
    1592 05242
    1592 07846
    1592 07846
    1592 07846
    1593 07692
    1593 07692
    1593 07692
    1593 08552
    1593 08552
    1593 08552
    1593 08552
    1593 08552
    1593 08552.1
    1594 04693
    1594 04693
    1594 06496
    1594 06496
    1594 06496
    1594 06496
    1594 06496
    1594 08034
    1594 08034
    1594 08034
    1594 08034
    1594 08034
    1594 08034.1
    1595 04736
    1595 04736
    1595 04736
    1595 04736
    1595 04736
    1596 08965
    1596 08965
    1596 08965
    1597 06198
    1598 05554
    1598 05554
    1599 04519
    1599 04519
    1599 04519
    1599 04520
    1599 04520
    1599 04520
    1599 05555
    1600 05464

    2 HYPERTENSION
    3 HYPERTENSION
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 LUNG DISEASE
    2 LUNG DISEASE
    3 LUNG DISEASE
    1 HEART
    1 EAR DYSFUNCTION

    Page 201

    Claims Data

    1600 05464
    1601 03669
    1602 06195
    1602 06195
    1603 04040
    1603 04040
    1603 04040
    1603 04040
    1603 04040
    1603 04040.1
    1603 04040.1
    1603 04040.1
    1603 04040.1
    1603 06834
    1603 07096
    1603 07096
    1603 07096
    1603 08964
    1603 08964
    1604 04036
    1604 04735
    1604 05463
    1604 05551
    1604 05552
    1604 05552
    1604 05808
    1604 05808
    1604 05809
    1604 06049
    1604 06050
    1605 05465
    1605 05465
    1605 05465
    1606 04270
    1606 04271
    1606 04271
    1606 05546
    1606 05546
    1606 05546.1
    1607 06703
    1607 06703
    1607 06703
    1607 06704
    1607 06704
    1607 06704
    1607 07094
    1607 07095
    1607 07095
    1607 08963
    1608 04516

    2 EAR DYSFUNCTION
    1 VISION CARE
    1 ANXIETY
    2 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    1 PAINFUL LEGS
    1 VARICOSE
    1 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    1
    2
    3
    1 CERVICAL SPONDYLOSIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 BACK PAIN
    2 BACK PAIN
    1 RENAL DYSFUNCTION
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    1 HYPERLIPIDERMIA - CHOLESTEROL

    Page 202

    Claims Data

    1608 04516
    1608 04517
    1608 04517
    1609 03875
    1609 03875
    1609 03935
    1609 03935
    1609 03935
    1609 03935
    1609 03935
    1609 04695
    1609 04695
    1609 04695
    1609 04695
    1609 04928
    1609 04928
    1609 04928
    1609 04928
    1610 02539.1
    1611 03512
    1611 03512
    1611 03512
    1611 03512
    1611 03512
    1611 04038
    1611 04038
    1611 04038
    1611 04880
    1611 04880
    1611 04880
    1611 04880
    1611 04880
    1611 04880.1
    1611 04880.1
    1611 05035
    1611 05035
    1611 05035
    1611 05035
    1611 05035
    1611 05035.1
    1611 06047
    1611 06093
    1611 06094
    1611 06095
    1611 06193
    1611 06833
    1611 06833
    1611 06833
    1612 04731
    1612 04731

    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ENDOCRINE DISORDERS
    2 ENDOCRINE DISORDERS
    1 GLAUCOMA
    2 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 CYST
    2 CYST
    3 CYST
    4 CYST
    1 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 PAINFUL LEGS
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 PAINFUL LEGS
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    Page 203

    Claims Data

    1612 04731
    1613 04355
    1614 04691
    1614 04691
    1614 04691
    1615 05243
    1615 05243
    1616 03623
    1616 03623
    1616 07693
    1616 07693
    1617 06197
    1617 06197
    1617 06197
    1618 05861
    1618 05861
    1618 05861
    1618 08961
    1618 08961
    1618 08962
    1618 08962
    1618 08962
    1618 08962
    1619 05549
    1619 05549
    1619 06702
    1619 06702
    1620 07847
    1620 07847
    1620 07847
    1621 05860
    1621 05860
    1622 04732
    1622 04732
    1622 04732
    1622 04732
    1624 05003
    1624 05004
    1624 05004
    1624 08550
    1624 08550
    1625 06832
    1625 06832
    1626 06051
    1626 06051
    1626 06051
    1626 06051
    1627 04692
    1627 04692
    1628 06943

    3 RENAL DYSFUNCTION
    1 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    1 TONSILLITIS
    2 TONSILLITIS
    1 TONSILLITIS
    2 TONSILLITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 RENAL DYSFUNCTION
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    1 BARTHOLIN'S CYST

    Page 204

    Claims Data

    1628 06943
    1629 08966
    1629 08966
    1630 04515
    1630 04515
    1631 07290
    1631 07290
    1631 07290
    1631 07290
    1632 04039
    1632 04039
    1632 04039
    1632 07688
    1632 07688
    1632 07688
    1633 06048
    1633 06048
    1633 06048
    1633 07689
    1633 07689
    1633 07689
    1633 07689
    1633 07689
    1633 07690
    1633 07690
    1633 07690
    1633 07690.1
    1633 07690.1
    1634 07691
    1634 07691
    1634 07691
    1635 05553
    1635 05553
    1635 05553
    1636 05238
    1636 05238
    1636 05238
    1636 05550
    1636 05550
    1637 04689
    1637 04689
    1637 04689
    1637 05547
    1637 05547
    1637 05547
    1637 05548
    1637 05548
    1637 05548
    1638 03625
    1638 03625

    2 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    1
    2
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    3
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 FEVER
    2 FEVER
    3 FEVER
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE

    Page 205

    Claims Data

    1638 03625
    1638 03626
    1638 03626
    1638 03626
    1638 03626
    1638 03626
    1638 03626.1
    1638 03626.1
    1638 03626.1
    1638 03626.1
    1638 03626.2
    1638 03626.2
    1638 03628
    1638 03628
    1638 03628
    1639 05165
    1639 05165
    1639 05165
    1639 05427
    1639 05427
    1640 06497
    1640 06497
    1640 06497
    1641 03624
    1641 03624
    1641 03624
    1642 05166
    1642 05166
    1642 05166
    1642 05166
    1643 03632
    1643 03632
    1643 03632
    1643 03632
    1643 03632
    1643 06053
    1643 06499
    1643 08124
    1643 08124
    1643 08124
    1644 03631
    1644 04041
    1644 04041.1
    1644 04041.1
    1644 04041.1
    1644 04041.1
    1644 04042
    1644 04154
    1644 04155
    1644 04155

    3 VISION CARE
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    5 STONE - URETER
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGY
    2 ALLERGY
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEPRESSION
    1 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    1 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE

    Page 206

    Claims Data

    1644 05167
    1644 05862
    1644 05863
    1644 06498
    1644 07546
    1644 07546
    1644 07547
    1644 07547
    1644 07547
    1644 07547
    1644 07548
    1644 07548
    1644 07549
    1644 07694
    1644 07695
    1644 07695
    1644 07695
    1644 07696
    1644 07696
    1645 08123
    1645 08123
    1646 06052
    1646 06052
    1647 04585
    1647 04585
    1647 04585.1
    1648 03984
    1649 05428
    1649 05864
    1650 05488
    1650 05488
    1650 05488
    1650 05488
    1650 07031
    1650 07031
    1651 06981
    1651 06981
    1651 06981
    1651 06981
    1652 07919
    1652 07919
    1652 07919
    1653 04523
    1653 04523
    1653 04523
    1653 05363
    1653 05363
    1653 05363
    1653 07960
    1653 07960

    1 VISION CARE
    1 DEPRESSION
    1 DENTAL CARE
    1 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DEPRESSION
    1
    2
    3
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 BACK PAIN
    2 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    1 ALLERGIC REACTION
    1 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CYST
    2 CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HEMATURIA
    2 HEMATURIA

    Page 207

    Claims Data

    1653 07960
    1653 07960
    1654 03940
    1654 03940
    1654 03940
    1655 06635
    1655 06635
    1656 08724
    1656 08724
    1656 08724
    1656 08725
    1656 08725
    1656 08725.1
    1657 04283
    1657 04283
    1658 04524
    1658 04524
    1658 04524
    1658 04525
    1658 04525
    1658 08052
    1658 08052
    1658 08052
    1658 08052
    1659 06278
    1659 06278
    1660 03941
    1660 03941
    1660 03941
    1661 08564
    1661 08564.1
    1662 07962
    1662 07962
    1663 03634
    1663 03634
    1663 03634
    1663 03634
    1663 03634
    1663 03635
    1663 03635
    1663 03635
    1663 03635
    1663 07238
    1663 07238
    1663 07238
    1663 08521
    1663 08521
    1663 08521
    1663 08522
    1663 08522

    3 HEMATURIA
    4 HEMATURIA
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 PAIN-BACK/SHOULDER
    1 GLAUCOMA
    2 GLAUCOMA
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CHOSTOCHRONDITIS
    1 THYROID
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    4 CHOSTOCHRONDITIS
    5 CHOSTOCHRONDITIS
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    4 COUGH - AIRWAY OBSTRUCTION
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS

    Page 208

    Claims Data

    1663 08522
    1664 08726
    1664 08726
    1664 08726
    1664 08726
    1665 03636
    1665 05012
    1665 05012
    1665 05012
    1665 05602
    1665 05602
    1665 07398
    1665 07398
    1666 03637
    1667 07965
    1667 07965
    1667 07965
    1667 07965
    1667 07965
    1667 07965.1
    1667 07965.1
    1667 08053
    1667 08053
    1667 08053
    1668 04285
    1668 04285
    1668 07097
    1668 08054
    1668 08054
    1668 08054.1
    1668 08054.1
    1668 08054.1
    1668 08054.1
    1669 03943
    1669 03943
    1669 07968
    1669 07968
    1669 07968
    1669 07968
    1670 07969
    1670 07969
    1670 07969.1
    1670 07969.1
    1670 07970
    1670 07970
    1670 07971
    1670 07971
    1670 08565
    1670 08565
    1670 08565

    3 ALLERGIC RHINITIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    1 AMMENORRHOEA
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    3 SOFT TISSUE DISORDERS/DISEASE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 VISION CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1
    2
    1 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    Page 209

    Claims Data

    1671 03522
    1671 03522
    1671 05036
    1671 05036
    1671 05036
    1672 05364
    1672 06807
    1672 06807
    1673 06015
    1673 06015
    1673 06016
    1673 06016
    1674 04284
    1674 04284
    1674 04284
    1674 04284
    1674 04284
    1675 07963
    1675 07964
    1675 07964
    1676 04989
    1676 04989
    1677 08324
    1677 08594
    1677 08594
    1678 06576
    1678 06576
    1678 08323
    1678 08323
    1678 08323
    1679 04205
    1679 04206
    1679 04206.1
    1679 07773
    1679 07773
    1680 04207
    1680 07774
    1680 07774
    1680 08534
    1681 05683
    1681 05683
    1681 06240
    1681 06240
    1681 06240
    1681 06340
    1682 05935
    1682 05936
    1682 05936
    1683 03605
    1683 03605

    1
    2
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BREAST DISORDERS
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HEART
    1 SINUSITIS
    2 SINUSITIS
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 REMOVAL OF MOLE
    1 DEVIATED NASAL SEPTUM
    1
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 ALLERGIC RHINITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    1
    2
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND
    1 INJURY - OPEN WOUND
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE

    Page 210

    Claims Data

    1683 03605
    1683 03606
    1684 03723
    1684 03723
    1684 03723
    1684 03724
    1684 05729
    1684 05729
    1684 05729
    1684 07089
    1684 07089
    1684 07089
    1684 07089
    1685 03725
    1685 03726
    1685 06624
    1685 06624
    1685 06625
    1685 08233
    1686 05032
    1686 05730
    1686 05730
    1686 05730
    1687 06092
    1687 06092
    1687 06092
    1687 06092
    1687 06626
    1687 06626
    1687 06626
    1687 08518
    1687 08518
    1687 08518
    1687 08518
    1688 04687
    1688 04687
    1688 04687
    1688 04687
    1688 04687
    1688 04687.1
    1688 04687.1
    1688 04687.1
    1688 04687.2
    1688 04687.2
    1688 04688
    1688 04688
    1688 05671
    1688 05671
    1688 07093
    1689 03933

    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 LUPUS
    2 LUPUS
    3 LUPUS
    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 HYPERTENSION
    1 PAIN-BACK/SHOULDER
    1
    2
    1 HYPERTENSION
    1 HYPERTENSION
    1
    1
    2
    3
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND
    4 INJURY - OPEN WOUND
    1 HEART
    2 HEART
    3 HEART
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1
    2
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1 EYE DISORDER
    1 EAR DYSFUNCTION

    Page 211

    Claims Data

    1689 03933
    1689 03933
    1689 07090
    1689 07090
    1689 07090
    1689 08305
    1689 08305
    1690 04686
    1690 04686.1
    1690 04686.2
    1690 07091
    1690 07091
    1690 07092
    1690 07092
    1690 07092
    1690 07092
    1691 03934
    1691 03934
    1691 03934
    1692 06591
    1692 07030
    1692 07030
    1693 06096
    1693 06096
    1693 06096
    1693 06872
    1693 06872
    1694 06873
    1694 06873
    1695 03876
    1695 03876
    1695 03876
    1695 03876
    1695 07918
    1696 04881
    1696 04881
    1697 04882
    1697 04882
    1697 04882
    1698 04212
    1698 04213
    1698 04213
    1698 04213
    1699 06944
    1699 06944
    1699 06944
    1700 07032
    1701 04157
    1701 04157
    1701 04157

    2 EAR DYSFUNCTION
    3 EAR DYSFUNCTION
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    3 PAINFUL HEEL
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 FEVER
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    1 BURSITIS
    2 BURSITIS
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 EYE DISORDER
    2 EYE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ALLERGIC RHINITIS
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    1 CYST
    2 CYST
    3 CYST
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    Page 212

    Claims Data

    1701 04157
    1701 04157
    1701 06097
    1702 07213
    1702 07213
    1703 06274
    1704 05731
    1704 05731
    1704 06275
    1704 06277
    1704 06277
    1704 06277.1
    1704 06277.1
    1704 06804
    1704 06805
    1704 06805
    1704 06805
    1705 07450
    1705 07450
    1705 07450
    1706 07214
    1706 07214
    1706 07214
    1707 05334
    1708 05732
    1708 05732
    1708 05732
    1709 07958
    1709 07958
    1709 07958
    1710 05128
    1710 05128
    1710 05129
    1710 05129
    1710 05129
    1710 07496
    1711 03514
    1711 03514
    1711 03514
    1711 03514
    1712 06595
    1712 06595
    1712 06595
    1712 08036
    1712 08036
    1712 08036
    1713 03515
    1713 03515
    1713 03515
    1713 03515

    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    1 DEPRESSION
    2 DEPRESSION
    1 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    1 DIAB'ETES
    2 DIAB'ETES
    1
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DENTAL CARE
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 DENGUE
    2 DENGUE
    3 DENGUE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS

    Page 213

    Claims Data

    1713 05007
    1713 05008
    1713 05008
    1713 05016
    1713 05016
    1713 06332
    1713 07551
    1713 07551
    1714 08035
    1715 07495
    1715 07495
    1715 07495
    1715 07495
    1716 06345
    1716 06345
    1716 06345
    1716 06345
    1717 06501
    1717 07395
    1717 07396
    1718 07392
    1718 08235
    1718 08235
    1718 08236
    1718 08236
    1718 08236
    1718 08236
    1719 06500
    1719 06500
    1719 06500
    1719 06500.1
    1720 08234
    1720 08234
    1721 07394
    1721 07394
    1721 07394
    1722 08040
    1723 04100
    1723 04100
    1723 04100
    1724 07218
    1724 07218
    1724 07218
    1725 04102
    1725 04102
    1725 04102
    1725 04102
    1725 04102
    1725 07220
    1725 07220

    1 OVARIAN CYST
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 BACK PAIN
    2 BACK PAIN
    1 MUSCULAR PAIN
    1 BACK PAIN
    2 BACK PAIN
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 EYE DISORDER
    1 ALLERGIC RHINITIS
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL

    Page 214

    Claims Data

    1725 07220
    1725 07220.1
    1725 07220.1
    1725 07220.1
    1726 04839
    1726 04839
    1726 04839
    1727 07497
    1727 07497
    1727 07497
    1728 04429
    1728 04429
    1728 04430
    1728 04430
    1728 04430.1
    1728 04431
    1728 05095
    1728 05095
    1728 05095
    1728 05095
    1728 05096
    1728 08626
    1729 03520
    1729 03520
    1729 06630
    1729 06630
    1729 06630
    1729 06631
    1729 06631
    1729 06631
    1730 03939
    1730 03939
    1730 03939
    1730 05097
    1730 05097
    1730 05097
    1730 05097
    1730 05098
    1730 05098
    1730 05100
    1730 05100
    1730 05100
    1730 05100
    1730 05737
    1730 05737
    1730 06836
    1730 06836
    1730 08627
    1730 08627.1
    1730 08627.1

    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 TENDONITIS
    2 TENDONITIS
    3 TENDONITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DEVIATED NASAL SEPTUM
    1 ALLERGIC REACTION
    1
    2
    3
    4
    1 DEPRESSION
    1 DEPRESSION
    1 VISION CARE
    2 VISION CARE
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 TONSILLITIS
    2 TONSILLITIS
    1 EYE DISORDER
    2 EYE DISORDER
    1 EYE DISORDER
    1 VISION CARE
    2 VISION CARE

    Page 215

    Claims Data

    1731 04929
    1731 04929
    1731 04929
    1731 08625
    1732 08720
    1732 08720
    1733 06512
    1733 06512
    1733 06512
    1733 06512
    1733 06512
    1734 05911
    1735 06401
    1735 06401
    1736 05006.1
    1736 05006.1
    1736 05006.1
    1736 05006.1
    1737 04098
    1737 05865
    1737 05865
    1737 05865
    1738 05733.1
    1739 04099
    1739 04099
    1739 04099
    1739 05011
    1739 05011
    1740 06346
    1741 05287
    1742 06842
    1742 06842

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 ALLERGIC REACTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BACK PAIN
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    1 HEART- ISCHEMIC HEART DISEASE
    1 DIAB'ETES
    2 DIAB'ETES

    Page 216

    Claims Data

    SERVICE DESCRIPTION
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PROCEDURE DESCRIPTION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    PROSTATE: TRANSURETHRAL RESECTION

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 217

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 218

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    Page 219

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    PREVENTIVE: DENTAL PROPHYLAXIS

    PROSTATE: TRANSURETHRAL RESECTION

    Page 220

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN

    Page 221

    Claims Data

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN

    COMPLETE EXAMINATION

    Page 222

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: FRAMES

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 223

    Claims Data

    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABDOMEN: GASTROSCOPY, OPERATIVE

    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OP


    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OP
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/P


    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/P

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 224

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    OTHER
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PROSTATE: TRANSURETHRAL RESECTION

    Page 225

    Claims Data

    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    COMPLETE EXAMINATION

    ABDOMEN: CUTTING ABDOMINAL CAVITY EXCEPT AS OTHERWISE SPECI

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    COMPLETE EXAMINATION

    Page 226

    Claims Data

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OTHER
    OTHER
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 227

    Claims Data

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OTHER
    OTHER
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 228

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    Page 229

    Claims Data

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    OTHER
    OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE

    PROSTATE: TRANSURETHRAL RESECTION


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/P
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    JOINT: INCISION FOR DIAG OR TREATMNT-INTRA-ARTICULAR STRUCTUR

    Page 230

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OTHER

    Page 231

    Claims Data

    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    MATERIALS: CONTACT, MEDICALLY REQUIRED

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    Page 232

    Claims Data

    PHYSIOTHERAPY
    OTHER
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSIOTHERAPY
    OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA

    Page 233

    Claims Data

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    OTHER
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: COMPLETE INTRAORAL SERIES OF PERIAPICAL X-RAYS


    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/P

    Page 234

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION

    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:

    FRAMES
    FRAMES
    LENS, EACH-SINGLE VISION
    LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E

    Page 235

    Claims Data

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    MATERIALS: LENS, EACH-TRI-FOCAL


    MATERIALS: FRAMES

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 236

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSIOTHERAPY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION

    Page 237

    Claims Data

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL STANNOUS FLUORIDE, ONE (EXCLUDE PROPHYL
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 238

    Claims Data

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL INTENSIVE CARE
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    Page 239

    Claims Data

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 240

    Claims Data

    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    MATERIALS: LENS, EACH-SINGLE VISION


    MATERIALS: FRAMES

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 241

    Claims Data

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 242

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 243

    Claims Data

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 244

    Claims Data

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:

    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM

    FILL
    FILL
    FILL
    FILL

    1
    1
    2
    3

    SURFACE CAVITY
    SURFACE CAVITY
    SURFACE CAVITY
    OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 245

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    SURGICAL INPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    SUTURING SURFACE WOUNDS: ONE OR MORE W 5 OR FEWER STITCHES

    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO

    Page 246

    Claims Data

    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO

    Page 247

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/P
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    Page 248

    Claims Data

    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    ABSCESSES, BOILS & CARBUNCLES: CUTTING OPERATION, HOSPITALIZA


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: FRAMES

    Page 249

    Claims Data

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    COMPLETE EXAMINATION

    Page 250

    Claims Data

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    PROSTHETICS: ADD TOOTH TO PRT DENT REPL EXTR TOOTH W/O CLSP
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    Page 251

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 252

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    OTHER
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CL

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: CUTTING OPERATION, HOSPITALIZA

    Page 253

    Claims Data

    MISC OUT HOSP-INJECTABLES


    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 254

    Claims Data

    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    MATERIALS: FRAMES
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    PREVENTIVE: DENTAL PROPHYLAXIS


    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    Page 255

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    VISION CARE

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION

    Page 256

    Claims Data

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    Page 257

    Claims Data

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA


    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    Page 258

    Claims Data

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OP

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PROSTATE: TRANSURETHRAL RESECTION

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    EYE: OTHER CUTTING OPERATION

    Page 259

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OTHER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION

    MATERIALS: LENS, EACH-SINGLE


    MATERIALS: LENS, EACH-SINGLE
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE
    MATERIALS: LENS, EACH-SINGLE
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE

    Page 260

    VISION
    VISION

    VISION
    VISION

    VISION

    Claims Data

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:

    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM

    FILL
    FILL
    FILL
    FILL
    FILL

    2
    2
    2
    1
    1

    SURFACE
    SURFACE
    SURFACE
    SURFACE
    SURFACE

    CAVITY
    CAVITY
    CAVITY
    CAVITY
    CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    Page 261

    Claims Data

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 262

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:

    LENS, EACH-SINGLE
    LENS, EACH-SINGLE
    FRAMES
    LENS, EACH-SINGLE
    LENS, EACH-SINGLE

    VISION
    VISION
    VISION
    VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    Page 263

    Claims Data

    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PREVENTATIVE

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: TREAT SIMPLE FRACTURE OF MANDIBLE, OPEN REDUCT
    ORAL SURGERY: TREAT SIMPLE FRACTURE OF MANDIBLE, OPEN REDUCT
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 264

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:

    DENTAL PROPHYLAXIS
    DENTAL PROPHYLAXIS
    TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO

    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 265

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    ABDOMEN: GASTROSCOPY, TAPPING


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    Page 266

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 267

    Claims Data

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CL
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    Page 268

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    PREVENTIVE: DENTAL PROPHYLAXIS


    OTHER
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OTHER
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 269

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: ALVEOLECTOMY, SURG PREP OF RIDGE FOR DENTURES

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE
    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 270

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    EMERGENCY ACCIDENT
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    PROPHYLAXIS
    PROPHYLAXIS
    PROPHYLAXIS
    PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION

    Page 271

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 272

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PREVENTATIVE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    MATERIALS: LENS, EACH-SINGLE VISION


    COMPLETE EXAMINATION
    PROSTHETICS: COMPLETE LOWER ACRYLIC BASE DENTURE
    PROSTHETICS: COMPLETE LOWER ACRYLIC BASE DENTURE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OTHER
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 273

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-HOSPITAL

    MATERIALS: LENS, EACH-SINGLE VISION


    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 274

    Claims Data

    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-NORMAL DELIVERY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    SURGICAL OUTPATIENT
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-NORMAL DELIVERY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    PREVENTIVE: DENTAL PROPHYLAXIS

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    EYE: OTHER CUTTING OPERATION
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 275

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 276

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    MATERNITY-NORMAL DELIVERY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    STONE OR TUMOR: REMOVAL OF FROM KIDNEY OR BLADDER (OPEN SU

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: PULP VITALITY TEST
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 277

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    UTERUS: DILATION & CURRETTAGE, OR OTHER SURGERY ON EXT GENIT

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    Page 278

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    EYE: OPERATION ON EYE, EYE MUSCLE, OR THROUGH SCLERA OR CORN

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 279

    Claims Data

    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    ABDOMEN: CUTTING ABDOMINAL CAVITY EXCEPT AS OTHERWISE SPECI

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CL


    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CL

    Page 280

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OTHER
    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 281

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC


    OTHER
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS


    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA
    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    CROWN & BRIDGE: BRIDGE, 3 UNITS (UNIT=EACH)


    CROWN & BRIDGE: BRIDGE, 3 UNITS (UNIT=EACH)
    CROWN & BRIDGE: BRIDGE, 3 UNITS (UNIT=EACH)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 282

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA

    PREVENTIVE: DENTAL PROPHYLAXIS


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION


    PROSTATE: TRANSURETHRAL RESECTION

    Page 283

    Claims Data

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ORAL SURGERY: REDUCE DISLOC TEMPOROMANDIBULAR JOINT, CLOSED
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OTHER
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    PREVENTIVE: DENTAL PROPHYLAXIS
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OTHER
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OTHER

    Page 284

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN

    Page 285

    Claims Data

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 286

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    Page 287

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL INPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENT 2 CLASP W

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    EYE: REMOVAL OF CATARACT

    Page 288

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    OTHER

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    Page 289

    Claims Data

    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 290

    Claims Data

    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 291

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 292

    Claims Data

    HOSPITAL MISC-LOCAL
    OTHER
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    UTERUS: DILATION & CURRETTAGE, OR OTHER SURGERY ON EXT GENIT

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    Page 293

    Claims Data

    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    OTHER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    Page 294

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    ORTHODONTICS:
    ORTHODONTICS:
    ORTHODONTICS:
    ORTHODONTICS:
    ORTHODONTICS:

    EACH
    EACH
    EACH
    EACH
    EACH

    ADDED
    ADDED
    ADDED
    ADDED
    ADDED

    ORTHODONTIC
    ORTHODONTIC
    ORTHODONTIC
    ORTHODONTIC
    ORTHODONTIC

    TREATMENT
    TREATMENT
    TREATMENT
    TREATMENT
    TREATMENT

    AFTER
    AFTER
    AFTER
    AFTER
    AFTER

    1ST
    1ST
    1ST
    1ST
    1ST

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 295

    Claims Data

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    DIAGNOSTIC LABORATORY
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    ABDOMEN: CUTTING ABDOMINAL CAVITY EXCEPT AS OTHERWISE SPECI

    COMPLETE EXAMINATION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    CROWN & BRIDGE: PORCELAIN JACKET CROWN W METAL THIMBLE
    CROWN & BRIDGE: PORCELAIN JACKET CROWN W METAL THIMBLE
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 296

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE

    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    Page 297

    Claims Data

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PROPHYLA

    PROPHYLA

    PROPHYLA

    PROPHYLA
    PROPHYLA

    PROPHYLA
    PROPHYLA

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 298

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE

    Page 299

    PROPHYLA
    PROPHYLA

    & POST OP
    & POST OP

    PROPHYLA
    PROPHYLA

    Claims Data

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E

    Page 300

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-NORMAL DELIVERY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    MATERNITY-PRENATAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    CROWN & BRIDGE: ACRYLIC JACKET CROWN


    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS

    MATERIALS: LENS, EACH-SINGLE VISION


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 301

    Claims Data

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 302

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    ABDOMEN: APPENDECTOMY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 303

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    SURGICAL INPATIENT
    HOSPITAL MISC-LOCAL
    OTHER
    SPECIALIST CNSLT-HOSPITAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS

    PROSTATE: TRANSURETHRAL RESECTION

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    OTHER

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W PARTIAL BONE IMPA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    STONE OR TUMOR: REMOVAL OF FROM KIDNEY OR BLADDER (OPEN SU

    Page 304

    Claims Data

    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    OTHER
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    Page 305

    Claims Data

    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: GOLD FOIL FILLING 2 SURFACE CAVITY

    Page 306

    Claims Data

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    OTHER
    DIAGNOSTIC: CEPHALOMETRIC X-RAY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OTHER

    Page 307

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    OTHER
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    ORTHODONTICS: FIXED SPACE MAINTAINER, BAND TYPE
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OTHER

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA

    Page 308

    Claims Data

    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    EYE: OTHER CUTTING OPERATION


    EYE: OTHER CUTTING OPERATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO

    Page 309

    Claims Data

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    OTHER

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 310

    Claims Data

    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    URETHRA: CIRCUMCISION
    URETHRA: CIRCUMCISION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS

    Page 311

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    PREVENTIVE: DENTAL PROPHYLAXIS


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION

    ORTHODONTICS: FIXED/CEMENTED APPLIANCE FOR TOOTH GUIDANCE


    ORTHODONTICS: FIXED/CEMENTED APPLIANCE FOR TOOTH GUIDANCE
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    PROSTHETICS: ADD TOOTH TO PRT DENT REPL EXTR TOOTH W/O CLSP
    OTHER
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: PULP VITALITY TEST

    Page 312

    Claims Data

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    COMPLETE EXAMINATION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 313

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W PARTIAL BONE IMPA

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 314

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO
    CROWN & BRIDGE: PORCELAIN JACKET CROWN W METAL THIMBLE
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    ORTHODONTICS: EACH ADDED ORTHODONTIC

    TREATMENT
    TREATMENT
    TREATMENT
    TREATMENT

    AFTER
    AFTER
    AFTER
    AFTER

    1ST
    1ST
    1ST
    1ST

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    Page 315

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    OTHER
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    Page 316

    Claims Data

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CL
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CL

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 317

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    PHYSICIAN VISIT-OFFICE

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP


    COMPLETE EXAMINATION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    Page 318

    Claims Data

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    Page 319

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH


    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    Page 320

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 321

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: CUTTING OPERATION, HOSPITALIZA

    Page 322

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    BIOPSY, SUPERFICIAL
    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    Page 323

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA


    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    EYE: REMOVAL OF CATARACT

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 324

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    Page 325

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PROSTATE: TRANSURETHRAL RESECTION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    Page 326

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    EYE: OTHER CUTTING OPERATION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    OTHER
    OTHER
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    Page 327

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 328

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PROSTATE: TRANSURETHRAL RESECTION

    EYE: OTHER CUTTING OPERATION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    Page 329

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    PHYSIOTHERAPY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    MISC OUT HOSP-OTHER

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    Page 330

    Claims Data

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 331

    Claims Data

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    Page 332

    Claims Data

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA
    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    COMPLETE EXAMINATION

    Page 333

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    Page 334

    Claims Data

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    PREVENTIVE: DENTAL PROPHYLAXIS


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 335

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP


    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    FRACTURE: HAND, FOOT OR STERNUM

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 336

    Claims Data

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    OTHER
    DENTAL CARE
    DENTAL CARE
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    MATERIALS: CONTACT, MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    COMPLETE EXAMINATION

    Page 337

    Claims Data

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 338

    Claims Data

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:

    DENTAL PROPHYLAXIS
    TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    OTHER

    Page 339

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: DIAGNOSTIC MODEL
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    MATERIALS: LENS, EACH-BI-FOCAL


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 340

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 341

    Claims Data

    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 342

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOME
    HOSPITAL LOCAL ROOM
    PHYSICIAN VISIT-HOSPITAL
    PRIVATE DUTY NURSING CARE
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    Page 343

    Claims Data

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM

    SPINE/SPINAL CORD: REMOVAL NUCLEUS PULPOSUS INTERVERTEBRAL D

    Page 344

    Claims Data

    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    Page 345

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    Page 346

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 347

    Claims Data

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    DIAGNOSTIC: PULP VITALITY TEST

    PREVENTIVE: DENTAL PROPHYLAXIS


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS

    Page 348

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL

    Page 349

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    CROWN & BRIDGE: RECEMENTING BRIDGE


    CROWN & BRIDGE: RECEMENTING BRIDGE

    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO


    OTHER

    Page 350

    Claims Data

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    CROWN & BRIDGE: REPLACE BROKEN FACING WITH STEELE'S/OTHER FA

    Page 351

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: LENS, EACH-BI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    Page 352

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    COMPLETE EXAMINATION

    EYE: OPERATION ON EYE, EYE MUSCLE, OR THROUGH SCLERA OR CORN

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OTHER

    Page 353

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    Page 354

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION

    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OP


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    Page 355

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    OTHER
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC:
    DIAGNOSTIC:
    DIAGNOSTIC:
    DIAGNOSTIC:
    DIAGNOSTIC:

    INITIAL ORAL EXAM (EXCLUDE X-RAY)


    BITEWING X-RAY, SINGLE VIEW
    BITEWING X-RAY, SINGLE VIEW
    BITEWING X-RAY, SINGLE VIEW
    BITEWING X-RAY, SINGLE VIEW

    PROSTATE: TRANSURETHRAL RESECTION

    Page 356

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 357

    Claims Data

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    Page 358

    Claims Data

    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    UTERUS: OTHER OPR ON UTERUS, TUBES, OVARIES BY ABDOMINAL APP

    UTERUS: DILATION & CURRETTAGE, OR OTHER SURGERY ON EXT GENIT

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 359

    Claims Data

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MATERIALS: LENS, EACH-TRI-FOCAL


    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 360

    Claims Data

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE

    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE


    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE
    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES

    Page 361

    Claims Data

    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    VARICOSE VEINS: INJECTION TREATMENT ON ONE LEG

    Page 362

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 363

    Claims Data

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 364

    Claims Data

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION

    Page 365

    Claims Data

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSIOTHERAPY
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RA

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: FRAMES
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    Page 366

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSIOTHERAPY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    Page 367

    Claims Data

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE

    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 368

    Claims Data

    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    Page 369

    Claims Data

    VISION CARE
    VISION CARE
    VISION CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    UTERUS: COMPLETE REMOVAL W/O REMOVAL OF TUBES OR OVARIES

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    OTHER
    OTHER
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: APICOECTOMY
    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 370

    Claims Data

    MISC OUT HOSP-INJECTABLES


    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: COMPLETE INTRAORAL SERIES OF PERIAPICAL X-RAYS
    DIAGNOSTIC: COMPLETE INTRAORAL SERIES OF PERIAPICAL X-RAYS
    PREVENTIVE: DENTAL PROPHYLAXIS

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA
    OTHER

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:

    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM

    FILL
    FILL
    FILL
    FILL

    1
    1
    2
    2

    SURFACE
    SURFACE
    SURFACE
    SURFACE

    CAVITY
    CAVITY
    CAVITY
    CAVITY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 371

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    Page 372

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    SURGICAL ANAESTHESIA
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    UTERUS: COMPLETE REMOVAL W/O REMOVAL OF TUBES OR OVARIES

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 373

    Claims Data

    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E

    Page 374

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E


    OTHER
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    MATERIALS: CONTACT, MEDICALLY REQUIRED

    Page 375

    Claims Data

    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IM
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    COMPLETE EXAMINATION
    PROSTHETICS: PRT UPR DENT W CHRM COBLT ALLOY PALATAL BAR 2 C
    PROSTHETICS: PRT UPR DENT W CHRM COBLT ALLOY PALATAL BAR 2 C

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    Page 376

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    HOSPITAL LOCAL ROOM
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PROSTATE: TRANSURETHRAL RESECTION

    SINUS OPERATION: TRACHEOTOMY

    Page 377

    Claims Data

    HOSPITAL LOCAL ROOM


    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    CROWN & BRIDGE: RECEMENTING BRIDGE
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    CROWN & BRIDGE: STAINLESS STEEL CROWN
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 378

    Claims Data

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:

    LENS, EACH-TRI-FOCAL
    FRAMES
    FRAMES
    FRAMES
    LENS, EACH-SINGLE VISION
    LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    Page 379

    Claims Data

    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    MATERIALS: LENS, EACH-BI-FOCAL


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 380

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ABDOMEN: CUTTING ABDOMINAL CAVITY EXCEPT AS OTHERWISE SPECI

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 381

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 382

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    OTHER
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    Page 383

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    Page 384

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    SUTURING SURFACE WOUNDS: ONE OR MORE W 5 OR FEWER STITCHES

    Page 385

    Claims Data

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 386

    Claims Data

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 387

    Claims Data

    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL STANNOUS FLUORIDE, ONE (EXCLUDE PROPHYL
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E

    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CL


    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CL

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    Page 388

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    CROWN & BRIDGE: ACRYLIC JACKET CROWN


    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 389

    Claims Data

    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION

    Page 390

    Claims Data

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTHETICS: COMPLETE UPPER ACRYLIC BASE DENTURE


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    EYE: REMOVAL OF CATARACT

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 391

    Claims Data

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    Page 392

    Claims Data

    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OTHER
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 393

    Claims Data

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 394

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER


    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER
    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION

    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:

    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM

    Page 395

    FILL
    FILL
    FILL
    FILL
    FILL

    1
    1
    1
    3
    3

    SURFACE CAVITY
    SURFACE CAVITY
    SURFACE CAVITY
    OR MORE SURFACE CAVITY
    OR MORE SURFACE CAVITY

    DENTISTS/P
    DENTISTS/P

    DENTISTS/P
    DENTISTS/P

    Claims Data

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-NORMAL DELIVERY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT


    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 396

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 397

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE INTRAORAL SERIES OF PERIAPICAL X-RAYS
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PROSTATE: TRANSURETHRAL RESECTION


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    Page 398

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER

    PREVENTIVE: DENTAL PROPHYLAXIS

    URETHRA: INTRA-URETHRAL CUTTING OPERATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    PROSTATE: TRANSURETHRAL RESECTION

    Page 399

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 400

    PROPHYLA
    PROPHYLA

    PROPHYLA
    PROPHYLA

    Claims Data

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    PROSTATE: TRANSURETHRAL RESECTION

    Page 401

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 402

    Claims Data

    MISC OUT HOSP-OTHER


    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    Page 403

    Claims Data

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSIOTHERAPY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER

    UTERUS: DILATION & CURRETTAGE, OR OTHER SURGERY ON EXT GENIT

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: PULP VITALITY TEST
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTO
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 404

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC X-RAY
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    SUTURING SURFACE WOUNDS: ONE OR MORE W 5 OR FEWER STITCHES


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    Page 405

    Claims Data

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 406

    Claims Data

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OP
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E

    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    Page 407

    Claims Data

    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    EMERGENCY ACCIDENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    EYE: REMOVAL OF CATARACT

    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED


    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    CHEST: OTHER CUTTING INTO THORACTIC CAVITY

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    Page 408

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER
    OTHER
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO


    COMPLETE EXAMINATION

    Page 409

    Claims Data

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    OTHER
    MISC OUT HOSP-ORAL DRUGS

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OTHER
    OTHER
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 410

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    BIOPSY, SUPERFICIAL

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    Page 411

    Claims Data

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY

    COMPLETE EXAMINATION

    Page 412

    Claims Data

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION

    EYE: OTHER CUTTING OPERATION

    UTERUS: COMPLETE REMOVAL W/O REMOVAL OF TUBES OR OVARIES


    COMPLETE EXAMINATION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 413

    Claims Data

    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    OTHER

    Page 414

    Claims Data

    MISC OUT HOSP-INJECTABLES


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION

    Page 415

    Claims Data

    VISION CARE
    VISION CARE
    SURGICAL OUTPATIENT
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    CROWN & BRIDGE: ACRYLIC JACKET CROWN


    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    Page 416

    Claims Data

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    PREVENTIVE: DENTAL PROPHYLAXIS


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    PROSTHETICS: PART LOWER ACRYLIC DENT W LINGUAL BAR 2 CLASP W
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    CROWN & BRIDGE: PORCELAIN JACKET CROWN
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    OTHER
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: FRAMES

    Page 417

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OP
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OTHER
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 418

    Claims Data

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    MATERIALS: FRAMES

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 419

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    PROSTHETICS: ADD TOOTH TO PRT DENT REPL EXTR TOOTH W/O CLSP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OTHER

    Page 420

    Claims Data

    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    Page 421

    Claims Data

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 422

    Claims Data

    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    COMPLETE EXAMINATION
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 423

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    Page 424

    Claims Data

    MISC OUT HOSP-INJECTABLES


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    Page 425

    Claims Data

    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE

    ABDOMEN: OPERATION ON GALL BLADDER


    ABDOMEN: OPERATION ON GALL BLADDER
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    Page 426

    Claims Data

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 427

    Claims Data

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PREVENTATIVE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    EYE: OTHER CUTTING OPERATION


    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST

    PREVENTIVE: DENTAL PROPHYLAXIS


    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSP

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    Page 428

    Claims Data

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH


    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA

    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    Page 429

    Claims Data

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLA
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTO

    COMPLETE EXAMINATION
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    Page 430

    Claims Data

    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    EYE: OPERATION ON EYE, EYE MUSCLE, OR THROUGH SCLERA OR CORN


    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    Page 431

    Claims Data

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPAC
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OP
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, E
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    ORAL SURGERY: ALVEOLECTOMY, SURG PREP OF RIDGE FOR DENTURES


    ORAL SURGERY: ALVEOLECTOMY, SURG PREP OF RIDGE FOR DENTURES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    Page 432

    Claims Data

    PROV1
    P104
    O076
    O076
    P001
    M695
    P215
    M695
    S049
    P090
    P090
    P090
    P215
    P005
    P090
    L96
    L001
    P215
    S191
    S049
    O061
    P090
    S069
    P215
    P090
    P090
    M215
    P215
    P090
    P215
    S296
    S296
    S296
    P090
    P001
    S049
    L001
    S191
    P090
    P005
    P215
    P090
    P090
    D90
    D90
    M297
    M297
    M297
    P115
    P435

    Amount
    $598.00
    $50.00
    $1,885.50
    $607.02
    $350.00
    $58.85
    $150.00
    $350.00
    $159.88
    $39.53
    $324.95
    $358.50
    $1,116.33
    $646.15
    $600.00
    $490.50
    $789.10
    $600.00
    $650.00
    $100.00
    $290.20
    $950.00
    $300.90
    $290.20
    $343.30
    $250.00
    $176.40
    $554.20
    $479.90
    $2,400.00
    $840.00
    $210.00
    $343.30
    $625.80
    $350.00
    $167.00
    $300.00
    $396.00
    $1,116.33
    $479.90
    $57.35
    $399.40 $18,710.99
    $250.00
    $150.00
    $370.00
    $200.00
    $150.00
    $16.60
    $34.44

    Page 433

    Claims Data

    P014
    O001
    O001
    O001
    O001
    O001
    O001
    M035
    P416
    P416
    D119
    D119
    M842
    P353
    P353
    P353
    P353
    O001
    O001
    O001
    S217
    S217
    S217
    P427
    M037
    M037
    H005
    L033
    M037
    L033
    P427
    S286
    S286
    S118
    O033
    M089
    L070
    L046
    M666
    M666
    M666
    M666
    M666
    P131
    P005
    P005
    D191
    D191
    D191
    P005

    $130.90
    $110.00
    $930.75
    $1,207.00
    $300.00
    $795.00
    $810.00
    $200.00
    $27.50
    $20.50
    $50.00
    $350.00
    $400.00
    $834.40
    $841.00
    $303.40
    $1,520.40
    $110.00
    $1,495.00
    $1,770.00
    $340.00
    $50.00
    $150.00
    $228.91
    $180.00
    $180.00
    $266.00
    $240.00
    $180.00
    $670.00
    $440.00
    $300.00
    $150.00
    $300.00
    $100.00
    $260.00
    $120.00
    $2,185.00
    $80.00
    $20.00
    $160.00
    $100.00
    $20.00
    $240.00
    $317.50
    $317.50
    $350.00
    $70.00
    $30.00
    $317.50

    Page 434

    Claims Data

    P005
    M762
    P472
    P394
    M229
    M229
    M229
    M229
    P031
    M229
    L001
    M229
    M542
    M542
    M542
    M542
    M542
    P014
    M629
    M629
    M629
    P426
    M581
    L025
    L025
    M225
    M225
    L001
    M225
    P031
    M763
    M104
    P427
    M089
    L070
    P122
    M089
    P122
    M089
    P122
    M089
    H005
    L006
    L006
    D125
    D125
    D125
    M298
    P435
    P435

    $317.50
    $100.00
    $80.00
    $744.00
    $160.00
    $25.00
    $175.00
    $160.00
    $161.86
    $200.00
    $320.00
    $200.00
    $150.00
    $25.00
    $75.00
    $4,300.00
    $1,050.00
    $12.00
    $240.00
    $25.00
    $35.00
    $180.50
    $200.00
    $451.00
    $257.00
    $480.00
    $120.00
    $865.00
    $50.00
    $251.89
    $100.00
    $400.00
    $500.10
    $200.00
    $200.00
    $68.40
    $180.00
    $425.50
    $180.00
    $121.50
    $180.00
    $690.00
    $275.00
    $275.00
    $140.00
    $160.00
    $80.00
    $240.00
    $524.57
    $26.49

    Page 435

    Claims Data

    M298
    H005
    M821
    P360
    M304
    M411
    P104
    M870
    P447
    M304
    M304
    P360
    M769
    L070
    L164
    M229
    P122
    D60
    D60
    D60
    D60
    D60
    M053
    P081
    P081
    M053
    P342
    P215
    M327
    P039
    P039
    H066
    S295
    S295
    P014
    M327
    P039
    M327
    P039
    M327
    P014
    M326
    P343
    P215
    P215
    P215
    P215
    P122
    P122
    M060

    $200.00
    $1,760.00
    $185.00
    $474.60
    $680.00
    $130.00
    $400.00
    $300.00
    $83.50
    $200.00
    $395.00
    $474.60
    $150.00
    $295.00
    $400.00
    $200.00
    $373.80
    $170.00
    $130.00
    $60.00
    $2,500.00
    $300.00
    $280.00
    $278.40
    $38.40
    $140.00
    $220.60
    $129.60
    $140.00
    $75.00
    $41.85
    $1,500.00
    $3,500.00
    $300.00
    $159.30
    $140.00
    $112.50
    $140.00
    $39.95
    $140.00
    $50.25
    $250.00
    $77.70
    $110.40
    $110.00
    $90.00
    $100.00
    $840.00
    $819.00
    $200.00

    Page 436

    Claims Data

    P122
    P122
    P122
    P122
    P122
    D411
    D411
    D411
    P122
    M624
    P049
    H006
    H006
    S130
    P076
    D48
    D48
    D48
    D48
    D48
    D48
    D48
    D48
    D48
    D420
    S077
    P014
    P014
    M811
    M756
    M756
    M756
    M756
    P426
    P426
    P426
    M756
    L065
    M581
    P182
    M304
    P182
    M304
    P182
    O004
    O004
    O004
    M304
    M304
    D01

    $87.50
    $25.95
    $750.50
    $840.00
    $840.00
    $200.00
    $100.00
    $50.00
    $840.00
    $100.00
    $14.25
    $3,300.00
    $50.00
    $340.00
    $216.50
    $50.00
    $160.00
    $330.00
    $70.00
    $50.00
    $160.00
    $330.00
    $70.00
    $1,100.00
    $300.00
    $300.00
    $61.00
    $40.00
    $200.00
    $100.00
    $100.00
    $90.00
    $10.00
    $81.00
    $9.00
    $52.00
    $300.00
    $240.00
    $150.00
    $134.95
    $185.00
    $27.95
    $185.00
    $159.60
    $100.00
    $556.00
    $1,516.00
    $140.00
    $635.00
    $385.00

    Page 437

    Claims Data

    D01
    M184
    M101
    P166
    P166
    P166
    P435
    P097
    P122
    P256
    P073
    P005
    P256
    P256
    P435
    P005
    P435
    P318
    P005
    P318
    P318
    P318
    P005
    P005
    P005
    P014
    P014
    S277
    P215
    H006
    P215
    P014
    S220
    P014
    UN01
    P215
    P215
    P215
    P014
    P215
    H006
    S220
    O004
    S290
    L034
    H003
    H003
    H003
    P373
    P373

    $115.00
    $200.00
    $150.00
    $248.85
    $296.00
    $217.25
    $645.36
    $189.00
    $122.85
    $282.00
    $4,654.55
    $4,478.64
    ($282.00)
    $282.00
    $386.15
    $3,104.36
    $86.14
    $1,491.55
    $5,500.68
    $424.30
    $259.90
    $212.15
    $1,052.52
    $2,315.18
    $376.04
    $451.70
    $35.00
    $200.00
    $84.00
    $327.00
    $517.60
    $201.00
    $220.00
    $117.25
    $165.00
    $61.40
    $94.10
    $55.00
    $117.25
    $423.10
    $327.00
    $220.00
    $200.00
    $400.00
    $1,700.00
    $400.00
    $265.00
    $150.00
    $145.25
    $103.80

    Page 438

    Claims Data

    P373
    S231
    P373
    L034
    T075
    H003
    T076
    M556
    D104
    D104
    D104
    D104
    D104
    D104
    D104
    D104
    O065
    O065
    O065
    P256
    P094
    M087
    P094
    P094
    M229
    M229
    P011
    L001
    O004
    O004
    S136
    S089
    S301
    S301
    S275
    S136
    D104
    D104
    D104
    D104
    D104
    D104
    D104
    D104
    D04
    D04
    O001
    O001
    D04
    D04

    $11.50
    $300.00
    $148.05
    $1,093.00
    $225.00
    $200.00
    $200.00
    $120.00
    $600.00
    $80.00
    $200.00
    $400.00
    $80.00
    $70.00
    $80.00
    $280.00
    $150.00
    $1,638.00
    $765.00
    $225.90
    $352.50
    $260.00
    $11.20
    $108.75
    $200.00
    $160.00
    $65.00
    $465.00
    $200.00
    $216.00
    $200.00
    $650.00
    $300.00
    $300.00
    $300.00
    $200.00
    $80.00
    $70.00
    $60.00
    $250.00
    $2,100.00
    $340.00
    $340.00
    $600.00
    $100.00
    $190.00
    $110.00
    $200.00
    $100.00
    $190.00

    Page 439

    Claims Data

    D04
    D04
    O007
    O007
    O007
    O004
    O004
    O002
    O002
    O002
    O015
    O015
    O015
    S296
    S296
    S296
    M692
    H005
    M056
    M056
    M056
    M190
    M190
    M190
    D330
    D330
    D330
    D330
    M186
    L143
    M186
    L032
    D143
    D143
    M030
    M030
    M030
    P343
    P155
    P155
    O033
    O033
    O033
    M556
    P435
    P435
    M304
    S356
    S356
    L025

    $140.00
    $285.00
    $100.00
    $1,440.00
    $2,325.00
    $200.00
    $1,408.00
    $35.00
    $1,944.00
    $1,516.00
    $120.00
    $1,980.00
    $3,805.00
    $800.00
    $400.00
    $1,500.00
    $700.00
    $1,330.00
    $150.00
    $50.00
    $70.00
    $100.00
    $25.00
    $75.00
    $780.00
    $220.00
    $450.00
    $2,800.00
    $200.00
    $150.00
    $120.00
    $350.00
    $175.00
    $25.00
    $160.00
    $50.00
    $110.00
    $321.03
    $148.59
    $152.41
    $100.00
    $1,327.50
    $1,341.00
    $120.00
    $77.10
    $46.99
    $200.00
    $300.00
    $1,400.00
    $285.00

    Page 440

    Claims Data

    M556
    L97
    M189
    D342
    D342
    D342
    D342
    D342
    D342
    O001
    O001
    S219
    D23
    S217
    H048
    L075
    L075
    M124
    H011
    H011
    H011
    S192
    M124
    L070
    L065
    L149
    M124
    S426
    M657
    P022
    M657
    H006
    H006
    P011
    H006
    S426
    L065
    O004
    O004
    O004
    L046
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    H047

    $120.00
    $180.00
    $140.00
    $300.00
    $840.00
    $300.00
    $120.00
    $120.00
    $8,000.00
    $110.00
    $1,258.00
    $450.00
    $100.00
    $500.00
    $232.00
    $3,182.25
    $47.75
    $250.00
    $5,500.00
    $14,307.00
    $2,850.00
    $8,500.00
    $250.00
    $80.00
    $585.00
    $2,200.00
    $50.00
    $300.00
    $100.00
    $245.70
    $200.00
    $150.00
    $70.00
    $174.00
    $490.00
    $600.00
    $918.00
    $100.00
    $858.19
    $596.25
    $300.00
    $33,550.00
    $22,050.00
    $17,527.00
    $5,873.00
    $18,000.00
    ($3,427.00)
    $3,427.00
    ($10,983.36)
    $10,983.36

    Page 441

    Claims Data

    H047
    H047
    H047
    H047
    H047
    M436
    M124
    L041
    M124
    P430
    P416
    P014
    H047
    S199
    H027
    P245
    P245
    P430
    P430
    P430
    P430
    P430
    P430
    P430
    P430
    O136
    O136
    O136
    M534
    L164
    P476
    M034
    P011
    O001
    H006
    H006
    M246
    S089
    L020
    M341
    M341
    M341
    P104
    D125
    D125
    D125
    O019
    O019
    O019
    O001

    ($1,282.00)
    $1,282.00
    $3,427.00
    $10,983.36
    $1,282.00
    $300.00
    $250.00
    $280.00
    $100.00
    $2,601.50
    $210.00
    $1,987.75
    $1,000.00
    $300.00
    $150.00
    $85.40
    $595.00
    $1,947.20
    ($1,947.20)
    $1,947.20
    $1,504.30
    ($1,504.30)
    $1,504.30
    $1,224.60
    $63.00
    $300.00
    $1,405.50
    $797.50
    $200.00
    $150.00
    $180.50
    $50.00
    $93.50
    $250.00
    $2,200.00
    $2,600.00
    $2,000.00
    $8,900.00
    $340.00
    $140.00
    $25.00
    $135.00
    $361.20
    $80.00
    $210.00
    $190.00
    $120.00
    $680.00
    $715.00
    $110.00

    Page 442

    Claims Data

    O001
    O001
    O001
    O001
    O001
    O001
    O001
    D59
    D59
    D59
    D59
    D59
    D59
    D59
    S114
    S114
    S120
    M597
    M597
    M597
    P115
    P115
    D171
    D171
    D171
    O001
    O001
    O001
    O001
    O001
    D125
    D125
    D125
    M019
    M019
    D125
    D125
    D125
    O168
    O168
    O168
    D291
    D291
    D291
    D291
    D291
    M067
    P003
    P003
    M346

    $225.60
    $425.00
    $1,425.90
    $110.00
    $335.75
    $425.00
    $1,292.00
    $80.00
    $400.00
    $100.00
    $400.00
    $100.00
    $2,200.00
    $240.00
    $60.01
    $339.99
    $300.00
    $100.00
    $100.00
    $250.00
    $366.00
    $91.50
    $100.00
    $245.00
    $105.00
    $110.00
    $99.00
    $706.50
    $859.14
    $220.86
    $80.00
    $35.00
    $45.00
    $84.00
    $216.00
    $200.00
    $200.00
    $350.00
    $180.00
    $1,135.00
    $2,270.00
    $100.00
    $210.00
    $300.00
    $400.00
    $400.00
    $160.00
    $87.00
    $12.50
    $200.00

    Page 443

    Claims Data

    M346
    P478
    P458
    M120
    P491
    P491
    M120
    P125
    M646
    P458
    P458
    S151
    S151
    M120
    P491
    O004
    O004
    O001
    O001
    O001
    O001
    S089
    M083
    S275
    H023
    H034
    H034
    H034
    D241
    D241
    D241
    D241
    D241
    P435
    P427
    UN02
    UN02
    M304
    M304
    H005
    P435
    P435
    M248
    P458
    P458
    M821
    H005
    M473
    P508
    L070

    $260.00
    $380.00
    $70.30
    $140.00
    $70.00
    $50.00
    $240.00
    $35.00
    $300.00
    $303.55
    $70.30
    $400.00
    $350.00
    $140.00
    $274.00
    $1,196.00
    $1,116.00
    $110.00
    $1,081.00
    $1,124.75
    $573.75
    $1,300.00
    $400.00
    $750.00
    $375.00
    $300.00
    $500.00
    $144.20
    $100.00
    $135.00
    $70.00
    $165.00
    $2,000.00
    $193.44
    $30.47
    $275.75
    $193.02
    $200.00
    $160.00
    $780.00
    $134.75
    $33.69
    $180.00
    $17.50
    $44.45
    $300.00
    $1,038.40
    $120.00
    $211.50
    $640.00

    Page 444

    Claims Data

    M473
    P094
    P508
    M473
    P508
    P508
    L070
    M473
    P508
    M473
    P508
    M473
    M388
    M388
    M388
    S052
    L013
    M693
    M693
    M120
    M120
    M120
    D379
    D379
    D379
    M693
    P154
    P154
    O076
    O076
    O076
    D244
    D244
    D171
    M204
    M204
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    P430
    P462

    $280.00
    $351.30
    $343.47
    $150.00
    $384.09
    $25.60
    $640.00
    $150.00
    $32.68
    $150.00
    $102.38
    $240.00
    $100.00
    $25.00
    $75.00
    $550.00
    $3,582.00
    $250.00
    $500.00
    $140.00
    $25.00
    $55.00
    $120.00
    $500.00
    $120.00
    $150.00
    $84.80
    $21.20
    $90.00
    $1,796.00
    $1,200.00
    $300.00
    $70.00
    $280.00
    $200.00
    $300.00
    $200.00
    $50.00
    $150.00
    $280.00
    $200.00
    $50.00
    $150.00
    $320.00
    $400.00
    $100.00
    $700.00
    $1,215.00
    $86.10
    $125.00

    Page 445

    Claims Data

    M693
    M693
    P430
    P430
    M693
    P430
    P430
    P167
    S201
    L013
    L013
    L013
    H008
    D125
    D125
    D125
    D125
    D346
    D346
    D346
    D346
    D346
    D346
    P167
    P167
    P167
    H048
    H048
    H048
    M755
    S217
    H048
    H048
    H005
    M607
    M607
    H048
    H048
    MM06
    S217
    P231
    S217
    P020
    S217
    S217
    MM07
    M483
    P020
    S217
    M607

    ($150.00)
    $150.00
    ($250.00)
    $250.00
    $150.00
    $202.00
    $48.00
    $1,938.60
    $300.00
    $330.00
    $800.00
    $300.00
    $2,000.00
    $80.00
    $35.00
    $45.00
    $300.00
    $150.00
    $100.00
    $400.00
    $6,500.00
    $3,000.00
    $900.00
    $1,938.60
    $2,165.85
    $2,165.85
    $900.00
    $1,350.00
    $14,480.00
    $5,500.00
    $22,450.00
    $12,068.00
    $4,884.00
    $1,143.60
    $75.00
    $180.00
    $398.00
    $438.00
    $465.50
    $340.00
    $591.90
    $340.00
    $189.00
    $340.00
    $413.00
    $530.00
    $120.00
    $120.00
    $340.00
    ($300.00)

    Page 446

    Claims Data

    M607
    M607
    M607
    P073
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M795
    M795
    M795
    M795
    M795
    M795
    M754
    M754
    M754
    M795
    M795
    M795
    M795
    M795
    S115
    P011
    P011
    S292
    P351
    O004
    O004
    O004
    D90
    D90
    D90
    D90
    M120

    $300.00
    ($350.00)
    $350.00
    $1,343.64
    $300.00
    $50.00
    $300.00
    ($200.00)
    $200.00
    ($2,046.00)
    $2,046.00
    ($300.00)
    $300.00
    ($300.00)
    $300.00
    ($240.00)
    $240.00
    $200.00
    $2,046.00
    $300.00
    $300.00
    $240.00
    $250.00
    $150.00
    $120.00
    $60.00
    $150.00
    $90.00
    $410.00
    $150.00
    $100.00
    $50.00
    $470.00
    $120.00
    $150.00
    $150.00
    $100.00
    $300.00
    $201.00
    $150.00
    $400.00
    $149.00
    $100.00
    $1,356.00
    $2,056.00
    $100.00
    $70.00
    $30.00
    $40.00
    $140.00

    Page 447

    Claims Data

    M120
    M120
    O004
    S060
    S060
    S060
    P019
    P435
    S060
    D89
    D89
    D89
    D89
    D89
    M072
    M693
    M693
    M693
    M693
    O004
    O004
    O004
    O004
    O004
    M205
    T060
    UN01
    M089
    M089
    P055
    S458
    M205
    P094
    M205
    P094
    M205
    P094
    D152
    D152
    D152
    M205
    M205
    M205
    P094
    L006
    M769
    M769
    P435
    M769
    M769

    $460.00
    $80.00
    $324.00
    $780.00
    $200.00
    $200.00
    $152.55
    $547.62
    $20.00
    $50.00
    $150.00
    $70.00
    $55.00
    $225.00
    $100.00
    $150.00
    $120.00
    $100.00
    $100.00
    $200.00
    $200.00
    $66.00
    $100.00
    $396.00
    $240.00
    $670.00
    $2,070.00
    $180.00
    $400.00
    $69.00
    $300.00
    $240.00
    $532.50
    $240.00
    $532.50
    $240.00
    $532.50
    $500.00
    $70.00
    $230.00
    $240.00
    $100.00
    $80.00
    $553.50
    $400.00
    $150.00
    $400.00
    $83.27
    $150.00
    $400.00

    Page 448

    Claims Data

    T041
    UN01
    T041
    D191
    D191
    D191
    M312
    O008
    O008
    O008
    D120
    D120
    M225
    M225
    L001
    L006
    T034
    T034
    M089
    H005
    P122
    H005
    D125
    D125
    D125
    D125
    P122
    P487
    S239
    L006
    L006
    M089
    P435
    M630
    P122
    P122
    P122
    P122
    P122
    P122
    M317
    M317
    D38
    M053
    P256
    M018
    M018
    P115
    P031
    P215

    $1,150.00
    $790.00
    $2,825.00
    $100.00
    $35.00
    $15.00
    $100.00
    $80.00
    $1,300.00
    $750.00
    $70.00
    $300.00
    $240.00
    $60.00
    $795.00
    $400.00
    $2,050.00
    $425.00
    $200.00
    $815.00
    $37.50
    $200.00
    $80.00
    $35.00
    $35.00
    $200.00
    $173.00
    $87.30
    $200.00
    $500.00
    $120.00
    $200.00
    $81.15
    $160.00
    $183.00
    $173.00
    $173.00
    $173.00
    $153.75
    $102.50
    $120.00
    $30.00
    $85.00
    $140.00
    $124.40
    $200.00
    $300.00
    $219.80
    $59.43
    $1,312.50

    Page 449

    Claims Data

    S114
    S114
    P106
    M422
    M422
    M422
    M422
    S114
    M630
    P093
    P066
    P066
    P005
    P005
    P011
    M473
    P435
    P435
    M473
    P435
    P435
    P435
    O033
    O033
    O033
    O033
    M473
    P435
    L001
    L046
    M030
    P115
    O001
    O001
    O001
    D343
    D343
    D343
    D343
    D343
    P094
    D343
    D343
    H005
    H005
    H005
    H005
    D143
    S452
    M473

    $400.00
    $50.00
    $246.75
    $320.00
    $100.00
    $80.00
    $30.00
    $1,200.00
    $180.00
    $560.00
    $487.31
    $3,271.25
    $947.94
    $631.96
    $56.00
    $120.00
    $151.78
    $108.01
    $120.00
    $285.94
    $108.41
    $285.94
    $230.00
    $625.50
    $373.50
    $1,015.00
    $120.00
    $306.36
    $640.00
    $140.00
    $160.00
    $88.80
    $110.00
    $575.00
    $1,050.00
    $200.00
    $210.00
    $70.00
    $260.00
    $80.00
    $156.75
    $290.00
    $70.00
    $455.00
    $13.95
    $300.00
    $585.31
    $250.00
    $300.00
    $140.00

    Page 450

    Claims Data

    P256
    M473
    H005
    H025
    S278
    S361
    D31
    D31
    S220
    O156
    S220
    D31
    D31
    M019
    P049
    P049
    O007
    M019
    M019
    P049
    P049
    P049
    D31
    D31
    M638
    L143
    M638
    L006
    M638
    M638
    M638
    M638
    M638
    O001
    O001
    O001
    O001
    S255
    S255
    D125
    D125
    D125
    D125
    M123
    M123
    M123
    M123
    M144
    P427
    P195

    $192.50
    $160.00
    $150.00
    $475.00
    $400.00
    $300.00
    $1,140.00
    $150.00
    $600.00
    $150.00
    $150.00
    $140.00
    $430.00
    $300.00
    $25.35
    $488.45
    $100.00
    $75.00
    $225.00
    $11.16
    $10.95
    $2.79
    $540.00
    $595.00
    $140.00
    $500.00
    $280.00
    $200.00
    $140.00
    $1,240.00
    $300.00
    $280.00
    $660.00
    $775.00
    $1,515.75
    $475.00
    $987.00
    $200.00
    $200.00
    $80.00
    $70.00
    $105.00
    $600.00
    $150.00
    $40.00
    $60.00
    $150.00
    $200.00
    $149.25
    $120.00

    Page 451

    Claims Data

    D264
    D264
    M693
    M693
    M693
    O004
    O004
    M248
    P458
    M248
    L97
    O076
    O076
    S084
    H006
    S209
    M144
    P467
    P467
    P467
    D253
    D104
    D104
    D104
    D104
    D104
    P435
    P203
    P303
    P436
    P436
    P203
    P303
    D04
    D04
    D04
    D04
    UN01
    UN01
    O001
    O001
    O001
    S302
    S302
    S137
    S137
    UN01
    M657
    L006
    P318

    $600.00
    $1,140.00
    $150.00
    $25.00
    $75.00
    $200.00
    $500.00
    $160.00
    $46.50
    $160.00
    $405.00
    $1,200.00
    $730.75
    $300.00
    $600.00
    $200.00
    $200.00
    $31.00
    $51.90
    $64.10
    $300.00
    $80.00
    $70.00
    $60.00
    $500.00
    $80.00
    $27.60
    $74.67
    $8.00
    $53.33
    $53.33
    $101.33
    $16.00
    $125.00
    $70.00
    $55.00
    $80.00
    $200.00
    $250.00
    $110.00
    $956.25
    $782.00
    $360.00
    $140.00
    $450.00
    $350.00
    $300.00
    $200.00
    $800.00
    $178.35

    Page 452

    Claims Data

    P318
    M657
    P031
    S279
    L075
    P508
    S279
    D66
    D66
    D66
    T061
    S279
    S312
    S312
    L065
    S277
    M310
    M310
    P306
    P399
    S363
    L070
    L070
    S363
    S277
    L070
    S363
    L070
    S239
    S376
    S376
    P435
    S369
    P491
    M534
    M534
    M534
    L164
    L164
    M331
    M331
    M331
    L174
    P179
    M076
    M076
    M727
    L068
    O001
    O004

    $120.75
    $100.00
    $167.16
    $500.00
    $3,420.00
    $340.74
    $400.00
    $280.00
    $340.00
    $610.00
    $1,840.00
    $400.00
    $150.00
    $450.00
    $225.00
    $300.00
    $150.00
    $320.00
    $86.00
    $101.30
    $300.00
    $690.00
    $200.00
    $400.00
    $300.00
    $1,330.00
    $200.00
    $40.00
    $300.00
    $450.00
    $515.00
    $122.43
    $400.00
    $147.50
    $200.00
    $100.00
    $60.00
    $400.00
    $360.00
    $140.00
    $25.00
    $175.00
    $340.00
    $209.00
    $500.00
    $1,250.00
    $400.00
    $750.00
    $270.00
    $200.00

    Page 453

    Claims Data

    O004
    M657
    P337
    P337
    L151
    S005
    M818
    S231
    P031
    P011
    P031
    T034
    S041
    L006
    M657
    L140
    M657
    M657
    L140
    L140
    L140
    L140
    P215
    S367
    P215
    D183
    D183
    S367
    P215
    D77
    D77
    D77
    D77
    D77
    D77
    D77
    L018
    D77
    M375
    O001
    O001
    O001
    M089
    D266
    D266
    P247
    D148
    D148
    D148
    D148

    $876.00
    $200.00
    $98.00
    $315.70
    $300.00
    $300.00
    $260.00
    $300.00
    $134.70
    $388.50
    $251.72
    $1,800.00
    $400.00
    $550.00
    $200.00
    $1,275.00
    $200.00
    $585.00
    $535.00
    $180.00
    $400.00
    $120.00
    $305.05
    $300.00
    $206.90
    $250.00
    $400.00
    $300.00
    $65.40
    $250.00
    $60.00
    $250.00
    $150.00
    $200.00
    $200.00
    $400.00
    $660.00
    $300.00
    $280.00
    $110.00
    $1,355.75
    $1,581.00
    $180.00
    $360.00
    $40.00
    $86.00
    $100.00
    $600.00
    $180.00
    $1,000.00

    Page 454

    Claims Data

    S089
    H006
    H006
    P512
    S089
    S089
    D353
    O001
    O001
    O001
    D353
    M633
    L034
    M633
    P155
    M633
    M633
    O004
    O004
    O004
    O004
    O004
    O004
    M633
    P155
    O076
    O076
    O076
    M352
    H006
    M352
    M352
    S301
    H047
    H047
    H047
    H047
    H047
    S250
    H006
    H005
    H005
    H005
    H005
    H005
    H005
    H005
    D113
    D113
    D113

    $450.00
    $180.00
    $360.00
    $169.75
    $450.00
    $225.00
    $220.00
    $110.00
    $1,820.00
    $1,320.00
    $220.00
    $200.00
    $400.00
    $100.00
    $175.00
    $100.00
    $300.00
    $100.00
    $796.00
    $1,656.00
    $100.00
    $796.00
    $1,016.00
    $100.00
    $452.20
    $90.00
    $952.88
    $1,057.87
    $310.00
    $700.00
    $320.00
    $40.00
    $200.00
    $8,000.00
    $4,800.00
    $80,503.10
    $27,312.12
    $12,484.78
    $200.00
    $400.00
    $90.00
    $335.00
    $130.00
    $200.00
    $82.95
    $208.50
    $52.13
    $80.00
    $150.00
    $90.00

    Page 455

    Claims Data

    D133
    D113
    M020
    P337
    D424
    D242
    M215
    L070
    D13
    D13
    D13
    D13
    D13
    M215
    S007
    P435
    S159
    S159
    S159
    S159
    S159
    D375
    D375
    D375
    D143
    O076
    O076
    M067
    M067
    P014
    H006
    S277
    S277
    M630
    M654
    P122
    P435
    P435
    M654
    S264
    S264
    S264
    L071
    O169
    O169
    D424
    D424
    D424
    D424
    M140

    $700.00
    $450.00
    $180.00
    $284.00
    $500.00
    $400.00
    $250.00
    $1,400.00
    $100.00
    $300.00
    $1,500.00
    $200.00
    $300.00
    $250.00
    $240.00
    $150.08
    $2,550.00
    $17,423.24
    $6,000.00
    $30,000.00
    $20,629.30
    $50.00
    $300.00
    $50.00
    $200.00
    $3,095.00
    $1,970.00
    $140.00
    $160.00
    $289.10
    $220.00
    $75.00
    $225.00
    $180.00
    $160.00
    $87.99
    $288.15
    $76.31
    $160.00
    $75.00
    $325.00
    $150.00
    $150.00
    $2,155.00
    $1,485.00
    $44.80
    $11.20
    $232.80
    $183.20
    $150.00

    Page 456

    Claims Data

    L065
    M060
    M060
    D411
    D411
    D411
    M549
    P081
    M060
    M060
    M099
    P011
    O025
    O025
    M045
    P090
    L001
    M045
    P090
    M045
    M045
    O001
    M707
    M707
    M707
    S379
    M707
    M707
    D41
    D41
    D41
    D41
    D41
    S433
    D264
    O002
    O002
    O001
    O001
    O001
    L001
    L001
    M068
    M707
    M772
    P474
    O001
    O001
    O001
    H005

    $390.00
    $400.00
    $200.00
    $200.00
    $50.00
    $50.00
    $100.00
    $394.50
    $200.00
    $300.00
    $120.00
    $78.00
    $950.00
    $795.00
    $150.00
    $73.50
    $50.00
    $150.00
    $78.75
    $150.00
    $50.00
    $110.00
    $300.00
    $100.00
    $140.00
    $400.00
    $250.00
    $270.00
    $100.00
    $500.00
    $100.00
    $100.00
    $900.00
    $300.00
    $360.00
    $200.00
    $275.00
    $110.00
    $786.25
    $527.00
    $164.00
    $241.00
    $16.00
    $520.00
    $120.00
    $528.75
    $110.00
    $2,495.00
    $960.00
    $380.00

    Page 457

    Claims Data

    H005
    H005
    S115
    P154
    S115
    M357
    H066
    H066
    M100
    P106
    P106
    D104
    D104
    D58
    D58
    D58
    D58
    M818
    O001
    D59
    D59
    D59
    D59
    D59
    D77
    D77
    M353
    O001
    M637
    P003
    P003
    M637
    P003
    O076
    O076
    O076
    O076
    D283
    D283
    O004
    O004
    O001
    O001
    O001
    M060
    M060
    M060
    M060
    H023
    H023

    $44.68
    $105.23
    $600.00
    $127.30
    $4,000.00
    $1,500.00
    $600.00
    $3,900.00
    $160.00
    $135.00
    $45.00
    $200.00
    $140.00
    $60.00
    $100.00
    $350.00
    $850.00
    $240.00
    $110.00
    $70.00
    $150.00
    $90.00
    $1,400.00
    $540.00
    $60.00
    $250.00
    $150.00
    $200.00
    $120.00
    $126.00
    $50.00
    $270.00
    $491.00
    $90.00
    $1,970.00
    $90.00
    $1,450.00
    $400.00
    $400.00
    $36.00
    $656.00
    $110.00
    $786.25
    $527.00
    $200.00
    $200.00
    $340.00
    $200.00
    $375.00
    $40.00

    Page 458

    Claims Data

    S313
    P066
    H023
    S313
    P031
    S046
    S313
    S313
    P435
    M638
    M638
    M638
    M638
    P488
    M638
    M638
    M638
    M230
    M230
    M230
    M230
    P475
    D104
    D104
    D104
    O076
    O076
    O076
    O076
    M374
    P435
    P435
    D125
    D125
    D125
    D125
    D125
    O004
    O004
    O004
    D439
    D439
    D439
    D439
    D59
    D59
    M549
    P256
    P031
    M692

    $300.00
    $360.75
    $375.00
    $300.00
    $264.48
    $350.00
    $400.00
    $400.00
    $29.39
    $140.00
    $300.00
    $25.00
    $55.00
    $239.00
    $140.00
    $140.00
    $100.00
    $300.00
    $25.00
    $175.00
    $1,100.00
    $95.00
    $80.00
    $280.00
    $340.00
    $90.00
    $1,036.00
    $1,773.00
    $65.00
    $200.00
    $100.80
    $57.83
    $80.00
    $100.00
    $30.00
    $300.00
    $360.00
    $100.00
    $716.00
    $1,656.00
    $110.00
    $100.00
    $90.00
    $480.00
    $200.00
    $290.00
    $100.00
    $278.30
    $230.49
    $500.00

    Page 459

    Claims Data

    S046
    S046
    L162
    P256
    D119
    D119
    D119
    D119
    D119
    D119
    M215
    M215
    P435
    M215
    O177
    O177
    O177
    S165
    P031
    S019
    S019
    M049
    P155
    D192
    D192
    D192
    D192
    D192
    D192
    D192
    O076
    O076
    O076
    M046
    L074
    P150
    M814
    M814
    M156
    M156
    P501
    M156
    P501
    M156
    M156
    H066
    P501
    S253
    S253
    M346

    $400.00
    $100.00
    $300.00
    $1,135.55
    $50.00
    $100.00
    $30.00
    $2,000.00
    $450.00
    $400.00
    $1,000.00
    $600.00
    $489.00
    $250.00
    $100.00
    $2,125.00
    $2,700.00
    $300.00
    $67.99
    $50.00
    $210.00
    $120.00
    $117.40
    $50.00
    $110.00
    $500.00
    $350.00
    $1,050.00
    $1,000.00
    $500.00
    $90.00
    $807.74
    $848.26
    $100.00
    $60.00
    $48.00
    $140.00
    $155.00
    $200.00
    $40.00
    $2,772.00
    $200.00
    $1,611.00
    $300.00
    $300.00
    $250.00
    $5,571.00
    $300.00
    $350.00
    $200.00

    Page 460

    Claims Data

    M346
    P247
    D09
    D09
    D09
    M285
    M285
    P057
    M285
    M285
    M285
    M285
    P057
    M007
    P450
    M007
    P450
    M786
    P450
    P450
    S130
    M108
    M108
    P031
    P031
    M108
    L006
    P031
    M190
    M190
    M584
    M584
    P483
    M190
    M190
    D59
    D59
    D59
    D59
    M694
    M694
    M694
    M694
    D239
    D239
    D239
    D239
    D239
    M164
    M171

    $200.00
    $127.75
    $75.00
    $25.00
    $300.00
    $120.00
    $130.00
    $487.50
    $120.00
    $80.00
    $80.00
    $70.00
    $483.00
    $100.00
    $652.50
    $20.00
    $191.40
    $100.00
    $508.50
    $16.00
    $300.00
    ($150.00)
    $150.00
    ($223.44)
    $223.44
    $150.00
    $550.00
    $223.44
    $80.00
    $60.00
    $600.00
    $191.00
    $141.60
    $100.00
    $100.00
    $375.00
    $1,975.00
    $590.00
    $1,160.00
    $100.00
    $140.00
    $200.00
    $100.00
    $90.00
    $25.00
    $50.00
    $120.00
    $575.00
    $120.00
    $300.00

    Page 461

    Claims Data

    P011
    P011
    M230
    M230
    P014
    M176
    M176
    M176
    M304
    M700
    P413
    L089
    M248
    P014
    P369
    P369
    P369
    M647
    M647
    M647
    M647
    S174
    S174
    H027
    P369
    M647
    M647
    S159
    S265
    S004
    P167
    M786
    M786
    P140
    M786
    D74
    D74
    D74
    D74
    D74
    D74
    D74
    M858
    M858
    H006
    M858
    M858
    S001
    L081
    L006

    $78.50
    $120.00
    $300.00
    $200.00
    $88.00
    $160.00
    $480.00
    $120.00
    $185.00
    $140.00
    $214.80
    $128.00
    $160.00
    $99.00
    $193.45
    $270.45
    $270.45
    $160.00
    $280.00
    $500.00
    $100.00
    $300.00
    $1,200.00
    $1,000.00
    $163.99
    $80.00
    $160.00
    $300.00
    $300.00
    $400.00
    $190.50
    $80.00
    $20.00
    $29.50
    $40.00
    $50.00
    $50.00
    $120.00
    $300.00
    $600.00
    $1,200.00
    $1,700.00
    $400.00
    $150.00
    $700.00
    $200.00
    $150.00
    $400.00
    $400.00
    $150.00

    Page 462

    Claims Data

    L021
    L006
    P066
    S001
    P005
    S001
    P511
    P066
    M597
    P435
    D82
    D143
    D143
    S400
    D143
    S400
    S400
    D143
    D143
    D143
    D77
    D77
    D77
    D232
    D232
    M501
    M501
    M501
    M501
    M501
    M501
    S220
    S220
    M055
    P246
    P031
    P435
    M189
    P059
    M189
    P059
    L065
    P059
    L065
    M189
    P059
    M215
    P372
    P343
    D224

    $170.00
    $400.00
    $417.75
    $300.00
    $385.90
    $300.00
    $726.00
    $457.32
    $200.00
    $206.31
    $400.00
    $2,600.00
    $600.00
    $300.00
    $600.00
    $300.00
    $350.00
    $600.00
    $600.00
    $600.00
    $300.00
    $60.00
    $60.00
    $560.00
    $520.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $80.00
    $200.00
    $200.00
    $358.20
    $69.39
    $39.74
    $120.00
    $270.00
    $240.00
    $140.00
    $90.00
    $1,120.00
    $170.00
    $120.00
    $182.00
    $250.00
    $635.00
    $319.20
    $900.00

    Page 463

    Claims Data

    D224
    D224
    D38
    D38
    D194
    D38
    M237
    M237
    M237
    D38
    M514
    P179
    S250
    P286
    P011
    S250
    P435
    S020
    P022
    L176
    S093
    S020
    S020
    S020
    P022
    S093
    S093
    S093
    S250
    S250
    P286
    M375
    M375
    P068
    M375
    L070
    L023
    M068
    L081
    M068
    M068
    L006
    M068
    L006
    M038
    M346
    M346
    P003
    M067
    M067

    $100.00
    $250.00
    $100.00
    $1,700.00
    $200.00
    $10,700.00
    $120.00
    $1,030.00
    $60.00
    $900.00
    $200.00
    $100.00
    $400.00
    $407.75
    $288.75
    $200.00
    $428.14
    $200.00
    $167.65
    $1,100.00
    $350.00
    $200.00
    $150.00
    $350.00
    $412.05
    $500.00
    $750.00
    $300.00
    $200.00
    $200.00
    $169.57
    $160.00
    $160.00
    $33.39
    $160.00
    $70.00
    $100.00
    $260.00
    $725.00
    $240.00
    $40.00
    $400.00
    $250.00
    $200.00
    $400.00
    $200.00
    $280.00
    $137.20
    ($160.00)
    $160.00

    Page 464

    Claims Data

    H006
    H006
    M067
    H006
    M138
    M138
    P170
    M215
    P170
    M138
    L124
    P170
    M138
    P170
    M138
    P170
    Missing
    Missing
    Missing
    H066
    S133
    L151
    O001
    O001
    O001
    O001
    O076
    O076
    O076
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    P106
    M183
    M183
    P014
    O076
    O076
    O001
    M002
    M002
    M002
    M002
    M002
    M202

    ($1,800.00)
    $1,800.00
    $160.00
    $1,800.00
    $120.00
    $120.00
    $480.00
    $100.00
    $1,470.00
    $120.00
    $150.00
    $472.50
    $100.00
    $367.00
    $100.00
    $1,530.00
    $750.00
    $300.00
    $337.00
    $800.00
    $3,000.00
    $300.00
    $110.00
    $1,464.00
    $536.00
    $484.00
    $90.00
    $2,173.38
    $618.37
    $450.00
    $350.00
    $100.00
    $25.00
    $135.00
    $920.00
    $300.00
    $400.00
    $413.25
    $150.00
    $280.00
    $330.00
    $90.00
    $1,475.00
    $925.00
    $410.00
    $225.00
    $100.00
    $130.00
    $200.00
    $200.00

    Page 465

    Claims Data

    H026
    M461
    M461
    L070
    M638
    M638
    M461
    M461
    L070
    P115
    M461
    M461
    O011
    O011
    O011
    M104
    P479
    M371
    M371
    M371
    P057
    D244
    D244
    S149
    M285
    M285
    M285
    S114
    S114
    S173
    S136
    H006
    M451
    M451
    M310
    M310
    M310
    D217
    D217
    M514
    H034
    O001
    O001
    O001
    D389
    D389
    D389
    D389
    D389
    O004

    $1,500.00
    $300.00
    $460.00
    $580.00
    $280.00
    $280.00
    $300.00
    $540.00
    $900.00
    $169.25
    $150.00
    $260.00
    $80.00
    $620.00
    $2,000.00
    $160.00
    $555.00
    $60.00
    $60.00
    $70.00
    $84.00
    $240.00
    $1,010.00
    $80.00
    $160.00
    $60.00
    $60.00
    $1,200.00
    $150.00
    $360.00
    $310.00
    $240.00
    $300.00
    $200.00
    $150.00
    $250.00
    $60.00
    $50.00
    $800.00
    $300.00
    $360.00
    $110.00
    $895.00
    $750.00
    $100.00
    $150.00
    $400.00
    $300.00
    $100.00
    $100.00

    Page 466

    Claims Data

    O004
    O076
    O076
    O076
    M726
    M726
    P450
    D188
    O076
    O076
    M346
    M346
    P179
    O061
    O061
    P066
    O061
    P066
    O002
    O002
    O002
    M248
    P422
    M248
    M248
    L97
    L97
    M758
    M248
    P422
    M001
    M001
    S192
    L061
    L149
    P435
    S192
    P435
    O004
    O004
    O004
    O001
    O001
    M388
    P223
    M225
    M225
    L006
    P055
    P055

    $100.00
    $90.00
    $947.88
    $1,152.87
    $100.00
    $40.00
    $68.50
    $300.00
    $1,525.50
    $1,375.00
    $100.00
    $100.00
    $168.00
    $190.00
    $190.00
    $71.79
    $190.00
    $215.37
    $70.00
    $1,355.75
    $2,422.50
    $140.00
    $111.25
    $140.00
    $100.00
    $180.00
    $265.00
    $180.00
    $140.00
    $226.80
    $200.00
    $20.00
    $300.00
    $70.00
    $150.00
    $439.39
    $300.00
    $1,032.08
    $100.00
    $1,036.00
    $776.00
    $1,525.00
    $810.00
    $240.00
    $224.00
    $440.00
    $260.00
    $1,100.00
    $81.99
    $118.50

    Page 467

    Claims Data

    S265
    S265
    D337
    D337
    M018
    M018
    S296
    H003
    H003
    H003
    H003
    H003
    P115
    D371
    S296
    P115
    M018
    M018
    S296
    L065
    S296
    S296
    L065
    M138
    M138
    M230
    M230
    P167
    D79
    D79
    D79
    O076
    O076
    O076
    O076
    O076
    O076
    P167
    M104
    P167
    S232
    L006
    D114
    D114
    D114
    D114
    D22
    M758
    P016
    L003

    $300.00
    $280.00
    $350.00
    $1,250.00
    $200.00
    $60.00
    $500.00
    $120.00
    $300.00
    $180.00
    $150.00
    $670.00
    $118.45
    $300.00
    $500.00
    $149.45
    $200.00
    $100.00
    $500.00
    $625.00
    $500.00
    $500.00
    $115.00
    $120.00
    $80.00
    $300.00
    $300.00
    $187.15
    $140.00
    $25.00
    $45.00
    $90.00
    $1,036.00
    $1,970.00
    $90.00
    $876.00
    $1,770.00
    $564.00
    $360.00
    $174.00
    $250.00
    $400.00
    $50.00
    $70.00
    $50.00
    $400.00
    $200.00
    $200.00
    $142.50
    $620.00

    Page 468

    Claims Data

    D257
    D257
    D257
    M864
    M864
    M864
    P240
    O076
    O076
    O076
    O108
    O108
    O108
    P340
    M346
    M346
    M346
    M346
    P115
    P115
    M346
    M346
    P115
    M346
    M346
    P115
    S370
    M505
    L152
    P477
    O054
    S174
    M814
    M814
    M814
    P318
    P318
    M138
    M138
    P195
    L046
    M441
    M441
    P014
    H006
    H006
    H006
    L065
    P246
    M067

    $120.00
    $280.00
    $2,000.00
    $100.00
    $20.00
    $20.00
    $45.15
    $90.00
    $563.35
    $1,122.38
    $85.00
    $1,395.00
    $1,220.00
    $863.00
    $200.00
    $200.00
    $100.00
    $100.00
    $24.15
    $49.00
    $100.00
    $100.00
    $67.55
    $200.00
    $200.00
    $46.80
    $3,000.00
    $180.00
    $310.00
    $172.75
    $120.00
    $300.00
    $100.00
    $32.00
    $8.00
    $7.20
    $1.80
    $100.00
    $100.00
    $51.00
    $160.00
    $200.00
    $450.00
    $183.35
    $100.00
    $1,130.00
    $150.00
    $960.00
    $997.40
    $460.00

    Page 469

    Claims Data

    M067
    L117
    P478
    S004
    M795
    M795
    M795
    M213
    M213
    P332
    M049
    P246
    M461
    M461
    M461
    L070
    M461
    M461
    M461
    P468
    H033
    M694
    M694
    M694
    M213
    M213
    M213
    M647
    M647
    S004
    L079
    L150
    L079
    L071
    M285
    M285
    M285
    M285
    M020
    M020
    M020
    M020
    M020
    P468
    S384
    S384
    M505
    M505
    O011
    O011

    $60.00
    $1,044.00
    $190.00
    $300.00
    $150.00
    $150.00
    $120.00
    $100.00
    $100.00
    $170.50
    $120.00
    $144.20
    $150.00
    $290.00
    $200.00
    $1,540.00
    $100.00
    $300.00
    $60.00
    $200.00
    $700.00
    $100.00
    $100.00
    $100.00
    $200.00
    $20.00
    $290.00
    $160.00
    $300.00
    $400.00
    $250.00
    $400.00
    $15.00
    $400.00
    $200.00
    $65.00
    $68.00
    $100.00
    $400.00
    $80.00
    $70.00
    $180.00
    $90.00
    $90.00
    $400.00
    $200.00
    $360.00
    $100.00
    $80.00
    $220.00

    Page 470

    Claims Data

    O011
    D82
    D82
    S281
    S281
    P115
    M317
    M317
    P465
    L034
    M046
    P150
    H033
    O030
    O030
    O030
    M007
    M007
    S170
    S170
    M647
    M647
    P504
    O170
    O170
    O170
    S403
    S076
    D133
    O008
    O008
    M694
    M694
    M029
    M029
    M029
    S354
    O008
    M200
    L074
    M200
    M200
    S020
    S020
    S020
    S384
    M792
    M792
    M792
    P191

    $710.00
    $120.00
    $330.00
    $400.00
    $400.00
    $1,037.40
    $120.00
    $40.00
    $294.00
    $400.00
    $60.00
    $56.70
    $400.00
    $80.00
    $535.80
    $288.20
    $100.00
    $20.00
    $300.00
    $300.00
    $80.00
    $120.00
    $200.00
    $90.00
    $700.00
    $800.00
    $400.00
    $350.00
    $500.00
    $650.00
    $320.00
    $100.00
    $300.00
    $100.00
    $100.00
    $75.00
    $300.00
    $2,190.00
    $120.00
    $265.00
    $60.00
    $30.00
    $200.00
    $500.00
    $50.00
    $400.00
    $100.00
    $200.00
    $50.00
    $56.50

    Page 471

    Claims Data

    M647
    M647
    M647
    O076
    O076
    O076
    M769
    M769
    M769
    M104
    M188
    D312
    D312
    D312
    D312
    L152
    S179
    P497
    H005
    H005
    S356
    M673
    S356
    H052
    P256
    P094
    P382
    O065
    O065
    O065
    O065
    O004
    O004
    O004
    O004
    O076
    O076
    O076
    O076
    O076
    M304
    M304
    M662
    M662
    M644
    P411
    M644
    M644
    S301
    O023

    $80.00
    $100.00
    $500.00
    $90.00
    $1,036.63
    $1,216.62
    $150.00
    $150.00
    $50.00
    $400.00
    $290.00
    $25.00
    $50.00
    $250.00
    $450.00
    $500.00
    $300.00
    $234.25
    $850.00
    $3,609.28
    $12,000.00
    $2,000.00
    $600.00
    $140.00
    $55.00
    $634.00
    $255.18
    $350.00
    $1,500.00
    $400.00
    $320.00
    $100.00
    $1,395.00
    $365.00
    $130.00
    $90.00
    $800.00
    $476.00
    $400.00
    $923.00
    $75.00
    $110.00
    $100.00
    $20.00
    $200.00
    $89.60
    $300.00
    $100.00
    $300.00
    $150.00

    Page 472

    Claims Data

    O023
    O023
    M216
    M216
    M216
    D77
    D77
    S296
    S296
    S296
    M053
    M053
    L001
    M119
    M119
    P154
    M647
    M647
    M647
    P504
    L070
    D301
    D301
    M341
    L174
    L174
    M341
    M792
    M792
    M792
    M792
    M792
    L070
    O162
    O162
    O162
    M346
    M346
    M346
    M346
    M647
    M647
    M647
    M647
    M732
    M732
    M732
    P140
    P140
    M647

    $1,850.00
    $2,475.00
    $80.00
    $40.00
    $275.00
    $250.00
    $240.00
    $1,050.00
    $400.00
    $3,900.00
    $140.00
    $280.00
    $172.00
    $60.00
    $60.00
    $160.40
    $160.00
    $100.00
    $100.00
    $90.00
    $470.00
    $160.00
    $90.00
    $140.00
    $160.00
    $190.00
    $140.00
    $100.00
    $140.00
    $715.00
    $80.00
    $600.00
    $360.00
    $75.00
    $150.00
    $200.00
    $800.00
    $800.00
    $300.00
    $300.00
    $240.00
    $460.00
    $1,000.00
    $200.00
    $100.00
    $20.00
    $70.00
    $567.50
    $226.10
    $80.00

    Page 473

    Claims Data

    M647
    P504
    P445
    M647
    M647
    P504
    M327
    M864
    M864
    M864
    M864
    M864
    M232
    M232
    D38
    D38
    M647
    M647
    M123
    M123
    M123
    M123
    M233
    M233
    M028
    M028
    M456
    M456
    D300
    D300
    D300
    D300
    D300
    D300
    D300
    M353
    M804
    M804
    M804
    P094
    M089
    M089
    M007
    S355
    P497
    P191
    M187
    L074
    D379
    D379

    $160.00
    $250.00
    $164.00
    $80.00
    $160.00
    $114.00
    $100.00
    $100.00
    $20.00
    $10.00
    $100.00
    $90.00
    $100.00
    $40.00
    $60.00
    $440.00
    $80.00
    $160.00
    $150.00
    $60.00
    $80.00
    $150.00
    $100.00
    $20.00
    $100.00
    $10.00
    $140.00
    $60.00
    $150.00
    $262.50
    $95.00
    $17.50
    $350.00
    $150.00
    $400.00
    $150.00
    $120.00
    $360.00
    $50.00
    $154.50
    $119.00
    $441.00
    $80.00
    $300.00
    $60.00
    $63.00
    $300.00
    $200.00
    $160.00
    $50.00

    Page 474

    Claims Data

    D379
    D379
    M200
    M200
    D103
    D103
    S052
    L96
    L075
    UN01
    M167
    M167
    O076
    O076
    O076
    O131
    O131
    O131
    S071
    P497
    M795
    M795
    M795
    M795
    S432
    H011
    H011
    H011
    S312
    S312
    S312
    S312
    S312
    M388
    M388
    P154
    D27
    D27
    S053
    S053
    S053
    M213
    M213
    P415
    M754
    M754
    M238
    M238
    M754
    M754

    $110.00
    $1,200.00
    $60.00
    $20.00
    $140.00
    $320.00
    $400.00
    $150.00
    $3,800.00
    $450.00
    $140.00
    $60.00
    $280.00
    $846.00
    $1,345.50
    $70.00
    $2,000.00
    $850.00
    $470.00
    $230.00
    $150.00
    $230.00
    $350.00
    $1,040.00
    $2,500.00
    $900.00
    $1,800.00
    $600.00
    $3,700.00
    $250.00
    $150.00
    $20.00
    $350.00
    $100.00
    $100.00
    $228.00
    $350.00
    $1,650.00
    $300.00
    $6,000.00
    $125.00
    $100.00
    $20.00
    $165.00
    $140.00
    $100.00
    $100.00
    $75.00
    $140.00
    $98.00

    Page 475

    Claims Data

    M754
    S187
    P154
    M461
    M461
    M304
    P337
    D132
    D132
    D132
    D132
    M853
    M662
    M662
    M662
    M662
    M662
    M662
    P428
    M662
    P139
    P428
    P458
    P428
    M662
    P011
    M662
    M662
    O001
    O001
    M662
    M002
    M002
    O004
    O004
    O004
    O004
    O004
    O004
    O004
    O004
    O076
    O076
    O076
    S152
    S152
    S152
    S152
    S152
    S152

    $45.00
    $50.00
    $59.99
    $150.00
    $200.00
    $125.00
    $260.00
    $60.00
    $340.00
    $100.00
    $100.00
    $400.00
    $60.00
    $40.00
    $60.00
    $40.00
    $40.00
    $100.00
    $194.90
    $100.00
    $300.00
    $295.80
    $10.00
    $36.85
    $100.00
    $41.00
    $200.00
    $200.00
    $110.00
    $110.00
    $280.00
    $130.00
    $120.00
    $1,316.00
    $379.00
    $184.00
    $465.00
    $1,236.00
    $359.00
    $264.00
    $331.00
    $80.00
    $716.00
    $1,100.00
    $300.00
    $200.00
    $400.00
    $4,000.00
    $100.00
    $100.00

    Page 476

    Claims Data

    O077
    O077
    O077
    O163
    O163
    O163
    O076
    O076
    O076
    O076
    O136
    O047
    O047
    M514
    M189
    D90
    D90
    D90
    D90
    D90
    S400
    L065
    L006
    M310
    M310
    M310
    M310
    O024
    O024
    O024
    O076
    O076
    O076
    M388
    M388
    P140
    M388
    M388
    H066
    P140
    P140
    M007
    M007
    P140
    P140
    M801
    M801
    M801
    M801
    O076

    $300.00
    $1,120.00
    $1,480.00
    $70.00
    $1,100.00
    $570.00
    $90.00
    $1,500.00
    $1,095.00
    $1,935.50
    $100.00
    $995.00
    $1,050.00
    $260.00
    $140.00
    $480.00
    $100.00
    $20.00
    $640.00
    $160.00
    $300.00
    $1,500.00
    $500.00
    $150.00
    $350.00
    $528.00
    $300.00
    $100.00
    $1,276.00
    $2,056.00
    $90.00
    $2,323.25
    $768.25
    $150.00
    $150.00
    $44.00
    $150.00
    $150.00
    $300.00
    $18.00
    $25.00
    $100.00
    $20.00
    $15.00
    $15.00
    $100.00
    $100.00
    $200.00
    $400.00
    $90.00

    Page 477

    Claims Data

    O076
    M294
    P315
    P315
    M093
    M093
    M093
    L156
    P008
    O065
    O065
    O065
    O065
    P433
    S370
    P240
    M718
    M718
    P407
    M733
    M733
    M733
    M388
    M388
    P407
    M388
    M388
    L070
    M018
    M018
    M028
    M028
    P140
    S210
    S210
    P433
    P145
    S210
    P145
    M156
    M156
    P433
    P145
    D125
    D125
    D125
    D125
    D125
    M156
    M156

    $90.00
    $100.00
    $405.00
    $479.55
    $120.00
    $40.00
    $24.00
    $45.00
    $146.65
    $150.00
    $990.00
    $1,764.00
    $110.00
    $144.40
    $300.00
    $65.65
    $100.00
    $100.00
    $141.35
    $100.00
    $20.00
    $80.00
    $100.00
    $100.00
    $60.00
    $100.00
    $600.00
    $350.00
    $600.00
    $150.00
    $100.00
    $15.00
    $60.00
    $300.00
    $400.00
    $129.00
    $220.00
    $200.00
    $875.00
    $100.00
    $300.00
    $191.90
    $375.00
    $70.00
    $250.00
    $75.00
    $265.00
    $320.00
    $100.00
    $300.00

    Page 478

    Claims Data

    P433
    P145
    P145
    M061
    M061
    O049
    O049
    O049
    M061
    M061
    M061
    M061
    M061
    M061
    M061
    M061
    M061
    M083
    M083
    M232
    M232
    M232
    M553
    P073
    S170
    S170
    L070
    P140
    P140
    O001
    O001
    O001
    O001
    O001
    S354
    L070
    M159
    P158
    M159
    M159
    M159
    H023
    H006
    S302
    S302
    S302
    P031
    D252
    D252
    D252

    $193.50
    $345.00
    $140.00
    $100.00
    $100.00
    $60.00
    $350.00
    $490.00
    $100.00
    $40.00
    $20.00
    $100.00
    $215.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $30.00
    $20.00
    $140.00
    $841.20
    $600.00
    $400.00
    $24.00
    $500.00
    $194.00
    $1,479.20
    $419.80
    $2,065.50
    $1,227.80
    $356.80
    $100.00
    $250.00
    $720.00
    $83.00
    $480.00
    $60.00
    $160.00
    $652.00
    $400.00
    $120.00
    $340.00
    $540.00
    $268.98
    $500.00
    $75.00
    $75.00

    Page 479

    Claims Data

    D252
    H003
    H003
    H003
    D263
    D263
    D263
    D263
    D263
    D263
    M055
    L174
    L021
    L065
    O001
    S096
    S096
    S201
    H008
    P462
    P462
    P462
    P435
    O004
    O004
    O004
    O004
    S160
    P435
    S265
    S265
    D35
    D35
    S201
    P435
    P435
    P435
    S160
    S160
    S128
    S128
    H006
    H006
    S277
    L025
    P478
    L174
    M857
    H025
    L018

    $350.00
    $600.00
    $400.00
    $250.00
    $150.00
    $350.00
    $77.00
    $23.00
    $700.00
    $300.00
    $300.00
    $740.00
    $150.00
    $1,190.00
    $110.00
    $90.00
    $210.00
    $300.00
    $154.00
    $7.25
    $507.11
    $56.34
    $199.50
    $120.00
    $80.00
    $1,380.00
    $515.00
    $240.00
    $68.56
    $300.00
    $150.00
    $120.00
    $450.00
    $300.00
    $498.85
    $49.88
    $62.05
    $400.00
    $120.00
    $400.00
    $480.00
    $437.00
    $2,100.00
    $200.00
    $125.00
    $105.00
    $340.00
    $200.00
    $60.00
    $240.00

    Page 480

    Claims Data

    S277
    L025
    D266
    D259
    D259
    D259
    S149
    D388
    D388
    D388
    S179
    S179
    S149
    M857
    M857
    S296
    S296
    M473
    S103
    L013
    P430
    S103
    S103
    D376
    D376
    M194
    M194
    M194
    M847
    M847
    M847
    M847
    M847
    M194
    M194
    M194
    M194
    L061
    P019
    O004
    O004
    O004
    O004
    O004
    D90
    D90
    D90
    M194
    M194
    M194

    $200.00
    $210.00
    $400.00
    $350.00
    $70.00
    $80.00
    $260.00
    $35.00
    $15.00
    $300.00
    $260.00
    $160.00
    $240.00
    $100.00
    $725.00
    $2,400.00
    $1,050.00
    $150.00
    $800.00
    $149.00
    $288.00
    ($800.00)
    $800.00
    $910.00
    $1,590.00
    $100.00
    $70.00
    $190.00
    $300.00
    $168.00
    $42.00
    $40.00
    $120.00
    $100.00
    $25.00
    $35.00
    $60.00
    $865.00
    $113.30
    $1,084.80
    $271.20
    $915.20
    $1,140.80
    $100.00
    $475.00
    $25.00
    $2,000.00
    $100.00
    $120.00
    $30.00

    Page 481

    Claims Data

    M194
    M194
    P019
    P014
    P014
    P019
    M694
    M694
    M694
    M694
    M694
    P019
    D31
    M124
    P435
    P435
    D31
    D31
    M437
    M437
    M437
    D341
    D341
    D341
    D341
    D341
    P286
    P286
    P286
    M668
    P435
    M300
    M300
    P081
    P155
    M300
    M053
    M053
    M053
    P081
    S214
    H005
    D125
    D125
    L001
    L075
    D31
    D31
    D31
    D31

    $136.00
    $34.00
    $109.50
    $26.40
    $6.60
    $448.00
    $100.00
    $320.00
    $80.00
    $112.00
    $28.00
    $447.00
    $325.00
    $250.00
    $32.42
    $168.44
    $310.00
    $310.00
    $250.00
    $25.00
    $50.00
    $100.00
    $70.00
    $170.00
    $700.00
    $500.00
    $600.00
    $705.00
    $160.00
    $220.00
    $284.45
    $320.00
    $500.00
    $67.50
    $225.55
    $1,000.00
    $280.00
    $210.00
    $60.00
    $200.00
    $1,920.00
    $1,500.00
    $80.00
    $280.00
    $1,672.00
    $3,800.00
    $325.00
    $140.00
    $460.00
    $75.00

    Page 482

    Claims Data

    D181
    D181
    D181
    D181
    M720
    M720
    M119
    M119
    M119
    P479
    S200
    O047
    O047
    O047
    O047
    M872
    M872
    M872
    M872
    P479
    H008
    M060
    P031
    P022
    P022
    M375
    M060
    P031
    P122
    D97
    H029
    H029
    O053
    O053
    O053
    M215
    L128
    L070
    P231
    S286
    L128
    M847
    M847
    M847
    M166
    M166
    P487
    L153
    L153
    L153

    $100.00
    $450.00
    $100.00
    $800.00
    $200.00
    $1,700.00
    $60.00
    $25.00
    $55.00
    $289.45
    $300.00
    $2,065.50
    $1,778.50
    $625.50
    $1,539.00
    $150.00
    $70.00
    $50.00
    $105.00
    $360.00
    $440.00
    $200.00
    $65.49
    $192.00
    $192.50
    $160.00
    $200.00
    $149.48
    $184.00
    $360.00
    $100.00
    $100.00
    $100.00
    $50.00
    $60.00
    $750.00
    $150.00
    $990.00
    $8.50
    $300.00
    $1,780.00
    $180.00
    $25.00
    $75.00
    $140.00
    $110.00
    $38.61
    $360.00
    $80.00
    $20.00

    Page 483

    Claims Data

    L153
    M166
    M166
    M166
    P487
    P487
    M166
    M166
    M166
    M166
    M166
    O037
    O037
    S279
    S279
    S279
    P435
    M437
    L96
    L96
    L96
    L96
    M152
    H034
    H034
    M067
    M067
    P104
    P454
    P104
    M067
    P435
    P435
    L020
    M067
    M067
    M067
    S355
    S355
    O076
    O076
    D322
    D322
    D322
    D322
    D322
    D260
    O001
    O001
    D150

    $550.00
    $160.00
    $80.00
    $20.00
    $8.98
    $2.24
    $140.00
    $112.00
    $28.00
    $80.00
    $20.00
    $1,000.00
    $1,800.00
    $500.00
    $232.00
    $200.00
    $59.06
    $300.00
    $400.00
    $700.00
    $250.00
    $500.00
    $300.00
    $260.00
    $800.00
    $160.00
    $160.00
    $16.00
    $84.00
    $129.65
    $300.00
    $147.97
    $400.48
    $720.00
    $25.00
    $15.00
    $160.00
    $300.00
    $440.00
    $90.00
    $1,395.00
    $375.00
    $70.00
    $30.00
    $375.00
    $100.00
    $700.00
    $270.00
    $1,925.00
    $150.00

    Page 484

    Claims Data

    D150
    P011
    P022
    S400
    S400
    S400
    H005
    P094
    S400
    H005
    H011
    H006
    H006
    S386
    L065
    P014
    S386
    P014
    M225
    M225
    L001
    L046
    L081
    L081
    S382
    S382
    P066
    P066
    S421
    L041
    P279
    P497
    P497
    MM06
    O004
    O004
    O004
    D181
    D181
    D181
    D181
    D181
    D181
    D181
    S275
    D181
    D181
    D432
    P005
    M225

    $350.00
    $15.00
    $8.00
    $400.00
    $300.00
    $350.00
    $100.00
    $59.50
    $400.00
    $100.00
    $160.00
    $4,050.00
    $50.00
    $300.00
    $2,090.00
    $139.30
    $300.00
    $88.90
    $250.00
    $130.00
    $960.00
    $1,100.00
    $200.00
    $60.00
    $300.00
    $180.00
    $129.00
    $69.00
    $300.00
    $200.00
    $350.00
    $157.50
    $399.00
    $281.75
    $100.00
    $1,596.00
    $1,896.00
    $100.00
    $450.00
    $350.00
    $100.00
    $450.00
    $100.00
    $800.00
    $300.00
    $1,723.00
    $77.00
    $350.00
    $405.76
    $70.00

    Page 485

    Claims Data

    M225
    L001
    M225
    M225
    L006
    P011
    M225
    D60
    D60
    D60
    D60
    S375
    S375
    P435
    M225
    M225
    L006
    M225
    M225
    T040
    T040
    M225
    M225
    L157
    P435
    L001
    L001
    D60
    D60
    D60
    D60
    D60
    M225
    M225
    M225
    P005
    P005
    M556
    P435
    P011
    P073
    D102
    D102
    D102
    D102
    O001
    O001
    D102
    D102
    D102

    $150.00
    $195.00
    $140.00
    $300.00
    $200.00
    $324.50
    $160.00
    $50.00
    $70.00
    $50.00
    $200.00
    $200.00
    $800.00
    $141.92
    $140.00
    $300.00
    $200.00
    $160.00
    $324.50
    $200.00
    $975.00
    $440.00
    $260.00
    $200.00
    $173.49
    $265.00
    $170.00
    $620.00
    $280.00
    $60.00
    $880.00
    $1,320.00
    $70.00
    $150.00
    $130.00
    $405.76
    $405.76
    $120.00
    $495.60
    $138.50
    $805.20
    $400.00
    $200.00
    $600.00
    $2,400.00
    $540.00
    $1,216.00
    $200.00
    $70.00
    $130.00

    Page 486

    Claims Data

    D102
    D102
    D102
    D102
    D07
    D07
    D07
    D19
    D19
    D19
    M034
    L006
    P014
    D31
    D31
    D31
    D31
    T060
    T060
    M034
    P011
    D77
    D77
    D232
    D232
    L049
    O001
    M030
    P011
    L001
    H005
    M030
    P091
    P435
    M030
    M060
    H023
    H023
    L070
    S137
    S137
    M473
    P022
    L070
    H023
    H023
    S137
    P022
    P022
    S137

    $400.00
    $1,200.00
    $910.00
    $3,090.00
    $475.00
    $70.00
    $30.00
    $250.00
    $420.00
    $405.00
    $50.00
    $250.00
    $15.00
    $325.00
    $325.00
    $295.00
    $325.00
    $2,490.00
    $2,270.00
    $50.00
    $21.00
    $150.00
    $250.00
    $280.00
    $360.00
    $180.00
    $110.00
    $160.00
    $168.00
    $40.00
    $455.00
    $320.00
    $112.20
    $375.93
    $160.00
    $200.00
    $575.00
    $345.00
    $80.00
    $450.00
    $400.00
    $140.00
    $185.00
    $440.50
    $375.00
    $650.00
    $450.00
    $65.00
    $50.00
    $400.00

    Page 487

    Claims Data

    M473
    P022
    M060
    P215
    M473
    P022
    L075
    L070
    M205
    P022
    S137
    S137
    M473
    S187
    D262
    D262
    D262
    D262
    D262
    S122
    S122
    S122
    M454
    L121
    L065
    S416
    D01
    D01
    D239
    D387
    D387
    M099
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    M178
    P427
    D171
    D171
    D171
    D171
    D171

    $120.00
    $170.25
    $200.00
    $102.75
    $120.00
    $184.54
    $3,800.00
    $639.00
    $240.00
    $74.90
    $450.00
    $49.00
    $240.00
    $200.00
    $135.00
    $70.00
    $35.00
    $200.00
    $400.00
    $300.00
    $300.00
    $200.00
    $260.00
    $250.00
    $586.50
    $300.00
    $85.00
    $4,515.00
    $90.00
    $85.00
    $165.00
    $120.00
    $135.00
    $45.00
    $50.00
    $390.00
    $180.00
    $135.00
    $45.00
    $135.00
    $45.00
    $135.00
    $45.00
    $400.00
    $160.65
    $300.00
    $280.00
    $200.00
    $135.00
    $45.00

    Page 488

    Claims Data

    S042
    L006
    M375
    P422
    L021
    M375
    M375
    P014
    M634
    P022
    O001
    O019
    D291
    D291
    D291
    D291
    P011
    D232
    D411
    D411
    D411
    D411
    D411
    S293
    S293
    M861
    M861
    M861
    M230
    M230
    P426
    S257
    M861
    H003
    H003
    M312
    M312
    P256
    M312
    H003
    P256
    P256
    D224
    MM05
    MM05
    D224
    D224
    D224
    D102
    M312

    $400.00
    $300.00
    $160.00
    $581.80
    $520.00
    $160.00
    $160.00
    $134.82
    $140.00
    $35.00
    $528.00
    $100.00
    $1,400.00
    $1,100.00
    $133.00
    $167.00
    $181.30
    $250.00
    $100.00
    $100.00
    $100.00
    $50.00
    $100.00
    $500.00
    $100.00
    $200.00
    $200.00
    $600.00
    $300.00
    $200.00
    $364.10
    $400.00
    $200.00
    $100.00
    $175.00
    $120.00
    $60.00
    $55.85
    $100.00
    $51.50
    $8.65
    $74.30
    $350.00
    $60.00
    $60.00
    $400.00
    $230.00
    $70.00
    $400.00
    $100.00

    Page 489

    Claims Data

    P094
    P256
    H003
    M312
    P094
    P256
    P256
    O001
    D39
    D01
    D102
    D102
    D01
    M312
    P373
    P256
    M807
    L149
    P104
    O001
    O001
    O001
    M760
    M760
    S174
    P467
    M815
    M815
    M815
    M815
    M815
    M815
    M815
    S275
    S275
    P435
    M577
    M766
    M341
    M341
    P014
    M341
    M341
    M341
    P014
    H006
    H006
    H006
    M341
    H006

    $109.50
    $85.50
    $1,390.00
    $100.00
    $183.50
    $43.00
    $59.55
    $496.00
    $600.00
    $300.00
    $100.00
    $400.00
    $9,700.00
    $100.00
    $26.50
    $77.35
    $400.00
    $150.00
    $14.95
    $100.00
    $1,395.00
    $660.00
    $100.00
    $100.00
    $300.00
    $457.00
    $160.00
    $140.00
    $100.00
    $35.00
    $215.00
    $160.00
    $1,200.00
    $60.01
    $239.99
    $513.38
    $200.00
    $200.00
    $140.00
    $100.00
    $418.60
    $60.00
    $140.00
    $100.00
    $418.60
    $450.00
    $1,045.00
    $355.00
    $100.00
    $450.00

    Page 490

    Claims Data

    H006
    H006
    H006
    M341
    M341
    P498
    US01
    H003
    S046
    S046
    M773
    M773
    P436
    S323
    S323
    S323
    P435
    D414
    S165
    S375
    D414
    S375
    D217
    H034
    D41
    D41
    D41
    D41
    D41
    D41
    D41
    M202
    M202
    P461
    D327
    D327
    D327
    D327
    D327
    D327
    M818
    M687
    P435
    S437
    M818
    M818
    M818
    M388
    M388
    P450

    $605.00
    $805.00
    $1,310.00
    $140.00
    $100.00
    $591.25
    $28,440.00
    $350.00
    $350.00
    $100.00
    $250.00
    $15.00
    $82.74
    $350.00
    $350.00
    $160.00
    $370.26
    $600.00
    $360.00
    $200.00
    $600.00
    $1,200.00
    $2,490.00
    $700.00
    $100.00
    $35.00
    $65.00
    $1,500.00
    $150.00
    $100.00
    $500.00
    $100.00
    $160.00
    $175.00
    $150.00
    $400.00
    $133.00
    $267.00
    $1,500.00
    $1,000.00
    $260.00
    $125.00
    $79.84
    $300.00
    $300.00
    $300.00
    $260.00
    $200.00
    $200.00
    $125.50

    Page 491

    Claims Data

    P140
    S450
    L149
    M833
    M833
    S083
    D232
    D232
    M577
    S404
    M577
    M454
    L065
    L149
    D169
    D169
    D169
    D169
    D169
    S191
    P154
    L041
    L041
    S437
    S437
    L061
    P154
    S421
    L041
    P060
    S052
    S151
    S151
    S151
    L157
    H005
    D232
    D232
    S112
    O001
    O001
    M580
    M580
    M580
    M580
    D336
    D336
    D336
    D336
    D336

    $311.15
    $300.00
    $900.00
    $240.00
    $60.00
    $400.00
    $50.00
    $250.00
    $200.00
    $300.00
    $240.00
    $200.00
    $235.00
    $150.00
    $160.00
    $440.00
    $105.00
    $115.00
    $300.00
    $500.00
    $1,744.50
    $400.00
    $2,400.00
    $300.00
    $250.00
    $250.00
    $108.45
    $200.00
    $150.00
    $259.95
    $300.00
    $350.00
    $350.00
    $170.00
    $450.00
    $840.00
    $495.00
    $705.00
    $300.00
    $250.00
    $904.00
    $100.00
    $400.00
    $100.00
    $200.00
    $110.00
    $70.00
    $120.00
    $940.00
    $1,770.00

    Page 492

    Claims Data

    M029
    M029
    H008
    S296
    M750
    H023
    H003
    M473
    H023
    M473
    P373
    M297
    M297
    M297
    L116
    L116
    P404
    M297
    D78
    D323
    D323
    D323
    D323
    D323
    D323
    S184
    S184
    P399
    M586
    P306
    D171
    D171
    D171
    M586
    P306
    D23
    D23
    D191
    D191
    D191
    D191
    D191
    M773
    M773
    D191
    D191
    S302
    M842
    M473
    S383

    $100.00
    $20.00
    $268.00
    $7,000.00
    $2,500.00
    $3,000.00
    $275.00
    $140.00
    $375.00
    $120.00
    $214.50
    $120.00
    $120.00
    $250.00
    $230.00
    $460.00
    $163.50
    $120.00
    $400.00
    $100.00
    $400.00
    $140.00
    $180.00
    $20.00
    $750.00
    $260.00
    $100.00
    $179.00
    $550.00
    $66.00
    $100.00
    $70.00
    $180.00
    $550.00
    $90.50
    $85.00
    $315.00
    $70.00
    $450.00
    $100.00
    $70.00
    $60.00
    $250.00
    $15.00
    $350.00
    $100.00
    $700.00
    $200.00
    $180.00
    $260.00

    Page 493

    Claims Data

    P049
    M331
    M331
    P014
    H034
    H034
    H034
    H034
    P456
    P427
    D134
    D134
    S386
    P303
    P014
    P014
    M760
    M760
    P340
    M295
    S187
    H030
    H030
    S187
    S187
    M864
    M864
    M864
    P158
    M864
    UN01
    L143
    S322
    H006
    H006
    H006
    S187
    P443
    S187
    M028
    M028
    M028
    M028
    M028
    M833
    M833
    D169
    M789
    L081
    P436

    $51.65
    $140.00
    $200.00
    $47.25
    $525.00
    $145.00
    $500.00
    $700.00
    $42.00
    $315.40
    $360.00
    $60.00
    $300.00
    $200.95
    $180.00
    $333.12
    $100.00
    $40.00
    $129.99
    $100.00
    $200.00
    $250.00
    $2,984.95
    $2,000.00
    $200.00
    $100.00
    $20.00
    $40.00
    $72.00
    $80.00
    $750.00
    $300.00
    $300.00
    $490.00
    $100.00
    $200.00
    $400.00
    $157.50
    $650.00
    $100.00
    $30.00
    $75.00
    $100.00
    $55.00
    $250.00
    $530.00
    $500.00
    $200.00
    $255.00
    $83.97

    Page 494

    Claims Data

    M638
    M638
    M638
    M638
    P106
    D119
    D119
    D119
    D119
    D119
    M683
    M683
    M683
    M683
    M683
    M683
    S259
    S259
    S112
    S384
    M443
    M443
    M326
    H025
    M265
    M265
    P369
    L018
    S293
    S293
    S293
    M326
    P478
    L091
    P071
    P071
    O001
    O001
    O001
    M310
    S162
    P246
    P246
    S087
    P031
    P031
    P031
    P031
    S123
    S365

    $280.00
    $580.00
    $100.00
    $140.00
    $120.00
    $50.00
    $350.00
    $80.00
    $40.00
    $600.00
    $260.00
    $270.00
    $30.00
    $250.00
    $279.00
    $31.00
    $600.00
    $2,000.00
    $300.00
    $500.00
    $200.00
    $450.00
    $250.00
    $60.00
    $200.00
    $200.00
    $47.45
    $60.00
    $600.00
    $300.00
    $5,000.00
    $200.00
    $360.70
    $400.00
    $226.80
    $168.50
    $110.00
    $2,120.75
    $442.00
    $150.00
    $300.00
    $159.70
    $69.25
    $300.00
    $309.80
    $34.86
    $1,549.00
    $209.16
    $500.00
    $460.00

    Page 495

    Claims Data

    S365
    M326
    S302
    S302
    S302
    D119
    D119
    D119
    D119
    M225
    M225
    T034
    T034
    P005
    P005
    P372
    O024
    O024
    O024
    D346
    D346
    D346
    D78
    D78
    M792
    M792
    M792
    P178
    O076
    O076
    O076
    O076
    O076
    O076
    S141
    S141
    S141
    S141
    L128
    S296
    D425
    D425
    M326
    M326
    H005
    L143
    L143
    M104
    P354
    P354

    $2,600.00
    $200.00
    $400.00
    $360.00
    $140.00
    $50.00
    $300.00
    $80.00
    $40.00
    $220.00
    $80.00
    $1,300.00
    $1,175.00
    $283.07
    $70.77
    $517.80
    $100.00
    $1,260.00
    $2,200.00
    $840.00
    $2,160.00
    $900.00
    $400.00
    $400.00
    $100.00
    $25.00
    $85.00
    $186.55
    $90.00
    $1,615.50
    $1,020.50
    $90.00
    $1,165.50
    $810.50
    $400.00
    $350.00
    $715.00
    $180.00
    $700.00
    $300.00
    $800.00
    $4,100.00
    $250.00
    $250.00
    $1,280.00
    $3,500.00
    $1,000.00
    $360.00
    $87.00
    $37.50

    Page 496

    Claims Data

    P057
    S207
    S207
    P161
    P161
    S207
    S207
    S329
    H066
    D125
    D125
    P122
    P435
    D411
    D411
    D411
    D411
    O001
    O076
    O076
    O076
    D131
    D131
    D131
    D131
    D131
    P057
    M354
    P148
    P148
    O008
    O008
    O008
    M326
    P014
    M326
    P203
    O001
    O001
    M104
    P435
    P090
    O076
    O076
    O076
    D113
    D113
    D113
    D113
    D113

    $418.95
    $300.00
    $2,100.00
    $290.40
    $175.00
    $300.00
    $1,400.00
    $300.00
    $400.00
    $80.00
    $80.00
    $290.45
    $13.28
    $200.00
    $100.00
    $50.00
    $100.00
    $110.00
    $90.00
    $716.00
    $1,593.00
    $120.00
    $120.00
    $210.00
    $500.00
    $400.00
    $50.00
    $140.00
    $54.00
    $294.00
    $70.00
    $700.00
    $260.00
    $200.00
    $120.00
    $250.00
    $116.50
    $110.00
    $110.00
    $600.00
    $31.33
    $57.40
    $90.00
    $1,615.50
    $1,695.00
    $80.00
    $120.00
    $200.00
    $800.00
    $450.00

    Page 497

    Claims Data

    D324
    P139
    D324
    H034
    M341
    M341
    M341
    M341
    L116
    P408
    D268
    D268
    L164
    L164
    L164
    P094
    S452
    S452
    S452
    S452
    P435
    M390
    M390
    M390
    O001
    O001
    O001
    M452
    P122
    M452
    P421
    D242
    O033
    P073
    M230
    M230
    M230
    P014
    D77
    D77
    D77
    P073
    D242
    D242
    O033
    O033
    O033
    S217
    S217
    P014

    $400.00
    $55.00
    $900.00
    $100.00
    $140.00
    $25.00
    $75.00
    $100.00
    $80.00
    $297.90
    $65.00
    $291.00
    $500.00
    $200.00
    $50.00
    $93.75
    $150.00
    $350.00
    $2,150.00
    $3,700.00
    $213.71
    $150.00
    $30.00
    $155.00
    $110.00
    $1,004.00
    $900.00
    $250.00
    $604.95
    $200.00
    $33.75
    $560.00
    $300.00
    $184.85
    $300.00
    $50.00
    $250.00
    $94.60
    $4,000.00
    $2,000.00
    $1,200.00
    $184.85
    $560.00
    $400.00
    $230.00
    $760.75
    $352.75
    $500.00
    $338.00
    $199.50

    Page 498

    Claims Data

    P005
    D07
    D07
    D07
    M630
    M630
    L001
    D346
    D346
    D346
    D346
    D346
    M298
    D298
    P031
    P031
    P435
    L96
    D346
    D346
    M205
    P031
    P031
    M629
    L070
    M033
    P088
    L070
    M033
    P332
    P332
    O173
    O173
    O173
    S197
    P487
    O007
    O007
    O007
    S293
    S293
    L070
    S390
    H066
    S390
    L070
    S293
    S293
    S293
    S293

    $190.40
    $375.00
    $200.00
    $1,150.00
    $80.00
    $100.00
    $260.00
    $150.00
    $160.00
    $240.00
    $1,400.00
    $500.00
    $240.00
    $260.00
    $76.99
    $80.43
    $110.07
    $250.00
    $3,000.00
    $900.00
    $240.00
    $122.49
    $269.97
    $280.00
    $1,130.00
    $200.00
    $383.30
    $300.00
    $100.00
    $112.00
    $30.00
    $100.00
    $450.00
    $650.00
    $300.00
    $64.50
    $100.00
    $967.50
    $1,440.00
    $500.00
    $500.00
    $140.00
    $600.00
    $550.00
    $300.00
    $140.00
    $500.00
    $31,000.00
    $3,000.00
    $8,500.00

    Page 499

    Claims Data

    H005
    H005
    D90
    D90
    D90
    D90
    D90
    D125
    D125
    D86
    D86
    D86
    D86
    D86
    D86
    D86
    D317
    D317
    D22
    D22
    D143
    D79
    D79
    D79
    D79
    D129
    D129
    D129
    D283
    D324
    D324
    D324
    D283
    P011
    O076
    O076
    O076
    D291
    D291
    D291
    D218
    M463
    M850
    P049
    D371
    D371
    D371
    P037
    M368
    P349

    $2,800.00
    $24,396.55
    $40.00
    $60.00
    $500.00
    $600.00
    $20.00
    $80.00
    $300.00
    $400.00
    $1,200.00
    $100.00
    $600.00
    $3,500.00
    $350.00
    $3,500.00
    $400.00
    $1,600.00
    $120.00
    $150.00
    $200.00
    $20.00
    $50.00
    $50.00
    $90.00
    $70.00
    $360.00
    $470.00
    $370.00
    $80.00
    $60.00
    $180.00
    $6,000.00
    $170.50
    $90.00
    $1,268.00
    $1,323.00
    $300.00
    $65.00
    $335.00
    $625.00
    $200.00
    $100.00
    $516.00
    $100.00
    $50.00
    $60.00
    $50.25
    $200.00
    $420.35

    Page 500

    Claims Data

    M666
    M666
    L97
    M211
    M211
    S459
    H011
    H011
    H011
    S459
    S237
    M807
    H011
    H011
    D351
    D351
    D59
    P437
    P115
    L97
    P348
    P106
    L97
    P106
    P106
    L065
    L065
    L065
    M230
    M230
    L065
    P435
    P509
    P509
    P353
    M851
    L143
    L061
    M200
    L126
    P131
    P003
    M186
    P003
    P286
    L065
    L065
    S103
    D402
    D402

    $160.00
    $240.00
    $400.00
    $200.00
    $300.00
    $600.00
    $3,800.00
    $435.00
    $357.00
    $8,000.00
    $1,500.00
    $250.00
    $900.00
    $2,776.00
    $40.00
    $110.00
    $150.00
    $62.50
    $31.20
    $250.00
    $69.95
    $104.95
    $600.00
    $83.00
    $78.40
    $175.00
    $175.00
    $175.00
    $300.00
    $200.00
    $240.00
    $24.53
    $71.30
    $464.25
    $57.50
    $600.00
    $620.00
    $910.00
    $120.00
    $660.00
    $111.00
    $120.00
    $405.00
    $45.00
    $226.00
    $280.00
    $1,295.00
    $400.00
    $35.00
    $85.00

    Page 501

    Claims Data

    D402
    M294
    M294
    M294
    M294
    M463
    P014
    O131
    O131
    O131
    H027
    H027
    S242
    P215
    S375
    M115
    M115
    M115
    M327
    M327
    M115
    M115
    M115
    M115
    M115
    D148
    D148
    D148
    D148
    D148
    P435
    P435
    S300
    P076
    P014
    L116
    P179
    L075
    P014
    S300
    P469
    T068
    T068
    M756
    M756
    P426
    M230
    M230
    P037
    P037

    $110.00
    $300.00
    $200.00
    $240.00
    $140.00
    $200.00
    $36.50
    $70.00
    $1,200.00
    $800.00
    $1,600.00
    $5,255.00
    $2,500.00
    $312.30
    $300.00
    $300.00
    $570.00
    $30.00
    $100.00
    $120.00
    $120.00
    $100.00
    $70.00
    $70.00
    $30.00
    $100.00
    $240.00
    $2,350.00
    $700.00
    $180.00
    $29.55
    $116.69
    $600.00
    $149.55
    $242.55
    $760.00
    $101.99
    $3,800.00
    $242.55
    $300.00
    $151.20
    $50.00
    $1,140.00
    $300.00
    $400.00
    $541.00
    $300.00
    $300.00
    $58.00
    $533.50

    Page 502

    Claims Data

    P182
    M267
    M267
    M267
    M029
    M029
    H008
    H008
    M505
    M505
    L152
    P115
    P049
    M189
    P076
    S197
    P372
    P372
    P372
    O004
    O004
    O004
    M030
    P031
    S220
    P076
    L97
    S191
    L041
    L041
    O176
    P154
    M461
    M461
    M461
    L070
    M461
    M461
    M463
    M463
    L143
    P167
    MM06
    M176
    P039
    L161
    M176
    P014
    D113
    D113

    $125.00
    $200.00
    $60.00
    $40.00
    $100.00
    $40.00
    $375.00
    $196.00
    $140.00
    $60.00
    $410.00
    $59.90
    $33.50
    $240.00
    $37.50
    $200.00
    $454.70
    $227.35
    $227.35
    $100.00
    $796.00
    $476.00
    $160.00
    $341.35
    $260.00
    $115.90
    $250.00
    $700.00
    $1,020.00
    $4,400.00
    $125.58
    $380.10
    $150.00
    $320.00
    $460.00
    $2,400.00
    $300.00
    $800.00
    $400.00
    $100.00
    $500.00
    $155.95
    $46.00
    $160.00
    $82.00
    $300.00
    $160.00
    $56.00
    $80.00
    $15.00

    Page 503

    Claims Data

    D113
    D113
    D113
    D113
    M230
    M230
    P509
    S162
    P014
    L97
    O065
    O065
    O065
    O065
    D173
    D173
    D173
    D173
    D173
    D173
    D173
    S240
    L081
    P349
    S103
    L046
    M660
    P059
    M814
    P167
    M814
    M814
    P167
    M197
    M197
    M197
    M197
    P479
    M197
    M197
    P019
    M299
    M299
    P394
    S197
    S197
    S197
    H023
    P399
    S197

    $65.00
    $40.00
    $560.00
    $3,500.00
    $300.00
    $400.00
    $328.60
    $480.00
    $127.50
    $200.00
    $150.00
    $800.00
    $1,920.00
    $150.00
    $140.00
    $30.00
    $130.00
    $2,750.00
    $900.00
    $300.00
    $100.00
    $200.00
    $800.00
    $53.00
    $700.00
    $650.00
    $200.00
    $180.00
    $100.00
    $16.45
    $100.00
    $720.00
    $1,413.00
    $200.00
    $335.00
    $440.00
    $100.00
    $405.00
    $100.00
    $60.00
    $477.00
    $120.00
    $80.00
    $613.00
    $300.00
    $200.00
    $4,700.00
    $1,800.00
    $129.50
    $200.00

    Page 504

    Claims Data

    P399
    S367
    S253
    L149
    M211
    P286
    P014
    D219
    P246
    P115
    H025
    H025
    M183
    M183
    O076
    O076
    O076
    M331
    M331
    P139
    P094
    L065
    M331
    M331
    P139
    S077
    S077
    P458
    D374
    D374
    D374
    P458
    P014
    M087
    M087
    M087
    P303
    S120
    P286
    P491
    D300
    D300
    D300
    D300
    S323
    S301
    S281
    S281
    S285
    L079

    $129.50
    $260.00
    $300.00
    $800.00
    $200.00
    $38.50
    $72.55
    $400.00
    $52.60
    $61.95
    $300.00
    $260.00
    $150.00
    $690.00
    $90.00
    $1,975.50
    $1,080.00
    $420.00
    $600.00
    $128.00
    $591.00
    $366.00
    $420.00
    $600.00
    $221.00
    $300.00
    $140.00
    $246.95
    $125.00
    $100.00
    $400.00
    $51.25
    $41.55
    $180.00
    $160.00
    $20.00
    $175.85
    $240.00
    $114.25
    $173.00
    $350.00
    $66.50
    $333.50
    $400.00
    $600.00
    $200.00
    $400.00
    $400.00
    $450.00
    $15.00

    Page 505

    Claims Data

    L079
    P458
    H034
    H034
    H034
    H034
    H034
    H034
    H034
    M386
    M386
    P435
    P428
    P428
    H034
    M171
    M441
    M441
    P115
    M189
    P115
    M327
    M327
    P115
    S347
    P115
    M189
    P115
    P115
    M189
    P115
    M189
    P115
    D396
    D396
    D396
    D396
    S384
    S384
    M793
    M793
    M793
    M793
    H034
    P115
    P037
    P077
    H011
    H011
    H011

    $400.00
    $150.15
    $300.00
    $712.70
    $300.00
    $300.00
    $400.00
    $350.00
    $650.00
    $460.00
    $25.00
    $107.85
    $131.20
    $51.60
    $960.00
    $100.00
    $200.00
    $300.00
    $176.10
    $120.00
    $112.00
    $300.00
    $230.00
    $158.40
    $300.00
    $145.00
    $280.00
    $49.00
    $20.70
    $280.00
    $35.80
    $140.00
    $58.35
    $200.00
    $35.00
    $90.00
    $375.00
    $400.00
    $400.00
    $400.00
    $300.00
    $350.00
    $625.00
    $550.00
    $237.00
    $90.35
    $180.00
    $850.00
    $266.00
    $15.00

    Page 506

    Claims Data

    O076
    O076
    O076
    S118
    M200
    S118
    P499
    M001
    L97
    L97
    M441
    H006
    S231
    P014
    M317
    M317
    P014
    M189
    L136
    P059
    O001
    O001
    O001
    S175
    S175
    M842
    M842
    P011
    H023
    D102
    D102
    D102
    D102
    D102
    S220
    S220
    D102
    D102
    D102
    P235
    M049
    P235
    L020
    M666
    M666
    H006
    M666
    M666
    M666
    L025

    $80.00
    $361.92
    $628.83
    $200.00
    $60.00
    $3,000.00
    $66.00
    $200.00
    $350.00
    $550.00
    $400.00
    $3,330.00
    $300.00
    $105.30
    $240.00
    $65.00
    $129.10
    $140.00
    $600.00
    $123.50
    $110.00
    $870.00
    $1,340.00
    $300.00
    $50.00
    $300.00
    $150.00
    $100.00
    $1,300.00
    $250.00
    $1,050.00
    $300.00
    $300.00
    $100.00
    $260.00
    $150.00
    $200.00
    $200.00
    $200.00
    $381.90
    $120.00
    $37.00
    $600.00
    $160.00
    $200.00
    $700.00
    $160.00
    $120.00
    $20.00
    $750.00

    Page 507

    Claims Data

    M310
    M310
    M310
    S454
    L044
    S454
    L128
    O001
    O001
    O001
    S213
    L124
    D217
    D217
    D217
    D217
    M100
    M100
    M100
    P014
    M100
    P014
    M100
    P104
    M213
    S295
    P472
    H048
    P125
    L97
    P169
    S279
    P169
    H048
    M678
    P125
    P125
    P450
    S383
    O004
    O004
    O004
    M514
    P071
    M317
    M317
    P014
    L126
    L126
    H003

    $150.00
    $500.00
    $230.00
    $1,300.00
    $3,050.00
    $500.00
    $700.00
    $110.00
    $760.75
    $1,028.50
    $600.00
    $200.00
    $30.00
    $60.00
    $180.00
    $640.00
    $160.00
    $160.00
    $85.00
    $114.90
    $80.00
    $183.35
    $150.00
    $597.00
    $100.00
    $400.00
    $220.20
    $169.00
    $97.00
    $500.00
    $46.00
    $400.00
    $650.00
    $232.00
    $500.00
    $231.00
    $668.00
    $1,826.00
    $360.00
    $180.00
    $100.00
    $2,056.00
    $200.00
    $97.85
    $240.00
    $40.00
    $68.50
    $120.00
    $1,040.00
    $1,400.00

    Page 508

    Claims Data

    H003
    H003
    H003
    S400
    P073
    P435
    L154
    L97
    P491
    P491
    O001
    O001
    L139
    P454
    P148
    M850
    P399
    O006
    O006
    O006
    M020
    M020
    S295
    L174
    P039
    M164
    P491
    O076
    O076
    O076
    S391
    S391
    M331
    M331
    P167
    S333
    S450
    S450
    M246
    H006
    P167
    S220
    O156
    D59
    D59
    D59
    D59
    H011
    H011
    H011

    $6,100.35
    $600.00
    $1,500.00
    $600.00
    $949.35
    $53.80
    $160.00
    $250.00
    $85.00
    $18.90
    $110.00
    $1,547.00
    $800.00
    $175.70
    $258.25
    $100.00
    $78.50
    $75.00
    $900.00
    $1,000.00
    $320.00
    $90.00
    $400.00
    $160.00
    $106.00
    $100.00
    $120.00
    $90.00
    $1,255.50
    $1,830.50
    $280.00
    $106.20
    $420.00
    $600.00
    $120.45
    $600.00
    $300.00
    $3,000.00
    $1,000.00
    $1,500.00
    $209.10
    $280.00
    $150.00
    $120.00
    $480.00
    $30.00
    $160.00
    $1,400.00
    $8,499.00
    $2,000.00

    Page 509

    Claims Data

    S312
    S237
    S340
    H034
    P179
    P476
    M441
    P115
    O001
    O001
    O001
    P353
    O136
    O136
    O136
    S136
    S440
    P014
    M312
    H003
    UN01
    M230
    M230
    P167
    D107
    D107
    L014
    O004
    D435
    D435
    D435
    D435
    P049
    D435
    M139
    M139
    M299
    M299
    P316
    M007
    M007
    M007
    M786
    M786
    M786
    M786
    M100
    M100
    P247
    P247

    $12,000.00
    $2,500.00
    $500.00
    $160.00
    $40.00
    $176.25
    $200.00
    $250.40
    $110.00
    $1,695.00
    $1,520.00
    $313.50
    $60.00
    $1,150.17
    $760.83
    $250.00
    $280.00
    $51.20
    $200.00
    $600.00
    $3,000.00
    $600.00
    $200.00
    $175.95
    $200.00
    $300.00
    $285.00
    $100.00
    $400.00
    $66.50
    $233.50
    $500.00
    $38.20
    $500.00
    $100.00
    $700.00
    $120.00
    $240.00
    $221.75
    $100.00
    $20.00
    $80.00
    $80.00
    $40.00
    $80.00
    $40.00
    $160.00
    $30.00
    $31.20
    $67.50

    Page 510

    Claims Data

    M067
    M067
    M067
    S120
    P394
    L97
    L97
    S068
    M792
    M792
    M792
    P140
    L091
    L091
    P071
    P435
    P014
    M331
    M331
    L176
    O008
    O008
    O008
    M029
    M029
    M029
    M704
    M704
    M704
    P154
    M494
    M494
    M494
    D45
    D45
    M371
    O167
    O167
    O167
    D252
    D252
    D252
    D252
    S162
    P115
    S346
    M103
    P478
    D86
    D86

    $160.00
    $40.00
    $40.00
    $240.00
    $200.00
    $400.00
    $250.00
    $300.00
    $100.00
    $50.00
    $200.00
    $262.00
    $300.00
    $45.50
    $42.85
    $106.88
    $167.30
    $280.00
    $200.00
    $650.00
    $80.00
    $900.00
    $1,300.00
    $100.00
    $30.00
    $30.00
    $100.00
    $110.00
    $30.00
    $93.95
    $1,000.00
    $410.00
    $490.00
    $2,000.00
    $2,000.00
    $140.00
    $100.00
    $841.75
    $660.00
    $125.00
    $25.00
    $1,450.00
    $1,250.00
    $300.00
    $227.80
    $200.00
    $60.00
    $38.00
    $50.00
    $350.00

    Page 511

    Claims Data

    D86
    D86
    S309
    L074
    H006
    D86
    D86
    O007
    O007
    O001
    O001
    O001
    O156
    O054
    O054
    O054
    M001
    P094
    P094
    H006
    H006
    S089
    M246
    S089
    O004
    D312
    D312
    D312
    D312
    D276
    D276
    D276
    D411
    D411
    D411
    D411
    D411
    D411
    S217
    S217
    S217
    S217
    S217
    T051
    M164
    M473
    L001
    P094
    S400
    L081

    $35.00
    $15.00
    $600.00
    $1,645.00
    $700.00
    $50.00
    $250.00
    $100.00
    $1,200.00
    $110.00
    $925.00
    $620.00
    $360.00
    $80.00
    $400.00
    $400.00
    $160.00
    $460.80
    $115.20
    $900.00
    $2,600.00
    $8,950.00
    $2,000.00
    $80.00
    $100.00
    $210.00
    $100.00
    $90.00
    $150.00
    $60.00
    $910.00
    $2,090.00
    $200.00
    $50.00
    $50.00
    $200.00
    $50.00
    $100.00
    $400.00
    $400.00
    $150.00
    $400.00
    $400.00
    $2,420.00
    $60.00
    $270.00
    $935.00
    $268.70
    $300.00
    $800.00

    Page 512

    Claims Data

    P094
    S356
    H005
    H025
    M374
    S428
    S428
    L154
    M225
    M225
    M452
    P435
    S445
    S445
    P435
    S084
    H006
    M304
    M304
    M304
    P343
    P435
    P435
    M437
    H005
    H005
    H005
    S278
    H005
    P435
    M817
    M817
    M817
    P435
    S151
    S151
    D299
    L034
    S401
    S401
    L046
    L046
    D41
    D41
    D41
    D41
    S302
    S302
    L97
    D41

    $149.25
    $300.00
    $200.00
    $60.00
    $200.00
    $350.00
    $240.00
    $400.00
    $230.00
    $190.00
    $450.00
    $482.23
    $350.00
    $75.00
    $186.47
    $300.00
    $350.00
    $185.00
    $515.00
    $100.00
    $44.99
    $228.64
    $104.72
    $250.00
    $300.00
    $1,100.00
    $7,227.73
    $2,500.00
    $520.00
    $130.71
    ($250.00)
    $250.00
    $250.00
    $314.49
    $400.00
    $250.00
    $500.00
    $300.00
    $300.00
    $150.00
    $300.00
    $300.00
    $100.00
    $500.00
    $35.00
    $65.00
    $360.00
    $300.00
    $400.00
    $100.00

    Page 513

    Claims Data

    D41
    M580
    M580
    M580
    M580
    M580
    P195
    H008
    H008
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    S242
    L041
    L041
    S242
    P195
    S405
    D228
    D228
    D228
    D228
    D228
    D228
    D228
    D228
    D228
    D259
    D259
    D259
    D259

    $500.00
    $100.00
    $25.00
    $375.00
    $100.00
    $400.00
    $1,421.50
    $440.00
    $523.00
    $80.00
    $300.00
    $100.00
    $160.00
    $80.00
    $250.00
    $100.00
    $160.00
    $80.00
    $300.00
    $100.00
    $160.00
    $80.00
    $350.00
    $70.00
    $30.00
    $240.00
    $80.00
    $350.00
    $70.00
    $30.00
    $160.00
    $500.00
    $350.00
    $370.00
    $2,500.00
    $150.00
    $300.00
    $300.00
    $70.00
    $80.00
    $1,050.00
    $200.00
    $700.00
    $300.00
    $300.00
    $150.00
    $50.00
    $300.00
    $70.00
    $80.00

    Page 514

    Claims Data

    D259
    D259
    D259
    D259
    D259
    D66
    D66
    D66
    D66
    M255
    M255
    M255
    D275
    M265
    M265
    L041
    L041
    D164
    D164
    D164
    M238
    M238
    P166
    S172
    M580
    M580
    M580
    M580
    D89
    D89
    D89
    D89
    D89
    D333
    D333
    D333
    D333
    D333
    M704
    S011
    P014
    S011
    P014
    L041
    M647
    M647
    P504
    M647
    M647
    M647

    $50.00
    $300.00
    $150.00
    $133.00
    $217.00
    $120.00
    $450.00
    $100.00
    $610.00
    $100.00
    $20.00
    $20.00
    $350.00
    $80.00
    $120.00
    $600.00
    $545.00
    $70.00
    $2,000.00
    $30.00
    $100.00
    $305.00
    $145.25
    $200.00
    $100.00
    $400.00
    $300.00
    $100.00
    $50.00
    $150.00
    $70.00
    $55.00
    $225.00
    $85.00
    $215.00
    $350.00
    $70.00
    $80.00
    $100.00
    $300.00
    $1,491.40
    $300.00
    $948.00
    $450.00
    $80.00
    $60.00
    $150.00
    $80.00
    $25.00
    $135.00

    Page 515

    Claims Data

    O076
    O076
    O076
    M871
    P340
    D02
    D02
    D02
    D02
    M686
    P188
    P188
    M686
    M686
    M686
    M686
    P294
    D35
    D198
    M726
    P450
    P450
    S160
    S160
    S160
    S223
    P154
    T077
    T077
    D41
    D41
    D41
    D41
    M018
    P303
    P303
    M018
    M018
    M018
    M018
    P303
    D41
    D255
    D255
    M747
    M747
    M747
    M747
    P469
    P469

    $90.00
    $895.50
    $1,323.00
    $140.00
    $100.10
    $250.00
    $70.00
    $90.00
    $750.00
    $80.00
    $120.00
    $45.00
    $25.00
    $95.00
    $80.00
    $120.00
    $30.00
    $120.00
    $400.00
    $100.00
    $141.00
    $4.50
    $200.00
    $120.00
    $180.00
    $300.00
    $94.55
    $1,950.00
    $750.00
    $100.00
    $40.00
    $60.00
    $500.00
    $200.00
    $125.95
    $61.15
    $200.00
    $25.00
    $35.00
    $200.00
    $110.15
    $500.00
    $520.00
    $80.00
    $120.00
    $20.00
    $120.00
    $223.00
    $213.48
    $9.12

    Page 516

    Claims Data

    M747
    D51
    D51
    M449
    M449
    M449
    M449
    M570
    M570
    M449
    M449
    M449
    M449
    S323
    D411
    D411
    D411
    D411
    D411
    D411
    S019
    S019
    S179
    S179
    S160
    H027
    P416
    D380
    D380
    D380
    D380
    D380
    D380
    O001
    O076
    O076
    O076
    M678
    P435
    D78
    M304
    M304
    O004
    M304
    O001
    O001
    O001
    S302
    S302
    S302

    $41.00
    $1,400.00
    $2,200.00
    $100.00
    $25.00
    $95.00
    $55.00
    $160.00
    $100.00
    $100.00
    $25.00
    $35.00
    $45.00
    $6,000.00
    $200.00
    $50.00
    $50.00
    $200.00
    $100.00
    $50.00
    $260.00
    $1,240.00
    $520.00
    $5,000.00
    $600.00
    $5,245.00
    $121.75
    $160.00
    $100.00
    $60.00
    $500.00
    $60.00
    $440.00
    $110.00
    $90.00
    $2,708.25
    $653.25
    $185.00
    $157.24
    $400.00
    $200.00
    $140.00
    $1,516.00
    $180.00
    $110.00
    $1,525.75
    $1,147.50
    $460.00
    $400.00
    $140.00

    Page 517

    Claims Data

    L070
    S384
    S384
    M327
    M327
    M327
    M327
    P014
    P014
    S416
    S415
    S415
    P468
    P433
    O076
    O076
    O076
    S199
    P416
    O076
    O076
    S160
    P416
    P416
    M232
    M232
    M232
    M653
    M653
    M653
    D310
    D278
    D278
    D278
    D278
    D89
    D89
    D89
    D89
    D64
    M104
    M104
    L070
    S302
    S302
    P106
    D89
    D89
    D89
    D89

    $820.00
    $400.00
    $400.00
    $140.00
    $25.00
    $35.00
    $140.00
    $127.00
    $12.75
    $450.00
    $100.00
    $100.00
    $72.50
    $222.90
    $90.00
    $1,356.00
    $1,255.50
    $350.00
    $123.90
    $180.00
    $405.00
    $200.00
    $30.95
    $84.95
    $100.00
    $60.00
    $20.00
    $100.00
    $60.00
    $20.00
    $450.00
    $100.00
    $140.00
    $340.00
    $60.00
    $600.00
    $900.00
    $125.00
    $50.00
    $300.00
    $180.00
    $40.00
    $140.00
    $400.00
    $1,600.00
    $126.40
    $50.00
    $150.00
    $225.00
    $125.00

    Page 518

    Claims Data

    D208
    D208
    D208
    D208
    D208
    P154
    S155
    P427
    P154
    P154
    P154
    P154
    S155
    L070
    P154
    S149
    H027
    H027
    H027
    S149
    H027
    H027
    H027
    D321
    D321
    H011
    H011
    H011
    S312
    M549
    O001
    O001
    O001
    M153
    M153
    S160
    H027
    H027
    S393
    M602
    M602
    D64
    D64
    D348
    D348
    D348
    D348
    H023
    H023
    H023

    $80.00
    $340.00
    $300.00
    $1,500.00
    $201.86
    $494.95
    $220.00
    $83.20
    $505.05
    $437.95
    $437.95
    $437.95
    $240.00
    $530.00
    $437.95
    $3,500.00
    $600.00
    $3,460.00
    $230.00
    $1,500.00
    $200.00
    $565.00
    $230.00
    $120.00
    $400.00
    $1,400.00
    $5,360.00
    $350.00
    $12,000.00
    $1,500.00
    $110.00
    $875.00
    $940.00
    $200.00
    $200.00
    $200.00
    $400.00
    $2,030.00
    $2,200.00
    $800.00
    $50.00
    $300.00
    $120.00
    $50.00
    $10.00
    $1,600.00
    $500.00
    $375.00
    $241.00
    $48.40

    Page 519

    Claims Data

    H023
    H023
    H023
    L081
    H44
    H44
    L081
    D102
    D102
    D102
    M505
    P049
    P049
    H025
    M067
    S103
    L070
    O001
    O001
    O001
    D90
    D90
    D90
    L075
    S427
    S427
    P066
    D148
    D148
    D148
    D380
    D380
    D380
    D380
    D380
    D380
    D380
    D380
    D380
    D426
    D426
    D426
    D426
    S103
    L070
    H023
    P005
    L113
    S103
    P104

    $75.00
    $1,847.00
    $380.00
    $24,000.00
    $60,490.00
    $59,000.00
    $6,400.00
    $200.00
    $140.00
    $60.00
    $140.00
    $12.50
    $28.50
    $240.00
    $160.00
    $400.00
    $525.00
    $110.00
    $675.00
    $660.00
    $85.00
    $415.00
    $104.00
    $3,800.00
    $350.00
    $350.00
    $783.55
    $50.00
    $70.00
    $1,800.00
    $120.00
    $100.00
    $500.00
    $120.00
    $400.00
    $150.00
    $120.00
    $400.00
    $100.00
    $70.00
    $140.00
    $2,000.00
    $470.00
    $800.00
    $115.00
    $236.60
    $418.61
    $2,000.00
    $25,000.00
    $290.50

    Page 520

    Claims Data

    S103
    S213
    P066
    S286
    S286
    H023
    L070
    H023
    L145
    P005
    P066
    S458
    S103
    M411
    M411
    P360
    P066
    M001
    P066
    O076
    O076
    O076
    M001
    P068
    P066
    S217
    S217
    S217
    S217
    H023
    O001
    O001
    O001
    S323
    S311
    S323
    O001
    O001
    S220
    S220
    T051
    M374
    P343
    T051
    T051
    T051
    T051
    T051
    M056
    M056

    $400.00
    $300.00
    $163.00
    $300.00
    $150.00
    $171.00
    $437.00
    $114.50
    $4,000.00
    $199.04
    $163.00
    $500.00
    $800.00
    $130.00
    $10.00
    $40.00
    $326.00
    $200.00
    $185.15
    $90.00
    $845.75
    $756.00
    $200.00
    $20.60
    $326.00
    $1,700.00
    $100.00
    $112.50
    $338.00
    $1,200.00
    $270.00
    $1,695.00
    $995.00
    $1,880.00
    $800.00
    $2,555.00
    $270.00
    $369.15
    $220.00
    $120.00
    $350.00
    $200.00
    $351.94
    $700.00
    $1,050.00
    $525.00
    $350.00
    $875.00
    $150.00
    $55.00

    Page 521

    Claims Data

    T051
    T051
    M248
    P428
    D283
    D283
    D324
    D324
    D324
    D324
    D283
    D283
    P011
    M001
    M001
    M001
    S112
    P106
    S302
    P106
    S302
    S302
    S302
    P106
    M266
    P506
    D103
    D103
    D103
    D103
    D103
    M001
    P458
    L117
    P458
    M076
    P203
    M001
    M001
    P139
    P458
    M001
    P458
    S400
    H005
    P022
    P011
    S400
    S384
    S384

    $350.00
    $700.00
    $100.00
    $49.20
    $85.00
    $285.00
    $80.00
    $35.00
    $150.00
    $55.00
    $580.00
    $5,420.00
    $170.50
    $150.00
    $100.00
    $30.00
    $300.00
    $125.90
    $400.00
    $350.00
    $360.00
    $300.00
    $140.00
    $295.90
    $200.00
    $257.35
    $140.00
    $320.00
    $200.00
    $180.00
    $3,400.00
    $160.00
    $266.75
    $3,800.00
    $710.60
    $250.00
    $160.26
    $400.00
    $355.00
    $158.00
    $229.80
    $200.00
    $326.50
    $300.00
    $100.00
    $164.85
    $67.50
    $200.00
    $400.00
    $400.00

    Page 522

    Claims Data

    S384
    S007
    P093
    S383
    P435
    M326
    P435
    D218
    D218
    CD01
    CD01
    CD01
    CD01
    P104
    M375
    P104
    M375
    M375
    H006
    H006
    L065
    M067
    M067
    L065
    L121
    D115
    D115
    D115
    D115
    D184
    D184
    D184
    D184
    D115
    D115
    M375
    S220
    L065
    P104
    M089
    P049
    L065
    M215
    M215
    M215
    D86
    D86
    D86
    D86
    D86

    $200.00
    $440.00
    $115.00
    $260.00
    $151.07
    $200.00
    $73.79
    $100.00
    $525.00
    $625.90
    $1,126.62
    $751.08
    $625.90
    $127.90
    $120.00
    $242.90
    $160.00
    $160.00
    $400.00
    $145.00
    $730.00
    $160.00
    $160.00
    $200.00
    $700.00
    $90.00
    $400.00
    $100.00
    $160.00
    $130.00
    $170.00
    $140.00
    $360.00
    $100.00
    $350.00
    $160.00
    $360.00
    $300.00
    $106.45
    $180.00
    $280.00
    $200.00
    $500.00
    $100.00
    $450.00
    $375.00
    $900.00
    $325.00
    $100.00
    $44.00

    Page 523

    Claims Data

    D86
    D86
    D86
    M015
    P435
    M015
    L149
    D86
    D86
    D86
    D86
    M015
    P104
    D04
    D04
    O001
    O001
    O001
    D143
    D143
    D143
    H005
    H005
    H005
    H005
    D143
    D299
    D299
    D90
    D90
    D90
    D90
    D90
    D90
    S152
    S152
    M842
    P081
    M842
    P081
    M842
    P081
    P081
    M842
    P081
    D78
    D78
    D78
    P066
    D143

    $556.00
    $510.00
    $2,990.00
    $200.00
    $781.41
    $200.00
    $150.00
    $85.00
    $265.00
    $510.00
    $2,990.00
    $200.00
    $418.65
    $312.00
    $78.00
    $110.00
    $786.25
    $629.00
    $2,000.00
    $6,000.00
    $600.00
    $2,250.00
    $2,653.04
    $700.00
    $2,100.00
    $1,200.00
    $500.00
    $500.00
    $15.00
    $85.00
    $65.00
    $435.00
    $85.00
    $515.00
    $300.00
    $300.00
    $100.00
    $280.65
    $300.00
    $105.00
    $200.00
    $195.65
    $275.20
    $200.00
    $178.00
    $200.00
    $2,201.00
    $99.00
    $835.50
    $50.00

    Page 524

    Claims Data

    D143
    P066
    M386
    M386
    M067
    L020
    P059
    D79
    D79
    D79
    D129
    D129
    D129
    D129
    D129
    M766
    M766
    M766
    H005
    S383
    P399
    S383
    S383
    P399
    S383
    L046
    D125
    D125
    D125
    L133
    L133
    L133
    H023
    S217
    S217
    P457
    D60
    D60
    D60
    D51
    D51
    D51
    D51
    T034
    T034
    P435
    P435
    S309
    P435
    P093

    $150.00
    $914.64
    $200.00
    $160.00
    $160.00
    $60.00
    $515.99
    $50.00
    $20.00
    $140.00
    $70.00
    $85.00
    $275.00
    $100.00
    $370.00
    $200.00
    $40.00
    $253.00
    $650.00
    $360.00
    $361.50
    $3,408.00
    $2,852.00
    $129.50
    $260.00
    $550.00
    $80.00
    $85.00
    $215.00
    $695.00
    $400.00
    $350.00
    $700.00
    $500.00
    $338.00
    $161.00
    ($300.00)
    $300.00
    $300.00
    $160.00
    $100.00
    $120.00
    $2,200.00
    $725.00
    $225.00
    $731.48
    $91.20
    $600.00
    $102.98
    $171.57

    Page 525

    Claims Data

    L065
    L065
    S076
    O004
    O004
    O004
    D148
    D148
    D148
    O004
    O004
    O004
    D60
    D60
    D60
    D60
    D60
    S165
    S301
    S301
    S301
    S401
    M328
    M707
    H023
    H023
    P435
    S275
    S275
    D323
    D323
    P435
    M668
    P014
    D148
    D148
    D148
    D148
    O004
    O004
    O004
    S151
    S151
    S151
    M185
    P122
    M060
    S244
    S244
    S244

    $630.00
    $672.58
    $250.00
    $100.00
    $396.00
    $716.00
    $300.00
    $1,000.00
    $1,500.00
    $100.00
    $2,396.00
    $1,016.00
    $50.00
    $250.00
    $150.00
    $30.00
    $400.00
    $300.00
    $200.00
    $200.00
    $200.00
    $8,000.00
    $4,000.00
    $2,100.00
    $3,100.00
    $9,266.38
    $161.38
    $900.00
    $300.00
    $650.00
    $2,050.00
    $346.81
    $220.00
    $384.50
    $50.00
    $70.00
    $3,800.00
    $700.00
    $100.00
    $1,516.00
    $776.00
    $350.00
    $300.00
    $170.00
    $360.00
    $247.50
    $200.00
    $300.00
    $300.00
    $600.00

    Page 526

    Claims Data

    S244
    S244
    D229
    S400
    L065
    H005
    S275
    S400
    S400
    M089
    M089
    L065
    M089
    P437
    O035
    O035
    O035
    P435
    P435
    P435
    P435
    P435
    S219
    S219
    S219
    S278
    S278
    S278
    S278
    H005
    S219
    M171
    L136
    P115
    P115
    O004
    L001
    O076
    O076
    O076
    L006
    D412
    D412
    D412
    D412
    M711
    P057
    M001
    P014
    P066

    $300.00
    $300.00
    $300.00
    $7,450.00
    $135.00
    $170.00
    $1,500.00
    $200.00
    $300.00
    $100.00
    $240.00
    $845.00
    $180.00
    $262.30
    $180.00
    $1,340.00
    $1,062.50
    $762.91
    $1,283.45
    $762.91
    $762.91
    $4,842.92
    $96.00
    $100.00
    $540.00
    $160.00
    $340.00
    $1,200.00
    $800.00
    $89.95
    $400.00
    $240.00
    $640.00
    $52.60
    $146.30
    $100.00
    $180.00
    $180.00
    $1,478.55
    $1,600.20
    $360.00
    $300.00
    $100.00
    $50.00
    $350.00
    $160.00
    $260.00
    $200.00
    $1,194.00
    $1,956.00

    Page 527

    Claims Data

    P005
    D205
    O174
    O174
    M387
    P324
    M387
    P324
    M060
    H005
    P081
    M068
    P203
    P203
    M068
    M068
    P085
    P085
    S091
    S091
    S091
    S091
    D181
    D181
    D181
    D181
    S091
    P003
    M304
    O026
    O026
    S315
    S315
    S315
    P349
    D38
    D38
    D38
    M230
    P014
    M666
    M666
    P131
    D90
    D90
    D90
    D90
    D90
    D90
    D90

    $1,534.55
    $350.00
    $50.00
    $927.00
    $200.00
    $124.99
    $200.00
    $96.76
    $200.00
    $260.00
    $70.90
    $250.00
    $86.33
    $228.71
    $60.00
    $140.00
    $209.24
    $67.31
    $230.00
    $290.00
    $160.00
    $280.00
    $100.00
    $450.00
    $100.00
    $250.00
    $160.00
    $501.20
    $200.00
    $100.00
    $100.00
    $120.00
    $1,000.00
    $120.00
    $128.10
    $130.00
    $20.00
    $400.00
    $300.00
    $486.00
    $240.00
    $120.00
    $93.00
    $171.00
    $129.00
    $1,500.00
    $159.00
    $500.00
    $1,200.00
    $20.00

    Page 528

    Claims Data

    D90
    D90
    S069
    S069
    P306
    O004
    O004
    O004
    O007
    O007
    O007
    O007
    S281
    S281
    S384
    S323
    S323
    O001
    O001
    O001
    D131
    D131
    D131
    D131
    M019
    D432
    D432
    D432
    D432
    S384
    S384
    M766
    M766
    P427
    O001
    O001
    O001
    M029
    P066
    H008
    H008
    D180
    O001
    D208
    D208
    D208
    D208
    D82
    D04
    D04

    $50.00
    $450.00
    $300.00
    $100.00
    $212.00
    $350.00
    $432.00
    $432.00
    $800.00
    $210.00
    $1,075.50
    $1,260.00
    $400.00
    $400.00
    $500.00
    $350.00
    $160.00
    $250.00
    $1,657.50
    $960.50
    $120.00
    $400.00
    $150.00
    $370.00
    $276.90
    $150.00
    $150.00
    $250.00
    $2,500.00
    $400.00
    $400.00
    $200.00
    $25.00
    $175.40
    $270.00
    $1,895.00
    $1,130.00
    $100.00
    $684.20
    $679.00
    $385.00
    $350.00
    $110.00
    $160.00
    $100.00
    $60.00
    $600.00
    $80.00
    $300.00
    $400.00

    Page 529

    Claims Data

    M134
    H022
    H022
    M545
    M545
    M867
    S244
    S244
    S244
    P435
    D01
    D01
    D221
    M067
    M067
    L020
    P049
    D260
    D260
    S302
    S302
    P094
    M045
    P094
    H005
    H005
    M171
    P435
    D324
    D324
    D324
    S091
    D324
    D324
    D324
    D324
    D324
    D324
    D324
    D324
    D324
    S279
    S279
    M473
    L006
    P373
    M229
    P373
    P373
    M229

    $150.00
    $80.00
    $200.00
    $150.00
    $240.00
    $150.00
    $600.00
    $600.00
    $300.00
    $98.29
    $171.00
    $179.00
    $1,900.00
    $160.00
    $60.00
    $210.00
    $81.00
    $125.00
    $175.00
    $360.00
    $140.00
    $168.00
    $150.00
    $40.50
    $300.00
    $1,200.00
    $100.00
    $151.64
    $80.00
    $260.00
    $440.00
    $160.00
    $840.00
    $1,160.00
    $80.00
    $120.00
    $120.00
    $400.00
    $500.00
    $1,000.00
    $450.00
    $900.00
    $232.00
    $180.00
    $400.00
    $162.50
    $160.00
    $153.55
    $28.35
    $160.00

    Page 530

    Claims Data

    M473
    P373
    M473
    P342
    M607
    M607
    P373
    H003
    H003
    H003
    H003
    P373
    P139
    M678
    D181
    D181
    D181
    D181
    M789
    M789
    P014
    O001
    O001
    O001
    D39
    D39
    D39
    D39
    S327
    H008
    M326
    M326
    M326
    M326
    P427
    H023
    L046
    P427
    P022
    P427
    P005
    P005
    M326
    P427
    O004
    O004
    M368
    M368
    P394
    M033

    $150.00
    $447.95
    $120.00
    $470.40
    $450.00
    $375.00
    $791.20
    $120.00
    $115.00
    $96.50
    $180.00
    $98.00
    $172.00
    $200.00
    $1,000.00
    $4,000.00
    $7,380.00
    $1,000.00
    $90.00
    $110.00
    $76.50
    $110.00
    $1,395.00
    $1,880.00
    $100.00
    $300.00
    $100.00
    $300.00
    $600.00
    $3,080.00
    $200.00
    $50.00
    $400.00
    $450.00
    $2,194.50
    $3,800.00
    $2,375.00
    $1,216.90
    $174.65
    $1,346.15
    $10,549.05
    $9,966.72
    $250.00
    $58.10
    $100.00
    $845.75
    $400.00
    $450.00
    $2,325.00
    $200.00

    Page 531

    Claims Data

    M008
    M008
    S281
    S281
    P014
    P332
    M463
    L070
    M368
    M368
    P394
    P435
    P457
    D244
    D244
    D244
    D244
    M212
    M212
    O004
    O004
    O004
    M430
    M430
    M430
    S184
    S184
    L006
    P399
    P399
    L065
    P399
    M430
    P399
    M212
    M212
    O169
    O169
    M186
    P353
    P353
    S159
    L075
    P353
    M186
    P399
    L149
    MM06
    S159
    P353

    $200.00
    $55.00
    $400.00
    $400.00
    $25.95
    $150.00
    $200.00
    $190.00
    $200.00
    $250.00
    $1,980.00
    $715.97
    $1,350.50
    $60.00
    $35.00
    $45.00
    $600.00
    $1,050.00
    $380.00
    $100.00
    $476.00
    $1,116.00
    $100.00
    $100.00
    $200.00
    $200.00
    $100.00
    $400.00
    $266.20
    $30.00
    $490.00
    $28.50
    $100.00
    $327.50
    $1,050.00
    $100.00
    $585.00
    $1,075.00
    $220.00
    $46.80
    $68.00
    $800.00
    $3,800.00
    $277.20
    $405.00
    $96.50
    $230.00
    $321.40
    $400.00
    $995.00

    Page 532

    Claims Data

    T068
    S159
    P435
    T068
    M577
    M577
    S126
    S126
    S126
    O001
    O001
    O001
    O076
    O076
    D257
    D257
    D257
    D58
    D58
    M215
    H023
    L070
    M215
    S374
    O001
    O001
    O001
    D345
    D345
    M028
    M254
    M254
    M254
    M189
    P115
    M033
    P318
    M833
    P106
    S312
    S312
    S312
    D257
    D257
    D257
    S237
    P014
    L061
    M229
    L001

    $1,080.00
    $800.00
    $850.35
    $1,080.00
    $200.00
    $40.00
    $300.00
    $1,200.00
    $500.00
    $110.00
    $1,525.75
    $1,496.00
    $2,335.50
    $876.00
    $35.00
    $65.00
    $400.00
    $140.00
    $610.00
    $250.00
    $505.00
    $1,080.00
    $250.00
    $350.00
    $110.00
    $795.00
    $1,641.00
    $700.00
    $1,800.00
    $100.00
    $200.00
    $200.00
    $200.00
    $140.00
    $11.50
    $100.00
    $57.60
    $160.00
    $49.00
    $250.00
    $350.00
    $150.00
    $35.00
    $65.00
    $1,250.00
    $500.00
    $541.65
    $70.00
    $40.00
    $320.00

    Page 533

    Claims Data

    M327
    M327
    D79
    D79
    S240
    L074
    M701
    P432
    P432
    M701
    O076
    M014
    P088
    L143
    M020
    L034
    M213
    M213
    M138
    M138
    M138
    O076
    O076
    O076
    D301
    D301
    D301
    D301
    D301
    O076
    O076
    O076
    O076
    O076
    O076
    O076
    M463
    M463
    P337
    P337
    S187
    P014
    P014
    M463
    M463
    M463
    P337
    M463
    O076
    M299

    $140.00
    $80.00
    $85.00
    $55.00
    $200.00
    $545.00
    $600.00
    $24.80
    $400.00
    $200.00
    $80.00
    $140.00
    $60.75
    $1,500.00
    $160.00
    $400.00
    $100.00
    $400.00
    $120.00
    $25.00
    $75.00
    $90.00
    $1,276.00
    $792.00
    $50.00
    $70.00
    $50.00
    $400.00
    $300.00
    $90.00
    $535.50
    $340.50
    $90.00
    $945.75
    $723.19
    $677.06
    $200.00
    $100.00
    $180.00
    $70.00
    $200.00
    $59.00
    $133.50
    $100.00
    $300.00
    $80.00
    $60.00
    $80.00
    $90.00
    $150.00

    Page 534

    Claims Data

    M299
    M299
    O004
    O161
    O161
    O004
    O161
    O161
    M304
    P014
    M230
    P014
    H006
    P005
    H006
    H006
    S128
    S128
    P091
    P091
    S069
    S069
    P267
    P267
    S069
    P267
    D397
    D397
    S271
    P039
    O004
    O004
    P427
    P005
    S304
    P427
    P005
    P465
    O004
    O004
    O004
    O004
    O004
    O004
    S184
    S184
    P337
    O004
    S384
    S384

    $25.00
    $205.00
    $200.00
    $1,200.00
    $600.00
    $200.00
    $1,400.00
    $1,100.00
    $140.00
    $239.45
    $300.00
    $331.05
    $365.00
    $2,028.80
    $24.00
    $306.00
    $400.00
    $480.00
    $52.40
    $13.10
    $250.00
    $200.00
    $70.00
    $195.00
    $250.00
    $130.00
    $100.00
    $300.00
    $380.00
    $105.00
    $100.00
    $476.00
    $25.00
    $524.24
    $200.00
    $1,176.00
    $655.30
    $46.00
    $100.00
    $1,036.00
    $1,036.00
    $100.00
    $476.00
    $396.00
    $200.00
    $100.00
    $234.00
    $100.00
    $300.00
    $400.00

    Page 535

    Claims Data

    M299
    L070
    M299
    M299
    L070
    M107
    P476
    O136
    O136
    M164
    M248
    P016
    P016
    D319
    D319
    M346
    M346
    M346
    P435
    M346
    M346
    P306
    M299
    M299
    M299
    P316
    M299
    M299
    M299
    M299
    D176
    D176
    D176
    D381
    D381
    D381
    M618
    L034
    P472
    M618
    P039
    M694
    M694
    M694
    M694
    D38
    D38
    M694
    M694
    M694

    $150.00
    $300.00
    $25.00
    $215.00
    $740.00
    $250.00
    $140.00
    $60.00
    $1,327.10
    $120.00
    $180.00
    $52.80
    $5.25
    $170.00
    $530.00
    $100.00
    $25.00
    $75.00
    $96.52
    $100.00
    $100.00
    $190.25
    $120.00
    $25.00
    $55.00
    $133.45
    $120.00
    $336.00
    $25.00
    $59.00
    $350.00
    $70.00
    $30.00
    $35.00
    $35.00
    $140.00
    $240.00
    $400.00
    $51.25
    $140.00
    $110.00
    $100.00
    $200.00
    $40.00
    $340.00
    $85.00
    $115.00
    $100.00
    $25.00
    $175.00

    Page 536

    Claims Data

    P366
    S247
    L065
    O076
    O076
    O076
    S433
    S433
    H005
    H005
    S433
    S433
    S433
    S433
    S433
    S433
    P031
    P031
    M225
    M225
    L001
    S214
    S214
    H005
    P215
    P066
    P215
    P215
    M374
    P031
    P436
    P487
    M374
    O001
    S220
    S127
    P031
    S220
    S220
    O156
    P005
    P005
    S020
    P031
    P435
    P031
    S220
    D86
    D86
    D86

    $220.00
    $100.00
    $200.00
    $90.00
    $628.00
    $880.00
    $200.00
    $50.00
    $240.00
    $60.00
    $2,300.00
    $9,700.00
    $1,875.00
    $1,125.00
    $1,875.00
    $4,375.00
    $13,221.99
    $494.31
    $480.00
    $120.00
    $232.75
    $350.00
    $3,400.00
    $2,400.00
    $486.60
    $700.00
    $34.15
    $32.50
    $350.00
    $84.98
    $290.90
    $178.63
    $200.00
    $110.00
    $360.00
    $300.00
    $351.00
    $220.00
    $240.00
    $300.00
    $781.76
    $390.88
    $400.00
    $98.99
    $129.00
    $337.50
    $260.00
    $50.00
    $170.00
    $280.00

    Page 537

    Claims Data

    P031
    P031
    P031
    P031
    P005
    M304
    P435
    P435
    P031
    P031
    S220
    O156
    M304
    M304
    US01
    US01
    P372
    US01
    US01
    US01
    US01
    O076
    O076
    O076
    M204
    L070
    S302
    S302
    S302
    O001
    O001
    P005
    P435
    M498
    M498
    S277
    P014
    H006
    S367
    M581
    M304
    S367
    M310
    P484
    M020
    M019
    M019
    M019
    P337
    L003

    $337.50
    $164.70
    $98.99
    $337.50
    $132.07
    $200.00
    $790.91
    $764.27
    $337.50
    $59.70
    $200.00
    $150.00
    $200.00
    $40.00
    $988.55
    $2,159.37
    $7,195.20
    $228.74
    $512.00
    $195.72
    $639.88
    $90.00
    $1,435.00
    $1,593.00
    $200.00
    $700.00
    $360.00
    $140.00
    $200.00
    $110.00
    $1,547.00
    $1,034.06
    $147.63
    $700.00
    $500.00
    $300.00
    $297.00
    $1,040.00
    $280.00
    $200.00
    $835.00
    $360.00
    $150.00
    $903.80
    $180.00
    $300.00
    $25.00
    $175.00
    $498.45
    $800.00

    Page 538

    Claims Data

    L003
    L003
    M230
    M230
    M230
    M019
    L003
    L003
    L003
    M230
    M230
    M327
    M327
    M327
    L074
    P484
    M019
    L065
    P484
    P472
    M230
    M230
    M230
    M019
    M019
    M019
    M019
    P484
    P484
    S046
    S046
    P435
    S219
    D103
    D103
    D103
    D103
    S296
    S296
    S296
    P435
    S219
    S219
    S219
    H005
    P381
    P435
    S376
    S376
    P435

    $100.00
    $60.00
    $250.00
    $1,250.00
    $250.00
    $300.00
    $800.00
    $25.00
    $25.00
    $250.00
    $1,025.00
    $140.00
    $25.00
    $35.00
    $70.00
    $194.60
    $500.00
    $300.00
    $441.00
    $105.80
    $400.00
    $450.00
    $150.00
    $100.00
    $600.00
    $500.00
    $800.00
    $73.85
    $50.50
    $400.00
    $100.00
    $395.83
    $400.00
    $140.00
    $320.00
    $140.00
    $320.00
    $1,050.00
    $400.00
    $2,400.00
    $1,421.00
    $400.00
    $800.00
    $50.00
    $440.00
    $94.70
    $236.97
    $400.00
    $1,420.00
    $239.64

    Page 539

    Claims Data

    P435
    D78
    D78
    D78
    M683
    M683
    M695
    M695
    P435
    P339
    M626
    P396
    P396
    M626
    P339
    M683
    M683
    P093
    H021
    H021
    S237
    M626
    P046
    M695
    M695
    M695
    M695
    M452
    M452
    P421
    P435
    P396
    P396
    D01
    D01
    D01
    M577
    D01
    H006
    H006
    S109
    S109
    S200
    H006
    S046
    S046
    L158
    L158
    D31
    D31

    $910.44
    $400.00
    $100.00
    $800.00
    $250.00
    $310.00
    $350.00
    $150.00
    $273.07
    $150.50
    $200.00
    $1,221.00
    $251.30
    $200.00
    $608.00
    $250.00
    $310.00
    $105.00
    $700.00
    $1,300.00
    $4,000.00
    $200.00
    $273.50
    $350.00
    $1,000.00
    $400.00
    $300.00
    $200.00
    $500.00
    $750.00
    $473.82
    $1,137.00
    $522.90
    $225.00
    $75.00
    $9,700.00
    $200.00
    $1,650.00
    $900.00
    $1,450.00
    $6,650.00
    $200.00
    $210.00
    $1,200.00
    $100.00
    $300.00
    $120.00
    $30.00
    $275.00
    $275.00

    Page 540

    Claims Data

    M473
    P435
    O007
    O007
    O007
    P066
    P014
    M448
    M448
    P014
    P014
    P014
    P014
    P066
    P014
    L139
    P014
    P066
    L139
    M297
    M297
    M297
    M297
    L116
    P422
    P066
    M393
    S107
    S107
    P005
    P487
    H023
    H023
    S266
    S279
    L177
    M393
    S383
    P031
    H44
    O033
    O033
    O033
    S173
    P122
    O156
    P122
    P435
    P435
    P435

    $60.00
    $371.33
    $100.00
    $855.00
    $985.50
    $881.55
    $556.00
    $200.00
    $400.00
    $139.50
    $163.00
    $340.15
    $197.25
    $719.72
    $518.00
    $200.00
    $1,035.00
    $1,341.84
    $200.00
    $120.00
    $25.00
    $225.00
    $20.00
    $220.00
    $164.00
    $84.06
    $470.00
    $300.00
    $100.00
    $803.20
    $308.61
    $2,470.68
    $29.32
    $4,000.00
    $500.00
    $3,400.00
    $250.00
    $760.00
    $361.47
    $4,850.00
    $100.00
    $701.25
    $2,065.50
    $260.00
    $225.00
    $240.00
    $225.00
    $982.91
    $407.47
    $317.36

    Page 541

    Claims Data

    M630
    P435
    P435
    P435
    P435
    P435
    P435
    P435
    L070
    P435
    P435
    L070
    P435
    UN01
    P435
    P435
    P435
    P435
    P435
    P435
    M630
    P031
    H023
    H023
    S300
    P435
    P055
    D103
    P031
    D103
    D103
    H023
    H023
    H023
    H023
    H023
    P435
    S213
    O001
    O001
    O001
    P005
    P486
    P054
    P005
    P005
    P054
    P005
    P005
    P054

    $200.00
    $39.90
    $496.16
    $407.47
    $173.40
    $129.80
    $290.09
    $383.53
    $1,660.00
    $490.69
    $210.00
    $200.00
    $420.00
    $539.90
    $868.12
    $112.50
    $843.18
    $66.69
    $108.82
    $395.83
    $180.00
    $37.49
    $750.00
    $1,650.00
    $2,500.00
    $105.42
    $193.20
    $380.00
    $13.00
    $140.00
    $320.00
    $375.00
    $127.03
    $2,690.00
    $960.00
    $241.00
    $152.10
    $300.00
    $110.00
    $1,325.00
    $1,310.00
    $317.50
    $39.00
    $40.30
    $158.75
    $158.75
    $41.90
    $158.75
    $158.75
    $40.30

    Page 542

    Claims Data

    P005
    P343
    H005
    S173
    S173
    S173
    S173
    S173
    S173
    S245
    H011
    O076
    O076
    O004
    S325
    P353
    M441
    P115
    M441
    P353
    H006
    P011
    S007
    P093
    L065
    M774
    L139
    L065
    S007
    L065
    D182
    D182
    D182
    D182
    D182
    M124
    P343
    P343
    P031
    L070
    P435
    M464
    P031
    M215
    P031
    S004
    P031
    P031
    M215
    P031

    $158.75
    $40.50
    $650.00
    $2,800.00
    $5,470.00
    $360.00
    $200.00
    $300.00
    $1,200.00
    $700.00
    $1,507.00
    $1,276.00
    $2,395.00
    $100.00
    $300.00
    $212.20
    $120.00
    $130.75
    $200.00
    $200.00
    $175.00
    $112.00
    $240.00
    $322.00
    $220.00
    $300.00
    $350.00
    $220.00
    $200.00
    $175.00
    $840.00
    $3,160.00
    $1,500.00
    $54.18
    $400.00
    $500.00
    $49.35
    $587.74
    $473.48
    $1,240.00
    $870.10
    $300.00
    $682.20
    $250.00
    $1,155.68
    $400.00
    $809.40
    $134.70
    $500.00
    $119.80

    Page 543

    Claims Data

    P031
    L96
    P031
    P031
    D129
    D129
    D129
    D129
    D129
    D103
    D103
    P005
    P005
    P011
    P011
    M607
    M607
    P011
    P011
    S182
    S182
    P011
    D309
    H048
    D309
    D309
    D309
    D309
    P011
    P011
    S244
    S365
    M473
    P343
    M473
    P343
    P435
    P435
    M473
    S300
    L075
    M473
    P122
    D103
    D103
    D103
    D103
    D103
    D103
    D103

    $1,155.68
    $1,800.00
    $859.20
    $1,109.10
    $80.00
    $70.00
    $1,100.00
    $600.00
    $60.00
    $2,025.00
    $11,575.00
    $1,926.63
    $85.00
    $625.00
    $267.12
    $250.00
    $120.00
    $203.98
    $97.09
    $90.00
    $210.00
    $317.72
    $400.00
    $120.00
    $150.00
    $50.00
    $100.00
    $375.00
    $1,156.00
    $353.35
    $300.00
    $300.00
    $120.00
    $262.50
    $150.00
    $104.00
    $277.31
    $69.26
    $180.00
    $600.00
    $6,000.00
    $120.00
    $162.50
    $140.00
    $320.00
    $140.00
    $140.00
    $240.00
    $140.00
    $320.00

    Page 544

    Claims Data

    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    M473
    P343
    M695
    M695
    S300
    S300
    M205
    M205
    P031
    S383
    P031
    P031
    S383
    P507
    EC01
    S383
    O004
    O004
    D152
    D152
    D152
    P055
    M630
    P055
    P055
    M630
    P055
    P055
    O015
    O015
    M630
    P055
    P055
    O015
    O015

    $140.00
    $140.00
    $240.00
    $160.00
    $140.00
    $240.00
    $160.00
    $350.00
    $140.00
    $240.00
    $160.00
    $2,100.00
    $480.00
    $330.00
    $660.00
    $120.00
    $338.10
    $350.00
    $150.00
    $300.00
    $100.00
    $240.00
    $650.00
    $1,331.26
    $1,140.00
    $144.98
    $206.46
    $600.00
    $396.00
    $502.26
    $260.00
    $716.00
    $1,576.00
    $300.00
    $70.00
    $130.00
    $322.50
    $360.00
    $361.30
    $57.30
    $180.00
    $18.30
    $20.00
    $130.00
    $530.00
    $180.00
    $185.90
    $302.00
    $540.00
    $605.00

    Page 545

    Claims Data

    M630
    P031
    O015
    O015
    O015
    P055
    P055
    M089
    P055
    M089
    D143
    P055
    D59
    D59
    D59
    O001
    T034
    P031
    M124
    M124
    O001
    O001
    O001
    O001
    O001
    L075
    H005
    O001
    O001
    O001
    H005
    H005
    H005
    H005
    H005
    D181
    S041
    L006
    H005
    H005
    S433
    M124
    P031
    T034
    UN01
    D181
    D181
    M630
    S214
    S214

    $180.00
    $254.85
    $130.00
    $130.00
    $415.00
    $169.50
    $339.00
    $180.00
    $189.70
    $180.00
    $600.00
    $169.95
    $340.00
    $170.00
    $280.00
    $110.00
    $16,200.00
    $4,169.54
    $250.00
    $250.00
    $110.00
    $100.00
    $900.00
    $900.00
    $200.00
    $3,800.00
    $631.82
    $100.00
    $895.00
    $1,280.00
    $380.00
    $1,141.30
    $240.00
    $600.00
    $3,800.00
    $100.00
    $700.00
    $1,050.00
    $280.00
    $44.68
    $500.00
    $250.00
    $99.80
    $5,100.00
    $750.00
    $140.00
    $860.00
    $200.00
    $1,900.00
    $25.00

    Page 546

    Claims Data

    H023
    H023
    M630
    M630
    D181
    D181
    O001
    O001
    P031
    H005
    H005
    H005
    H005
    P031
    P031
    M089
    H047
    H005
    H005
    P031
    S219
    S219
    P343
    S107
    S107
    P031
    T034
    S383
    O177
    O177
    O177
    D38
    D38
    M473
    S363
    L070
    O177
    O177
    O177
    M473
    P435
    M473
    S363
    H006
    S151
    S151
    S151
    M452
    P435
    D427

    $400.00
    $1,192.00
    $180.00
    $180.00
    $800.00
    $180.00
    $1,270.75
    $1,615.00
    $1,465.28
    $280.00
    $200.00
    $500.00
    $400.00
    $75.25
    $1,014.23
    $280.00
    $400.00
    $208.00
    $500.00
    $192.48
    $400.00
    $400.00
    $89.99
    $300.00
    $100.00
    $174.49
    $18,225.00
    $360.00
    $100.00
    $805.50
    $1,890.00
    $140.00
    $1,260.00
    $100.00
    $300.00
    $130.00
    $100.00
    $355.50
    $360.00
    $200.00
    $295.26
    $130.00
    $400.00
    $350.00
    $350.00
    $300.00
    $170.00
    $250.00
    $217.33
    $400.00

    Page 547

    Claims Data

    H023
    H023
    H023
    S407
    S006
    S433
    S433
    P435
    O004
    O004
    O004
    S162
    P068
    O001
    O001
    O001
    M101
    P154
    P154
    M101
    P154
    P154
    M463
    M463
    P154
    P154
    O001
    O001
    O001
    S149
    S149
    S149
    S149
    S149
    S149
    O001
    M233
    M233
    M215
    P031
    P011
    M215
    P011
    O004
    O004
    O004
    M212
    M212
    M246
    S128

    $1,100.00
    $3,007.00
    $375.00
    $800.00
    $300.00
    $2,000.00
    $2,700.00
    $593.74
    $100.00
    $1,196.00
    $2,056.00
    $240.00
    $310.45
    $110.00
    $854.75
    $520.00
    $150.00
    $235.90
    $111.95
    $160.00
    $49.90
    $36.00
    $200.00
    $120.00
    $280.60
    $54.00
    $110.00
    $2,495.00
    $1,550.00
    $200.00
    $300.00
    $200.00
    $200.00
    $25.00
    $275.00
    $110.00
    $100.00
    $30.00
    $500.00
    $108.43
    $336.00
    $250.00
    $112.00
    $100.00
    $1,196.00
    $1,256.00
    $750.00
    $400.00
    $1,925.00
    $14,500.00

    Page 548

    Claims Data

    H006
    H006
    S277
    P007
    H006
    P007
    H006
    M577
    L065
    D283
    D283
    D283
    D283
    D78
    H029
    H029
    H029
    H029
    H029
    D379
    D379
    D379
    D379
    O004
    O004
    O004
    S387
    H027
    O001
    O001
    L041
    P416
    D182
    D182
    D89
    D51
    D51
    D51
    D51
    D51
    D38
    S160
    S160
    S160
    S160
    S160
    S160
    P005
    O001
    P005

    $2,700.00
    $11,509.00
    $4,000.00
    $71.80
    $150.00
    $309.50
    $360.00
    $200.00
    $462.50
    $100.00
    $400.00
    $860.00
    $1,640.00
    $400.00
    $700.00
    $200.00
    $355.00
    $400.00
    $615.00
    $180.00
    $70.00
    $110.00
    $500.00
    $100.00
    $716.00
    $396.00
    $500.00
    $1,470.00
    $250.00
    $635.80
    $40.00
    $574.80
    $1,500.00
    $2,000.00
    $425.00
    $144.00
    $70.00
    $74.00
    $450.00
    $54.00
    $150.00
    $200.00
    $25.00
    $635.00
    $200.00
    $25.00
    $375.00
    $409.06
    $110.00
    $409.06

    Page 549

    Claims Data

    P005
    P005
    P005
    P005
    P435
    M393
    P155
    P155
    P155
    P435
    P435
    P435
    M393
    S400
    P343
    P122
    M374
    L070
    P435
    M695
    M695
    M695
    H011
    S137
    S137
    S137
    S137
    S137
    D432
    D432
    O001
    O001
    H005
    H005
    S302
    M328
    M695
    M695
    S076
    P031
    P031
    S137
    S137
    S137
    S137
    S137
    S076
    P435
    S137
    S137

    $409.06
    $818.12
    $409.60
    $409.06
    $731.69
    $220.00
    $43.00
    $51.10
    $79.50
    $731.69
    $731.69
    $664.11
    $250.00
    $300.00
    $376.45
    $371.40
    $200.00
    $250.00
    $103.82
    $350.00
    $150.00
    $150.00
    $500.00
    $450.00
    $25.00
    $375.00
    $450.00
    $400.00
    $150.00
    $350.00
    $2,120.75
    $850.00
    $1,940.00
    $11,135.88
    $10,000.00
    $4,000.00
    $350.00
    $350.00
    $350.00
    $67.99
    $124.99
    $450.00
    $400.00
    $450.00
    $25.00
    $375.00
    $250.00
    $101.51
    $450.00
    $450.00

    Page 550

    Claims Data

    S076
    P435
    US01
    US01
    US01
    US01
    US01
    US01
    H051
    S446
    S446
    S296
    S296
    H025
    S323
    S323
    M049
    P081
    D63
    O015
    O015
    D411
    D411
    D411
    D04
    D04
    D04
    D04
    D04
    D04
    D04
    D04
    D04
    M443
    P427
    M060
    M060
    S160
    P154
    S199
    S199
    S199
    S124
    P154
    P154
    S115
    P154
    P154
    S199
    P154

    $500.00
    $127.18
    ($1,782.76)
    $1,782.76
    ($802.44)
    $802.44
    ($2,240.41)
    $2,240.41
    $500.00
    $5,000.00
    $5,867.00
    $2,400.00
    $1,050.00
    $260.00
    $350.00
    $160.00
    $120.00
    $203.30
    $300.00
    $130.00
    $2,860.00
    $200.00
    $25.00
    $25.00
    $100.00
    $200.00
    $100.00
    $200.00
    $100.00
    $140.00
    $100.00
    $140.00
    $100.00
    $450.00
    $996.20
    $180.00
    $180.00
    $200.00
    $184.40
    $300.00
    $25.00
    $175.00
    $300.00
    $130.00
    $32.50
    $300.00
    $23.50
    $261.98
    $300.00
    $38.08

    Page 551

    Claims Data

    P154
    P154
    L041
    S124
    P154
    L041
    S124
    S124
    S160
    P014
    M304
    P337
    P337
    H005
    O004
    O004
    O004
    D173
    D173
    D173
    S302
    P014
    S127
    S127
    S127
    S127
    M053
    P081
    P081
    H023
    H023
    H023
    H023
    S279
    S279
    P435
    M045
    L001
    S279
    S279
    S279
    O004
    O004
    O004
    D04
    D04
    M060
    M060
    M060
    M060

    $50.40
    $9.52
    $350.00
    $200.00
    $162.50
    $400.00
    $1,360.00
    $340.00
    $200.00
    $59.50
    $140.00
    $120.00
    $91.75
    $420.00
    $200.00
    $1,516.00
    $1,896.00
    $800.00
    $600.00
    $300.00
    $860.00
    $76.50
    $400.00
    $1,200.00
    $3,000.00
    $2,000.00
    $290.00
    $216.50
    $31.90
    $375.00
    $383.76
    $14.95
    $210.00
    $500.00
    $700.00
    $49.99
    $150.00
    $505.00
    $400.00
    $182.00
    $100.00
    $100.00
    $1,356.00
    $1,656.00
    $140.00
    $285.00
    $200.00
    $25.00
    $315.00
    $200.00

    Page 552

    Claims Data

    M060
    M060
    M060
    M577
    S217
    L177
    P031
    L96
    H023
    H023
    P427
    H023
    S217
    S217
    S217
    S217
    D86
    D86
    H023
    S217
    H023
    P435
    T074
    M060
    L070
    P348
    P435
    H023
    O004
    S151
    H005
    L068
    O076
    O076
    O076
    O065
    O065
    O065
    D38
    D411
    D411
    D411
    D382
    D382
    D382
    D382
    S275
    S275
    S275
    US01

    $25.00
    $315.00
    $200.00
    $200.00
    $500.00
    $3,400.00
    $199.15
    $500.00
    $950.00
    $17,759.72
    $48.90
    $171.15
    $100.00
    $12,000.00
    $4,500.00
    $4,000.00
    $50.00
    $300.00
    $4,318.85
    $800.00
    $100.60
    $366.21
    $1,730.00
    $200.00
    $80.00
    $14.78
    $93.03
    $94.50
    $688.00
    $1,050.00
    $600.00
    $1,130.00
    $180.00
    $1,525.50
    $1,170.00
    $150.00
    $810.00
    $180.00
    $900.00
    $200.00
    $25.00
    $25.00
    $200.00
    $260.00
    $500.00
    $305.00
    $300.00
    $25.00
    $925.00
    $787.50

    Page 553

    Claims Data

    US01
    US01
    US01
    US01
    P372
    P372
    S244
    P011
    S296
    S296
    S296
    M124
    P011
    O001
    O001
    O001
    S296
    S296
    S296
    M124
    M124
    L070
    P077
    M164
    P077
    P077
    P077
    P077
    M164
    P077
    P077
    H026
    M164
    P077
    D34
    D34
    M204
    M204
    M204
    O004
    O004
    O004
    O004
    O004
    S120
    P014
    S120
    P093
    H011
    P093

    $1,575.00
    $630.00
    $13,860.00
    $17,640.00
    $2,585.00
    $26,200.00
    $300.00
    $476.00
    $1,500.00
    $450.00
    $800.00
    $600.00
    $28.50
    $110.00
    $1,871.25
    $1,365.00
    $1,050.00
    $400.00
    $3,900.00
    $500.00
    $200.00
    $1,110.00
    $310.00
    $100.00
    $98.00
    $310.00
    $310.00
    $310.00
    $100.00
    $5.00
    $20.00
    $83.00
    $120.00
    $310.00
    $100.00
    $250.00
    $200.00
    $200.00
    $60.00
    $200.00
    $776.00
    $200.00
    $1,516.00
    $1,016.00
    $300.00
    $27.95
    $240.00
    $66.74
    $220.00
    $55.10

    Page 554

    Claims Data

    S184
    S184
    S381
    P090
    S400
    S400
    H005
    L143
    D07
    D07
    D07
    D102
    M178
    S247
    O004
    O004
    O004
    S026
    P382
    D86
    D86
    D86
    M452
    M452
    M452
    Missing
    S144
    S144
    M231
    S417
    H066
    H066
    H066
    H047
    P343
    H005
    M089
    L070
    M216
    M216
    M207
    P167
    M207
    P167
    D92
    D92
    P484
    M207
    P167
    M207

    $200.00
    $100.00
    $400.00
    $72.60
    $300.00
    $550.00
    $1,280.00
    $500.00
    $475.00
    $80.00
    $20.00
    $200.00
    $200.00
    $100.00
    $100.00
    $1,516.00
    $680.00
    $160.00
    $300.00
    $50.00
    $240.00
    $60.00
    $240.00
    $60.00
    $290.00
    $300.00
    $300.00
    $200.00
    $100.00
    $300.00
    $800.00
    $500.00
    $2,500.00
    $1,300.00
    $123.20
    $200.00
    $380.00
    $295.00
    $100.00
    $100.00
    $200.00
    $1,223.40
    $200.00
    $1,703.90
    $85.00
    $415.00
    $60.00
    $100.00
    $675.75
    $200.00

    Page 555

    Claims Data

    P167
    O001
    O001
    O001
    M207
    P167
    M207
    P484
    P167
    M207
    P167
    D07
    D07
    D07
    D07
    D07
    D07
    D07
    D07
    D07
    D07
    M346
    M346
    P478
    P478
    M230
    M230
    P167
    M584
    M584
    O004
    M584
    D114
    D114
    D114
    D114
    D114
    S374
    O001
    P014
    S069
    P014
    P014
    M089
    M089
    M089
    M089
    M089
    D22
    D22

    $562.25
    $110.00
    $1,295.00
    $650.00
    $300.00
    $1,916.00
    $100.00
    $67.50
    $59.75
    $400.00
    $2,518.30
    $150.00
    $350.00
    $35.00
    $1,265.00
    $325.00
    $100.00
    $1,350.00
    $1,350.00
    $875.00
    $100.00
    $100.00
    $100.00
    $7.00
    $46.20
    $300.00
    $300.00
    $205.25
    $150.00
    $52.00
    $1,140.00
    $150.00
    $120.00
    $70.00
    $10.00
    $340.00
    $540.00
    $200.00
    $200.00
    $121.25
    $650.00
    $20.00
    $37.15
    $180.00
    $200.00
    $100.00
    $180.00
    $20.00
    $200.00
    $480.00

    Page 556

    Claims Data

    M657
    P014
    L006
    L006
    L140
    L140
    P005
    S296
    S296
    S296
    D232
    D129
    D129
    D129
    D129
    D129
    M189
    M019
    P435
    P085
    M304
    M189
    M304
    P435
    P435
    M087
    M087
    M087
    P081
    P081
    D437
    D437
    D437
    P081
    M374
    L006
    P085
    M325
    M325
    S115
    M294
    O076
    O076
    M294
    M775
    M775
    S113
    H027
    M863
    M310

    $100.00
    $148.40
    $350.00
    $350.00
    $1,728.00
    $216.00
    $312.88
    $800.00
    $450.00
    $1,500.00
    $250.00
    $70.00
    $320.00
    $70.00
    $60.00
    $370.00
    $140.00
    $300.00
    $42.00
    $188.25
    $745.00
    $140.00
    $865.00
    $529.75
    $529.75
    $160.00
    $20.00
    $160.00
    $81.00
    $33.75
    $35.00
    $15.00
    $500.00
    $144.00
    $200.00
    $400.00
    $109.10
    $100.00
    $40.00
    $200.00
    $100.00
    $80.00
    $1,200.00
    $100.00
    $300.00
    $140.00
    $900.00
    $390.00
    $100.00
    $150.00

    Page 557

    Claims Data

    M310
    L97
    M310
    M310
    M310
    S136
    M633
    P343
    S136
    P007
    S136
    S091
    P014
    P447
    P465
    M298
    P106
    P106
    P011
    P066
    M298
    M298
    S450
    M211
    P093
    M006
    L065
    S159
    S159
    M378
    M378
    H005
    D141
    M378
    H005
    P435
    P005
    M378
    M378
    D141
    H023
    S220
    O156
    P005
    H006
    H006
    S277
    S277
    S220
    S220

    $320.00
    $400.00
    $150.00
    $475.00
    $125.00
    $250.00
    $100.00
    $204.89
    $200.00
    $49.95
    $200.00
    $160.00
    $45.85
    $107.45
    $399.00
    $240.00
    $96.45
    $119.00
    $555.00
    $93.00
    $40.00
    $920.00
    $6,000.00
    $200.00
    $100.70
    $300.00
    $440.00
    $400.00
    $200.00
    $400.00
    $125.00
    $674.50
    $300.00
    $350.00
    $280.00
    $356.99
    $1,418.70
    $350.00
    $50.00
    $360.00
    $3,819.85
    $220.00
    $150.00
    $451.02
    $900.00
    $5,385.00
    $150.00
    $2,000.00
    $220.00
    $150.00

    Page 558

    Claims Data

    P005
    P001
    M454
    H006
    H006
    H006
    H006
    M229
    P055
    P055
    O001
    O001
    H025
    H025
    S383
    P055
    M229
    L001
    M326
    M030
    P031
    P031
    O001
    O001
    O001
    S375
    P066
    S046
    S046
    M186
    P487
    P487
    H026
    H026
    L075
    S216
    S216
    P343
    P005
    S235
    P435
    P005
    M300
    S069
    S069
    P507
    P343
    P507
    S235
    M771

    $451.02
    $286.60
    $800.00
    $2,200.00
    $350.00
    $300.00
    $3,900.50
    $140.00
    $3,553.00
    $2,655.25
    $110.00
    $173.04
    $260.00
    $300.00
    $260.00
    $6,501.65
    $140.00
    $303.80
    $250.00
    $160.00
    $99.60
    $137.99
    $110.00
    $930.75
    $1,207.00
    $200.00
    $278.64
    $350.00
    $50.00
    $85.00
    $133.32
    $10.10
    $379.95
    $80.00
    $1,900.00
    $1,200.00
    $600.00
    $167.30
    $5,363.94
    $300.00
    $494.68
    $818.12
    $320.00
    $300.00
    $1,200.00
    $637.10
    $224.24
    $27.00
    $300.00
    $300.00

    Page 559

    Claims Data

    M771
    T051
    T051
    P435
    P435
    P427
    P427
    P005
    P435
    M657
    P435
    P435
    P435
    L075
    P435
    P435
    H005
    H005
    H005
    P427
    P427
    S159
    M673
    P435
    P427
    M657
    P005
    L140
    S159
    P427
    P427
    P427
    M657
    P427
    M299
    L034
    M299
    L061
    M299
    M299
    L061
    P337
    L061
    L061
    P337
    M187
    L97
    S007
    P231
    H023

    $400.00
    $750.00
    $393.00
    $156.11
    $17.35
    $48.60
    $5.40
    $617.70
    $678.92
    $200.00
    $178.12
    $19.79
    $678.92
    $3,400.00
    $92.91
    $10.32
    $800.00
    $1,400.00
    $12,862.72
    $1,047.60
    $116.40
    $20,000.00
    $5,000.00
    $1,883.58
    $153.85
    $200.00
    $312.88
    $1,640.00
    $800.00
    $276.50
    $63.00
    $189.00
    $200.00
    $235.90
    $150.00
    $400.00
    $60.00
    $145.00
    $25.00
    $265.00
    $180.00
    $54.00
    $300.00
    $205.00
    $90.00
    $200.00
    $250.00
    $440.00
    $94.50
    $750.00

    Page 560

    Claims Data

    H023
    H023
    H023
    H023
    M001
    M001
    P476
    P399
    O002
    O002
    M156
    M156
    P145
    D31
    L143
    D41
    D41
    S458
    S458
    O163
    O163
    O163
    S136
    S136
    P014
    M858
    P014
    O006
    O006
    O001
    O006
    O006
    M230
    M858
    L054
    M104
    L070
    P466
    S123
    M167
    M167
    M167
    M327
    M327
    M327
    M327
    P426
    S375
    P235
    S375

    $3,000.00
    $2,190.00
    $25.00
    $25.00
    $160.00
    $50.00
    $33.60
    $138.50
    $70.00
    $495.00
    $100.00
    $200.00
    $275.00
    $325.00
    $500.00
    $1,000.00
    $500.00
    $300.00
    $300.00
    $70.00
    $1,245.00
    $1,200.00
    $200.00
    $300.00
    $65.00
    $200.00
    $406.25
    $500.00
    $900.00
    $110.00
    $1,095.00
    $700.00
    $300.00
    $300.00
    $300.00
    $360.00
    $230.00
    $151.50
    $400.00
    $140.00
    $25.00
    $35.00
    $80.00
    $140.00
    $60.00
    $60.00
    $188.00
    $200.00
    $2,457.00
    $200.00

    Page 561

    Claims Data

    P001
    S375
    M053
    M053
    M053
    M053
    M345
    P014
    S184
    P014
    P014
    M345
    M304
    M345
    M188
    O001
    O001
    O001
    M188
    L082
    L082
    S096
    S096
    P140
    P140
    L013
    L013
    S439
    S367
    O161
    O161
    S367
    H006
    H006
    S306
    H025
    O004
    M184
    M184
    L001
    O004
    O004
    S090
    P034
    M215
    P014
    P014
    P022
    M215
    M053

    $100.93
    $200.00
    $75.00
    $65.00
    $20.00
    $140.00
    $200.00
    $421.00
    $300.00
    $83.60
    $10.80
    $200.00
    $585.00
    $200.00
    $100.00
    $250.00
    $1,020.00
    $1,440.75
    $100.00
    $240.00
    $625.00
    $300.00
    $300.00
    $1.40
    $119.00
    $4,990.00
    $475.00
    $300.00
    $340.00
    $800.00
    $600.00
    $260.00
    $450.00
    $150.00
    $400.00
    $150.00
    $200.00
    $60.00
    $140.00
    $260.00
    $100.00
    $2,056.00
    $180.00
    $77.00
    $250.00
    $369.00
    $118.50
    $175.00
    $250.00
    $140.00

    Page 562

    Claims Data

    P435
    P435
    M053
    P435
    P435
    M053
    P435
    P435
    M053
    P435
    O007
    O007
    O007
    O007
    M053
    P435
    M053
    S046
    P435
    M053
    P435
    P435
    M053
    P435
    P435
    O004
    O004
    O004
    M630
    M630
    M089
    M089
    M630
    M630
    P435
    P435
    M630
    M630
    L034
    M630
    M630
    P435
    P435
    S281
    S281
    S281
    S281
    S281
    L049
    M630

    $108.41
    $303.55
    $140.00
    $24.12
    $365.98
    $140.00
    $32.37
    $239.97
    $140.00
    $141.05
    $100.00
    $675.00
    $1,440.00
    $100.00
    $140.00
    $646.62
    $140.00
    $400.00
    $255.31
    $140.00
    $153.45
    $58.19
    $140.00
    $108.23
    $56.51
    $100.00
    $1,196.00
    $1,280.00
    $75.00
    $105.00
    $180.00
    $180.00
    $75.00
    $105.00
    $126.64
    $31.66
    $75.00
    $105.00
    $500.00
    $75.00
    $105.00
    $105.45
    $26.36
    $150.00
    $250.00
    $364.44
    $91.11
    $410.00
    $600.00
    $180.00

    Page 563

    Claims Data

    S281
    S281
    M630
    P435
    D58
    D58
    D58
    M077
    D219
    M687
    P437
    P437
    M786
    M786
    S086
    S086
    L070
    S086
    S086
    O004
    O004
    O004
    M388
    M388
    M388
    D309
    D309
    D309
    D309
    D309
    M786
    M786
    H008
    H008
    S032
    P140
    P492
    S032
    M159
    P283
    M159
    S209
    S256
    D260
    D260
    D260
    S256
    P011
    P011
    S256

    $400.00
    $200.00
    $180.00
    $98.29
    $35.00
    $25.00
    $450.00
    $600.00
    $200.00
    $250.00
    $55.50
    $420.75
    $120.00
    $120.00
    $300.00
    $450.00
    $400.00
    $1,200.00
    $1,200.00
    $100.00
    $2,396.00
    $680.00
    $150.00
    $25.00
    $125.00
    $35.00
    $15.00
    $50.00
    $400.00
    $20.00
    $100.00
    $20.00
    $450.00
    $1,581.80
    $5,300.00
    $125.75
    $115.50
    $1,000.00
    $900.00
    $255.95
    $160.00
    $200.00
    $350.00
    $300.00
    $100.00
    $400.00
    $350.00
    $126.00
    $16.00
    $180.00

    Page 564

    Claims Data

    M386
    M386
    M386
    D41
    D41
    D41
    D41
    S391
    P014
    S391
    P014
    M304
    M304
    M304
    M304
    M608
    S007
    S281
    S281
    L006
    L070
    O154
    O154
    D413
    D413
    D413
    D413
    D413
    M046
    P049
    P049
    S005
    D129
    D129
    M030
    L001
    O033
    O033
    P115
    M156
    P115
    M156
    M156
    P115
    P115
    S174
    P435
    P435
    S210
    P115

    $125.00
    $25.00
    $75.00
    $100.00
    $140.00
    $360.00
    $500.00
    $280.00
    $61.95
    $280.00
    $127.95
    $140.00
    $400.00
    $25.00
    $75.00
    $200.00
    $400.00
    $800.00
    $400.00
    $400.00
    $650.00
    $475.00
    $360.00
    $80.00
    $35.00
    $285.00
    $350.00
    $200.00
    $60.00
    $51.00
    $30.50
    $300.00
    $140.00
    $330.00
    $160.00
    $325.00
    $100.00
    $567.00
    $3,285.00
    $100.00
    $2,235.00
    $100.00
    $100.00
    $3,285.00
    $2,235.00
    $300.00
    $471.39
    $18.00
    $100.00
    $2,133.00

    Page 565

    Claims Data

    S210
    P115
    M156
    P115
    M156
    P115
    P115
    M156
    M156
    P115
    H023
    H023
    H44
    D31
    D31
    D31
    P014
    M630
    P435
    D51
    D51
    D51
    D291
    D291
    D291
    O033
    O033
    O033
    S151
    H005
    P022
    P427
    S089
    P435
    P014
    D78
    D78
    S458
    S242
    P430
    P467
    M694
    M694
    M694
    D253
    P106
    H025
    M124
    P001
    L070

    $100.00
    $3,285.00
    $100.00
    $2,202.00
    $100.00
    $3,285.00
    $2,202.00
    $100.00
    $100.00
    $3,285.00
    $2,437.50
    $62.50
    $6,050.00
    $35.00
    $40.00
    $150.00
    $153.30
    $180.00
    $263.55
    $180.00
    $70.00
    $600.00
    $400.00
    $210.00
    $190.00
    $134.00
    $96.00
    $190.00
    $3,150.00
    $969.00
    $132.00
    $66.00
    $450.00
    $14.70
    $52.50
    $42.00
    $1,058.00
    $300.00
    $850.00
    $168.20
    $79.00
    $700.00
    $25.00
    $75.00
    $900.00
    $247.50
    $240.00
    $750.00
    $1,076.70
    $1,855.00

    Page 566

    Claims Data

    S151
    S151
    S151
    S286
    S286
    L128
    P031
    M124
    P435
    P034
    P034
    H011
    H011
    P286
    H011
    O065
    O065
    M183
    M183
    M186
    P397
    M189
    L065
    M463
    M463
    M463
    P115
    P011
    M015
    P005
    M015
    P115
    P005
    M346
    P499
    L075
    T073
    D60
    D60
    D60
    D60
    D60
    D60
    P014
    P003
    P003
    P014
    S384
    S384
    M341

    $400.00
    $300.00
    $170.00
    $350.00
    $100.00
    $700.00
    $876.98
    $250.00
    $151.53
    $106.80
    $92.70
    $750.00
    $215.00
    $500.00
    $257.00
    $150.00
    $3,300.00
    $150.00
    $140.00
    $220.00
    $130.00
    $120.00
    $630.00
    $400.00
    $200.00
    $300.00
    $49.00
    $16.00
    $200.00
    $1,734.24
    $200.00
    $190.65
    $3,791.97
    $320.00
    $150.00
    $3,610.00
    $900.00
    $50.00
    $300.00
    $50.00
    $70.00
    $300.00
    $300.00
    $273.00
    $199.80
    $299.80
    $210.00
    $100.00
    $300.00
    $100.00

    Page 567

    Claims Data

    M341
    M341
    M341
    S384
    O001
    O001
    O001
    O001
    O001
    O001
    S281
    S281
    P014
    L149
    L147
    M120
    M120
    M120
    S367
    H006
    S374
    S374
    L139
    M814
    M814
    M814
    P337
    M814
    M814
    P195
    P272
    D113
    D113
    D113
    D113
    S071
    S071
    P014
    P014
    P014
    M189
    P077
    P115
    P115
    M067
    M067
    M067
    P049
    P435
    M067

    $40.00
    $80.00
    $20.00
    $400.00
    $110.00
    $675.75
    $561.00
    $110.00
    $400.00
    $1,062.00
    $400.00
    $200.00
    $106.00
    $150.00
    $250.00
    $140.00
    $80.00
    $93.00
    $260.00
    $7,540.00
    $350.00
    $350.00
    $650.00
    $70.00
    $30.00
    $40.00
    $65.00
    $100.00
    $500.00
    $84.00
    $73.58
    $100.00
    $50.00
    $110.00
    $850.00
    $84.00
    $566.00
    $184.15
    $44.48
    $9.17
    $140.00
    $140.00
    $51.60
    $74.90
    $160.00
    $25.00
    $55.00
    $87.50
    $221.46
    $760.00

    Page 568

    Claims Data

    M164
    P077
    P106
    P106
    M851
    P014
    P106
    L025
    O004
    S165
    S165
    P106
    H006
    S165
    P014
    P106
    P106
    S266
    S266
    P055
    P022
    S323
    P055
    H023
    H023
    P435
    H023
    M550
    M452
    P421
    M452
    M452
    M452
    M452
    P421
    M550
    P435
    P055
    P055
    P435
    P435
    S323
    L079
    D60
    D60
    D60
    P469
    S245
    H011
    L121

    $120.00
    $46.00
    $597.00
    $285.00
    $500.00
    $40.95
    $1,791.00
    $575.00
    $100.00
    $360.00
    $4,000.00
    $298.50
    $4,500.00
    $300.00
    $119.25
    $60.00
    $597.00
    $400.00
    $200.00
    $651.95
    $60.00
    $450.00
    $228.00
    $241.00
    $4,380.00
    $82.57
    $2,170.00
    $800.00
    $250.00
    $88.20
    $540.00
    $250.00
    $810.00
    $250.00
    $166.60
    $300.00
    $1,507.68
    $420.60
    $270.00
    $27.24
    $59.28
    $1,060.00
    $630.00
    $85.00
    $65.00
    $60.00
    $102.50
    $400.00
    $360.00
    $700.00

    Page 569

    Claims Data

    M297
    M297
    D60
    D60
    M297
    L116
    L116
    L021
    L174
    H011
    S245
    H011
    S316
    S239
    L97
    S300
    M139
    M139
    M139
    M139
    M139
    M139
    M139
    M139
    M139
    M851
    H034
    H034
    H005
    M851
    M851
    P014
    S111
    S111
    H011
    D414
    D414
    O001
    O001
    O001
    P034
    P034
    S214
    S214
    H005
    H005
    L065
    D143
    D143
    H023

    $120.00
    $20.00
    $60.00
    $200.00
    $610.00
    $119.50
    $52.00
    $1,445.00
    $800.00
    $400.00
    $300.00
    $580.00
    $400.00
    $200.00
    $800.00
    $300.00
    $100.00
    $700.00
    $200.00
    $40.00
    $100.00
    $1,000.00
    $100.00
    $25.00
    $675.00
    $500.00
    $610.00
    $1,180.00
    $2,500.00
    $200.00
    $300.00
    $158.85
    $300.00
    $200.00
    $300.00
    $60.00
    $440.00
    $110.00
    $745.00
    $1,730.00
    $254.80
    $277.50
    $350.00
    $1,500.00
    $400.00
    $1,592.00
    $1,225.00
    $3,700.00
    $400.00
    $375.00

    Page 570

    Claims Data

    H023
    D141
    D141
    O004
    S084
    H006
    H006
    M189
    P059
    M002
    M002
    M002
    M002
    M189
    P059
    M189
    P059
    P059
    L025
    P011
    M393
    P343
    M393
    P343
    P005
    P005
    M393
    P005
    P005
    L081
    L081
    M393
    M393
    P005
    P005
    S091
    P049
    S091
    D205
    D205
    D205
    D205
    D60
    D60
    D60
    D60
    D60
    D60
    M254
    M254

    $50.00
    $300.00
    $300.00
    $100.00
    $300.00
    $3,000.00
    $440.00
    $140.00
    $720.00
    $130.00
    $50.00
    $130.00
    $135.00
    $140.00
    $720.00
    $140.00
    $95.00
    $20.00
    $190.00
    $45.50
    $220.00
    $175.15
    $220.00
    $268.00
    $412.04
    $518.58
    $60.00
    $518.58
    $412.04
    $400.00
    $345.72
    $370.00
    $950.00
    $691.44
    $412.00
    $160.00
    $90.10
    $160.00
    $4,000.00
    $450.00
    $300.00
    $135.00
    $50.00
    $105.00
    $75.00
    $300.00
    $300.00
    $200.00
    $200.00
    $250.00

    Page 571

    Claims Data

    M254
    M152
    M152
    M152
    L067
    M152
    L067
    O002
    O002
    O002
    M152
    M152
    M152
    L121
    L074
    S138
    S138
    S138
    M345
    M345
    M345
    L147
    P484
    M345
    L147
    M345
    M345
    S386
    S004
    P005
    H006
    D48
    D48
    D48
    D48
    D48
    S346
    H003
    H003
    S346
    S346
    H003
    H003
    P247
    P005
    S346
    H023
    S346
    P247
    P005

    $300.00
    $150.00
    $25.00
    $95.00
    $80.00
    $150.00
    $120.00
    $50.00
    $707.50
    $862.50
    $150.00
    $25.00
    $95.00
    $250.00
    $70.00
    $250.00
    $25.00
    $25.00
    $200.00
    $25.00
    $175.00
    $100.00
    $71.50
    $200.00
    $450.00
    $25.00
    $275.00
    $500.00
    $600.00
    $698.48
    $3,330.00
    $50.00
    $100.00
    $14.00
    $25.00
    $25.00
    $300.00
    $1,750.00
    $11,369.30
    $5,200.00
    $10,200.00
    $7,000.00
    $687.95
    $42.75
    $367.82
    $400.00
    $1,600.00
    $200.00
    $135.00
    $349.24

    Page 572

    Claims Data

    P104
    M304
    M304
    P247
    P247
    P247
    P247
    S346
    D148
    D148
    D148
    D148
    D148
    D148
    D148
    D148
    S228
    O178
    P140
    D420
    D420
    D420
    H011
    H011
    H011
    H011
    O002
    O002
    S250
    S446
    S160
    M189
    M189
    P059
    P059
    P059
    P059
    M265
    M265
    S069
    P167
    M020
    P039
    S069
    M136
    P039
    O001
    O001
    O001
    M851

    $185.00
    $100.00
    $100.00
    $507.64
    $126.91
    $92.56
    $23.14
    $200.00
    $600.00
    $100.00
    $400.00
    $100.00
    $156.00
    $3,344.00
    $120.00
    $300.00
    $300.00
    $1,500.00
    $140.00
    $250.00
    $250.00
    $80.00
    $350.00
    $250.00
    $5.60
    $1.40
    $50.00
    $950.00
    $300.00
    $300.00
    $200.00
    $120.00
    $140.00
    $120.00
    $25.00
    $252.00
    $152.00
    $80.00
    $120.00
    $450.00
    $244.00
    $160.00
    $330.00
    $450.00
    $160.00
    $199.00
    $110.00
    $925.00
    $1,010.00
    $500.00

    Page 573

    Claims Data

    L126
    M138
    M138
    M138
    D173
    D173
    D173
    D173
    D173
    D173
    D38
    D38
    S242
    P497
    P497
    O001
    O001
    D113
    D113
    D113
    D113
    D113
    P483
    P483
    P483
    D412
    D426
    D426
    D426
    O065
    O065
    O065
    M067
    P077
    D397
    D397
    D397
    P034
    P034
    P034
    P034
    D114
    D114
    D114
    D114
    H005
    H005
    H005
    P122
    S001

    $550.00
    $100.00
    $25.00
    $75.00
    $140.00
    $70.00
    $90.00
    $450.00
    $450.00
    $400.00
    $85.00
    $215.00
    $250.00
    $83.00
    $23.00
    $110.00
    $1,674.00
    $80.00
    $450.00
    $140.00
    $310.00
    $80.00
    $115.00
    $45.80
    $134.65
    $300.00
    $350.00
    $1,600.00
    $470.00
    $150.00
    $1,080.00
    $540.00
    $320.00
    $1,386.00
    $400.00
    $170.00
    $330.00
    $5.00
    $176.25
    $106.15
    $269.80
    $120.00
    $340.00
    $70.00
    $10.00
    $455.00
    $254.84
    $200.00
    $123.80
    $400.00

    Page 574

    Claims Data

    S001
    S001
    H005
    H023
    H023
    H023
    S450
    H006
    H006
    S450
    M246
    M657
    P090
    P090
    O001
    O001
    O001
    O001
    O001
    O001
    S266
    H021
    P353
    S314
    P073
    O004
    O004
    S019
    S019
    S019
    S019
    S019
    S019
    S019
    M666
    M666
    M666
    O076
    O076
    O076
    L025
    M068
    M068
    L081
    M068
    M068
    P203
    M215
    L96
    L070

    $100.00
    $750.00
    $455.00
    $375.00
    $532.00
    $178.80
    $300.00
    $300.00
    $1,000.00
    $3,700.00
    $1,000.00
    $200.00
    $1,232.00
    $2,420.80
    $50.00
    $220.00
    $750.00
    $645.00
    $450.00
    $1,320.00
    $400.00
    $613.80
    $2,208.00
    $300.00
    $454.70
    $100.00
    $180.00
    $780.00
    $360.00
    $240.00
    $780.00
    $25.00
    $135.00
    $260.00
    $160.00
    $50.00
    $30.00
    $90.00
    $1,885.50
    $1,695.00
    $200.00
    $300.00
    $125.00
    $375.00
    $300.00
    $390.00
    $143.81
    $250.00
    $500.00
    $980.00

    Page 575

    Claims Data

    L96
    M215
    M215
    P014
    L091
    M026
    L001
    L001
    O002
    O002
    L075
    O177
    O177
    O177
    O177
    D276
    D276
    D276
    D276
    D276
    H047
    H047
    O007
    O007
    O007
    O007
    M814
    P457
    P457
    O004
    O004
    O004
    S277
    H006
    D129
    S277
    H006
    D103
    D103
    D103
    D103
    D103
    M225
    M225
    P055
    M225
    M225
    P055
    P055
    M225

    $700.00
    $250.00
    $250.00
    $118.50
    $350.00
    $440.00
    $210.00
    $185.00
    $1,657.50
    $2,120.75
    $3,800.00
    $100.00
    $1,890.00
    $1,935.00
    $150.00
    $60.00
    $128.00
    $32.00
    $140.00
    $160.00
    $75.00
    $325.00
    $100.00
    $700.00
    $627.50
    $810.00
    $100.00
    $32.00
    $8.00
    $200.00
    $1,356.00
    $1,656.00
    $300.00
    $506.00
    $300.00
    $300.00
    $625.00
    $320.00
    $120.00
    $35.00
    $140.00
    $320.00
    $220.00
    $280.00
    $70.00
    $220.00
    $50.00
    $15.25
    $189.70
    $220.00

    Page 576

    Claims Data

    M225
    M225
    P055
    P011
    L001
    D103
    D103
    M613
    D103
    D103
    D103
    D103
    D103
    D103
    M225
    M225
    M225
    M225
    M225
    M188
    M188
    M188
    S194
    L013
    P167
    O168
    O168
    O168
    O168
    O168
    O168
    H011
    H011
    H011
    H011
    S226
    P435
    P435
    P231
    P011
    P372
    S226
    P173
    P073
    H023
    P011
    S295
    P467
    P467
    O151

    $130.00
    $100.00
    $79.75
    $101.00
    $1,990.00
    $1,720.00
    $5,080.00
    $2,400.00
    $140.00
    $320.00
    $140.00
    $140.00
    $320.00
    $140.00
    $440.00
    $170.00
    $170.00
    $40.00
    $70.00
    $140.00
    $25.00
    $75.00
    $300.00
    $127.00
    $156.45
    $90.00
    $1,195.00
    $1,520.00
    $90.00
    $1,345.00
    $1,520.00
    $550.00
    $365.00
    $485.00
    $250.00
    $1,600.00
    $2,960.02
    $174.42
    $1,822.50
    $204.00
    $805.20
    $1,600.00
    $1,704.75
    $2,862.50
    $1,656.20
    $405.00
    $300.00
    $201.60
    $7.00
    $895.00

    Page 577

    Claims Data

    O151
    S295
    S295
    S295
    US01
    P467
    P487
    O065
    O065
    P169
    M067
    M067
    P011
    P011
    H011
    H011
    H011
    H011
    S386
    P498
    S237
    S250
    M183
    H011
    H011
    S250
    S237
    M167
    M167
    M167
    H005
    H005
    H005
    H005
    H005
    S114
    S114
    S114
    S114
    P427
    S137
    S137
    S137
    S137
    S137
    S137
    S137
    S137
    S137
    L025

    $400.00
    $300.00
    $400.00
    $300.00
    $2,890.80
    $35.00
    $696.86
    $250.00
    $340.00
    $240.50
    $600.00
    $160.00
    $176.00
    $185.00
    $510.00
    $30.00
    $160.00
    $395.00
    $300.00
    $42.00
    $500.00
    $300.00
    $700.00
    $700.00
    $2,960.00
    $10,000.00
    $900.00
    $140.00
    $25.00
    $35.00
    $274.32
    $180.68
    $35.64
    $23.47
    $297.81
    $2,000.00
    $25.00
    $25.00
    $200.00
    $252.70
    $800.00
    $450.00
    $25.00
    $1,200.00
    $800.00
    $450.00
    $25.00
    $1,200.00
    $450.00
    $220.00

    Page 578

    Claims Data

    P435
    O076
    O076
    O076
    M791
    M791
    M791
    M791
    M791
    P353
    P353
    P353
    P353
    P353
    S144
    P430
    P140
    S030
    D171
    D171
    D171
    D171
    D171
    D152
    D152
    D152
    P090
    S118
    P090
    P090
    P090
    H005
    S266
    P090
    S314
    P090
    P005
    L140
    L140
    L140
    L070
    L070
    M505
    P049
    L081
    L152
    L112
    M505
    M505
    M505

    $181.53
    $90.00
    $1,440.75
    $1,395.00
    $200.00
    $200.00
    $300.00
    $200.00
    $110.00
    $195.00
    $59.60
    $1,306.00
    $130.00
    $268.00
    $600.00
    $206.50
    $1,685.95
    $240.00
    $100.00
    $350.00
    $100.00
    $60.00
    $240.00
    $200.00
    $300.00
    $500.00
    $269.90
    $700.00
    $45.80
    $15.50
    $214.65
    $200.00
    $400.00
    $307.50
    $300.00
    $93.35
    $219.95
    $180.00
    $400.00
    $60.00
    $216.00
    $689.00
    $180.00
    $4,221.00
    $900.00
    $810.00
    $8,847.60
    $180.00
    $25.00
    $175.00

    Page 579

    Claims Data

    L152
    M505
    P049
    P049
    S165
    P246
    L018
    S076
    P422
    P422
    M076
    M076
    M076
    M076
    M076
    P388
    P422
    O001
    O001
    S076
    P422
    S165
    S165
    M076
    M076
    S044
    S044
    P246
    P076
    P076
    S286
    S286
    S286
    L065
    M076
    M076
    P487
    P487
    S044
    S044
    P014
    P014
    P014
    S220
    D143
    D04
    D04
    O011
    O011
    O011

    $385.00
    $180.00
    $74.00
    $92.25
    $360.00
    $128.90
    $300.00
    $350.00
    $206.15
    $241.80
    $225.00
    $225.00
    $240.00
    $50.00
    $10.00
    $75.00
    $80.60
    $110.00
    $1,819.00
    $250.00
    $214.90
    $75.00
    $225.00
    $75.00
    $175.00
    $300.00
    $300.00
    $76.00
    $84.96
    $21.24
    $150.00
    $150.00
    $150.00
    $153.00
    $225.00
    $525.00
    $36.07
    $9.02
    $175.00
    $125.00
    $101.32
    $7.83
    $17.50
    $240.00
    $1,200.00
    $80.00
    $120.00
    $80.00
    $780.00
    $2,000.00

    Page 580

    Claims Data

    M215
    P286
    P286
    P068
    L97
    M692
    L065
    S159
    L075
    S159
    O004
    O004
    S044
    S375
    P011
    S083
    S083
    P031
    O015
    O015
    O015
    US01
    D141
    S244
    S244
    D141
    M225
    M225
    P022
    P022
    P487
    P094
    O156
    O001
    O001
    P011
    S111
    P286
    M562
    M562
    M562
    O065
    O065
    M304
    P104
    M411
    P465
    P465
    M411
    P465

    $500.00
    $750.00
    $165.00
    $63.90
    $800.00
    $500.00
    $610.00
    $400.00
    $3,610.00
    $400.00
    $200.00
    $180.00
    $400.00
    $300.00
    $146.00
    $400.00
    $200.00
    $62.00
    $450.00
    $2,090.00
    $3,390.00
    $7,745.32
    $300.00
    $300.00
    $200.00
    $260.00
    $660.00
    $390.00
    $354.05
    $112.35
    $195.48
    $83.15
    $300.00
    $1,695.00
    $1,760.00
    $292.50
    $300.00
    $159.79
    $150.00
    $100.00
    $140.00
    $150.00
    $68.00
    $185.00
    $150.60
    $130.00
    $15.00
    $101.80
    $130.00
    $65.00

    Page 581

    Claims Data

    M700
    M249
    P014
    D78
    D78
    P022
    L033
    O004
    O004
    P380
    P380
    D238
    S426
    L065
    L065
    S419
    S419
    P005
    M657
    P215
    S055
    P155
    S055
    H023
    H023
    O001
    O001
    O001
    D380
    D380
    D380
    S329
    S329
    M138
    M138
    M138
    T034
    T034
    D78
    P435
    S083
    H023
    S083
    M707
    S361
    D180
    D180
    D180
    D180
    D180

    $100.00
    $120.00
    $228.20
    $300.00
    $400.00
    $39.50
    $605.00
    $2,716.00
    $1,656.00
    $622.50
    $90.00
    $1,100.00
    $600.00
    $900.00
    $880.00
    $250.00
    $25.00
    $617.10
    $200.00
    $313.60
    $200.00
    $90.00
    $1,700.00
    $2,000.00
    $1,800.00
    $110.00
    $1,125.00
    $970.00
    $160.00
    $160.00
    $500.00
    $60.00
    $240.00
    $100.00
    $25.00
    $55.00
    $2,475.00
    $800.00
    $400.00
    $30.21
    $2,100.00
    $4,353.56
    $7,762.50
    $1,200.00
    $250.00
    $100.00
    $35.00
    $165.00
    $350.00
    $100.00

    Page 582

    Claims Data

    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    S231
    T060
    UN01
    UN01
    S141
    O076
    O076
    T064
    S217
    T064
    T064
    M353
    M353
    P049
    D04
    D04
    D04
    D04
    D04
    D04
    D04
    S083
    S083
    D421
    D421
    D421
    L025
    M421
    M851
    L065
    P427
    P427
    S290
    M463
    M463
    O001
    O001
    O001
    L97
    O001
    O001

    $70.00
    $130.00
    $400.00
    $2,280.00
    $460.00
    $100.00
    $70.00
    $130.00
    $400.00
    $200.00
    $1,040.00
    $300.00
    $580.00
    $4,165.00
    $180.00
    $472.50
    $1,040.00
    $400.00
    $1,370.00
    $2,590.00
    $300.00
    $70.00
    $182.85
    $85.00
    $115.00
    $100.00
    $200.00
    $200.00
    $80.00
    $100.00
    $700.00
    $200.00
    $400.00
    $100.00
    $400.00
    $285.00
    $450.00
    $300.00
    $700.00
    $35.25
    $188.40
    $2,540.00
    $250.00
    $150.00
    $110.00
    $895.00
    $1,720.00
    $200.00
    $110.00
    $895.00

    Page 583

    Claims Data

    O001
    M230
    P475
    P475
    M144
    P467
    M598
    M598
    M144
    L041
    P369
    S223
    S223
    M602
    L041
    D114
    D114
    D114
    D114
    D114
    US01
    US01
    US01
    US01
    M814
    O076
    O076
    O076
    P076
    P076
    L147
    M230
    M230
    M230
    P435
    P435
    P435
    UN01
    M451
    L049
    D78
    D78
    Missing
    S300
    D64
    D64
    D64
    M229
    L001
    S041

    $1,350.00
    $300.00
    $40.00
    $235.00
    $200.00
    $313.85
    $200.00
    $110.00
    $200.00
    $390.00
    $146.15
    $600.00
    $2,500.00
    $600.00
    $2,000.00
    $120.00
    $70.00
    $10.00
    $340.00
    $1,080.00
    $1,615.44
    $1,097.10
    $3,185.72
    $1,025.02
    $100.00
    $90.00
    $930.75
    $1,080.00
    $98.25
    $36.25
    $210.00
    $300.00
    $25.00
    $175.00
    $141.71
    ($141.71)
    $141.71
    $600.00
    $300.00
    $180.00
    $100.00
    $800.00
    $300.00
    $300.00
    $35.00
    $15.00
    $350.00
    $160.00
    $510.00
    $800.00

    Page 584

    Claims Data

    L006
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    S192
    P106
    P248
    L061
    D04
    D04
    S312
    P011
    D04
    D04
    S453
    O147
    O004
    O004
    D283
    D283

    $520.00
    $288.00
    $264.00
    $120.00
    $360.00
    $868.80
    $552.00
    $120.00
    $345.60
    $299.52
    $168.00
    $180.00
    $168.00
    $293.76
    $144.00
    $240.00
    $86.40
    $24.00
    $167.04
    $120.00
    $117.50
    $2,548.80
    $168.00
    $360.00
    $96.00
    $360.00
    $1,392.00
    $240.00
    $903.60
    $68.40
    $288.00
    $288.00
    $192.00
    $2,606.40
    $800.00
    $439.80
    $378.00
    $540.00
    $100.00
    $185.00
    $250.00
    $125.00
    $100.00
    $200.00
    $250.00
    $800.00
    $100.00
    $2,056.00
    $150.00
    $350.00

    Page 585

    Claims Data

    O163
    O163
    O163
    H011
    H011
    H011
    S446
    S237
    H011
    M304
    P337
    S111
    S111
    O001
    O001
    O001
    D22
    D22
    D22
    D22
    D22
    D22
    D22
    S103
    L070
    D391
    P469
    P071
    D391
    D391
    D438
    D438
    D438
    P465
    D391
    D391
    D129
    D129
    D129
    D129
    D129
    D129
    P055
    P372
    D283
    D283
    D283
    M008
    M008
    M008

    $70.00
    $1,000.00
    $800.00
    $400.00
    $1,000.00
    $5,890.00
    $10,000.00
    $1,500.00
    $55.00
    $140.00
    $120.00
    $40.00
    $60.00
    $100.00
    $1,130.00
    $895.00
    $300.00
    $650.00
    $350.00
    $680.00
    $80.00
    $320.00
    $380.00
    $400.00
    $200.00
    $100.00
    $125.00
    $117.50
    $800.00
    $120.00
    $200.00
    $380.00
    $2,500.00
    $243.40
    $1,140.00
    $260.00
    $80.00
    $50.00
    $80.00
    $320.00
    $80.00
    $280.00
    $537.90
    $566.10
    $75.00
    $525.00
    $600.00
    $220.00
    $10.00
    $30.00

    Page 586

    Claims Data

    M008
    S403
    S403
    D327
    D327
    D327
    D327
    L034
    L034
    L061
    L061
    P005
    P014
    H006
    H006
    M463
    S426
    L065
    H006
    H006
    S426
    D182
    D182
    D182
    D182
    P011
    P011
    P005
    D283
    D283
    D283
    D283
    D283
    D283
    D283
    M310
    M310
    M310
    D283
    D283
    D283
    D283
    L065
    P011
    P066
    P005
    S426
    P458
    P458
    D104

    $20.00
    $300.00
    $600.00
    $150.00
    $95.00
    $305.00
    $300.00
    $360.00
    $800.00
    $1,180.00
    $388.50
    $40.27
    $142.50
    $540.00
    $45.00
    $200.00
    $600.00
    $440.00
    $315.00
    $675.00
    $900.00
    $600.00
    $3,400.00
    $3,000.00
    $1,500.00
    $170.50
    $2,200.00
    $1,231.66
    $272.00
    $100.00
    $128.00
    $100.00
    $80.00
    $304.00
    $96.00
    $150.00
    $275.00
    $290.00
    $1,280.00
    $620.00
    $320.00
    $180.00
    $395.00
    $340.00
    $393.00
    $1,269.38
    $300.00
    $1,270.10
    $10.00
    $200.00

    Page 587

    Claims Data

    D104
    D23
    D23
    D23
    M505
    L152
    M505
    M505
    P478
    M505
    M505
    L152
    P478
    P478
    P478
    S109
    O134
    O134
    M505
    M505
    M505
    P478
    L97
    S300
    D393
    D393
    M647
    M647
    M647
    M647
    M647
    P504
    L070
    L070
    L070
    P478
    O007
    O007
    O007
    P465
    P465
    L97
    S214
    S214
    P148
    S004
    M225
    M225
    M225
    L001

    $600.00
    $50.00
    $100.00
    $290.00
    $360.00
    $655.00
    $25.00
    $75.00
    $315.00
    $360.00
    $200.00
    $660.00
    $305.20
    $120.00
    $225.00
    $200.00
    $900.00
    $660.00
    $180.00
    $25.00
    $75.00
    $147.00
    $200.00
    $300.00
    $60.00
    $120.00
    $80.00
    $25.00
    $235.00
    $240.00
    $220.00
    $1,326.40
    $390.00
    $200.00
    $200.00
    $27.80
    $100.00
    $1,160.00
    $290.00
    $304.80
    $50.75
    $300.00
    $300.00
    $2,000.00
    $202.25
    $400.00
    $220.00
    $180.00
    $80.00
    $958.50

    Page 588

    Claims Data

    M225
    M225
    M030
    P507
    P507
    P031
    P055
    M225
    P031
    L006
    M225
    S136
    P435
    S136
    P435
    S296
    S296
    S296
    S296
    S120
    P014
    H006
    H006
    H006
    S191
    S191
    M246
    M246
    H006
    P353
    P353
    H006
    H006
    P167
    P349
    P167
    M751
    M751
    P014
    P472
    P215
    M751
    P472
    O076
    O076
    O076
    H006
    H006
    H006
    P005

    $220.00
    $80.00
    $160.00
    $520.80
    $45.64
    $50.27
    $179.30
    $50.00
    $107.10
    $200.00
    $220.00
    $400.00
    $227.27
    $600.00
    $15.00
    $300.00
    $400.00
    $800.00
    $1,500.00
    $300.00
    $36.40
    $450.00
    $315.00
    $3,600.00
    $3,600.00
    $1,900.00
    $900.00
    $600.00
    $121.50
    $174.40
    $43.60
    $1,400.00
    $915.00
    $393.05
    $643.30
    $393.05
    $240.00
    $495.00
    $160.00
    $274.60
    $1,163.35
    $120.00
    $462.00
    $90.00
    $985.00
    $1,080.00
    $125.00
    $60.00
    $120.00
    $2,126.07

    Page 589

    Claims Data

    P404
    O076
    O076
    O076
    M140
    M140
    P360
    P360
    M140
    P360
    P360
    M001
    P068
    P068
    S551
    L021
    P476
    D253
    D253
    D253
    D253
    H011
    H011
    S250
    P091
    S120
    P093
    D41
    D41
    D41
    P353
    D41
    D41
    O001
    M067
    M067
    P303
    P303
    D192
    D192
    D192
    D192
    D192
    D192
    D303
    D303
    D303
    D303
    D303
    D303

    $330.00
    $90.00
    $925.50
    $1,030.50
    $150.00
    $150.00
    $152.25
    $42.00
    $150.00
    $367.00
    $35.00
    $200.00
    $162.00
    $118.05
    $500.00
    $450.00
    $339.00
    $100.00
    $25.00
    $25.00
    $800.00
    $500.00
    $1,000.00
    $2,000.00
    $92.00
    $240.00
    $43.70
    $100.00
    $300.00
    $200.00
    $84.00
    $500.00
    $200.00
    $110.00
    $160.00
    $80.00
    $72.00
    $23.95
    $620.00
    $50.00
    $50.00
    $300.00
    $120.00
    $680.00
    $250.00
    $500.00
    $150.00
    $300.00
    $150.00
    $120.00

    Page 590

    Claims Data

    D303
    D303
    D303
    D303
    P154
    P154
    P443
    P154
    P154
    P154
    P154
    O076
    O076
    L97
    P154
    D297
    D297
    D297
    D297
    D297
    D297
    D63
    D63
    D63
    D07
    D07
    D07
    P131
    S323
    S323
    M139
    M139
    M139
    M139
    S445
    H006
    S445
    P353
    P353
    O004
    M353
    M353
    P034
    P435
    P435
    S162
    P068
    P435
    L018
    L018

    $880.00
    $100.00
    $500.00
    $300.00
    $310.65
    $30.00
    $69.50
    $106.45
    $15.95
    $16.10
    $12.40
    $180.00
    $405.00
    $300.00
    $54.00
    $70.00
    $75.00
    $125.00
    $400.00
    $180.00
    $180.00
    $170.00
    $230.00
    $200.00
    $325.00
    $70.00
    $150.00
    $360.00
    $350.00
    $300.00
    $100.00
    $30.00
    $190.00
    $80.00
    $2,520.00
    $225.00
    $880.00
    $125.00
    $555.00
    $1,056.00
    $150.00
    $150.00
    $19.95
    $97.20
    $193.54
    $300.00
    $192.45
    $109.50
    $120.00
    $180.00

    Page 591

    Claims Data

    O033
    O033
    L97
    L97
    L97
    S300
    O058
    O058
    O058
    D51
    D51
    D51
    P353
    S197
    D102
    D102
    M297
    L116
    P179
    M114
    P419
    M020
    P014
    D188
    D188
    D188
    M020
    P484
    P484
    P167
    M020
    M020
    M020
    L034
    P191
    P191
    S355
    L041
    P445
    M461
    M461
    M461
    M014
    M014
    M014
    M014
    M317
    O001
    O001
    O001

    $230.00
    $150.00
    ($250.00)
    $250.00
    $250.00
    $300.00
    $80.00
    $1,700.00
    $650.00
    $300.00
    $200.00
    $400.00
    $235.00
    $300.00
    $1,000.00
    $3,000.00
    $250.00
    $200.00
    $185.00
    $40.00
    $121.80
    $160.00
    $239.85
    $360.00
    $50.00
    $50.00
    $160.00
    $54.00
    $16.00
    $46.90
    $350.00
    $25.00
    $95.00
    $800.00
    $164.99
    $136.50
    $300.00
    $260.00
    $152.90
    $150.00
    $25.00
    $265.00
    $140.00
    $25.00
    $40.00
    $70.00
    $120.00
    $110.00
    $575.00
    $1,010.00

    Page 592

    Claims Data

    L091
    L091
    L091
    L091
    L091
    L091
    L091
    L091
    M317
    P498
    M317
    M317
    S385
    L065
    P005
    M127
    L091
    M799
    M310
    M310
    M310
    O011
    O011
    O011
    O011
    O011
    O011
    M346
    M346
    M346
    M346
    M346
    M346
    S198
    P031
    S198
    P073
    S103
    S103
    P031
    P031
    P031
    P073
    P005
    M310
    M310
    S080
    S080
    L075
    M310

    $400.00
    $149.50
    $22.50
    $900.00
    $700.00
    $500.00
    $145.00
    $375.00
    $240.00
    $231.30
    $240.00
    $130.00
    $400.00
    $175.00
    $1,488.44
    $300.00
    $1,075.00
    $300.00
    $150.00
    $225.00
    $420.00
    $80.00
    $690.00
    $700.00
    $80.00
    $780.00
    $1,500.00
    $100.00
    $25.00
    $75.00
    $100.00
    $25.00
    $75.00
    $400.00
    $1,545.09
    $800.00
    $2,698.20
    $800.00
    $3,500.00
    $434.70
    $89.10
    $1,500.00
    $1,798.80
    $899.40
    $80.00
    $170.00
    $80.00
    $220.00
    $3,800.00
    $100.00

    Page 593

    Claims Data

    H023
    H023
    H023
    M402
    M402
    M402
    P430
    M647
    M647
    P504
    M647
    M647
    M647
    M647
    P504
    M580
    M580
    M580
    L041
    M647
    M647
    M647
    S191
    S191
    H006
    H006
    P435
    M045
    L001
    D81
    D81
    D81
    D81
    D81
    D81
    D81
    D81
    D81
    S083
    S083
    M224
    P022
    P022
    M167
    M167
    M167
    M167
    M167
    M167
    M167

    $440.00
    $310.00
    $7,629.00
    $100.00
    $25.00
    $75.00
    $260.40
    $80.00
    $60.00
    $220.00
    $80.00
    $25.00
    $35.00
    $210.00
    $60.00
    $100.00
    $500.00
    $400.00
    $300.00
    $160.00
    $50.00
    $270.00
    $600.00
    $400.00
    $180.00
    $500.00
    $753.41
    $150.00
    $355.00
    $120.00
    $35.00
    $45.00
    $180.00
    $1,620.00
    $320.00
    $480.00
    $720.00
    $560.00
    $400.00
    $150.00
    $300.00
    $161.85
    $31.75
    $60.00
    $80.00
    $120.00
    $60.00
    $80.00
    $96.00
    $24.00

    Page 594

    Claims Data

    M586
    M586
    P306
    P437
    O065
    O065
    O065
    O065
    H023
    H023
    H023
    H023
    H023
    P031
    M630
    P031
    M089
    P435
    S112
    P014
    O004
    O004
    O004
    O004
    S195
    S195
    M662
    M662
    M662
    H005
    P122
    P122
    M229
    L001
    M105
    L124
    M028
    O076
    O076
    M028
    M028
    O076
    O076
    O004
    O004
    O004
    O004
    L133
    O108
    O108

    $60.00
    $140.00
    $69.80
    $62.40
    $50.00
    $300.00
    $800.00
    $150.00
    $375.00
    $127.28
    $200.00
    $730.00
    $180.00
    $213.29
    $200.00
    $335.98
    $180.00
    $303.48
    $300.00
    $35.50
    $100.00
    $476.00
    $556.00
    $180.00
    $500.00
    $1,800.00
    $100.00
    $45.00
    $55.00
    $630.00
    $84.15
    $9.35
    $200.00
    $505.00
    $170.00
    $440.00
    $235.00
    $1,325.75
    $1,925.75
    $100.00
    $15.00
    $840.00
    $846.75
    $425.00
    $771.00
    $200.00
    $916.00
    $3,900.00
    $90.00
    $1,390.00

    Page 595

    Claims Data

    O108
    O015
    O015
    D263
    D263
    D263
    D263
    M758
    M248
    P458
    O076
    O076
    O076
    O076
    O076
    O076
    M019
    M019
    P154
    S302
    S302
    S019
    S019
    S019
    S019
    S019
    S019
    S114
    D411
    D411
    D411
    S019
    S019
    S019
    S428
    H006
    S314
    D421
    D421
    D421
    D421
    D421
    H025
    H025
    M456
    M456
    M456
    H008
    M456
    M456

    $1,970.00
    $130.00
    $2,690.00
    $150.00
    $350.00
    $70.00
    $230.00
    $220.00
    $100.00
    $87.50
    $90.00
    $930.75
    $825.00
    $90.00
    $642.24
    $1,293.63
    $200.00
    $260.00
    $284.50
    $360.00
    $140.00
    $260.00
    $25.00
    $335.00
    $260.00
    $25.00
    $255.00
    $400.00
    $200.00
    $100.00
    $50.00
    $260.00
    $25.00
    $335.00
    $1,050.00
    $165.00
    $300.00
    $50.00
    $400.00
    $70.00
    $30.00
    $100.00
    $240.00
    $60.00
    $140.00
    $25.00
    $35.00
    $182.00
    $140.00
    $160.00

    Page 596

    Claims Data

    P055
    S418
    P005
    P005
    M215
    P256
    L070
    L96
    D141
    D141
    D141
    D141
    D141
    D141
    S296
    S296
    S296
    M577
    P435
    M124
    M124
    P435
    M152
    P008
    P034
    P008
    D60
    D60
    D60
    S112
    M735
    M735
    O033
    O033
    O033
    D113
    M580
    M580
    M580
    M580
    M580
    S089
    M029
    M029
    M029
    D137
    M019
    P318
    P318
    P073

    $151.35
    $400.00
    $578.85
    $578.85
    $250.00
    $165.30
    $2,250.00
    $1,800.00
    $400.00
    $140.00
    $360.00
    $400.00
    $140.00
    $360.00
    $2,400.00
    $1,250.00
    $400.00
    $200.00
    $490.69
    $250.00
    $50.00
    $85.07
    $300.00
    $46.15
    $189.00
    $357.00
    $50.00
    $200.00
    $200.00
    $300.00
    $250.00
    $350.00
    $100.00
    $845.75
    $348.50
    $950.00
    $100.00
    $200.00
    $400.00
    $200.00
    $200.00
    $850.00
    $100.00
    $20.00
    $20.00
    $850.00
    $300.00
    $162.85
    $179.40
    $654.03

    Page 597

    Claims Data

    P005
    P005
    P245
    M456
    P057
    P057
    M456
    M456
    M456
    S122
    P245
    D436
    D436
    D436
    D436
    D436
    O004
    O004
    O004
    S384
    S384
    M304
    S011
    S198
    L046
    L001
    O004
    O004
    M156
    M156
    M156
    P145
    M255
    M255
    M255
    M469
    M469
    M469
    O151
    O151
    O151
    M390
    M390
    M390
    M390
    M390
    M390
    M390
    M390
    M390

    $312.88
    $312.88
    $378.35
    $140.00
    $100.00
    $54.00
    $120.00
    $200.00
    $1,400.00
    $600.00
    $359.10
    $70.00
    $375.00
    $70.00
    $55.00
    $180.00
    $100.00
    $1,196.00
    $1,016.00
    $400.00
    $400.00
    $125.00
    $300.00
    $700.00
    $140.00
    $215.00
    $100.00
    $1,576.00
    $100.00
    $25.00
    $125.00
    $345.00
    $100.00
    $40.00
    $60.00
    $80.00
    $80.00
    $60.00
    $75.00
    $895.00
    $1,295.00
    $150.00
    $150.00
    $95.00
    $150.00
    $150.00
    $360.00
    $150.00
    $400.00
    $100.00

    Page 598

    Claims Data

    M390
    M390
    O156
    O156
    O156
    O156
    M353
    H026
    L021
    M835
    M835
    M835
    M835
    M835
    M835
    M835
    M866
    M866
    M866
    D371
    D371
    M331
    M331
    P076
    M464
    M464
    P076
    D134
    D134
    D134
    P066
    M297
    M297
    P075
    P075
    M297
    M297
    L116
    P014
    P014
    P076
    P076
    O011
    O011
    O011
    M390
    M390
    M103
    M103
    M103

    $120.00
    $105.00
    $100.00
    $100.00
    $1,124.25
    $993.75
    $300.00
    $97.00
    $500.00
    $300.00
    $202.50
    $197.50
    $125.00
    $200.00
    $1,345.00
    $300.00
    $125.00
    $200.00
    $400.00
    $280.00
    $370.00
    $280.00
    $400.00
    $298.70
    $400.00
    $600.00
    $127.95
    $400.00
    $70.00
    $30.00
    $430.74
    $610.00
    $250.00
    $275.90
    $56.00
    $60.00
    $200.00
    $180.00
    $39.20
    $62.79
    $31.95
    $41.30
    $80.00
    $290.00
    $600.00
    $200.00
    $510.00
    $140.00
    $20.00
    $140.00

    Page 599

    Claims Data

    M103
    M103
    L021
    M103
    P014
    L021
    M103
    M331
    M331
    M331
    M667
    P168
    O011
    O011
    O011
    M006
    H034
    P076
    O175
    O175
    O175
    D143
    D143
    S001
    S001
    S001
    L021
    D143
    M393
    P155
    P155
    S384
    S384
    S384
    P011
    P435
    S281
    S281
    L049
    M317
    M317
    M317
    M317
    M317
    M317
    M317
    S343
    L170
    M341
    M341

    $140.00
    $20.00
    $320.00
    $140.00
    $54.60
    $400.00
    $20.00
    $280.00
    $50.00
    $350.00
    $200.00
    $57.30
    $80.00
    $1,610.00
    $1,900.00
    $160.00
    $510.00
    $86.10
    $50.00
    $1,350.00
    $1,800.00
    $85.00
    $715.00
    $400.00
    $200.00
    $200.00
    $160.00
    $1,600.00
    $250.00
    $257.90
    $122.00
    $400.00
    $800.00
    $800.00
    $240.00
    $578.66
    $400.00
    $200.00
    $600.00
    $120.00
    $70.00
    $5.00
    $120.00
    $70.00
    $120.00
    $70.00
    $300.00
    $180.00
    $140.00
    $60.00

    Page 600

    Claims Data

    S029
    D171
    H034
    H034
    O131
    O131
    O131
    O065
    O065
    O065
    D59
    D59
    D59
    D59
    D345
    M152
    M152
    M152
    L021
    M087
    P353
    P353
    M087
    M087
    M514
    L021
    S130
    L169
    P179
    P179
    S130
    S130
    M390
    M390
    M390
    M390
    M390
    M799
    M799
    M230
    M230
    L032
    P337
    M230
    M230
    P014
    P014
    M077
    M077
    M230

    $160.00
    $280.00
    $100.00
    $1,710.00
    $70.00
    $1,300.00
    $800.00
    $150.00
    $675.00
    $1,242.00
    $70.00
    $430.00
    $35.00
    $45.00
    $700.00
    $300.00
    $25.00
    $95.00
    $250.00
    $180.00
    $179.10
    $19.90
    $300.00
    $140.00
    $200.00
    $460.00
    $100.00
    $150.00
    $115.00
    $36.00
    $100.00
    $40.00
    $175.00
    $35.00
    $285.00
    $150.00
    $340.00
    $300.00
    $200.00
    $300.00
    $300.00
    $250.00
    $160.00
    $300.00
    $300.00
    $34.10
    $216.75
    $480.00
    $300.00
    $900.00

    Page 601

    Claims Data

    M230
    P014
    P337
    P337
    P337
    D113
    O162
    O162
    O162
    M300
    P094
    D190
    D190
    D190
    D190
    S120
    S136
    S136
    S136
    S136
    S136
    S120
    S120
    P104
    P104
    O001
    O001
    O001
    M067
    L020
    L065
    L149
    M189
    O063
    O065
    L025
    M189
    L025
    L126
    S347
    M189
    P059
    H011
    H011
    H011
    M189
    P059
    S250
    S245
    P286

    $400.00
    $105.00
    $649.50
    $396.00
    $242.00
    $4,400.00
    $75.00
    $1,475.00
    $895.00
    $160.00
    $103.60
    $50.00
    $35.00
    $5.00
    $2,000.00
    $300.00
    $200.00
    $25.00
    $35.00
    $200.00
    $160.00
    $540.00
    $300.00
    $122.95
    $29.89
    $110.00
    $1,300.00
    $1,520.00
    $420.00
    $360.00
    $290.00
    $150.00
    $120.00
    $150.00
    $1,150.00
    $160.00
    $280.00
    $235.00
    $300.00
    $300.00
    $140.00
    $96.00
    $550.00
    $250.00
    $184.00
    $140.00
    $25.00
    $300.00
    $400.00
    $690.00

    Page 602

    Claims Data

    S245
    P115
    S245
    L065
    L065
    M189
    L149
    M189
    M575
    M138
    M138
    M138
    L121
    D41
    D41
    M103
    M103
    L021
    H011
    D41
    P093
    D41
    D41
    S383
    S086
    S086
    S086
    S086
    S086
    S086
    D228
    D228
    D228
    D228
    P443
    M104
    L070
    O001
    O001
    S432
    P453
    P453
    M386
    M386
    M386
    M386
    M647
    M647
    M647
    S103

    $300.00
    $96.95
    $300.00
    $250.00
    $375.00
    $140.00
    $150.00
    $120.00
    $100.00
    $100.00
    $25.00
    $55.00
    $650.00
    $712.50
    $287.50
    $50.00
    $90.00
    $200.00
    $21.00
    $400.00
    $91.00
    $170.00
    $330.00
    $260.00
    $350.00
    $1,200.00
    $1,200.00
    $1,800.00
    $1,200.00
    $1,600.00
    $350.00
    $70.00
    $80.00
    $450.00
    $157.50
    $160.00
    $680.00
    $110.00
    $1,462.00
    $260.00
    $346.75
    $407.50
    $365.00
    $31.00
    $26.00
    $30.00
    $160.00
    $50.00
    $270.00
    $700.00

    Page 603

    Claims Data

    L013
    O004
    O004
    O004
    M647
    M647
    M647
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    S071
    S071
    P450
    P450
    DT04
    DT04
    M786
    M683
    M683
    D38
    D38
    D278
    D278
    M733
    M733
    M733
    M733
    M733
    M019
    P416
    P416
    L046
    M124
    P372
    P005
    M124
    M437
    M437
    S286
    L070
    P435
    P005

    $699.00
    $100.00
    $1,276.00
    $1,516.00
    $80.00
    $25.00
    $235.00
    $50.00
    $300.00
    $70.00
    $80.00
    $350.00
    $50.00
    $300.00
    $70.00
    $50.00
    $350.00
    $800.00
    $496.00
    $124.00
    $257.56
    $64.39
    $700.00
    $2,300.00
    $100.00
    $300.00
    $260.00
    $1,400.00
    $200.00
    $300.00
    $240.00
    $60.00
    $120.00
    $60.00
    $370.00
    $130.00
    $300.00
    $205.50
    $222.80
    $500.00
    $250.00
    $1,000.00
    $937.76
    $50.00
    $250.00
    $250.00
    $300.00
    $1,053.00
    $49.95
    $884.40

    Page 604

    Claims Data

    P005
    P372
    M185
    P005
    L001
    P055
    L133
    L133
    H026
    P005
    P005
    P005
    M374
    H003
    M026
    P031
    P031
    P031
    M026
    P085
    P031
    M317
    M317
    M317
    M297
    M297
    L116
    M202
    P408
    D102
    D102
    D102
    D102
    D102
    D102
    M026
    P094
    P094
    P073
    P066
    P094
    M026
    P094
    L001
    P073
    H003
    H003
    H003
    H003
    H003

    $937.76
    $1,000.00
    $300.00
    $405.76
    $313.50
    $154.00
    $400.00
    $1,265.00
    $1,275.00
    $405.76
    $405.76
    $840.17
    $200.00
    $100.00
    $220.00
    $406.26
    $61.26
    $262.29
    $440.00
    $280.00
    $33.75
    $120.00
    $80.00
    $5.00
    $120.00
    $120.00
    $760.00
    $200.00
    $1,305.00
    $860.00
    $3,140.00
    $400.00
    $200.00
    $400.00
    $500.00
    $220.00
    $315.00
    $288.75
    $635.00
    $672.00
    $94.50
    $440.00
    $1,251.80
    $38.00
    $635.00
    $100.00
    $185.85
    $445.00
    $60.00
    $140.00

    Page 605

    Claims Data

    H003
    H003
    H003
    H003
    P085
    S006
    H005
    M099
    M344
    P437
    M344
    P437
    M344
    S133
    L041
    H066
    P437
    S370
    O004
    O004
    M344
    P032
    S375
    D102
    D102
    D102
    O025
    O025
    M229
    L001
    P066
    P031
    S302
    S302
    S302
    P031
    S162
    S162
    P011
    P031
    P031
    M509
    M509
    S162
    P031
    M509
    P031
    M229
    P011
    O004

    $75.00
    $125.00
    $300.00
    $650.00
    $108.95
    $200.00
    $700.00
    $120.00
    $150.00
    $35.95
    $150.00
    $290.00
    $150.00
    $300.00
    $750.00
    $700.00
    $598.75
    $300.00
    $1,916.00
    $476.00
    $150.00
    $47.60
    $200.00
    $500.00
    $500.00
    $100.00
    $1,275.00
    $950.00
    $360.00
    $288.00
    $372.00
    $273.00
    $100.00
    $260.00
    $440.00
    $123.99
    $400.00
    $200.00
    $149.00
    $182.97
    $4.06
    $100.00
    $80.00
    $240.00
    $88.49
    $150.00
    $277.50
    $200.00
    $86.45
    $100.00

    Page 606

    Claims Data

    O004
    O004
    M509
    M509
    P011
    P031
    P031
    M509
    M509
    P031
    P031
    P031
    O004
    O004
    O004
    M229
    P106
    L001
    P106
    L001
    M300
    D22
    D224
    D224
    S049
    O061
    S049
    S049
    S049
    O019
    O019
    O019
    S049
    O061
    S049
    O061
    S324
    S324
    M608
    M608
    M608
    M608
    D171
    D171
    D171
    D171
    D171
    M100
    S220
    S220

    $1,356.00
    $1,516.00
    $100.00
    $80.00
    $44.65
    $239.00
    $77.99
    $100.00
    $90.00
    $415.58
    $63.82
    $28.99
    $100.00
    $1,196.00
    $2,056.00
    $200.00
    $1,620.00
    $610.00
    $459.90
    $190.00
    $160.00
    $1,400.00
    $140.00
    $250.00
    $400.00
    $110.00
    $2,750.00
    $500.00
    $5,510.00
    $120.00
    $1,160.50
    $1,711.50
    $400.00
    $110.00
    $400.00
    $110.00
    $250.00
    $150.00
    $200.00
    $50.00
    $190.00
    $40.00
    $100.00
    $175.00
    $75.00
    $300.00
    $750.00
    $880.00
    $280.00
    $200.00

    Page 607

    Claims Data

    S200
    M375
    L081
    L065
    O054
    O054
    O004
    O004
    O004
    H006
    H006
    S424
    M788
    S402
    S084
    P316
    S257
    O004
    O004
    O004
    O004
    O001
    S383
    P215
    O001
    P215
    P215
    P215
    P215
    S383
    P215
    M229
    P014
    L046
    L001
    H005
    M229
    P085
    O108
    O108
    O108
    O108
    M124
    M616
    S107
    S107
    P115
    P435
    S004
    L075

    $250.00
    $160.00
    $400.00
    $310.00
    $80.00
    $1,095.00
    $100.00
    $796.00
    $800.00
    $4,500.00
    $25,418.70
    $5,000.00
    $2,400.00
    $500.00
    $800.00
    $128.50
    $200.00
    $100.00
    $800.00
    $100.00
    $740.00
    $200.00
    $260.00
    $300.00
    $110.00
    $300.00
    $300.00
    $300.00
    $300.00
    $260.00
    $365.40
    $200.00
    $145.30
    $200.00
    $675.00
    $2,500.00
    $200.00
    $45.75
    $90.00
    $90.00
    $1,195.00
    $920.00
    $250.00
    $120.00
    $600.00
    $150.00
    $414.00
    $352.50
    $600.00
    $3,800.00

    Page 608

    Claims Data

    H034
    L165
    M354
    M354
    P148
    L165
    S130
    S130
    L169
    P071
    P071
    P071
    P182
    M666
    M666
    M666
    M666
    P131
    M666
    M666
    M666
    M666
    P490
    M666
    M666
    M666
    P490
    M666
    M666
    M666
    M666
    M480
    M073
    S441
    S441
    M325
    M325
    P150
    P150
    P150
    L046
    D97
    D97
    D97
    D97
    D97
    D97
    D97
    M251
    M251

    $180.00
    $590.00
    $120.00
    $160.00
    $89.95
    $560.00
    $300.00
    $60.00
    $775.00
    $4.00
    $305.00
    $5.22
    $130.00
    $80.00
    $50.00
    $50.00
    $40.00
    $266.75
    $60.00
    $160.00
    $50.00
    $20.00
    $190.18
    $70.00
    $160.00
    $60.00
    $297.36
    $80.00
    $50.00
    $100.00
    $50.00
    $250.00
    $200.00
    $400.00
    $1,500.00
    $75.00
    $65.00
    $193.60
    $48.40
    $3.20
    $540.00
    $300.00
    $1,100.00
    $440.00
    $150.00
    $660.00
    $660.00
    $660.00
    $300.00
    $50.00

    Page 609

    Claims Data

    M251
    M251
    D77
    M190
    M190
    M190
    M213
    M213
    D102
    D77
    D77
    D19
    D82
    M087
    M087
    P332
    H034
    M176
    P014
    M189
    P435
    O001
    O001
    O001
    D232
    S309
    H006
    O004
    O004
    O004
    S091
    P306
    O019
    L079
    P436
    O004
    O004
    O004
    M821
    H005
    H005
    H005
    P435
    L041
    S091
    S091
    P427
    D41
    D41
    D368

    $150.00
    $160.00
    $250.00
    $100.00
    $25.00
    $55.00
    $200.00
    $40.00
    $200.00
    $170.00
    $230.00
    $1,000.00
    $400.00
    $260.00
    $140.00
    $324.00
    $200.00
    $160.00
    $76.65
    $140.00
    $51.41
    $110.00
    $760.75
    $1,504.50
    $250.00
    $300.00
    $700.00
    $100.00
    $1,916.00
    $776.00
    $160.00
    $165.00
    $120.00
    $200.00
    $219.47
    $250.00
    $686.40
    $1,200.00
    $380.00
    $208.00
    $25.00
    $235.63
    $266.53
    $350.00
    $160.00
    $160.00
    $27.30
    $70.00
    $30.00
    $100.00

    Page 610

    Claims Data

    D368
    D308
    D300
    D300
    S077
    P427
    S146
    S146
    H005
    O001
    O001
    O001
    S219
    M026
    M026
    P343
    P343
    P343
    P343
    P343
    D299
    D299
    D299
    D299
    D299
    D299
    D299
    D299
    O001
    O001
    D299
    D299
    D299
    D299
    O001
    O001
    M026
    M026
    P343
    P343
    M026
    P215
    P005
    L070
    L070
    D299
    D299
    D299
    D64
    D64

    $150.00
    $250.00
    $100.00
    $400.00
    $300.00
    $66.70
    $300.00
    $300.00
    $200.00
    $110.00
    $1,126.25
    $858.50
    $400.00
    $80.00
    $140.00
    $201.50
    $75.70
    $97.35
    $33.99
    $144.50
    $85.00
    $15.00
    $300.00
    $500.00
    $85.00
    $15.00
    $300.00
    $500.00
    $110.00
    $1,600.00
    $800.00
    $700.00
    $800.00
    $700.00
    $38.00
    $72.00
    $80.00
    $140.00
    $831.60
    $10.05
    $220.00
    $217.60
    $1,854.18
    $290.00
    $180.00
    $1,500.00
    $2,100.00
    $800.00
    $170.00
    $230.00

    Page 611

    Claims Data

    D64
    S107
    S107
    D07
    D07
    H047
    H047
    P056
    P056
    H005
    H005
    M166
    M166
    M166
    P056
    S144
    D144
    L013
    O004
    O004
    O004
    O007
    O007
    O007
    D205
    D205
    H051
    S174
    D216
    D216
    D216
    D216
    M332
    P049
    P049
    M332
    P049
    S069
    M316
    P451
    D60
    D60
    D60
    D60
    M501
    P073
    O001
    O001
    O001
    M215

    $400.00
    $400.00
    $150.00
    $1,400.00
    $3,600.00
    $400.00
    $1,550.00
    $2,746.20
    $469.00
    $380.00
    $4,601.21
    $140.00
    $60.00
    $80.00
    $153.30
    $300.00
    $200.00
    $352.00
    $100.00
    $1,916.00
    $1,516.00
    $130.00
    $900.00
    $1,285.00
    $170.00
    $280.00
    $10,500.00
    $300.00
    $100.00
    $35.00
    $45.00
    $1,200.00
    $100.00
    $500.50
    $105.00
    $100.00
    $2,065.50
    $360.00
    $100.00
    $50.40
    $50.00
    $170.00
    $130.00
    $2,500.00
    $400.00
    $820.00
    $110.00
    $1,196.00
    $1,520.00
    $250.00

    Page 612

    Claims Data

    P094
    M215
    L070
    S302
    P215
    S302
    O065
    O065
    M267
    M267
    O156
    O156
    P085
    O001
    M185
    P122
    S174
    S174
    L041
    L041
    L041
    L041
    O011
    O011
    O011
    D281
    D257
    D257
    M152
    M152
    M152
    M164
    S127
    S127
    D150
    D150
    P011
    P011
    P005
    M229
    P343
    O033
    O033
    O033
    O033
    O033
    O033
    P343
    P005
    P155

    $238.50
    $250.00
    $1,440.00
    $400.00
    $73.70
    $140.00
    $250.00
    $600.00
    $200.00
    $120.00
    $760.00
    $800.00
    $275.00
    $50.00
    $180.00
    $353.00
    $150.00
    $150.00
    $575.00
    $8.40
    $75.00
    $120.00
    $80.00
    $1,200.00
    $780.00
    $200.00
    $140.00
    $310.00
    $300.00
    $25.00
    $95.00
    $140.00
    $200.00
    $400.00
    $150.00
    $200.00
    $477.00
    $370.00
    $126.44
    $160.00
    $102.70
    $100.00
    $1,035.00
    $427.50
    $100.00
    $895.50
    $427.50
    $79.80
    $126.44
    $160.00

    Page 613

    Claims Data

    P005
    H003
    H003
    M774
    P353
    P353
    L075
    S107
    S107
    P085
    P085
    M205
    P343
    P343
    D205
    D205
    D143
    O004
    O004
    O004
    O004
    S128
    S128
    M089
    L006
    D66
    M647
    M647
    M647
    P504
    H016
    P166
    M647
    M647
    M647
    M647
    M647
    M647
    L041
    S124
    P158
    S124
    D194
    S242
    P158
    D413
    D413
    M801
    M801
    P208

    $316.10
    $300.00
    $300.00
    $200.00
    $180.00
    $45.00
    $3,420.00
    $300.00
    $200.00
    $103.60
    $25.90
    $240.00
    $219.10
    $25.00
    $600.00
    $480.00
    $250.00
    $1,000.50
    $1,395.50
    $499.50
    $696.50
    $800.00
    $800.00
    $360.00
    $500.00
    $750.00
    $80.00
    $25.00
    $95.00
    $190.00
    $60.00
    $60.00
    $80.00
    $25.00
    $95.00
    $80.00
    $25.00
    $95.00
    $70.00
    $200.00
    $150.00
    $2,200.00
    $210.00
    $250.00
    $75.00
    $70.00
    $200.00
    $500.00
    $100.00
    $407.00

    Page 614

    Claims Data

    P208
    D313
    S353
    H066
    P045
    S327
    S327
    H066
    P467
    S327
    L134
    H066
    H066
    S327
    M357
    P467
    O076
    O076
    O076
    S353
    S327
    L070
    H066
    D200
    D200
    D200
    D200
    S296
    S296
    S296
    S385
    P467
    S237
    P467
    L013
    L013
    M580
    M580
    M580
    M580
    M694
    M694
    M694
    M694
    M732
    M732
    M732
    M732
    M732
    M732

    $183.90
    $320.00
    $200.00
    $360.00
    $230.00
    $250.00
    $200.00
    $550.00
    $126.00
    $200.00
    $715.00
    $800.00
    $2,960.00
    $1,500.00
    $1,200.00
    $175.00
    $90.00
    $1,276.00
    $1,080.00
    $200.00
    $200.00
    $110.00
    $2,500.00
    $100.00
    $35.00
    $25.00
    $800.00
    $450.00
    $2,400.00
    $1,000.00
    $600.00
    $225.00
    $500.00
    $21.00
    $6,300.00
    $87.00
    $100.00
    $500.00
    $100.00
    $100.00
    $100.00
    $500.00
    $400.00
    $100.00
    $200.00
    $50.00
    $250.00
    $200.00
    $20.00
    $200.00

    Page 615

    Claims Data

    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    D313
    D313
    D313
    D313
    D313
    D313
    D313
    D313
    D313
    S115
    P309
    P309
    M732
    P309
    P427
    P427
    M732
    M732
    P427
    P427
    S179
    S179
    P279
    P279
    P279
    O004
    O004
    O004
    O004
    O004
    D260
    D260
    S427
    L070
    P005
    P005
    D260
    D260
    P005
    M123
    M123

    $200.00
    $20.00
    $100.00
    $200.00
    $2,430.00
    $100.00
    $25.00
    $75.00
    $20.00
    $70.00
    $130.00
    $300.00
    $150.00
    $70.00
    $80.00
    $100.00
    $70.00
    $80.00
    $300.00
    $481.88
    $120.47
    $100.00
    $31.99
    $161.75
    $35.95
    $100.00
    $170.00
    $107.16
    $26.79
    $36.00
    $204.00
    $58.50
    $6.50
    $115.00
    $100.00
    $1,756.00
    $439.00
    $164.00
    $1,412.00
    $860.00
    $2,140.00
    $350.00
    $400.00
    $261.00
    $1,094.90
    $300.00
    $580.00
    $4,620.10
    $150.00
    $80.00

    Page 616

    Claims Data

    M123
    M123
    O151
    O151
    O151
    D228
    D228
    D228
    D228
    D228
    S353
    S103
    H008
    S277
    H006
    H006
    S359
    H006
    H006
    S359
    H023
    H023
    S353
    S353
    S456
    H066
    L069
    S417
    S322
    L143
    L069
    UN01
    M029
    M274
    P154
    H029
    H029
    S113
    S086
    S086
    S086
    S086
    L061
    S086
    M449
    M449
    M449
    M449
    M449
    M449

    $60.00
    $150.00
    $75.00
    $1,195.00
    $1,650.00
    $50.00
    $300.00
    $70.00
    $80.00
    $2,250.00
    $400.00
    $300.00
    $330.00
    $600.00
    $825.00
    $1,200.00
    $700.00
    $300.00
    $750.00
    $2,000.00
    $1,900.00
    $40,600.00
    $7,500.00
    $25,000.00
    $650.00
    $400.00
    $830.00
    $600.00
    $300.00
    $10,000.00
    $380.00
    $200.00
    $100.00
    $120.00
    $235.00
    $1,200.00
    $3,494.00
    $850.00
    $1,800.00
    $600.00
    $1,200.00
    $400.00
    $290.00
    $450.00
    $100.00
    $25.00
    $75.00
    $100.00
    $100.00
    $40.00

    Page 617

    Claims Data

    M449
    M795
    M795
    M795
    M759
    M759
    P457
    M759
    M759
    D148
    D148
    D148
    D148
    P015
    P430
    P349
    O001
    O001
    O001
    O027
    O027
    O027
    O174
    O174
    O174
    O174
    O174
    O174
    M204
    H066
    H066
    P318
    M204
    P318
    H008
    M237
    M237
    M237
    P453
    M167
    M167
    M167
    S391
    O076
    O076
    S160
    P154
    M598
    M598
    M598

    $65.00
    $150.00
    $60.00
    $120.00
    $100.00
    $100.00
    $163.00
    $100.00
    $100.00
    $100.00
    $700.00
    $170.00
    $730.00
    $297.00
    $857.00
    $103.60
    $110.00
    $1,014.00
    $1,520.00
    $40.00
    $750.00
    $1,450.00
    $50.00
    $400.00
    $877.00
    $50.00
    $1,228.00
    $1,250.00
    $400.00
    $700.00
    $350.00
    $74.10
    $200.00
    $75.30
    $360.00
    $170.00
    $50.00
    $110.00
    $94.50
    $280.00
    $25.00
    $25.00
    $280.00
    $1,525.50
    $2,225.50
    $200.00
    $70.95
    $200.00
    $90.00
    $40.00

    Page 618

    Claims Data

    M598
    D27
    O008
    O008
    O008
    D408
    D408
    D408
    M461
    M461
    M694
    M694
    M461
    M461
    M813
    P495
    P495
    O076
    O076
    M325
    P150
    P150
    D305
    D305
    D305
    D305
    D255
    D255
    D255
    D255
    M159
    M159
    P479
    S318
    S318
    L041
    L041
    L041
    S423
    H027
    L041
    S382
    L041
    L041
    L041
    M352
    M352
    L074
    M352
    M352

    $480.00
    $1,010.00
    $80.00
    $700.00
    $1,400.00
    $35.00
    $55.00
    $260.00
    $150.00
    $600.00
    $160.00
    $500.00
    $150.00
    $520.00
    $100.00
    $66.70
    $202.30
    $1,095.00
    $1,100.00
    $140.00
    $135.20
    $56.70
    $50.00
    $140.00
    $60.00
    $900.00
    $105.00
    $135.00
    $300.00
    $2,500.00
    $140.00
    $40.00
    $34.00
    $300.00
    $250.00
    $600.00
    $600.00
    $250.00
    $200.00
    $250.00
    $350.00
    $2,400.00
    $370.00
    $300.00
    $30.00
    $250.00
    $175.00
    $240.00
    $150.00
    $50.00

    Page 619

    Claims Data

    M352
    M352
    P435
    P435
    M377
    S083
    S083
    S083
    M377
    P435
    L074
    S419
    P366
    P366
    S419
    P366
    D389
    D389
    D389
    D389
    O076
    O076
    O076
    O108
    O108
    O108
    M575
    M575
    D114
    D114
    D114
    D114
    H066
    D188
    D188
    D188
    D188
    D188
    D219
    D219
    D219
    D219
    D219
    O171
    O171
    M633
    P081
    P081
    M053
    M053

    $100.00
    $60.00
    $57.38
    $6.38
    $80.00
    $400.00
    $200.00
    $1,800.00
    $120.00
    $415.38
    $290.00
    $300.00
    $31.00
    $219.75
    $200.00
    $153.50
    $50.00
    $20.00
    $70.00
    $14.00
    $90.00
    $2,480.37
    $880.37
    $90.00
    $895.00
    $390.00
    $110.00
    $300.00
    $120.00
    $340.00
    $140.00
    $320.00
    $700.00
    $80.00
    $35.00
    $45.00
    $800.00
    $900.00
    $70.00
    $300.00
    $280.00
    $520.00
    $230.00
    $675.00
    $800.00
    $300.00
    $15.00
    $572.30
    $280.00
    $240.00

    Page 620

    Claims Data

    M053
    P081
    P081
    M053
    M053
    P081
    S200
    O076
    S432
    O076
    O145
    H006
    H006
    H006
    H006
    M304
    M304
    P031
    M304
    P031
    P031
    M089
    S008
    P094
    L128
    P427
    M692
    L065
    H023
    H023
    H023
    M868
    M868
    P427
    S286
    S286
    H023
    M225
    M225
    M225
    L064
    S063
    S063
    D224
    D224
    M111
    M111
    M111
    M111
    D39

    $140.00
    $53.20
    $45.00
    $280.00
    $300.00
    $70.20
    $470.00
    $400.00
    $570.00
    $500.00
    $500.00
    $450.00
    $25.00
    $140.00
    $145.00
    $400.00
    $915.00
    $17.50
    $450.00
    $114.90
    $23.25
    $180.00
    $200.00
    $399.95
    $250.00
    $1,147.90
    $1,200.00
    $70.00
    $1,100.00
    $2,617.48
    $2,472.50
    $2,500.00
    $800.00
    $1,147.90
    $250.00
    $700.00
    $1,900.00
    $400.00
    $200.00
    $500.00
    $400.00
    $300.00
    $350.00
    $495.00
    $5.00
    $400.00
    $30.00
    $80.00
    $120.00
    $170.00

    Page 621

    Claims Data

    D39
    M541
    P155
    S231
    S231
    T034
    T034
    M045
    M045
    P022
    P022
    M304
    M304
    M045
    M045
    M304
    P014
    S279
    S279
    S279
    D83
    M067
    M657
    L032
    H023
    M019
    M067
    S076
    O004
    O004
    M706
    P451
    P451
    P451
    S216
    S216
    O001
    O001
    O001
    H003
    O004
    O004
    O004
    H003
    S006
    M053
    M053
    M053
    D346
    D346

    $830.00
    $200.00
    $180.00
    $80.00
    $220.00
    $480.00
    $1,720.00
    $80.00
    $70.00
    $9.75
    $23.70
    $80.00
    $70.00
    $80.00
    $70.00
    $160.00
    $132.65
    $150.00
    $350.00
    $132.00
    $200.00
    $400.00
    $150.00
    $216.00
    $1,900.00
    $300.00
    $200.00
    $600.00
    $100.00
    $1,416.00
    $100.00
    $452.00
    $102.00
    $36.00
    $100.00
    $300.00
    $110.00
    $1,211.25
    $1,211.24
    $200.00
    $100.00
    $1,196.00
    $876.00
    $200.00
    $200.00
    $140.00
    $20.00
    $140.00
    $100.00
    $300.00

    Page 622

    Claims Data

    S300
    S300
    M030
    P256
    P256
    M225
    M225
    P507
    P507
    P215
    S103
    L070
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    P390
    P390
    P360
    P360
    D77
    D77
    D232
    M089
    O076
    O076
    O076
    M156
    M156
    P145
    P145
    D39
    D39
    S292
    P430
    S427
    S427
    S427
    P005
    US01
    US01
    M229

    $50.00
    $250.00
    $160.00
    $261.80
    $66.35
    $440.00
    $260.00
    $2.50
    $31.70
    $165.50
    $400.00
    $200.00
    $200.00
    $420.00
    $180.00
    $700.00
    $2,400.00
    $100.00
    $400.00
    $420.00
    $180.00
    $3,000.00
    $50.00
    $2,400.00
    $142.50
    $199.50
    $199.00
    $199.00
    $910.00
    $690.00
    $280.00
    $200.00
    $90.00
    $1,214.49
    $1,475.51
    $100.00
    $200.00
    $60.00
    $175.00
    $400.00
    $400.00
    $400.00
    $170.50
    $50.00
    $25.00
    $675.00
    $631.96
    $96.00
    $95.10
    $160.00

    Page 623

    Claims Data

    M229
    O161
    O161
    L113
    H003
    S383
    H006
    H027
    S374
    S374
    S374
    M215
    L070
    O004
    O004
    H003
    H003
    H006
    H006
    S296
    S296
    L113
    S296
    H006
    H006
    H006
    H006
    H006
    H023
    H023
    H44
    S266
    S266
    H006
    M577
    P011
    P011
    M577
    M577
    L070
    M449
    M449
    M449
    M449
    M449
    M549
    L128
    D79
    S126
    L97

    $280.00
    $500.00
    $700.00
    $3,000.00
    $400.00
    $1,000.00
    $1,200.00
    $4,500.00
    $4,700.00
    $200.00
    $1,000.00
    $250.00
    $1,270.00
    $1,145.60
    $286.40
    $350.00
    $525.00
    $400.00
    $275.00
    $1,500.00
    $400.00
    $2,000.00
    $800.00
    $250.00
    $2,028.00
    $705.00
    $355.00
    $600.00
    $950.00
    $5,854.82
    $4,850.00
    $4,000.00
    $800.00
    $400.00
    $200.00
    $150.00
    $22.50
    $200.00
    $40.00
    $510.00
    $100.00
    $60.00
    $25.00
    $135.00
    $90.00
    $100.00
    $150.00
    $200.00
    $600.00
    $180.00

    Page 624

    Claims Data

    P014
    S126
    H023
    H011
    L070
    S375
    O065
    O065
    O065
    M189
    P059
    P059
    D78
    D78
    D78
    D78
    D78
    P091
    P091
    D180
    H022
    S290
    S136
    P007
    P007
    S122
    S122
    M156
    S427
    L061
    P430
    P462
    S427
    P430
    P462
    P462
    P430
    P430
    P462
    M580
    M580
    M580
    M580
    M580
    P462
    P430
    P430
    P462
    D77
    O004

    $19.25
    $300.00
    $2,000.00
    $100.00
    $115.00
    $300.00
    $150.00
    $1,395.00
    $1,399.50
    $120.00
    $91.20
    $102.80
    $525.00
    $85.00
    $140.00
    $245.00
    $155.00
    $110.25
    $47.25
    $350.00
    $360.00
    $1,200.00
    $200.00
    $84.19
    $9.99
    $1,000.00
    $2,000.00
    $300.00
    $350.00
    $170.00
    $768.00
    $1,387.50
    $200.00
    $768.00
    $1,387.50
    $1,387.50
    $768.00
    $768.00
    $1,387.50
    $200.00
    $900.00
    $200.00
    $200.00
    $500.00
    $1,387.50
    $768.00
    $768.00
    $1,387.50
    $533.00
    $100.00

    Page 625

    Claims Data

    O004
    O004
    M584
    S004
    S004
    S159
    S357
    L065
    H005
    L075
    M386
    M041
    M041
    P167
    P167
    M002
    M002
    M002
    H006
    H006
    D371
    D371
    D371
    D371
    D371
    D371
    O006
    O006
    D371
    D371
    S309
    L020
    M374
    M374
    L006
    L006
    L070
    L070
    D66
    D66
    P139
    P014
    D397
    D397
    S121
    M187
    M187
    M187
    P014
    P349

    $2,796.00
    $1,816.00
    $120.00
    $200.00
    $400.00
    $800.00
    $300.00
    $400.00
    $2,220.00
    $3,420.00
    $1,920.00
    $200.00
    $50.00
    $2.10
    $111.95
    $150.00
    $210.00
    $20.00
    $700.00
    $695.00
    $50.00
    $200.00
    $85.00
    $65.00
    $120.00
    $200.00
    $75.00
    $650.00
    $150.00
    $400.00
    $300.00
    $890.00
    $350.00
    $50.00
    $100.00
    $20.00
    $890.00
    $120.00
    $70.00
    $130.00
    $180.00
    $108.15
    $135.00
    $65.00
    $300.00
    $200.00
    $50.00
    $30.00
    $93.90
    $83.90

    Page 626

    Claims Data

    M067
    P049
    M067
    P049
    M067
    P049
    P049
    D151
    D151
    O001
    O001
    O001
    M019
    M019
    M019
    M019
    P492
    P492
    M194
    M194
    M194
    M194
    P154
    M194
    P154
    D196
    D196
    D196
    D259
    D259
    D259
    D259
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255

    $160.00
    $733.50
    $160.00
    $580.55
    $160.00
    $1,290.00
    $247.95
    $85.00
    $165.00
    $110.00
    $760.75
    $2,082.00
    $400.00
    $400.00
    $200.00
    $500.00
    $170.50
    $70.95
    $100.00
    $25.00
    $115.00
    $60.00
    $191.50
    $80.00
    $59.70
    $85.00
    $115.00
    $660.00
    $50.00
    $300.00
    $70.00
    $80.00
    $100.00
    $20.00
    $20.00
    $100.00
    $20.00
    $40.00
    $100.00
    $25.00
    $15.00
    $20.00
    $100.00
    $20.00
    $20.00
    $20.00
    $100.00
    $20.00
    $20.00
    $100.00

    Page 627

    Claims Data

    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    S346
    P240
    L013
    O065
    M304
    P215
    M873
    M873
    M395
    L020
    M395
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123

    $25.00
    $15.00
    $20.00
    $100.00
    $20.00
    $40.00
    $100.00
    $20.00
    $20.00
    $100.00
    $20.00
    $60.00
    $200.00
    $466.00
    $3,400.00
    $150.00
    $185.00
    $135.00
    $200.00
    $10.00
    $200.00
    $240.00
    $20.00
    $100.00
    $400.00
    $100.00
    $200.00
    $200.00
    $700.00
    $200.00
    $500.00
    $200.00
    $900.00
    $300.00
    $300.00
    $200.00
    $100.00
    $200.00
    $100.00
    $180.00
    $80.00
    $60.00
    $150.00
    $450.00
    $420.00
    $160.00
    $1,730.00
    $150.00
    $80.00
    $210.00

    Page 628

    Claims Data

    M123
    M123
    M123
    M123
    M769
    M769
    O170
    O170
    O170
    O001
    O001
    O001
    L140
    P049
    M657
    P049
    O001
    S375
    O156
    S375
    P472
    S375
    P487
    P472
    O156
    S375
    S319
    L034
    L074
    P332
    P332
    H011
    H011
    M151
    S319
    S199
    O004
    M463
    M463
    M463
    M327
    L034
    P014
    P014
    P475
    D310
    M312
    H003
    H003
    P360

    $150.00
    $80.00
    $60.00
    $150.00
    $150.00
    $70.00
    $90.00
    $557.87
    $1,752.88
    $110.00
    $1,284.00
    $1,320.00
    $1,640.00
    $4,638.50
    $300.00
    $6,024.45
    $110.00
    $500.00
    $500.00
    $5,000.00
    $97.85
    $200.00
    $216.94
    $201.00
    $500.00
    $5,000.00
    $620.00
    $400.00
    $70.00
    $90.00
    $60.00
    $1,800.00
    $7,560.00
    $1,500.00
    $8,000.00
    $300.00
    $100.00
    $200.00
    $600.00
    $800.00
    $280.00
    $400.00
    $76.95
    $2.25
    $75.00
    $450.00
    $100.00
    $159.08
    $120.00
    $105.65

    Page 629

    Claims Data

    H003
    S375
    P360
    M140
    P360
    L126
    L126
    P360
    M857
    H003
    S375
    P104
    S433
    M211
    M211
    L149
    P014
    M297
    M297
    L116
    P404
    L116
    P404
    M657
    P005
    M215
    M215
    H023
    P031
    M215
    M215
    M215
    H023
    H023
    H023
    P031
    D426
    D426
    S103
    L013
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    P014
    S091

    $200.00
    $200.00
    $442.25
    $150.00
    $198.00
    $300.00
    $310.00
    $236.35
    $100.00
    $175.00
    $200.00
    $443.25
    $300.00
    $200.00
    $300.00
    $150.00
    $79.00
    $240.00
    $580.00
    $1,020.00
    $465.40
    $300.00
    $70.00
    $200.00
    $709.35
    $500.00
    $50.00
    $600.00
    $81.06
    $250.00
    $25.00
    $75.00
    $375.00
    $75.00
    $52.28
    $6.30
    $70.00
    $140.00
    $800.00
    $550.00
    $80.00
    $105.00
    $135.00
    $500.00
    $400.00
    $1,050.00
    $600.00
    $1,365.00
    $38.85
    $160.00

    Page 630

    Claims Data

    S091
    S091
    S091
    S122
    S122
    S122
    S122
    H011
    H011
    H011
    H011
    H011
    H011
    H011
    H011
    H011
    H011
    H011
    H011
    S091
    S091
    S091
    S091
    S091
    O004
    O004
    S091
    S091
    P066
    P066
    M068
    M068
    P436
    H005
    M248
    P005
    M304
    P066
    P005
    P005
    P005
    P001
    P487
    P001
    P094
    O004
    O004
    O004
    M248
    O030

    $230.00
    $160.00
    $370.00
    $80.00
    $220.00
    $160.00
    $40.00
    $560.00
    $1,840.00
    $2,180.00
    $480.00
    $842.72
    $210.68
    $1,432.28
    $279.32
    $7,225.00
    $2,775.00
    $2,000.00
    $500.00
    $160.00
    $25.00
    $205.00
    $160.00
    $370.00
    $100.00
    $776.00
    $160.00
    $230.00
    $849.15
    $849.15
    $600.00
    $250.00
    $361.99
    $350.00
    $140.00
    $413.37
    $490.00
    $312.00
    $811.52
    $811.52
    $347.31
    $903.80
    $36.00
    $1,342.14
    $150.00
    $100.00
    $1,356.00
    $1,356.00
    $140.00
    $100.00

    Page 631

    Claims Data

    O030
    O030
    S375
    S375
    M183
    M183
    M183
    M183
    M183
    M183
    M706
    M706
    L174
    O168
    O168
    M456
    P178
    P057
    M456
    P178
    M780
    P019
    M123
    M123
    M123
    M123
    M123
    L070
    M456
    M456
    P057
    P057
    M456
    P178
    P178
    P178
    S086
    S086
    M456
    P178
    P178
    M456
    P178
    M456
    P005
    P178
    P178
    D25
    D25
    M123

    $2,605.50
    $1,552.50
    $5,000.00
    $200.00
    $200.00
    $25.00
    $25.00
    $300.00
    $70.00
    $400.00
    $100.00
    $100.00
    $160.00
    $1,040.00
    $1,050.00
    $140.00
    $1,020.35
    $35.00
    $280.00
    $1,265.39
    $300.00
    $760.70
    $300.00
    $50.00
    $110.00
    $300.00
    $120.00
    $160.00
    $140.00
    $60.00
    $113.75
    $162.50
    $140.00
    $55.00
    $283.40
    $99.60
    $750.00
    $300.00
    $280.00
    $552.07
    $363.85
    $140.00
    $560.36
    $140.00
    $312.88
    $66.50
    $141.70
    $860.00
    $5,540.00
    $450.00

    Page 632

    Claims Data

    M123
    P178
    M123
    M123
    P178
    D388
    D86
    D86
    D86
    O136
    O136
    O136
    D319
    D319
    D319
    D319
    D319
    D319
    O076
    O076
    M779
    M779
    M779
    M779
    P394
    D60
    D60
    D60
    D60
    D60
    D60
    D275
    D275
    D275
    D275
    P489
    O076
    O076
    O169
    M353
    O007
    O007
    O026
    O037
    O037
    S245
    H026
    P014
    P014
    M773

    $180.00
    $871.00
    $240.00
    $450.00
    $55.00
    $200.00
    $85.00
    $365.00
    $450.00
    $60.00
    $1,777.50
    $1,057.50
    $60.00
    $300.00
    $70.00
    $30.00
    $1,600.00
    $120.00
    $805.50
    $425.50
    $140.00
    $25.00
    $275.00
    $60.00
    $177.50
    $50.00
    $70.00
    $50.00
    $800.00
    $300.00
    $2,700.00
    $50.00
    $35.00
    $15.00
    $300.00
    $148.90
    $75.00
    $1,200.00
    $1,095.00
    $150.00
    $100.00
    $1,350.00
    $200.00
    $400.00
    $440.00
    $300.00
    $585.00
    $174.00
    $180.00
    $300.00

    Page 633

    Claims Data

    P011
    O004
    M045
    P342
    D60
    D60
    D60
    D60
    D60
    D60
    D60
    D60
    D60
    H026
    H025
    H025
    H025
    D60
    D60
    M378
    S356
    S356
    S323
    D119
    D119
    D119
    D119
    D38
    D119
    L96
    S298
    S298
    P505
    T068
    M375
    M375
    M375
    M375
    L97
    M262
    M262
    M262
    M262
    M262
    M262
    D137
    D137
    D137
    M262
    S277

    $28.50
    $100.00
    $150.00
    $30.00
    $50.00
    $360.00
    $200.00
    $400.00
    $800.00
    $100.00
    $175.00
    $175.00
    $2,500.00
    $250.00
    $60.00
    $240.00
    $260.00
    $200.00
    $330.00
    $350.00
    $300.00
    $2,400.00
    $100.00
    $140.00
    $360.00
    $400.00
    $120.00
    $900.00
    $500.00
    $700.00
    $260.00
    $360.00
    $81.90
    $1,080.00
    $200.00
    $460.00
    $160.00
    $500.00
    $400.00
    $200.00
    $25.00
    $75.00
    $200.00
    $25.00
    $75.00
    $380.00
    $300.00
    $780.00
    $200.00
    $400.00

    Page 634

    Claims Data

    H006
    S277
    H006
    S220
    O156
    O156
    O156
    O156
    O156
    O156
    M076
    M076
    P011
    S286
    M076
    M076
    M076
    M076
    Missing
    M230
    M230
    M230
    P475
    P475
    D90
    D90
    D90
    M230
    M230
    M230
    M230
    M230
    P475
    P475
    M230
    M230
    M230
    P475
    P475
    P475
    S356
    D90
    D90
    D90
    H005
    M230
    M230
    P337
    M326
    M326

    $120.00
    $400.00
    $1,170.00
    $220.00
    $500.00
    $100.00
    $200.00
    $1,075.50
    $389.60
    $483.40
    $250.00
    $75.00
    $75.00
    $300.00
    $250.00
    $750.00
    $200.00
    $50.00
    $350.00
    $240.00
    $60.00
    $300.00
    $65.00
    $125.00
    $300.00
    $70.00
    $130.00
    $240.00
    $60.00
    $160.00
    $25.00
    $15.00
    $11.00
    $94.00
    $240.00
    $60.00
    $300.00
    $30.00
    $156.00
    $39.00
    $300.00
    $350.00
    $350.00
    $1,200.00
    $2,400.00
    $300.00
    $300.00
    $720.80
    $200.00
    $50.00

    Page 635

    Claims Data

    P011
    M657
    M164
    P169
    P169
    D228
    D228
    D103
    D103
    D103
    D103
    M754
    P167
    P167
    D208
    D208
    D208
    D297
    D297
    S060
    S060
    P045
    P045
    M317
    M317
    H034
    P168
    O006
    O006
    O006
    S301
    S114
    M304
    L97
    M211
    M211
    S274
    M700
    L035
    S274
    M700
    O001
    P104
    D228
    D228
    D228
    P057
    M412
    P237
    M078

    $84.00
    $100.00
    $100.00
    $25.00
    $30.00
    $500.00
    $350.00
    $140.00
    $250.00
    $140.00
    $320.00
    $200.00
    $1,400.00
    $150.00
    $35.00
    $25.00
    $550.00
    $70.00
    $250.00
    $260.00
    $20.00
    $45.00
    $260.00
    $120.00
    $100.00
    $400.00
    $199.50
    $75.00
    $1,075.00
    $350.00
    $200.00
    $400.00
    $185.00
    $600.00
    $300.00
    $400.00
    $140.00
    $140.00
    $195.00
    $420.00
    $300.00
    $110.00
    $71.60
    $250.00
    $70.00
    $80.00
    $65.00
    $200.00
    $42.99
    $100.00

    Page 636

    Claims Data

    L006
    O004
    O004
    M375
    L079
    S371
    S371
    M729
    H010
    D160
    D160
    D160
    M626
    M626
    M829
    M067
    P049
    MM06
    M067
    M067
    M067
    P049
    L020
    M067
    M067
    P049
    M067
    M183
    O004
    O004
    O004
    O076
    O076
    O076
    M152
    M152
    M152
    S242
    P008
    M138
    M138
    M138
    M371
    M371
    M371
    M371
    M371
    M371
    O004
    O004

    $400.00
    $100.00
    $1,116.00
    $160.00
    $400.00
    $300.00
    $3,000.00
    $600.00
    $1,800.00
    $170.00
    $230.00
    $100.00
    $300.00
    $20.00
    $350.00
    $160.00
    $869.40
    $285.00
    $460.00
    $40.00
    $300.00
    $571.40
    $740.00
    $240.00
    $40.00
    $124.95
    $240.00
    $400.00
    $250.00
    $1,516.00
    $2,056.00
    $90.00
    $1,165.50
    $2,265.50
    $150.00
    $25.00
    $105.00
    $250.00
    $204.60
    $100.00
    $25.00
    $55.00
    $100.00
    $25.00
    $75.00
    $100.00
    $25.00
    $15.00
    $100.00
    $556.00

    Page 637

    Claims Data

    O004
    M346
    M346
    L126
    H006
    H006
    S239
    L149
    P049
    S239
    P115
    P115
    S245
    P014
    P014
    O001
    O001
    O001
    M229
    P022
    M411
    M411
    P115
    M353
    P115
    P155
    D59
    D59
    D59
    D59
    D111
    D111
    D111
    D111
    D111
    D111
    D111
    D111
    D111
    D111
    P215
    O015
    O015
    O015
    O015
    O015
    D218
    S280
    D103
    D103

    $260.00
    $200.00
    $240.00
    $150.00
    $1,200.00
    $50.00
    $400.00
    $150.00
    $119.00
    $5,000.00
    $35.00
    $64.50
    $400.00
    $212.00
    $109.20
    $110.00
    $870.75
    $1,134.25
    $160.00
    $220.50
    $130.00
    $30.00
    $43.50
    $150.00
    $48.75
    $77.00
    $60.00
    $80.00
    $590.00
    $150.00
    $180.00
    $395.00
    $100.00
    $960.00
    $360.00
    $1,040.00
    $700.00
    $180.00
    $60.00
    $649.00
    $225.00
    $150.00
    $1,216.00
    $604.00
    $1,184.00
    $1,516.00
    $360.00
    $195.00
    $140.00
    $320.00

    Page 638

    Claims Data

    O033
    P215
    D103
    P215
    D218
    D218
    M437
    M437
    L070
    P215
    D218
    D218
    D218
    P215
    S313
    S313
    S313
    S313
    P215
    S256
    S256
    M189
    P115
    M095
    P231
    L001
    S052
    M766
    M766
    D119
    D119
    D119
    D119
    M060
    P011
    D64
    D64
    D64
    D64
    P456
    P456
    P014
    S319
    S319
    L034
    O076
    O076
    O076
    M115
    M155

    $230.00
    $360.00
    $400.00
    $306.00
    $120.00
    $120.00
    $200.00
    $50.00
    $108.00
    $215.20
    $200.00
    $120.00
    $100.00
    $306.00
    $300.00
    $25.00
    $375.00
    $350.00
    $111.60
    $350.00
    $180.00
    $140.00
    $49.00
    $160.00
    $70.00
    $420.00
    $300.00
    $200.00
    $200.00
    $50.00
    $70.00
    $50.00
    $400.00
    $200.00
    $67.00
    $50.00
    $180.00
    $140.00
    $30.00
    $300.00
    $300.00
    $170.05
    $970.00
    $260.00
    $400.00
    $90.00
    $1,276.00
    $1,395.00
    $100.00
    $30.00

    Page 639

    Claims Data

    M115
    L046
    M774
    L070
    P005
    O002
    O002
    M316
    P014
    P014
    M103
    P076
    P408
    S165
    P351
    M662
    M662
    M662
    O169
    O169
    D59
    D257
    D257
    D257
    D59
    D59
    O004
    O004
    O004
    M099
    L070
    H034
    P456
    M014
    M014
    M014
    M014
    L065
    M014
    M014
    M014
    M014
    M014
    L034
    P332
    M014
    M014
    M014
    M014
    M014

    $70.00
    $300.00
    $300.00
    $607.00
    $1,217.28
    $1,295.00
    $500.00
    $100.00
    $19.45
    $63.30
    $140.00
    $111.95
    $6.00
    $300.00
    $663.70
    $100.00
    $25.00
    $35.00
    $675.00
    $1,975.00
    $133.00
    $147.00
    $400.00
    $500.00
    $200.00
    $780.00
    $100.00
    $1,516.00
    $2,056.00
    $120.00
    $250.00
    $300.00
    $78.99
    $140.00
    $25.00
    $95.00
    $120.00
    $180.00
    $140.00
    $25.00
    $55.00
    $120.00
    $140.00
    $400.00
    $57.50
    $140.00
    $25.00
    $55.00
    $140.00
    $25.00

    Page 640

    Claims Data

    M014
    S114
    S114
    S114
    L117
    S187
    M325
    P477
    P457
    S187
    P477
    S187
    S187
    O001
    M194
    M194
    M194
    S079
    L013
    P479
    P136
    M580
    M580
    M580
    M581
    L124
    D27
    M115
    M115
    M115
    M115
    L172
    M115
    S367
    S367
    M657
    L034
    P014
    P014
    M213
    M213
    M213
    M213
    M213
    M213
    M213
    M213
    D248
    D248
    D248

    $95.00
    $1,600.00
    $50.00
    $50.00
    $3,800.00
    $200.00
    $140.00
    $32.95
    $114.00
    $250.00
    $48.50
    $200.00
    $1,600.00
    $110.00
    $200.00
    $300.00
    $150.00
    $300.00
    $175.00
    $127.80
    $29.40
    $100.00
    $100.00
    $500.00
    $150.00
    $740.00
    $680.00
    $200.00
    $30.00
    $50.00
    $40.00
    $520.00
    $20.00
    $920.00
    $500.00
    $200.00
    $650.00
    $139.65
    $31.50
    $100.00
    $20.00
    $100.00
    $20.00
    $200.00
    $20.00
    $200.00
    $20.00
    $70.00
    $90.00
    $300.00

    Page 641

    Claims Data

    S232
    S232
    O004
    O004
    O004
    S232
    M304
    M304
    D35
    D35
    D35
    D35
    D125
    D125
    D125
    D125
    D125
    H047
    H006
    H006
    S311
    S311
    M841
    S244
    S244
    M056
    M056
    D342
    D342
    D342
    S112
    S244
    S244
    M473
    P031
    S019
    S019
    P055
    S019
    M056
    M056
    H005
    H005
    H005
    P122
    D102
    D102
    D102
    O076
    O076

    $5,400.00
    $2,600.00
    $100.00
    $1,196.00
    $396.00
    $300.00
    $200.00
    $525.00
    $120.00
    $450.00
    $120.00
    $450.00
    $80.00
    $70.00
    $140.00
    $400.00
    $280.00
    $700.00
    $450.00
    $400.00
    $800.00
    $600.00
    $1,500.00
    $300.00
    $400.00
    $150.00
    $50.00
    $300.00
    $1,000.00
    $3,500.00
    $300.00
    $300.00
    $300.00
    $140.00
    $27.45
    $260.00
    $520.00
    $83.10
    $260.00
    $150.00
    $20.00
    $455.00
    $170.40
    $200.00
    $87.99
    $100.00
    $150.00
    $50.00
    $90.00
    $625.50

    Page 642

    Claims Data

    O076
    M759
    S247
    P031
    P005
    D150
    S302
    S302
    P031
    L070
    S247
    P005
    P343
    P005
    M817
    M437
    L96
    P005
    P005
    M026
    S042
    L006
    P031
    H011
    H011
    H011
    P003
    M706
    M706
    L091
    H011
    H011
    H011
    P049
    S194
    S194
    H008
    P315
    L013
    L070
    P005
    S194
    L070
    L070
    M035
    P315
    S194
    P309
    M035
    M166

    $2,155.50
    $100.00
    $200.00
    $34.86
    $976.49
    $350.00
    $400.00
    $200.00
    $246.48
    $540.00
    $200.00
    $1,952.98
    $128.20
    $476.25
    $250.00
    $500.00
    $700.00
    $317.50
    $635.00
    $220.00
    $1,600.00
    $300.00
    $424.30
    $550.00
    $258.00
    $15.00
    $83.00
    $100.00
    $305.00
    $510.00
    $550.00
    $24.00
    $725.00
    $132.55
    $300.00
    $300.00
    $150.00
    $326.00
    $3,600.00
    $650.00
    $2,681.97
    $1,000.00
    $200.00
    $180.00
    $200.00
    $75.00
    $300.00
    $239.40
    $200.00
    $140.00

    Page 643

    Claims Data

    M166
    M166
    M166
    M166
    M166
    D257
    D257
    M035
    M035
    L070
    D120
    D120
    S242
    S242
    S242
    L041
    M580
    M580
    M580
    S160
    M035
    M035
    S279
    S279
    P435
    S001
    S001
    O156
    O156
    D75
    D75
    D75
    D01
    S019
    M087
    P373
    M304
    M304
    H005
    D303
    M254
    M254
    M254
    EC01
    EC01
    EC01
    D79
    D217
    D217
    D217

    $180.00
    $60.00
    $140.00
    $100.00
    $80.00
    $130.00
    $270.00
    $200.00
    $200.00
    $780.00
    $70.00
    $300.00
    $250.00
    $350.00
    $150.00
    $350.00
    $100.00
    $400.00
    $100.00
    $200.00
    $90.00
    $110.00
    $500.00
    $3,000.00
    $89.59
    $700.00
    $200.00
    $200.00
    $1,200.00
    $395.00
    $700.00
    $2,250.00
    $300.00
    $260.00
    $160.00
    $231.00
    $200.00
    $40.00
    $560.00
    $300.00
    $1,000.00
    $400.00
    $400.00
    $2,484.00
    $782.40
    $144.00
    $300.00
    $50.00
    $45.00
    $260.00

    Page 644

    Claims Data

    D217
    P179
    D217
    O001
    O001
    D192
    M347
    P081
    D192
    M534
    M534
    M534
    M534
    L075
    H023
    S385
    H005
    O001
    O001
    O001
    M034
    L006
    L003
    D397
    M851
    L172
    P167
    H006
    H006
    H006
    D07
    D07
    M454
    M454
    P049
    D07
    D286
    D286
    D286
    P090
    M443
    P073
    L070
    D119
    D119
    D119
    M375
    M375
    L065
    L123

    $390.00
    $69.00
    $560.00
    $110.00
    $1,504.50
    $600.00
    $600.00
    $1,422.00
    $500.00
    $200.00
    $2,035.00
    $500.00
    $1,855.00
    $6,000.00
    $3,380.00
    $400.00
    $200.00
    $110.00
    $1,395.00
    $1,740.00
    $50.00
    $155.00
    $800.00
    $500.00
    $500.00
    $1,020.00
    $438.00
    $250.00
    $185.00
    $385.00
    $575.00
    $100.00
    $280.00
    $684.25
    $156.00
    $7,500.00
    $100.00
    $25.00
    $375.00
    $148.50
    $200.00
    $1,308.06
    $460.00
    $50.00
    $120.00
    $250.00
    $280.00
    $122.55
    $435.00
    $420.00

    Page 645

    Claims Data

    S184
    M375
    M375
    L117
    M375
    T032
    T032
    M375
    M833
    D60
    D60
    D60
    P435
    D150
    D150
    D150
    D150
    S107
    S367
    S107
    S367
    D305
    D305
    D255
    D255
    D255
    D255
    M343
    M343
    L065
    L065
    D255
    D255
    M325
    P477
    P014
    O076
    D427
    D427
    D427
    O001
    O001
    O001
    D192
    D192
    D192
    D192
    D192
    M473
    P343

    $300.00
    $160.00
    $60.00
    $3,800.00
    $120.00
    $1,100.00
    $1,360.00
    $160.00
    $240.00
    $50.00
    $10.00
    $300.00
    $66.33
    $150.00
    $350.00
    $200.00
    $400.00
    $400.00
    $360.00
    $200.00
    $360.00
    $400.00
    $100.00
    $50.00
    $50.00
    $40.00
    $260.00
    $300.00
    $40.00
    $240.00
    $345.00
    $900.00
    $950.00
    $280.00
    $184.90
    $644.55
    $90.00
    $400.00
    $600.00
    $500.00
    $250.00
    $2,056.00
    $476.00
    $100.00
    $50.00
    $250.00
    $600.00
    $600.00
    $240.00
    $85.75

    Page 646

    Claims Data

    L070
    L046
    P343
    M473
    O004
    O004
    O004
    D276
    D276
    D276
    S149
    S149
    S149
    S149
    S149
    S393
    S393
    M602
    H027
    H027
    S550
    S550
    O076
    O076
    M166
    M166
    M166
    M166
    M166
    M166
    M233
    M233
    M233
    M233
    S144
    L013
    L070
    S115
    P309
    D244
    D244
    D244
    D244
    M233
    M233
    S109
    S109
    S109
    O001
    O001

    $795.00
    $690.00
    $104.00
    $150.00
    $100.00
    $1,756.00
    $1,016.00
    $1,550.00
    $80.00
    $200.00
    $200.00
    $300.00
    $200.00
    $100.00
    $200.00
    $200.00
    $1,000.00
    $800.00
    $400.00
    $2,300.00
    $200.00
    $200.00
    $180.00
    $1,200.00
    $140.00
    $170.00
    $160.00
    $140.00
    $100.00
    $600.00
    $100.00
    $100.00
    $100.00
    $100.00
    $500.00
    $550.00
    $1,550.00
    $300.00
    $346.50
    $750.00
    $200.00
    $120.00
    $550.00
    $100.00
    $120.00
    $300.00
    $3,400.00
    $270.00
    $1,041.25
    $1,819.00

    Page 647

    Claims Data

    M233
    L013
    L013
    M233
    D253
    D253
    D173
    D173
    D173
    D173
    D173
    S361
    D90
    D90
    M275
    M275
    M626
    M829
    D411
    O033
    O033
    O033
    H006
    UN01
    UN01
    UN01
    D06
    D06
    M026
    S266
    S049
    O156

    $150.00
    $165.00
    $375.00
    $100.00
    $50.00
    $500.00
    $260.00
    $140.00
    $450.00
    $350.00
    $450.00
    $250.00
    $650.00
    $350.00
    $300.00
    $200.00
    $200.00
    $300.00
    $200.00
    $100.00
    $1,192.50
    $688.50
    $3,000.00
    $150.00
    $345.00
    $470.00
    $140.00
    $80.00
    $220.00
    $400.00
    $900.00
    $500.00

    Page 648

    Assignment
    List patients by subtotals in claim in a high to low spending order
    Define how many patients spend 50% of the total claims
    151
    Define how much money was spent by the 10% of the High spenders
    3,217,294.80
    Define how much was spent in Pharmacy and in Hospital
    Define which are the 3 "Cause" that spend more money
    DENTAL CARE
    VISION CARE
    (blank)
    HEART
    MISCARRIAGE

    863,219.65
    846,777.27
    575,393.57
    566,248.33
    263,793.10

    Beneficiary ID CLAIM #
    1 06994
    1 Total
    2 05140
    2 05140
    2 Total
    3 03489
    3 03729
    3 03729
    3 03729.1
    3 03730
    3 03814
    3 03814
    3 03814.1
    3 04368
    3 04883
    3 05104
    3 05365
    3 05365
    3 05365
    3 05365
    3 05369
    3 05369
    3 05672
    3 05816
    3 05816
    3 06025
    3 06025.1
    3 06214
    3 06214
    3 06405
    3 06632
    3 06888
    3 06888
    3 06888
    3 06889
    3 07098
    3 07099
    3 07402
    3 07402
    3 07480
    3 08634
    3 08635
    3 08636
    3 08636.1
    3 Total
    4 04070
    4 04070
    4 05676
    4 05676
    4 05676
    4 05676
    4 05676

    Seq CAUSE DESCRIPTION


    1 GLAUCOMA
    1 VISION CARE
    2 VISION CARE

    SERVICE DESCRIPTION
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    1 PROSTATE
    MISC OUT HOSP-ORAL DRUGS
    1 SKIN - ECZEMA
    PHYSICIAN VISIT-OFFICE
    2 SKIN - ECZEMA
    MISC OUT HOSP-ORAL DRUGS
    1 SKIN - ECZEMA
    MISC OUT HOSP-ORAL DRUGS
    1 GLAUCOMA
    SPECIALIST CNSLT-OFFICE
    1
    MISC OUT HOSP-ORAL DRUGS
    2
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 CATARACT
    MISC OUT HOSP-ORAL DRUGS
    1 PROSTATE
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 PROSTATE
    DIAGNOSTIC X-RAY
    2 PROSTATE
    DIAGNOSTIC LABORATORY
    3 PROSTATE
    MISC OUT HOSP-ORAL DRUGS
    4 PROSTATE
    SPECIALIST CNSLT-OFFICE
    1 GLAUCOMA
    SPECIALIST CNSLT-OFFICE
    2 GLAUCOMA
    DIAGNOSTIC X-RAY
    1
    MISC OUT HOSP-ORAL DRUGS
    1 SKIN - ECZEMA
    PHYSICIAN VISIT-OFFICE
    2 SKIN - ECZEMA
    MISC OUT HOSP-ORAL DRUGS
    1
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 SKIN - ECZEMA
    PHYSICIAN VISIT-OFFICE
    2 SKIN - ECZEMA
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 GLAUCOMA
    MISC OUT HOSP-ORAL DRUGS
    1 CONSTIPATION
    SURGICAL OUTPATIENT
    2 CONSTIPATION
    MISC OUT HOSP-OTHER
    3 CONSTIPATION
    MISC OUT HOSP-OTHER
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 PROSTATE
    MISC OUT HOSP-ORAL DRUGS
    1 CATARACT
    SPECIALIST CNSLT-OFFICE
    1 PROSTATE
    DIAGNOSTIC LABORATORY
    2 PROSTATE
    SPECIALIST CNSLT-OFFICE
    1 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 PROSTATE
    MISC OUT HOSP-ORAL DRUGS
    1 GLAUCOMA
    MISC OUT HOSP-ORAL DRUGS
    1 BURSITIS
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    5 DEVIATED NASAL

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    4 05676.1

    1 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS

    5 04083
    5 04083
    5 04083

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    6 05474
    6 05474
    6 05474

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    7 08882
    7 08882
    7 08882

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    8 08278
    8 08278

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    9 04380
    9 04380
    9 05505
    9 05505.1
    9 06517
    9 06892
    9 06892
    9 06892

    1 PROSTATE
    2 PROSTATE
    1 PROSTATE
    1 HYPERTENSION
    1 PROSTATE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    4 Total

    5 Total

    6 Total

    7 Total

    8 Total

    9 Total
    10 04939
    10 04939
    10 04939
    10 04939
    10 06250
    10 08275
    10 08275
    10 08275
    10 08275.1
    10 08275.1
    10 08275.1
    10 08276
    10 08276
    10 08277

    1 FRACTURE - HAND BONES SPECIALIST CNSLT-OFFICE


    2 FRACTURE - HAND BONES MISC OUT HOSP-INJECTABLES
    3 FRACTURE - HAND BONES MISC OUT HOSP-INJECTABLES
    4 FRACTURE - HAND BONES MISC OUT HOSP-ORAL DRUGS
    1 FRACTURE - HAND BONES PHYSICIAN VISIT-OFFICE
    1 THYROID
    PHYSICIAN VISIT-OFFICE
    2 THYROID
    DIAGNOSTIC LABORATORY
    3 THYROID
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 ANXIETY
    SPECIALIST CNSLT-OFFICE
    2 ANXIETY
    DIAGNOSTIC X-RAY
    1 SKIN - LESION
    SPECIALIST CNSLT-OFFICE

    11 04759
    11 08242
    11 08242
    11 08242

    1 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS

    12 05373
    12 05373
    12 05373.1
    12 05373.1
    12 05373.1
    12 05373.1
    12 05373.2

    1 BONE & CARTILAGE DISORDER


    PHYSICIAN VISIT-OFFICE
    2 BONE & CARTILAGE DISORDER
    DIAGNOSTIC LABORATORY
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    MISC OUT HOSP-INJECTABLES
    3 FEVER
    MISC OUT HOSP-INJECTABLES
    4 FEVER
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS

    10 Total
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    11 Total

    12 06742
    12 07151
    12 07151
    12 07151
    12 07577
    12 08741
    12 08894
    12 08894
    12 08894.1

    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 HEMORRHOIDS
    MISC OUT HOSP-ORAL DRUGS

    13 03612
    13 03612
    13 03612
    13 04707
    13 04707
    13 08462
    13 08462
    13 08462.1

    1
    2
    3
    1 BACK PAIN
    2 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE

    14 06945
    14 06945
    14 06945
    14 07157
    14 07157
    14 07157

    1 ALLERGIC
    2 ALLERGIC
    3 ALLERGIC
    1 ALLERGIC
    2 ALLERGIC
    3 ALLERGIC

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    15 04065
    15 04065
    15 04065
    15 04065
    15 05605
    15 05605
    15 09044

    1 INTESTINAL COLIC
    PHYSICIAN VISIT-OFFICE
    2 INTESTINAL COLIC
    MISC OUT HOSP-INJECTABLES
    3 INTESTINAL COLIC
    MISC OUT HOSP-INJECTABLES
    4 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY

    16 07146
    16 07146
    16 07146
    16 07146.1
    16 07146.1

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 SKIN - ECZEMA
    DIAGNOSTIC LABORATORY
    2 SKIN - ECZEMA
    MISC OUT HOSP-ORAL DRUGS

    17 05141

    1 HYPERTENSION

    18 03491
    18 03491
    18 05106
    18 05106
    18 05106
    18 05317
    18 05317
    18 06746
    18 06746
    18 07769
    18 07769

    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE


    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-ORAL DRUGS
    1 ARTHRITIS
    PHYSICIAN VISIT-OFFICE
    2 ARTHRITIS
    DIAGNOSTIC LABORATORY
    3 ARTHRITIS
    MISC OUT HOSP-ORAL DRUGS
    1 ARTHRITIS
    PHYSICIAN VISIT-OFFICE
    2 ARTHRITIS
    MISC OUT HOSP-ORAL DRUGS
    1 THYROID
    PHYSICIAN VISIT-OFFICE
    2 THYROID
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY

    12 Total

    13 Total
    REACTION
    REACTION
    REACTION
    REACTION
    REACTION
    REACTION

    14 Total

    15 Total

    16 Total
    PHYSICIAN VISIT-OFFICE

    17 Total

    18 07769.1
    18 07769.1

    1 BREAST DISORDERS
    2 BREAST DISORDERS

    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY

    19 04228
    19 04228
    19 04228

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    20 05103
    20 05103
    20 05103.1
    20 05103.2
    20 05103.2

    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 ARTHRITIS
    1 SINUSITIS
    2 SINUSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    21 04272
    21 04272
    21 04272.1
    21 07149
    21 07149
    21 07150
    21 07150
    21 08241
    21 08241
    21 08241

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 JAUNDICE
    DIAGNOSTIC LABORATORY
    1 EYE DISORDER
    PHYSICIAN VISIT-OFFICE
    2 EYE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS

    22 03608
    22 03886
    22 05041
    22 07142
    22 07142

    1
    1
    1 DILATION & CURRETAGE
    1 ANXIETY
    2 ANXIETY

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    23 05606
    23 05606
    23 05606
    23 05606
    23 05606
    23 06024
    23 06024
    23 06024
    23 06639
    23 06639
    23 06639

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    24 04441
    24 04441
    24 04441
    24 05295
    24 05295
    24 05295
    24 05295
    24 06748
    24 06748
    24 07992
    24 07992

    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    3 PAINFUL HEEL
    4 PAINFUL HEEL
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 DEVIATED NASAL
    2 DEVIATED NASAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    18 Total

    19 Total

    20 Total

    21 Total

    22 Total

    23 Total
    SEPTUM
    SEPTUM
    SEPTUM

    SEPTUM
    SEPTUM

    24 08464
    24 08464

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    25 07403
    25 07403

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    26 03610
    26 05017
    26 06106
    26 08731

    1 AMMENORRHOEA
    1 AMMENORRHOEA
    1 AMMENORRHOEA
    1 AMMENORRHOEA

    MISC
    MISC
    MISC
    MISC

    27 03523
    27 04436
    27 05040
    27 05040
    27 05040.1
    27 05612
    27 06406
    27 07501
    27 08240
    27 08240
    27 08240
    27 08405

    1 HYPERTENSION
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 EAR DYSFUNCTION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS

    28 03672
    28 03672
    28 04361
    28 04361
    28 04362
    28 04362
    28 05917
    28 05917
    28 05917
    28 05917
    28 05918
    28 05918
    28 05918
    28 05918
    28 06845
    28 06845
    28 07585
    28 07585
    28 07585
    28 08260

    1 BACK PAIN
    PHYSICIAN VISIT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 EPILEPSY
    DIAGNOSTIC X-RAY
    2 EPILEPSY
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 OTITIS - EAR
    PHYSICIAN VISIT-OFFICE
    2 OTITIS - EAR
    MISC OUT HOSP-ORAL DRUGS
    3 OTITIS - EAR
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    PHYSICIAN VISIT-OFFICE

    29 03531
    29 03531
    29 03531
    29 03531
    29 03531
    29 03531.1
    29 03531.1
    29 03531.2

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    2 FEVER
    1 DENGUE

    24 Total

    25 Total
    OUT
    OUT
    OUT
    OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS

    26 Total

    27 Total

    28 Total
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    29 03531.2
    29 06067

    2 DENGUE
    1 PAINFUL HEEL

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    30 05172
    30 05172.2
    30 05172.2
    30 05172.3
    30 05172.3
    30 08279
    30 08279
    30 08279

    1 INFECTION THUMB
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    31 06348
    31 06348

    1 FEVER
    2 FEVER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    32 07931
    32 07931
    32 08067

    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    33 06057
    33 06057
    33 06057
    33 06057.1

    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    34 04437
    34 04437
    34 04437
    34 04437
    34 04437
    34 04437.1
    34 04437.2
    34 04437.2
    34 04758
    34 05503
    34 07100
    34 07100
    34 07100
    34 07451
    34 07451.1
    34 08347
    34 08347
    34 08347.1
    34 08347.1

    1 HYPERLIPIDERMIA 2 HYPERLIPIDERMIA 3 HYPERLIPIDERMIA 4 HYPERLIPIDERMIA 5 HYPERLIPIDERMIA 1 HYPERLIPIDERMIA 1 HYPERLIPIDERMIA 2 HYPERLIPIDERMIA 1 DIAB'ETES


    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 ACUTE ENTERITIS
    1 HEART
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 HEART
    2 HEART

    35 03524
    35 03525
    35 04366
    35 04366
    35 04366
    35 04367
    35 04367
    35 06007
    35 06007

    1 GLAUCOMA
    1 THYROID
    1 THYROID
    2 THYROID
    3 THYROID
    1 CATARACT
    2 CATARACT
    1 GLAUCOMA
    2 GLAUCOMA

    29 Total

    30 Total

    31 Total

    32 Total

    33 Total
    CHOLESTEROL
    MISC OUT
    CHOLESTEROL
    MISC OUT
    CHOLESTEROL
    MISC OUT
    CHOLESTEROL
    MISC OUT
    CHOLESTEROL
    MISC OUT
    CHOLESTEROL
    MISC OUT
    CHOLESTEROL
    MISC OUT
    CHOLESTEROL
    MISC OUT
    MISC OUT
    MISC OUT
    MISC OUT
    MISC OUT
    MISC OUT
    MISC OUT
    MISC OUT
    MISC OUT
    MISC OUT
    MISC OUT
    MISC OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    34 Total
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    35 06007
    35 06546
    35 06547
    35 07927
    35 07928
    35 07928
    35 08638
    35 08639

    3 GLAUCOMA
    1 THYROID
    1 GLAUCOMA
    1 THYROID
    1 GLAUCOMA
    2 GLAUCOMA
    1 THYROID
    1 CATARACT

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE

    36 05366
    36 05367
    36 06645
    36 06844
    36 06844
    36 06844
    36 06844
    36 06844
    36 06844.1
    36 07041
    36 07041
    36 07321
    36 07503
    36 07699
    36 07930

    1 VISION CARE
    1 DILATION & CURRETAGE
    1 MUSCULAR PAIN
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN
    1 HYPERTENSION
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 BACK PAIN

    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE

    37 06021

    1 CHOSTOCHRONDITIS

    PHYSICIAN VISIT-OFFICE

    38 04109
    38 04109
    38 04109
    38 04109
    38 04110
    38 04110
    38 04110
    38 04110
    38 05980
    38 05980
    38 05980

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE

    39 03487
    39 03728
    39 04589
    39 04589
    39 04589
    39 05471
    39 05471.1
    39 05471.1
    39 05471.1
    39 06644
    39 06644

    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1
    PHYSICIAN VISIT-OFFICE
    2
    MISC OUT HOSP-ORAL DRUGS
    3
    MISC OUT HOSP-ORAL DRUGS
    1 CIRCULATORY DISORDER
    PHYSICIAN VISIT-OFFICE
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    3 HYPERTENSION
    DIAGNOSTIC LABORATORY
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE

    40 03670
    40 03671

    1 SKIN - ECZEMA
    1 BARTHOLIN'S CYST

    35 Total

    36 Total
    37 Total

    38 Total

    39 Total
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT

    40 04273
    40 04274
    40 05169
    40 05170
    40 06596
    40 06596
    40 06596
    40 06596
    40 06810
    40 08028
    40 08028
    40 08028

    1 COUGH - AIRWAY OBSTRUCTION


    SPECIALIST CNSLT-OFFICE
    1 COUGH - AIRWAY OBSTRUCTION
    SPECIALIST CNSLT-OFFICE
    1 INFECTION - MALE GENITAL SPECIALIST CNSLT-OFFICE
    1 DEVIATED NASAL SEPTUM SPECIALIST CNSLT-OFFICE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE

    41 05013
    41 05013
    41 05818
    41 05818
    41 05819
    41 05819
    41 05819
    41 05819

    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    42 04178
    42 04178
    42 04178
    42 04660
    42 04660

    1 VISION
    2 VISION
    3 VISION
    1 VISION
    2 VISION

    VISION
    VISION
    VISION
    VISION
    VISION

    43 08144
    43 08144
    43 08144

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    44 03883
    44 03883
    44 03883
    44 06840
    44 06840
    44 06840
    44 06841
    44 06841

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 HYPERTENSION
    2 HYPERTENSION

    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    45 06351
    45 06351
    45 06351.1

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 MUSCULAR PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    46 04171
    46 04171
    46 04171
    46 05473
    46 05473
    46 05473
    46 05473

    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    40 Total

    41 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    42 Total

    43 Total

    44 Total

    45 Total

    46 Total

    47 07520
    47 07520
    47 07520.1
    47 07520.1

    1
    2
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    48 03530
    48 03530
    48 05042
    48 05042
    48 05042
    48 05042
    48 05042
    48 05042.1
    48 06329
    48 06329
    48 06329

    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    5
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    49 03488
    49 03488
    49 03488
    49 05687
    49 05687
    49 05687
    49 05687
    49 06022
    49 06022
    49 06330

    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1
    2
    3
    4
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    1 FRACTURE - HAND BONES

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    50 04066
    50 04066
    50 04066
    50 04066
    50 04066
    50 04066.1
    50 06808
    50 06808

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE

    51 05105
    51 06248
    51 06253
    51 06253
    51 06347
    51 06347.1
    51 06352
    51 07042
    51 07042
    51 07042
    51 07042
    51 07809
    51 07809
    51 07809
    51 07809
    51 07809

    1 SKIN - ATOPIC DERMATITIS SPECIALIST CNSLT-OFFICE


    1 DENTAL CARE
    DENTAL CARE
    1
    SPECIALIST CNSLT-OFFICE
    2
    DIAGNOSTIC X-RAY
    1
    DIAGNOSTIC X-RAY
    1
    DIAGNOSTIC X-RAY
    1
    PHYSICIAN VISIT-OFFICE
    1 DENGUE
    HOSPITAL LOCAL ROOM
    2 DENGUE
    HOSPITAL MISC-LOCAL
    3 DENGUE
    PHYSICIAN VISIT-HOSPITAL
    4 DENGUE
    SPECIALIST CNSLT-HOSPITAL
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    DIAGNOSTIC LABORATORY
    3 FEVER
    DIAGNOSTIC LABORATORY
    4 FEVER
    DIAGNOSTIC X-RAY
    5 FEVER
    DIAGNOSTIC LABORATORY

    47 Total

    48 Total

    49 Total

    50 Total

    51 Total
    52 05981
    52 05982
    52 05982
    52 05983
    52 05983
    52 05983
    52 05983
    52 05983.1
    52 08680
    52 08680
    52 08681
    52 08681
    52 08681

    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    1 INFECTION THUMB
    PHYSICIAN VISIT-OFFICE
    2 INFECTION THUMB
    MISC OUT HOSP-ORAL DRUGS
    1 DILATION & CURRETAGE
    PHYSICIAN VISIT-OFFICE
    2 DILATION & CURRETAGE
    PHYSICIAN VISIT-OFFICE
    3 DILATION & CURRETAGE
    DIAGNOSTIC LABORATORY
    4 DILATION & CURRETAGE
    MISC OUT HOSP-ORAL DRUGS
    1 BREAST DISORDERS
    DIAGNOSTIC X-RAY
    1 HEART- ISCHEMIC HEART DISEASE
    PHYSICIAN VISIT-OFFICE
    2 HEART- ISCHEMIC HEART DISEASE
    DIAGNOSTIC LABORATORY
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE

    53 08317

    1 MISCARRIAGE

    54 04158
    54 04158
    54 04158
    54 04158
    54 04158
    54 04158.1
    54 04158.1
    54 04158.1
    54 04158.1
    54 04158.1
    54 04158.1
    54 04158.2
    54 04158.2
    54 04158.2
    54 05340
    54 05340
    54 05340
    54 05340
    54 05340
    54 05340.1
    54 05340.1
    54 06017
    54 06516
    54 06516
    54 06516
    54 06516
    54 06638
    54 06638.1
    54 06638.1
    54 07399
    54 07399.1
    54 07399.1
    54 08533
    54 08533

    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    1 HEART
    2 HEART
    2 HEART
    3 HEART
    3 HEART
    1 HEART
    2 HEART
    3 HEART
    1 HEART- ISCHEMIC
    2 HEART- ISCHEMIC
    3 HEART- ISCHEMIC
    4 HEART- ISCHEMIC
    5 HEART- ISCHEMIC
    1 HEART- ISCHEMIC
    2 HEART- ISCHEMIC
    1 HEART
    1
    2
    3
    4
    1 HEART
    1 HEART
    2 HEART
    1 HEART- ISCHEMIC
    1 HEART- ISCHEMIC
    2 HEART- ISCHEMIC
    1 HYPERTENSION
    2 HYPERTENSION

    55 08742

    1 VISION CARE

    52 Total
    DIAGNOSTIC LABORATORY

    53 Total

    HEART
    HEART
    HEART
    HEART
    HEART
    HEART
    HEART

    HEART
    HEART
    HEART

    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    OTHER
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    DISEASE
    PHYSICIAN VISIT-OFFICE
    DISEASE
    PHYSICIAN VISIT-OFFICE
    DISEASE
    DIAGNOSTIC LABORATORY
    DISEASE
    DIAGNOSTIC LABORATORY
    DISEASE
    MISC OUT HOSP-ORAL DRUGS
    DISEASE
    MISC OUT HOSP-ORAL DRUGS
    DISEASE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DISEASE
    MISC OUT HOSP-ORAL DRUGS
    DISEASE
    MISC OUT HOSP-ORAL DRUGS
    DISEASE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    54 Total
    VISION CARE

    55 08742
    55 08742

    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE

    56 05603
    56 05603
    56 05603

    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    57 06659
    57 06659

    1 OTITIS - EAR
    2 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    58 07046

    1 VISION CARE

    VISION CARE

    59 03882
    59 03882
    59 03882
    59 03882
    59 03882
    59 06066
    59 06066
    59 06066
    59 06066

    1 DILATION & CURRETAGE


    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    5 DILATION & CURRETAGE
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    60 07516
    60 07516
    60 07516

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    61 07452
    61 07452
    61 07452

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    62 04275
    62 04275
    62 04275
    62 04275
    62 04276
    62 04276
    62 04276
    62 04276
    62 04935
    62 04935
    62 04935
    62 04935
    62 04935
    62 04935.1
    62 04935.1
    62 04936
    62 04936
    62 05493
    62 05494
    62 05494
    62 05494
    62 05494
    62 05494

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEART
    2 HEART
    1 BARTHOLIN'S CYST
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    55 Total

    56 Total

    57 Total
    58 Total

    59 Total

    60 Total

    61 Total

    62 05496
    62 05496
    62 05496
    62 05496.1
    62 06407.1
    62 06407.1
    62 06407.1
    62 06407.1
    62 06640
    62 06640
    62 06640
    62 07239
    62 07239
    62 08341
    62 08341
    62 08341

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    63 08406
    63 08406
    63 08406

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    64 08682
    64 08682
    64 08682
    64 08682
    64 08682

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    65 06544
    65 06544
    65 06544
    65 07484
    65 07484
    65 07484

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    66 04107
    66 04108
    66 04108
    66 04108
    66 04225
    66 04225
    66 05814
    66 05814
    66 05815
    66 07326
    66 07326
    66 08340
    66 08340

    1 OVARIAN CYST
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1
    2
    1 OVARIAN CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    67 08321
    67 08321

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    68 08532
    68 08532

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    62 Total

    63 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    64 Total

    65 Total

    66 Total

    67 Total

    68 08532
    68 08532

    3 VISION CARE
    4 VISION CARE

    VISION CARE
    VISION CARE

    69 05314
    69 05314

    1 MISCARRIAGE
    2 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    70 05288

    PHYSICIAN VISIT-OFFICE

    71 06280

    PHYSICIAN VISIT-HOSPITAL

    72 03533
    72 03533
    72 03533

    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    73 05335
    73 05335
    73 05335
    73 05335
    73 05866
    73 05866
    73 05866
    73 08342
    73 08342
    73 08343
    73 08343
    73 08343
    73 08343
    73 08343

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    5 DEVIATED NASAL

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    74 08900
    74 08900
    74 08900

    1 FEVER
    2 FEVER
    3 FEVER

    75 06055
    75 06055
    75 06055
    75 06350
    75 06350
    75 07148
    75 07148
    75 07148
    75 07972
    75 07972
    75 07972
    75 07972
    75 08349
    75 08349
    75 08350
    75 08350
    75 08351

    1
    PHYSICIAN VISIT-HOSPITAL
    2
    HOSPITAL MISC-LOCAL
    3
    PHYSICIAN VISIT-OFFICE
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERTENSION
    DIAGNOSTIC LABORATORY
    1
    PHYSICIAN VISIT-OFFICE
    2
    MISC OUT HOSP-ORAL DRUGS
    3
    MISC OUT HOSP-ORAL DRUGS
    1 SOFT TISSUE DISORDERS/DISEASE
    PHYSICIAN VISIT-OFFICE
    2 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-ORAL DRUGS
    3 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-ORAL DRUGS
    4 SOFT TISSUE DISORDERS/DISEASE
    DIAGNOSTIC LABORATORY
    1 DIAB'ETES
    PHYSICIAN VISIT-OFFICE
    2 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1 DIAB'ETES
    PHYSICIAN VISIT-OFFICE
    2 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1 FEVER
    PHYSICIAN VISIT-OFFICE

    76 05677
    76 05677

    1 ARTHRITIS
    2 ARTHRITIS

    68 Total

    69 Total
    70 Total
    71 Total

    72 Total

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    73 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    74 Total

    75 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    76 05677
    76 08145
    76 08145

    3 ARTHRITIS
    1 BACK PAIN
    2 BACK PAIN

    MISC OUT HOSP-INJECTABLES


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    77 03613
    77 03613
    77 03951
    77 03951
    77 03951
    77 03989
    77 03989
    77 03989
    77 03990
    77 03990
    77 03990
    77 06747
    77 06747
    77 06747
    77 08463
    77 08463

    1 INGROWING TOE NAIL


    2 INGROWING TOE NAIL
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE

    78 07481
    78 07482
    78 07482

    1 DENTAL CARE
    1
    2

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT

    79 03733
    79 03733
    79 03733
    79 03733
    79 03734
    79 03734
    79 03734
    79 03734
    79 03736
    79 03736
    79 03736
    79 03736
    79 03736
    79 03736.1
    79 06254
    79 06254
    79 06254
    79 06254
    79 06254.1
    79 06254.1
    79 06254.1

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    80 03527
    80 03529
    80 03529
    80 03529
    80 03529
    80 03529

    1 HYPERTENSION
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    5 MUSCULAR PAIN

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT

    76 Total

    77 Total

    78 Total

    79 Total

    80 03812
    80 03812
    80 03812
    80 03812
    80 04446
    80 04446
    80 04446
    80 04446
    80 05139
    80 05139
    80 05248
    80 06839
    80 07991

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    1 HEART
    1 HEART

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    81 03889
    81 03889
    81 03889
    81 03889
    81 03889
    81 03889.1
    81 03889.1
    81 03889.1
    81 03889.2
    81 03889.2
    81 03889.2
    81 03889.2
    81 03889.2
    81 04891
    81 04891
    81 05740
    81 05740
    81 06518
    81 06518
    81 06518
    81 07263
    81 07263
    81 07264

    1 BONE & CARTILAGE DISORDER


    HOSPITAL LOCAL ROOM
    2 BONE & CARTILAGE DISORDER
    HOSPITAL LOCAL ROOM
    3 BONE & CARTILAGE DISORDER
    HOSPITAL MISC-LOCAL
    4 BONE & CARTILAGE DISORDER
    SURGICAL ANAESTHESIA
    5 BONE & CARTILAGE DISORDER
    SURGICAL INPATIENT
    1 BONE & CARTILAGE DISORDER
    OTHER
    2 BONE & CARTILAGE DISORDER
    OTHER
    3 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 BONE & CARTILAGE DISORDER
    PHYSICIAN VISIT-OFFICE
    2 BONE & CARTILAGE DISORDER
    PHYSICIAN VISIT-OFFICE
    3 BONE & CARTILAGE DISORDER
    DIAGNOSTIC LABORATORY
    4 BONE & CARTILAGE DISORDER
    DIAGNOSTIC X-RAY
    5 BONE & CARTILAGE DISORDER
    OTHER
    1 BACK PAIN
    PHYSICIAN VISIT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    PHYSICIAN VISIT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1
    SPECIALIST CNSLT-OFFICE
    2
    DIAGNOSTIC X-RAY
    3
    OTHER
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    1 RADICULOPATHY INFLAME NERVE
    SPECIALIST
    ROOT CNSLT-OFFICE

    82 04859
    82 04859
    82 04859
    82 04859
    82 04859.1
    82 04859.2
    82 04859.2
    82 04859.2
    82 05387
    82 05387
    82 05387
    82 05387
    82 05387
    82 05387
    82 05387.1

    1
    1
    2
    2
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    3 HYPERTENSION
    1 EAR DYSFUNCTION

    80 Total

    81 Total
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    82 05387.1
    82 05387.2
    82 05387.2
    82 05387.3
    82 05387.3
    82 05387.3
    82 05387.4
    82 05387.5
    82 06174

    1 EAR DYSFUNCTION
    DIAGNOSTIC LABORATORY
    1 PROSTATE
    DIAGNOSTIC LABORATORY
    1 PROSTATE
    DIAGNOSTIC LABORATORY
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    DIAGNOSTIC LABORATORY
    3 HYPERTENSION
    DIAGNOSTIC X-RAY
    1 EAR DYSFUNCTION
    DIAGNOSTIC LABORATORY
    1 PROSTATE
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE

    83 04071
    83 04071
    83 04071
    83 04605
    83 04605
    83 04605
    83 05881
    83 05881
    83 05881
    83 05921
    83 05921
    83 07523
    83 07523
    83 07523.1

    1 HEADACHE- MIGRAINE TENSION


    PHYSICIAN VISIT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-ORAL DRUGS
    3 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-ORAL DRUGS
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    MISC OUT HOSP-ORAL DRUGS
    3 FEVER
    MISC OUT HOSP-OTHER
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    MISC OUT HOSP-INJECTABLES
    3 FEVER
    MISC OUT HOSP-ORAL DRUGS
    1 FEVER
    MISC OUT HOSP-OTHER
    2 FEVER
    MISC OUT HOSP-INJECTABLES
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS

    84 04377
    84 04377
    84 04377
    84 04378
    84 04378
    84 08027.1
    84 08027.1
    84 08027.1
    84 08637
    84 08637
    84 08637
    84 08637

    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    85 07590
    85 07590
    85 07590

    1 INJURY - OPEN WOUND


    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND

    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS

    86 04606
    86 05922
    86 05922
    86 05922
    86 05922
    86 05922
    86 05922.1
    86 05923
    86 05923
    86 05923
    86 05923

    1 VISION CARE
    VISION CARE
    1 ADENOTONSILLITIS ALLERGIC
    SPECIALIST CNSLT-OFFICE
    2 ADENOTONSILLITIS ALLERGIC
    MISC OUT HOSP-OTHER
    3 ADENOTONSILLITIS ALLERGIC
    MISC OUT HOSP-INJECTABLES
    4 ADENOTONSILLITIS ALLERGIC
    MISC OUT HOSP-ORAL DRUGS
    5 ADENOTONSILLITIS ALLERGIC
    MISC OUT HOSP-ORAL DRUGS
    1 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE

    82 Total

    83 Total

    84 Total

    85 Total

    86 05923
    86 06286
    86 07591
    86 07591
    86 07591
    86 07591
    86 08411
    86 08411
    86 08411
    86 08412
    86 08412

    5 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND
    4 INJURY - OPEN WOUND
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    87 03490
    87 03490
    87 03490

    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY

    88 04092
    88 04092
    88 04092
    88 06838

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    89 04379
    89 04379
    89 05342
    89 05342
    89 06515
    89 06515
    89 08408
    89 08408
    89 08408
    89 08409
    89 08409
    89 08409
    89 08409.1

    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    90 06026
    90 06027
    90 06027
    90 06027
    90 06027
    90 06027
    90 06408
    90 06408
    90 07863

    1 OVARIAN CYST
    1
    2
    3
    4
    5
    1
    2
    1 PAIN-BACK/SHOULDER

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSIOTHERAPY
    OTHER
    PHYSICIAN VISIT-OFFICE

    91 06890
    91 06890
    91 06890

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    92 07406

    1 BACK PAIN

    PHYSICIAN VISIT-OFFICE

    93 05675
    93 05675

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    86 Total

    87 Total

    88 Total

    89 Total

    90 Total

    91 Total
    92 Total

    93 05675
    93 06728
    93 06728

    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE

    VISION CARE
    DENTAL CARE
    DENTAL CARE

    94 04843
    94 04843
    94 04843
    94 04843.1
    94 06837
    94 06837

    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    1 DILATION & CURRETAGE
    1 BACK PAIN
    2 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSIOTHERAPY
    OTHER

    95 03727
    95 03727
    95 03727
    95 03727.1
    95 03884
    95 03884
    95 03884
    95 03884
    95 03885
    95 03885
    95 04226
    95 04226
    95 04226.1
    95 04227
    95 04227.1
    95 04435
    95 04435
    95 05739
    95 06279
    95 07144
    95 08346
    95 08633

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 PROSTATE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 PROSTATE
    2 PROSTATE
    1 HEART
    1 PROSTATE
    1 DIAB'ETES
    1 SINUSITIS
    2 SINUSITIS
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    96 04279
    96 04279

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    97 07261

    1 DENTAL CARE

    DENTAL CARE

    98 08143
    98 08143

    1 INJURY - UNSPECIFIED
    2 INJURY - UNSPECIFIED

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    99 07143
    99 07143
    99 07143
    99 07143
    99 07258

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DILATION & CURRETAGE
    1 HYPERTENSION

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    93 Total

    94 Total

    95 Total

    96 Total
    97 Total

    98 Total

    99 Total
    100 04440
    100 04440
    100 04440
    100 04442
    100 04442.1

    100 04442.2
    100 04442.3
    100 06545

    1 CYSTITIS
    1 ANAEMIA
    1 MUSCULAR PAIN

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    101 04290
    101 04290
    101 04290
    101 04290
    101 04290
    101 08743

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    102 03887
    102 05044
    102 05044
    102 05138
    102 05470
    102 05470
    102 05470.1
    102 06331
    102 06811
    102 06811
    102 06811
    102 06811
    102 07145
    102 07145
    102 07145
    102 07145.1

    1 HYPERTENSION
    1 TENDONITIS
    2 TENDONITIS
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 TENDONITIS
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    103 04940
    103 04940

    1 OTITIS - EAR
    2 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    104 04884
    104 04884
    104 04884

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    105 03532
    105 03880
    105 03880
    105 03880
    105 05014
    105 05014
    105 05015
    105 05015
    105 05173
    105 05173
    105 05371
    105 05371
    105 06105
    105 06809
    105 08744
    105 08744
    105 08745
    105 08745

    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 BACK PAIN
    2 BACK PAIN
    1 DENTAL CARE
    1 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    100 Total

    101 Total

    102 Total

    103 Total

    104 Total

    105 Total
    106 04890
    106 04890

    1 BREAST DISORDERS
    2 BREAST DISORDERS

    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE

    107 05880

    1 LARYNGITIS

    SPECIALIST CNSLT-OFFICE

    108 03492
    108 03492
    108 03493
    108 03493
    108 03493
    108 04528
    108 04528
    108 05700
    108 05700
    108 05700
    108 06968
    108 06968.1
    108 06968.1
    108 06968.1
    108 06968.1
    108 06968.1
    108 07259
    108 07259
    108 07323
    108 07323
    108 07324
    108 07324
    108 07324.1
    108 07324.1
    108 07324.1
    108 07324.2
    108 07324.2
    108 07522
    108 07522
    108 07522
    108 07522

    1 DENTAL CARE
    2 DENTAL CARE
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 VISION CARE
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    4 INGROWING TOE NAIL
    5 INGROWING TOE NAIL
    1 DENTAL CARE
    2 DENTAL CARE
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1 HEART
    2 HEART
    3 HEART
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE

    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    109 04106
    109 06641

    1 CANCER-BREAST
    1 CANCER-BREAST

    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE

    110 06660
    110 06660
    110 06660
    110 06660

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    111 05984
    111 05984
    111 05984
    111 05984
    111 07586
    111 07586
    111 08029

    1
    2
    3
    4
    1
    2
    1

    106 Total
    107 Total

    108 Total

    109 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    110 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    111 Total
    112 03638
    112 04858

    1 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    113 06745
    113 06745
    113 06745

    1 ALLERGY
    2 ALLERGY
    3 ALLERGY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    114 08407
    114 08407

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    115 04439
    115 04439
    115 06991
    115 06991

    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    116 04363
    116 04363
    116 08274
    116 08274

    1 VISION CARE
    2 VISION CARE
    1 PAINFUL LEGS
    2 PAINFUL LEGS

    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    117 05247
    117 06597
    117 06597
    117 06597
    117 06597.1
    117 06658

    1 EYE DISORDER
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 PHARYNGITIS
    1 DENTAL CARE

    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    118 05168
    118 05168
    118 05168
    118 05168
    118 05168

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    119 07320
    119 07320
    119 07502
    119 07502
    119 07698
    119 08320
    119 08320

    1 THYROID
    2 THYROID
    1 THYROID
    2 THYROID
    1 THYROID
    1 THYROID
    2 THYROID

    MISC
    MISC
    MISC
    MISC
    MISC
    MISC
    MISC

    120 04760
    120 04760
    120 04760
    120 04760

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    121 03737
    121 03737
    121 03879
    121 03879
    121 03879
    121 05019

    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BARTHOLIN'S CYST

    112 Total

    113 Total

    114 Total

    115 Total

    116 Total

    117 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    118 Total
    OUT
    OUT
    OUT
    OUT
    OUT
    OUT
    OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    119 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    120 Total
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE

    121 05019
    121 05388
    121 05388
    121 05504

    2 BARTHOLIN'S CYST
    DIAGNOSTIC LABORATORY
    1
    SPECIALIST CNSLT-OFFICE
    2
    MISC OUT HOSP-INJECTABLES
    1 BONE & CARTILAGE DISORDER
    PHYSICIAN VISIT-OFFICE

    122 06100
    122 06100
    122 06100
    122 06100
    122 06891
    122 06891
    122 07043
    122 07043
    122 07043.1
    122 07407
    122 08280
    122 08280
    122 08280
    122 08467
    122 08467

    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1
    2
    1
    1 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN

    123 03609
    123 03609
    123 03609.1
    123 03609.1
    123 05502
    123 05502
    123 05879
    123 05879
    123 06656
    123 06656
    123 06656.1
    123 07400
    123 07400.1
    123 07400.1
    123 08273
    123 08273

    1 OVARIAN CYST
    PHYSICIAN VISIT-OFFICE
    2 OVARIAN CYST
    DIAGNOSTIC LABORATORY
    1 THYROID
    DIAGNOSTIC LABORATORY
    2 THYROID
    SPECIALIST CNSLT-OFFICE
    1 HEADACHE- MIGRAINE TENSION
    PHYSICIAN VISIT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    DIAGNOSTIC LABORATORY
    1 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    2 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 BURSITIS
    SPECIALIST CNSLT-OFFICE
    2 BURSITIS
    DIAGNOSTIC LABORATORY
    1 THYROID
    DIAGNOSTIC LABORATORY
    1 BURSITIS
    PHYSICIAN VISIT-OFFICE
    1 THYROID
    PHYSICIAN VISIT-OFFICE
    2 THYROID
    DIAGNOSTIC LABORATORY
    1 ARTHRITIS
    SPECIALIST CNSLT-OFFICE
    2 ARTHRITIS
    DIAGNOSTIC LABORATORY

    124 04438
    124 07405
    124 07405
    124 08679

    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 SKIN - ECZEMA

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    125 05372
    125 05372

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    126 07521
    126 07521
    126 07521
    126 07521
    126 07521.1

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY

    127 07412

    1 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE

    121 Total
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSIOTHERAPY
    SPECIALIST CNSLT-OFFICE

    122 Total

    123 Total

    124 Total

    125 Total

    126 Total

    127 07412
    127 07412
    127 07412
    127 07412

    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    128 08410
    128 08410

    1 PHIMOSIS
    2 PHIMOSIS

    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT

    129 06657
    129 06657

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY

    130 06636

    1 VISION CARE

    VISION CARE

    131 07339
    131 07339

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    132 06339
    132 06339
    132 06339.1

    1 TENDONITIS
    2 TENDONITIS
    1 SINUSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    133 07588
    133 07588
    133 07589

    1 MISCARRIAGE
    2 MISCARRIAGE
    1 SKIN - ECZEMA

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE

    134 07531
    134 07531
    134 07531
    134 07531.1
    134 08954

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 HYPERTENSION
    1 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY

    135 04979
    135 04979
    135 04981
    135 04981
    135 05507
    135 05507
    135 05507
    135 05507.1
    135 05507.1
    135 05507.1
    135 05507.2
    135 06077
    135 06077
    135 06077.1
    135 06077.1
    135 07505
    135 07505
    135 08247

    1 BREAST DISORDERS
    PHYSICIAN VISIT-OFFICE
    2 BREAST DISORDERS
    DIAGNOSTIC X-RAY
    1 HEADACHE- MIGRAINE TENSION
    PHYSICIAN VISIT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    DIAGNOSTIC LABORATORY
    1 CHEST PAIN
    PHYSICIAN VISIT-OFFICE
    2 CHEST PAIN
    DIAGNOSTIC LABORATORY
    3 CHEST PAIN
    DIAGNOSTIC LABORATORY
    1
    PREVENTATIVE
    2
    PREVENTATIVE
    3
    PREVENTATIVE
    1 ALLERGIC RHINITIS
    MISC OUT HOSP-ORAL DRUGS
    1 GLAUCOMA
    SPECIALIST CNSLT-OFFICE
    2 GLAUCOMA
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 EYE DISORDER
    PHYSICIAN VISIT-OFFICE
    2 EYE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE

    136 04169
    136 04169
    136 04170
    136 04987

    1 DENTAL
    2 DENTAL
    1 DENTAL
    1 DENTAL

    127 Total

    128 Total

    129 Total
    130 Total

    131 Total

    132 Total

    133 Total

    134 Total

    135 Total
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    136 04987
    136 04987
    136 05893
    136 05894
    136 06012

    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1
    PREVENTATIVE
    1 DENTAL CARE
    DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE

    137 08378
    137 08378
    137 08378
    137 08379

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE

    138 04986
    138 04986
    138 04986

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    139 04984
    139 04984
    139 04984
    139 04984
    139 08254
    139 08254
    139 08254
    139 08254
    139 08856
    139 08856

    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 BARTHOLIN'S CYST
    SPECIALIST CNSLT-OFFICE
    2 BARTHOLIN'S CYST
    DIAGNOSTIC LABORATORY
    3 BARTHOLIN'S CYST
    DIAGNOSTIC X-RAY
    4 BARTHOLIN'S CYST
    MISC OUT HOSP-ORAL DRUGS
    1 HORMONE REPLACMENT THERAPY
    SPECIALIST CNSLT-OFFICE
    2 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC X-RAY

    140 03947
    140 05776
    140 05776
    140 05776
    140 08246

    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE

    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE

    141 07166
    141 07166
    141 08948
    141 08948
    141 08948.1
    141 08948.1
    141 08949
    141 08949
    141 08949
    141 08950
    141 08950
    141 08950
    141 08951
    141 08951

    1 OVARIAN CYST
    2 OVARIAN CYST
    1 FEVER
    2 FEVER
    1 HEART
    2 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALOPECIA
    2 ALOPECIA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    142 03811
    142 03811
    142 03811
    142 05777
    142 05777
    142 05777

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    136 Total

    137 Total

    138 Total

    139 Total

    140 Total

    141 Total

    142 05777.1
    142 06103

    1 ALLERGIC REACTION
    1 ALLERGIC REACTION

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE

    143 08186
    143 08186
    143 08186
    143 08186
    143 08186

    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART

    HOSPITAL LOCAL ROOM


    HOSPITAL INTENSIVE CARE
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA

    144 05779
    144 05779

    1 BREAST DISORDERS
    2 BREAST DISORDERS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    145 07876
    145 07876
    145 07876
    145 07876
    145 07876
    145 07876.1
    145 07876.1

    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS

    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    146 04167
    146 04167
    146 04167
    146 04985
    146 04985
    146 05223
    146 05223
    146 06684
    146 06684

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL
    1 CYST
    2 CYST
    1 DENTAL
    2 DENTAL

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    147 08381
    147 08381
    147 08382
    147 08382
    147 08382
    147 08382
    147 08382
    147 08857

    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    148 04160
    148 04160
    148 06281.1
    148 06281.1
    148 06281.1
    148 06281.1
    148 06281.1
    148 08248
    148 08248
    148 08248
    148 08248

    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1
    2
    3
    4
    5
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    149 04159
    149 04159

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    142 Total

    143 Total

    144 Total

    145 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE

    146 Total

    147 Total

    148 Total

    149 Total
    150 08728
    150 08729
    150 08729

    1 DEVIATED NASAL SEPTUM


    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    151 03944
    151 03944
    151 03944
    151 04164
    151 04164
    151 04164
    151 04164
    151 04164.1
    151 04166
    151 05508
    151 05508
    151 05508
    151 05508
    151 06011
    151 06011
    151 06035
    151 06035
    151 06035
    151 06035

    1 THYROID
    2 THYROID
    3 THYROID
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    1 SKIN - ATOPIC DERMATITIS
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    152 04356
    152 04356

    1
    2

    PREVENTATIVE
    PREVENTATIVE

    153 04359
    153 04359.1
    153 04988
    153 04988
    153 04988
    153 07879.1
    153 07879.1
    153 08956
    153 08956.1

    1
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 SKIN - ECZEMA
    1

    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE

    154 08380
    154 08380

    1 OTITIS - EAR
    2 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    155 03810
    155 03810
    155 05780
    155 05780
    155 05780
    155 08252
    155 08252
    155 08252.1
    155 08252.1

    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 TENDONITIS
    PHYSICIAN VISIT-OFFICE
    2 TENDONITIS
    MISC OUT HOSP-INJECTABLES

    156 08952

    1 VISION CARE

    150 Total

    151 Total

    152 Total

    153 Total

    154 Total

    155 Total
    156 Total

    VISION CARE

    157 04526
    157 04527
    157 04527.1
    157 08255
    157 08256
    157 08256.1

    1 OVARIAN CYST
    1 RECTAL ABCESS
    1
    1 FRACTURE - HAND BONES
    1 EAR DYSFUNCTION
    1

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE

    158 08375
    158 08375
    158 08375
    158 08375
    158 08375
    158 08375.1

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    159 04168
    159 07506
    159 07506
    159 08257
    159 08257
    159 08257
    159 08426
    159 08426
    159 08426

    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    3

    160 04162
    160 04163
    160 04163
    160 07378
    160 07378
    160 07378

    1
    PREVENTATIVE
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE

    161 04978
    161 04978
    161 04978

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION

    162 06682
    162 06682
    162 06682
    162 06682
    162 06682
    162 06682.1

    1 BONE
    2 BONE
    3 BONE
    4 BONE
    5 BONE
    1 BONE

    163 08953
    163 08953
    163 08953.1

    1 GASTRIC - PEPTIC ULCER/GERD


    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 ALLERGIC RHINITIS
    MISC OUT HOSP-ORAL DRUGS

    164 03809
    164 03809

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    165 06685
    165 06685
    165 06685
    165 06685

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    157 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    158 Total
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    159 Total

    160 Total
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    161 Total
    &
    &
    &
    &
    &
    &

    CARTILAGE
    CARTILAGE
    CARTILAGE
    CARTILAGE
    CARTILAGE
    CARTILAGE

    DISORDER
    PHYSICIAN VISIT-OFFICE
    DISORDER
    MISC OUT HOSP-ORAL DRUGS
    DISORDER
    SURGICAL INPATIENT
    DISORDER
    SURGICAL ANAESTHESIA
    DISORDER
    HOSPITAL LOCAL ROOM
    DISORDER
    HOSPITAL MISC-LOCAL

    162 Total

    163 Total

    164 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    165 Total
    166 06681

    1 ASTHMA

    PHYSICIAN VISIT-OFFICE

    167 08250
    167 08251
    167 08251
    167 08251
    167 08251
    167 08251

    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    168 04161
    168 04161
    168 04357
    168 04358
    168 04982
    168 04982
    168 04982.1
    168 04983
    168 04983

    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DEPRESSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    169 06133
    169 06133
    169 06134
    169 06134

    1 VISION
    2 VISION
    1 VISION
    2 VISION

    VISION
    VISION
    VISION
    VISION

    170 07464
    170 07465
    170 07881
    170 07881

    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE

    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE

    171 05481
    171 05481
    171 05481

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    172 05271
    172 05272
    172 05272
    172 05273

    1 DEVIATED NASAL SEPTUM


    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE

    173 03496
    173 03496
    173 06135
    173 06135
    173 06137
    173 06138
    173 07273
    173 07274
    173 07275
    173 07275.1
    173 07275.1

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 BEHAVIOURIAL PROBLEMS
    2 BEHAVIOURIAL PROBLEMS
    1 ABDOMINAL PAINS
    1 DEVIATED NASAL SEPTUM
    1 TONSILLITIS
    1 ANAEMIA
    1 ANAEMIA
    1 ANAEMIA
    2 ANAEMIA

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    174 04627
    174 04627

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    166 Total

    167 Total

    168 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    169 Total

    170 Total

    171 Total

    172 Total

    173 Total

    174 04627
    174 04627
    174 04627
    174 04721
    174 04721
    174 04721

    3 DEVIATED NASAL SEPTUM


    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    3 FEVER

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    175 06036
    175 06036
    175 06036
    175 06036
    175 06036

    1 INTESTINAL
    2 INTESTINAL
    3 INTESTINAL
    4 INTESTINAL
    5 INTESTINAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    176 07656
    176 07656
    176 07656

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    177 07487
    177 07487
    177 07487
    177 07487

    1 VISION
    2 VISION
    3 VISION
    4 VISION

    VISION
    VISION
    VISION
    VISION

    178 05270
    178 05270
    178 05270
    178 07655
    178 07655
    178 07655
    178 07655
    178 07655

    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    179 06976
    179 06976
    179 06976
    179 07880
    179 07880
    179 07880
    179 07880
    179 08159
    179 08159

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    180 03619
    180 03619
    180 03619
    180 04628
    180 04628
    180 04628
    180 04628
    180 04628
    180 06037
    180 06037
    180 06037
    180 06037

    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    5 ASTHMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    174 Total
    COLIC
    COLIC
    COLIC
    COLIC
    COLIC

    175 Total

    176 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    177 Total

    178 Total

    179 Total

    180 06037
    180 06037.1

    5 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    181 04463.1
    181 04463.1
    181 04463.1
    181 04464

    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    182 08213
    182 08213
    182 08213

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    183 03699
    183 03699
    183 07193
    183 07193

    1 EYE DISORDER
    2 EYE DISORDER
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    184 03680
    184 03680
    184 03681
    184 03681
    184 03681
    184 04449
    184 04449
    184 07170
    184 07170

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    185 05954
    185 05954
    185 05954

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    186 05109
    186 05109
    186 05109
    186 05110
    186 05110

    1 ABDOMINAL PAINS
    PHYSICIAN VISIT-OFFICE
    2 ABDOMINAL PAINS
    DIAGNOSTIC LABORATORY
    3 ABDOMINAL PAINS
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY

    187 04448
    187 04448
    187 04448
    187 04448.1
    187 04448.1
    187 07724
    187 07724
    187 07724
    187 07724

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 HEART
    2 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    188 04450
    188 04450
    188 05051
    188 05051
    188 05051
    188 05052

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    180 Total

    181 Total

    182 Total

    183 Total

    184 Total

    185 Total

    186 Total

    187 Total

    188 05052
    188 05052

    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    189 05512
    189 05512
    189 05512
    189 06362
    189 06362
    189 07725
    189 07725
    189 07725

    1
    2
    3
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    190 03686
    190 03686
    190 03686.1
    190 03686.1
    190 06758
    190 06758
    190 06758.1

    1 DIAB'ETES
    2 DIAB'ETES
    1
    2
    1 DIAB'ETES
    2 DIAB'ETES
    1 SKIN - ECZEMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    191 05055

    1 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE

    192 04453
    192 04453
    192 04453
    192 04453
    192 04453.1
    192 04453.1
    192 04453.1

    1 ABDOMINAL
    1 ABDOMINAL
    3 ABDOMINAL
    3 ABDOMINAL
    1 ABDOMINAL
    2 ABDOMINAL
    3 ABDOMINAL

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    193 03714
    193 03714
    193 03715
    193 03715
    193 03715
    193 03717
    193 03717

    1 ACUTE ENTERITIS
    PHYSICIAN VISIT-OFFICE
    2 ACUTE ENTERITIS
    MISC OUT HOSP-INJECTABLES
    1 BRONCHITIS - ACUTE
    PHYSICIAN VISIT-OFFICE
    2 BRONCHITIS - ACUTE
    MISC OUT HOSP-ORAL DRUGS
    3 BRONCHITIS - ACUTE
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-INJECTABLES

    194 05514
    194 05514
    194 05514
    194 05514

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    195 04457
    195 04457
    195 04457
    195 04457
    195 06368
    195 06368
    195 06368
    195 08192
    195 08192

    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    188 Total

    189 Total

    190 Total
    191 Total
    PAINS
    PAINS
    PAINS
    PAINS
    PAINS
    PAINS
    PAINS

    192 Total

    193 Total
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    194 Total

    195 Total

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    196 03684

    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE

    197 04455
    197 04455
    197 04455.1
    197 05941
    197 05941
    197 05941

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    198 05111
    198 05111
    198 05111

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    199 04458

    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE

    200 07171
    200 07171
    200 07171

    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    201 03685
    201 03685.1

    1 HYPERTENSION
    1 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    202 03687
    202 04461
    202 05516
    202 06759
    202 06759
    202 06759
    202 06759
    202 06760
    202 06760
    202 06760
    202 06760
    202 08194
    202 08194
    202 08195
    202 08195

    1 SINUSITIS
    1 ALLERGIC RHINITIS
    1 ALLERGY
    1 LACERATION TO FOOT
    2 LACERATION TO FOOT
    3 LACERATION TO FOOT
    4 LACERATION TO FOOT
    1
    2
    3
    4
    1 CHEST PAIN
    2 CHEST PAIN
    1 OTITIS - EAR
    2 OTITIS - EAR

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    SURGICAL INPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE

    203 05515
    203 05515

    1 BONE & CARTILAGE DISORDER


    PHYSICIAN VISIT-OFFICE
    2 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-ORAL DRUGS

    204 05056
    204 05056
    204 05056
    204 05056.1

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 CONSTIPATION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    205 05948
    205 05948
    205 05948
    205 05948
    205 05948
    205 05948.1
    205 05948.1

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    196 Total

    197 Total

    198 Total
    199 Total

    200 Total

    201 Total

    202 Total

    203 Total

    204 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    205 Total
    206 05048
    206 05048
    206 05048
    206 05049
    206 05049
    206 05939
    206 05939
    206 05939
    206 05939
    206 05939
    206 05939.1
    206 06757
    206 06757
    206 06757.1
    206 06757.1
    206 08187

    1 CHEST PAIN
    PHYSICIAN VISIT-OFFICE
    2 CHEST PAIN
    MISC OUT HOSP-INJECTABLES
    3 CHEST PAIN
    DIAGNOSTIC X-RAY
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    MISC OUT HOSP-INJECTABLES
    1 HORMONE REPLACMENT THERAPY
    PHYSICIAN VISIT-OFFICE
    2 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC LABORATORY
    3 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC X-RAY
    4 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC LABORATORY
    5 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC X-RAY
    1 HORMONE REPLACMENT THERAPY
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    PHYSICIAN VISIT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 AMMENORRHOEA
    MISC OUT HOSP-ORAL DRUGS

    207 06366
    207 06366

    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    208 03708
    208 03709
    208 04492
    208 04493
    208 05157
    208 05158
    208 05158
    208 06398
    208 06776
    208 08228

    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 OVARIAN CYST
    1 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    209 05059
    209 05059
    209 05059
    209 06370
    209 06370

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    210 08199
    210 08199.1
    210 08199.2

    1 PAIN-BACK/SHOULDER
    1 FEVER
    1 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    211 08197
    211 08197.1
    211 08197.2

    1 RENAL DYSFUNCTION
    1 FEVER
    1 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    212 07177
    212 07177

    1 EYE DISORDER
    2 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    213 05062
    213 05062
    213 05300
    213 05300

    1 SINUSITIS
    2 SINUSITIS
    1 BACK PAIN
    2 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    206 Total

    207 Total

    208 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    209 Total

    210 Total

    211 Total

    212 Total

    213 Total
    214 04460
    214 04460
    214 04460.1
    214 04460.1
    214 04460.1
    214 04460.2
    214 04460.2
    214 08193
    214 08193

    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE


    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    3 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS

    215 03701
    215 03701
    215 03701.1
    215 03702
    215 05531
    215 05531

    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE

    216 05528
    216 05528
    216 05528
    216 07191
    216 07739
    216 07739
    216 07739
    216 08212

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE

    217 07176
    217 07176

    1 SKIN - LOCAL INFECTION


    2 SKIN - LOCAL INFECTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    218 05050
    218 05050
    218 05050
    218 05937
    218 05937
    218 05938.1
    218 05938.1
    218 06756
    218 06756
    218 07167
    218 07167
    218 07167
    218 07167
    218 07168
    218 07168
    218 07168
    218 07168
    218 08188
    218 08188

    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 VARICOSE
    2 VARICOSE
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 VARICOSE
    2 VARICOSE
    1
    2
    3
    4
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    1 VARICOSE
    2 VARICOSE

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    219 05455
    219 05455
    219 05455.1

    1
    2
    1 TONSILLITIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    214 Total

    215 Total

    216 Total

    217 Total

    218 Total

    219 06374
    219 06374.1
    219 06374.1

    1 HYPERTENSION
    1
    2

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    220 04462
    220 04462
    220 06369
    220 06369
    220 06369
    220 06369.1
    220 06369.1
    220 07728

    1 AMMENORRHOEA
    PHYSICIAN VISIT-OFFICE
    2 AMMENORRHOEA
    DIAGNOSTIC LABORATORY
    1 HORMONE REPLACMENT THERAPY
    PHYSICIAN VISIT-OFFICE
    2 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC LABORATORY
    3 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC X-RAY
    1 KNEE INTERNAL DERANGEMENT
    PHYSICIAN VISIT-OFFICE
    2 KNEE INTERNAL DERANGEMENT
    DIAGNOSTIC X-RAY
    1 ENDOMETROSIS
    PHYSICIAN VISIT-OFFICE

    221 06360
    221 06360
    221 06360

    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC

    222 03621
    222 03621
    222 03621
    222 03621
    222 03621.1
    222 03621.1

    1 HEADACHE1 HEADACHE2 HEADACHE2 HEADACHE1 HEADACHE2 HEADACHE-

    223 04490
    223 04490
    223 04490
    223 05156
    223 05156
    223 06774
    223 06774
    223 06774
    223 07756
    223 07756
    223 08226
    223 08226

    1 GASTRIC - PEPTIC ULCER/GERD


    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    3 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 CHEST PAIN
    PHYSICIAN VISIT-OFFICE
    2 CHEST PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 HEART- ISCHEMIC HEART DISEASE
    PHYSICIAN VISIT-OFFICE
    2 HEART- ISCHEMIC HEART DISEASE
    DIAGNOSTIC LABORATORY
    3 HEART- ISCHEMIC HEART DISEASE
    MISC OUT HOSP-ORAL DRUGS
    1 TONSILLITIS
    PHYSICIAN VISIT-OFFICE
    2 TONSILLITIS
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    PHYSICIAN VISIT-OFFICE
    2 HEART
    MISC OUT HOSP-ORAL DRUGS

    224 03705
    224 03705
    224 03705

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    225 06761
    225 06761
    225 06762

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 ALLERGIC REACTION

    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    DIAGNOSTIC X-RAY

    226 05161
    226 05161
    226 05161
    226 05161

    1 VISION
    2 VISION
    3 VISION
    4 VISION

    VISION
    VISION
    VISION
    VISION

    227 03691
    227 03691
    227 03691

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    219 Total

    220 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    221 Total
    MIGRAINE
    MIGRAINE
    MIGRAINE
    MIGRAINE
    MIGRAINE
    MIGRAINE

    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    DIAGNOSTIC X-RAY
    TENSION
    DIAGNOSTIC X-RAY
    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    DIAGNOSTIC X-RAY

    222 Total

    223 Total

    224 Total

    225 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    226 Total
    VISION CARE
    VISION CARE
    VISION CARE

    227 Total
    228 05112
    228 05113
    228 05114
    228 05114
    228 05114
    228 05114
    228 05114
    228 05114.1

    1 DENTAL
    1 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    229 03694

    1 OTITIS - EAR

    230 05148
    230 05148
    230 05148

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS

    231 07179
    231 07179
    231 07179

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    232 05153
    232 05153
    232 05153
    232 05538
    232 05538

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 URTICARIA
    2 URTICARIA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    233 07172

    1 DEPRESSION

    PHYSICIAN VISIT-OFFICE

    234 05956

    DIAGNOSTIC LABORATORY

    235 03692
    235 03692
    235 03692
    235 07183
    235 07183
    235 07183
    235 07183
    235 07183
    235 07183.1
    235 07186
    235 07186

    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    236 06375
    236 06375
    236 06375

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    237 06765
    237 06765

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS

    238 06769
    238 06769
    238 06769
    238 06769

    1 INGROWING
    2 INGROWING
    3 INGROWING
    4 INGROWING

    228 Total
    MISC OUT HOSP-ORAL DRUGS

    229 Total

    230 Total

    231 Total

    232 Total
    233 Total
    234 Total

    235 Total

    236 Total

    237 Total
    TOE
    TOE
    TOE
    TOE

    NAIL
    NAIL
    NAIL
    NAIL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    238 Total
    239 03711
    239 03711

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    240 05061
    240 07175
    240 07175
    240 07175

    1 DEVIATED NASAL SEPTUM


    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    241 07734
    241 07734

    1 BONE & CARTILAGE DISORDER


    PHYSICIAN VISIT-OFFICE
    2 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-INJECTABLES

    242 04483
    242 04484
    242 04484
    242 05537
    242 05537

    1 GLAUCOMA
    1 FEVER
    2 FEVER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    243 08198
    243 08198
    243 08198

    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    244 08206
    244 08206

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    245 05942
    245 05942
    245 07174
    245 07174
    245 07174
    245 07730
    245 07730
    245 07730
    245 07730
    245 07730

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    246 03718
    246 03719
    246 04500
    246 04500
    246 04500

    1 VISION
    1 VISION
    1 VISION
    2 VISION
    3 VISION

    VISION
    VISION
    VISION
    VISION
    VISION

    247 06387
    247 06387
    247 06387
    247 06486
    247 07182
    247 07182

    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    3 CERVICAL STRAIN
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE

    248 06775
    248 06775
    248 06775

    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    239 Total

    240 Total

    241 Total

    242 Total

    243 Total

    244 Total

    245 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    246 Total

    247 Total

    248 Total

    249 05053
    249 05511
    249 05511
    249 06361
    249 06361

    1 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA

    MISC
    MISC
    MISC
    MISC
    MISC

    OUT
    OUT
    OUT
    OUT
    OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    250 05943
    250 05943
    250 05943

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    251 03690
    251 03690
    251 03690.1
    251 08200
    251 08200
    251 08200
    251 08201
    251 08201
    251 08201

    1 ABSCESS
    2 ABSCESS
    1 HYPERTENSION
    1
    2
    3
    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    252 06377
    252 06377

    1 DIAB'ETES
    2 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    253 04482
    253 04482
    253 04482
    253 04482
    253 04482.1
    253 04482.1

    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    1 HYPERTENSION
    2 HYPERTENSION

    254 05522
    254 05522
    254 05522

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    255 07198
    255 07198

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    256 07192
    256 07192

    1 CYSTITIS
    2 CYSTITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    257 08227
    257 08227
    257 08227
    257 08227
    257 08227.1

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    258 05517
    258 05517

    1 HEARING LOSS
    2 HEARING LOSS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER

    259 03693
    259 03693

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    260 03712

    1 CONSTIPATION

    PHYSICIAN VISIT-OFFICE

    249 Total

    250 Total

    251 Total

    252 Total
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    253 Total

    254 Total

    255 Total

    256 Total

    257 Total

    258 Total

    259 Total

    260 03712
    260 03712
    260 04497
    260 04497
    260 04497
    260 04497
    260 04497
    260 04497.1
    260 04499
    260 05542
    260 07211
    260 07212
    260 07212
    260 07212
    260 07212
    260 07757
    260 08229
    260 08229

    2 CONSTIPATION
    3 CONSTIPATION
    1 LARYNGITIS
    2 LARYNGITIS
    3 LARYNGITIS
    4 LARYNGITIS
    5 LARYNGITIS
    1 LARYNGITIS
    1 DENTAL CARE
    1 CONSTIPATION
    1 ALLERGIC RHINITIS
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    1 ENDOCRINE DISORDERS
    1 CONSTIPATION
    2 CONSTIPATION

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    261 03706
    261 03706
    261 04478
    261 04478
    261 04478

    1 FEVER
    2 FEVER
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    262 07732
    262 07732
    262 07732

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    263 05960
    263 05960
    263 05960
    263 05961
    263 05961
    263 05961
    263 07205
    263 07205.1
    263 07205.1

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    264 07761
    264 07761

    1 THYROID
    2 THYROID

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    265 05959
    265 05959
    265 05959
    265 05959

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    266 04468

    1 DENTAL CARE

    DENTAL CARE

    267 08205
    267 08205

    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    268 03700

    DIAGNOSTIC LABORATORY

    260 Total

    261 Total

    262 Total

    263 Total

    264 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    265 Total
    266 Total

    267 Total

    268 Total
    269 04489
    269 04489
    269 04489

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    270 06365
    270 06365
    270 06365
    270 06365

    1 CERVICAL
    2 CERVICAL
    3 CERVICAL
    4 CERVICAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    271 05121
    271 05121
    271 05121

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    272 03688
    272 03688
    272 03688

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    273 06766

    1 SKIN - ECZEMA

    MISC OUT HOSP-ORAL DRUGS

    274 04486
    274 04486
    274 05154
    274 05154
    274 05154
    274 05154.1
    274 05539
    274 05539
    274 05539
    274 07755
    274 07755
    274 07755

    1 BACK PAIN
    2 BACK PAIN
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 BACK PAIN
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    275 05953

    1 GLAUCOMA

    SURGICAL OUTPATIENT

    276 05957
    276 05957

    1 DIAB'ETES
    2 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    277 04909
    277 06385
    277 06386
    277 06978
    277 06978
    277 06978
    277 06978
    277 06978
    277 07882
    277 07882
    277 07882
    277 07882

    1 OTITIS - EAR
    1 VISION CARE
    1
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    5 DEVIATED NASAL
    1
    2
    3
    4

    MISC OUT HOSP-ORAL DRUGS


    OTHER
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    278 05525
    278 05525

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    269 Total
    STRAIN
    STRAIN
    STRAIN
    STRAIN

    270 Total

    271 Total

    272 Total
    273 Total

    274 Total
    275 Total

    276 Total

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    277 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    278 05525

    3 ABDOMINAL PAINS

    MISC OUT HOSP-ORAL DRUGS

    279 05521
    279 05521
    279 05521

    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL

    280 04472
    280 04472

    1 HYPERTENSION
    2 HYPERTENSION

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    281 07190
    281 07190
    281 07190
    281 07190
    281 08208

    1 CERVICAL
    2 CERVICAL
    3 CERVICAL
    4 CERVICAL
    1 CERVICAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    282 06379
    282 06379
    282 06379

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER

    283 06384
    283 06384.1
    283 06384.1

    1 HYPERTENSION
    1 SKIN - LESION
    2 SKIN - LESION

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    284 07208
    284 07208

    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    285 07203
    285 07203
    285 07203
    285 07203

    1 CHEST
    2 CHEST
    3 CHEST
    4 CHEST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY

    286 05952
    286 05952
    286 05952
    286 05952
    286 06383

    1 ABDOMINAL
    2 ABDOMINAL
    3 ABDOMINAL
    4 ABDOMINAL
    1 ABDOMINAL

    287 07754
    287 07754
    287 07754

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    288 06392
    288 06392
    288 06392

    1 INGROWING TOE NAIL


    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER

    289 07206
    289 07206

    1 CHEST PAIN
    2 CHEST PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    290 06363

    1 BONE & CARTILAGE DISORDER


    DIAGNOSTIC LABORATORY

    291 05117
    291 05117
    291 05117

    1 INFECTION - MALE GENITAL PHYSICIAN VISIT-OFFICE


    2 INFECTION - MALE GENITAL DIAGNOSTIC LABORATORY
    3 INFECTION - MALE GENITAL DIAGNOSTIC LABORATORY

    278 Total

    279 Total

    280 Total
    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS

    281 Total

    282 Total

    283 Total

    284 Total
    PAIN
    PAIN
    PAIN
    PAIN

    285 Total
    PAINS
    PAINS
    PAINS
    PAINS
    PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY

    286 Total

    287 Total

    288 Total

    289 Total
    290 Total

    291 06770

    1 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE

    292 06764
    292 06764
    292 06764
    292 06764.1

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    293 05054.1
    293 05054.1
    293 05054.1
    293 06364
    293 06364
    293 06364

    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    294 06763
    294 06763

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    295 05115
    295 05115
    295 05526
    295 05526
    295 05526

    1 CHlCKEN POX
    2 CHlCKEN POX
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE

    296 05060
    296 05060
    296 06372
    296 06372
    296 06372
    296 06373
    296 06373
    296 06373

    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    297 05940

    DIAGNOSTIC X-RAY

    298 03689
    298 03689
    298 03689

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    299 06367
    299 06367
    299 06367

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    300 05524
    300 05524

    1 BLOOD DISORDER
    2 BLOOD DISORDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    301 05155
    301 06773

    1 HYPERTENSION
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    302 07188
    302 07188
    302 07188

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    303 04466

    1 VISION CARE

    VISION CARE

    291 Total

    292 Total

    293 Total

    294 Total

    295 Total

    296 Total
    297 Total

    298 Total

    299 Total

    300 Total

    301 Total

    302 Total

    303 04466
    303 04466
    303 04467
    303 05518
    303 05944

    2 VISION CARE
    3 VISION CARE
    1 GLAUCOMA
    1 EYE DISORDER
    1 DENTAL CARE

    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE

    304 05520
    304 05520

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    305 05541
    305 05541

    1 BURSITIS
    2 BURSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    306 06380
    306 06380.1
    306 06380.1
    306 06381
    306 06381.1

    1 FEVER
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    1 VISION CARE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    307 05872
    307 05872
    307 07187
    307 07187

    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    308 07748
    308 07748
    308 07748

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PREVENTATIVE

    309 05955

    DIAGNOSTIC LABORATORY

    310 04488
    310 04488
    310 04488
    310 04488
    310 06772
    310 06772
    310 06772

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT

    311 04476
    311 04476
    311 04476

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    312 07758
    312 07758
    312 07758

    1 ALLERGY
    2 ALLERGY
    3 ALLERGY

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    313 05963

    1 ARTHRITIS

    PHYSICIAN VISIT-OFFICE

    314 06777
    314 07204
    314 07204
    314 07204
    314 07204

    1
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    303 Total

    304 Total

    305 Total

    306 Total

    307 Total

    308 Total
    309 Total

    310 Total

    311 Total

    312 Total
    313 Total

    314 Total

    CARE
    CARE
    CARE
    CARE

    315 04469

    DIAGNOSTIC LABORATORY

    316 07194
    316 07194

    1 MISCARRIAGE
    2 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    317 04473
    317 04473
    317 04473
    317 04473
    317 04473
    317 04473.1
    317 04473.1
    317 04473.1
    317 04473.1

    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    5 VARICOSE
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    318 07729
    318 07729
    318 07729
    318 07729

    1 VISION
    2 VISION
    3 VISION
    4 VISION

    VISION
    VISION
    VISION
    VISION

    319 03695
    319 03695
    319 03695
    319 03695
    319 03864
    319 03864
    319 03864
    319 03864
    319 03864
    319 06977
    319 06977

    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    4 VISION CARE
    VISION CARE
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    4 VISION CARE
    VISION CARE
    5 VISION CARE
    VISION CARE
    1 KNEE INTERNAL DERANGEMENT
    PHYSICIAN VISIT-OFFICE
    2 KNEE INTERNAL DERANGEMENT
    PHYSICIAN VISIT-OFFICE

    320 05118
    320 05118

    1 DIAB'ETES
    2 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    321 05119
    321 05119
    321 07740
    321 07740

    1 RENAL
    2 RENAL
    1 RENAL
    2 RENAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    322 04474
    322 05120
    322 05120
    322 05120

    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PREVENTATIVE
    VISION CARE
    VISION CARE
    VISION CARE

    323 05124
    323 05124
    323 05124
    323 07197
    323 07197

    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE

    324 05532
    324 05532

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    MISC OUT HOSP-OTHER


    DIAGNOSTIC LABORATORY

    315 Total

    316 Total

    317 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    318 Total

    319 Total

    320 Total
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION

    321 Total

    322 Total

    323 Total

    324 05532
    324 07726
    324 07727
    324 07727

    3 ABDOMINAL PAINS
    1 SINUSITIS
    1 FATIGUE
    2 FATIGUE

    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    325 07743
    325 07743
    325 07743
    325 07743
    325 07743
    325 07743.1
    325 07743.1
    325 07743.1

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    326 07745
    326 07745
    326 07746
    326 07746
    326 07746
    326 07746.1

    1 DENTAL CARE
    2 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 OTITIS - EAR

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    327 07747
    327 07747
    327 07747
    327 07747
    327 07747
    327 07747.1

    1 HORMONE
    2 HORMONE
    3 HORMONE
    4 HORMONE
    5 HORMONE
    1 HORMONE

    328 06771
    328 06771
    328 06771

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    329 07199
    329 07199
    329 07749
    329 07749

    1 STROKE
    2 STROKE
    1 STROKE
    2 STROKE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    330 05534
    330 05534
    330 05534
    330 05534
    330 05535
    330 05535
    330 05535
    330 05535
    330 05535.1
    330 05536
    330 05536
    330 05536
    330 05536
    330 07751
    330 07751
    330 07751

    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 CHOSTOCHRONDITIS
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    324 Total

    325 Total

    326 Total
    REPLACMENT
    REPLACMENT
    REPLACMENT
    REPLACMENT
    REPLACMENT
    REPLACMENT

    THERAPY
    PHYSICIAN VISIT-OFFICE
    THERAPY
    MISC OUT HOSP-INJECTABLES
    THERAPY
    PREVENTATIVE
    THERAPY
    DIAGNOSTIC LABORATORY
    THERAPY
    DIAGNOSTIC X-RAY
    THERAPY
    DIAGNOSTIC LABORATORY

    327 Total

    328 Total

    329 Total

    330 Total
    331 04494

    1 PSORIASIS

    PHYSICIAN VISIT-OFFICE

    332 05152
    332 05152
    332 05152
    332 05958
    332 05958
    332 08220
    332 08220

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    333 03707
    333 03707
    333 05540
    333 05540

    1
    2
    1 PAINFUL HEEL
    2 PAINFUL HEEL

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    334 04491
    334 04491
    334 04491
    334 04491
    334 06391
    334 06391

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 ARTHRITIS
    2 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    335 04471
    335 04471
    335 05116
    335 05116

    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    336 08189
    336 08189
    336 08189
    336 08189
    336 08189
    336 08189.1
    336 08189.1
    336 08190

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 SKIN - LESION

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    337 05162
    337 05162
    337 05162
    337 05162

    1 ALLERGIC
    2 ALLERGIC
    3 ALLERGIC
    4 ALLERGIC

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    338 07243
    338 07243

    1 BONE & CARTILAGE DISORDER


    PHYSICIAN VISIT-OFFICE
    2 BONE & CARTILAGE DISORDER
    PHYSICIAN VISIT-OFFICE

    339 05163
    339 05163
    339 05163
    339 05163

    1 OTITIS
    2 OTITIS
    3 OTITIS
    4 OTITIS

    340 06399
    340 06399

    1 THYROID
    2 THYROID

    331 Total

    332 Total

    333 Total

    334 Total

    335 Total

    336 Total
    REACTION
    REACTION
    REACTION
    REACTION

    337 Total

    338 Total
    -

    EAR
    EAR
    EAR
    EAR

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    339 Total

    340 Total

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    341 06779
    341 06779
    341 06779
    341 06779

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    342 04501
    342 04501

    1 BURSITIS
    2 BURSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    343 04722
    343 04722
    343 04723
    343 04723
    343 04723
    343 04723.1

    1 DENTAL CARE
    2 DENTAL CARE
    1 FATIGUE
    2 FATIGUE
    3 FATIGUE
    1

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    344 07752
    344 07752
    344 07753
    344 07753
    344 07753

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE

    345 07189
    345 07189
    345 07189

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    346 06376
    346 06376

    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE


    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-ORAL DRUGS

    347 05513
    347 05513
    347 05513
    347 05513

    1 CHEST
    2 CHEST
    3 CHEST
    4 CHEST

    348 08224

    1 DIAB'ETES

    MISC OUT HOSP-ORAL DRUGS

    349 04844
    349 04844
    349 04844
    349 04844
    349 05057
    349 05057
    349 05057
    349 05057

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    350 05058
    350 05058
    350 05058.1

    1 FEVER
    2 FEVER
    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    351 03696
    351 03696

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    352 06371
    352 06371

    1 EYE DISORDER
    2 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT

    341 Total

    342 Total

    343 Total

    344 Total

    345 Total

    346 Total
    PAIN
    PAIN
    PAIN
    PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY

    347 Total
    348 Total

    349 Total

    350 Total

    351 Total

    352 06371

    3 EYE DISORDER

    MISC OUT HOSP-ORAL DRUGS

    353 05510
    353 05510
    353 05510

    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    354 03622
    354 03622
    354 06388
    354 06388
    354 07242
    354 07242
    354 07242

    1 FEVER
    2 FEVER
    1 DIAB'ETES
    2 DIAB'ETES
    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    355 03683
    355 03683

    1 DILATION & CURRETAGE


    2 DILATION & CURRETAGE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    356 05302
    356 05302

    1 URTICARIA
    2 URTICARIA

    PHYSICIAN VISIT-OFFICE
    OTHER

    357 05108
    357 05108
    357 05523
    357 05523
    357 05523
    357 05523

    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    358 05945

    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE

    359 04475
    359 04475
    359 04475.1
    359 04475.1
    359 04475.2
    359 05122
    359 05122
    359 05123
    359 05123
    359 07195
    359 07195.1
    359 07195.1
    359 07195.1
    359 07195.1
    359 07241
    359 07241
    359 07741
    359 07742
    359 08214
    359 08214
    359 08214
    359 08892
    359 08892
    359 08892

    1 FEVER
    2 FEVER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 ASTHMA
    2 ASTHMA
    1 BACK PAIN
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 VISION CARE
    1 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    352 Total

    353 Total

    354 Total

    355 Total

    356 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    357 Total
    358 Total

    359 08892
    359 08893
    359 08893
    359 08893
    359 08893

    4 VISION
    1 VISION
    2 VISION
    3 VISION
    4 VISION

    CARE
    CARE
    CARE
    CARE
    CARE

    VISION
    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE
    CARE

    360 05519
    360 05519
    360 05519

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    361 05063
    361 05063
    361 05947
    361 07280
    361 08204
    361 08204

    1 CERVICAL
    2 CERVICAL
    1
    1 CERVICAL
    1 CERVICAL
    2 CERVICAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    362 06378
    362 06378
    362 06378

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    363 03703
    363 03703
    363 03703

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    364 07738
    364 07738
    364 07738
    364 07738

    1 VISION
    2 VISION
    3 VISION
    4 VISION

    VISION
    VISION
    VISION
    VISION

    365 07733
    365 07733
    365 07733

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    366 07759

    1 BACK PAIN

    PHYSICIAN VISIT-OFFICE

    367 08211

    1 GASTRIC - PEPTIC ULCER/GERD


    PHYSICIAN VISIT-OFFICE

    368 07380
    368 07380
    368 07380
    368 07380
    368 07380

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    369 04364
    369 04364
    369 04364
    369 06964
    369 06964
    369 06964
    369 06964
    369 06966
    369 06966

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE

    359 Total

    360 Total
    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS

    361 Total

    362 Total

    363 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    364 Total

    365 Total
    366 Total
    367 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    368 Total
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    369 06966

    3 VISION CARE

    VISION CARE

    370 04465
    370 04465
    370 04465

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    371 03697
    371 03697
    371 03697
    371 03698
    371 03698
    371 03698
    371 03698
    371 03698.1
    371 04208
    371 04208
    371 04208
    371 04208
    371 07737
    371 07737
    371 07737
    371 07737

    1 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    2 PAIN-BACK/SHOULDER
    MISC OUT HOSP-INJECTABLES
    3 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    1 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    2 PAIN-BACK/SHOULDER
    MISC OUT HOSP-INJECTABLES
    3 PAIN-BACK/SHOULDER
    DIAGNOSTIC X-RAY
    4 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 PHARYNGITIS
    PHYSICIAN VISIT-OFFICE
    2 PHARYNGITIS
    MISC OUT HOSP-INJECTABLES
    3 PHARYNGITIS
    MISC OUT HOSP-ORAL DRUGS
    4 PHARYNGITIS
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-INJECTABLES
    3 HYPERLIPIDERMIA - CHOLESTEROL
    PREVENTATIVE
    4 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY

    372 08209
    372 08210

    1 VISION CARE
    1 VISION CARE

    VISION CARE
    VISION CARE

    373 05530
    373 05530
    373 05530.1

    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    374 04487
    374 04487
    374 04487
    374 04487
    374 04487

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    375 08207
    375 08207
    375 08207
    375 08207

    1 VISION
    2 VISION
    3 VISION
    4 VISION

    VISION
    VISION
    VISION
    VISION

    376 05946

    1 LARYNGITIS

    MISC OUT HOSP-ORAL DRUGS

    377 07731
    377 07731

    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    378 04470
    378 04470
    378 04470
    378 05527
    378 05527
    378 05527
    378 05949

    1 DEVIATED
    2 DEVIATED
    3 DEVIATED
    1 DEVIATED
    2 DEVIATED
    3 DEVIATED
    1 DEVIATED

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    369 Total

    370 Total

    371 Total

    372 Total

    373 Total

    374 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    375 Total
    376 Total

    377 Total
    NASAL
    NASAL
    NASAL
    NASAL
    NASAL
    NASAL
    NASAL

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    378 05949
    378 05949
    378 07735
    378 07735
    378 07735

    2 DEVIATED NASAL SEPTUM


    3 DEVIATED NASAL SEPTUM
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY

    379 06767
    379 06767

    1 DIAB'ETES
    2 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    380 07750
    380 07750
    380 07750

    1 HEMORRHOIDS
    2 HEMORRHOIDS
    3 HEMORRHOIDS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    381 04479
    381 04479
    381 04479
    381 04479.1
    381 04479.2
    381 04479.2
    381 05149
    381 05149
    381 05149
    381 05149
    381 08217
    381 08217
    381 08217
    381 08217
    381 08217
    381 08218
    381 08218
    381 08218
    381 08218
    381 08218.1

    1 VARICOSE
    PHYSICIAN VISIT-OFFICE
    2 VARICOSE
    MISC OUT HOSP-INJECTABLES
    3 VARICOSE
    MISC OUT HOSP-ORAL DRUGS
    1 ARTHRITIS
    MISC OUT HOSP-ORAL DRUGS
    1 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-INJECTABLES
    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-ORAL DRUGS
    1
    PHYSICIAN VISIT-OFFICE
    2
    MISC OUT HOSP-INJECTABLES
    3
    MISC OUT HOSP-ORAL DRUGS
    4
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    5 DENTAL CARE
    DENTAL CARE
    1 VARICOSE
    PHYSICIAN VISIT-OFFICE
    2 VARICOSE
    MISC OUT HOSP-INJECTABLES
    3 VARICOSE
    MISC OUT HOSP-ORAL DRUGS
    4 VARICOSE
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS

    382 05150
    382 05150
    382 05151
    382 05151
    382 05151
    382 05159
    382 05159
    382 05159
    382 06389
    382 06389
    382 06390
    382 06390
    382 07202
    382 07202

    1 DIAB'ETES
    PHYSICIAN VISIT-OFFICE
    2 DIAB'ETES
    DIAGNOSTIC LABORATORY
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 ALLERGIC REACTION
    PHYSICIAN VISIT-OFFICE
    2 ALLERGIC REACTION
    MISC OUT HOSP-ORAL DRUGS
    3 ALLERGIC REACTION
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 ILL DEFINED - FAINTING
    PHYSICIAN VISIT-OFFICE
    2 ILL DEFINED - FAINTING
    MISC OUT HOSP-ORAL DRUGS
    1 TENDONITIS
    PHYSICIAN VISIT-OFFICE
    2 TENDONITIS
    MISC OUT HOSP-INJECTABLES

    383 08219
    383 08219

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    384 07201

    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE

    378 Total

    379 Total

    380 Total

    381 Total

    382 Total

    383 Total

    384 07201
    384 07201

    2 DIAB'ETES
    3 DIAB'ETES

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    385 05533
    385 05533

    1
    2

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    386 06393
    386 06393
    386 06393
    386 06393
    386 06393
    386 06395
    386 06395
    386 06397
    386 06397
    386 06397

    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    5 VARICOSE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    387 05160
    387 05160

    1 HEMATURIA
    2 HEMATURIA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    388 04495
    388 04495
    388 05962
    388 05962
    388 07207

    1 STROKE
    2 STROKE
    1 STROKE
    2 STROKE
    1 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    389 05303
    389 05303.1
    389 05304
    389 05304
    389 05304
    389 05304

    1 RENAL
    1
    1 RENAL
    2 RENAL
    3 RENAL
    4 RENAL

    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    390 04405
    390 04405
    390 04405
    390 04405
    390 05069
    390 05069
    390 05069

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 FEVER
    2 FEVER
    3 FEVER

    CARE
    CARE
    CARE
    CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    391 06780
    391 06780
    391 06781
    391 06781
    391 06781
    391 06781

    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    392 04809
    392 04809
    392 04809
    392 07490
    392 07492

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 VISION CARE

    384 Total

    385 Total

    386 Total

    387 Total

    388 Total
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION

    389 Total

    390 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    391 Total
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE

    392 Total
    393 03507
    393 03507
    393 03507
    393 03507
    393 03507
    393 03507.1
    393 03507.1
    393 03507.1
    393 03507.2
    393 03507.2
    393 03507.2
    393 03507.2
    393 03774
    393 03774
    393 04638
    393 04638
    393 05028
    393 05028
    393 05459
    393 05459
    393 05459
    393 05459
    393 07493
    393 07493
    393 08121
    393 08121
    393 08121
    393 08121

    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    5 SINUSITIS
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    394 04077
    394 04077
    394 04077
    394 05027
    394 05275
    394 05684
    394 06243
    394 08386
    394 08386
    394 08387

    1 THYROID
    2 THYROID
    3 THYROID
    1
    1 AMMENORRHOEA
    1 CANCER-BREAST
    1
    1 THYROID
    2 THYROID
    1 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE

    395 04639
    395 04639
    395 04639
    395 04640
    395 05280
    395 05280
    395 05280
    395 06577
    395 06577
    395 08388

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DEVIATED NASAL SEPTUM

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    396 05276

    1 THYROID

    PHYSICIAN VISIT-OFFICE

    393 Total

    394 Total

    395 Total

    396 05276

    2 THYROID

    DIAGNOSTIC LABORATORY

    397 04132
    397 04132
    397 06692

    1 ANAEMIA
    2 ANAEMIA
    1 ANAEMIA

    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE

    398 06695
    398 06695
    398 06695
    398 06695.1
    398 06695.1

    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 PROSTATE
    2 PROSTATE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    399 06140
    399 06140

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    400 04138
    400 04138
    400 04138
    400 04281
    400 04281
    400 04281
    400 04281
    400 04281
    400 04923
    400 04923
    400 04923
    400 04923
    400 04923
    400 04923.1
    400 05460
    400 05460
    400 05460
    400 05460
    400 05460
    400 05685
    400 05685
    400 05685
    400 06081
    400 06081
    400 06081
    400 06081
    400 06081
    400 06081.1
    400 06081.1
    400 06081.1
    400 06081.2
    400 08122
    400 08122
    400 08122
    400 08122
    400 08122
    400 08122.1

    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    5 ALLERGIC REACTION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 HYPERTENSION
    1
    2
    3
    4
    5
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    396 Total

    397 Total

    398 Total

    399 Total

    400 Total

    401 04133
    401 08541
    401 08541
    401 08541
    401 08542
    401 08543
    401 08544
    401 08544
    401 08544

    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    402 04135
    402 04135
    402 04135
    402 04135
    402 04135
    402 04136
    402 04136
    402 04136
    402 05278
    402 05278

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 SINUSITIS
    2 SINUSITIS

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    403 03652
    403 03652
    403 03652
    403 03652
    403 03652.1
    403 04874
    403 04874
    403 04874
    403 04874
    403 04875
    403 04875
    403 05713
    403 05713

    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    4 CANDIDIASIS
    1 CANDIDIASIS
    1
    2
    3
    4
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE

    404 04134
    404 05277.1
    404 06139
    404 06139
    404 06139
    404 06139
    404 06696
    404 06696
    404 06696
    404 06696
    404 06823
    404 06823

    1
    1 PAINFUL LEGS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABSCESS
    2 ABSCESS

    PREVENTATIVE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT

    405 03654
    405 03654
    405 03654
    405 03654
    405 05714

    1 COUGH - AIRWAY
    2 COUGH - AIRWAY
    3 COUGH - AIRWAY
    4 COUGH - AIRWAY
    1 VISION CARE

    401 Total

    402 Total

    403 Total

    404 Total
    OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    OBSTRUCTION
    MISC OUT HOSP-INJECTABLES
    OBSTRUCTION
    MISC OUT HOSP-INJECTABLES
    OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE

    405 05714
    405 05714
    405 05850
    405 05850
    405 07283
    405 07283
    405 07283
    405 07283
    405 07283
    405 07283.1

    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    3 KIDNEY DISEASE
    4 KIDNEY DISEASE
    5 KIDNEY DISEASE
    1 KIDNEY DISEASE

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    406 03655
    406 03655
    406 03656
    406 05282
    406 05715
    406 05715
    406 05715
    406 07541

    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1 HYPERTENSION
    1 HYPERTENSION
    1 COUGH - AIRWAY
    2 COUGH - AIRWAY
    3 COUGH - AIRWAY
    1 BURSITIS

    407 04873
    407 05306
    407 05306
    407 05306.1
    407 05306.1
    407 05306.1
    407 05711
    407 05711
    407 05711
    407 05711
    407 08164
    407 08164

    1 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 HEART
    2 HEART

    408 04869
    408 04869
    408 04869
    408 04869
    408 04869
    408 04869.1
    408 05544
    408 05544
    408 05544
    408 05544
    408 07797
    408 07797
    408 07797
    408 07797
    408 07797
    408 07797.1
    408 07797.2
    408 07797.2
    408 07797.2
    408 07797.2

    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE


    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-INJECTABLES
    3 DEVIATED NASAL SEPTUM MISC OUT HOSP-INJECTABLES
    4 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    5 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-INJECTABLES
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-INJECTABLES
    4 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 HEADACHE- MIGRAINE TENSION
    PHYSICIAN VISIT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-INJECTABLES
    3 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-INJECTABLES
    4 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-ORAL DRUGS
    5 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-ORAL DRUGS
    1
    PREVENTATIVE
    1
    PHYSICIAN VISIT-OFFICE
    2
    PHYSICIAN VISIT-OFFICE
    3
    MISC OUT HOSP-ORAL DRUGS
    4
    MISC OUT HOSP-ORAL DRUGS

    405 Total
    SEPTUM
    SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    406 Total
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    407 Total

    408 Total
    409 07537
    409 07537

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    410 03649
    410 03649
    410 03649
    410 03649
    410 07533
    410 07533
    410 07533.1
    410 07533.2
    410 07533.2

    1 TENDONITIS
    2 TENDONITIS
    3 TENDONITIS
    4 TENDONITIS
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    411 07538
    411 07538
    411 07538
    411 07538
    411 07538
    411 07538.1
    411 07538.1
    411 07538.1
    411 08165
    411 08165
    411 08165.1
    411 08165.1
    411 08165.2
    411 08165.2
    411 08166

    1 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    2 PAIN-BACK/SHOULDER
    MISC OUT HOSP-INJECTABLES
    3 PAIN-BACK/SHOULDER
    DIAGNOSTIC X-RAY
    4 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    5 PAIN-BACK/SHOULDER
    MISC OUT HOSP-INJECTABLES
    1 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    2 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    3 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 ANAEMIA
    MISC OUT HOSP-INJECTABLES
    2 ANAEMIA
    MISC OUT HOSP-INJECTABLES
    1 BACK PAIN
    PHYSICIAN VISIT-OFFICE

    412 04871
    412 04871
    412 04872
    412 04872

    1 ANXIETY
    2 ANXIETY
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE

    413 04131
    413 04131
    413 04131
    413 08540
    413 08540

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    414 05708

    1 DENTAL CARE

    DENTAL CARE

    415 05710
    415 05710
    415 06697
    415 06697
    415 06697
    415 06697
    415 07534
    415 07534
    415 07534
    415 07534

    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST

    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    409 Total

    410 Total

    411 Total

    412 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    413 Total
    414 Total

    415 07534
    415 08163
    415 08163

    5 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    416 03653
    416 04139
    416 04139
    416 04876
    416 04876
    416 04876
    416 05281
    416 05281
    416 07535
    416 07535
    416 07535
    416 08167

    1 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    1 HEADACHE- MIGRAINE
    2 HEADACHE- MIGRAINE
    3 HEADACHE- MIGRAINE
    1 HEADACHE- MIGRAINE
    2 HEADACHE- MIGRAINE
    1 STROKE
    2 STROKE
    3 STROKE
    1 PAINFUL LEGS

    417 04137
    417 04137

    1 FEVER
    2 FEVER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    418 04866
    418 04866
    418 04866
    418 04866
    418 04867
    418 04867
    418 04867
    418 04867
    418 04867
    418 04867.1
    418 04868
    418 04868
    418 04868

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE

    419 06693
    419 06693
    419 06693
    419 06694
    419 06694
    419 06694
    419 06694
    419 06822
    419 08545
    419 08545

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE

    420 05709

    1 DENTAL CARE

    DENTAL CARE

    421 03578
    421 04210
    421 04210
    421 04210
    421 04210.1
    421 04210.1

    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    PHYSICIAN VISIT-OFFICE
    3 FEVER
    DIAGNOSTIC LABORATORY
    1
    PHYSICIAN VISIT-OFFICE
    2
    PHYSICIAN VISIT-OFFICE

    415 Total
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    TENSION
    SPECIALIST CNSLT-OFFICE
    TENSION
    DIAGNOSTIC LABORATORY
    TENSION
    MISC OUT HOSP-ORAL DRUGS
    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    416 Total

    417 Total

    418 Total

    419 Total
    420 Total

    421 04210.1
    421 04210.1
    421 04210.1
    421 04264
    421 04264
    421 04264
    421 04264
    421 04725
    421 04725
    421 04725
    421 04878
    421 04878
    421 04878
    421 04878
    421 04878
    421 04878.1
    421 04878.1
    421 07507
    421 07507
    421 07507
    421 07507
    421 07507
    421 07507.1
    421 08032.1
    421 08032.1
    421 08032.1
    421 08032.1
    421 08032.1
    421 08172
    421 08172
    421 08172
    421 08438
    421 08884

    3
    DIAGNOSTIC LABORATORY
    4
    MISC OUT HOSP-ORAL DRUGS
    5
    MISC OUT HOSP-INJECTABLES
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 ABSCESS
    PHYSICIAN VISIT-OFFICE
    2 ABSCESS
    SURGICAL OUTPATIENT
    3 ABSCESS
    MISC OUT HOSP-ORAL DRUGS
    1 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    2 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    3 PAIN-BACK/SHOULDER
    DIAGNOSTIC X-RAY
    4 PAIN-BACK/SHOULDER
    DIAGNOSTIC LABORATORY
    5 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    1 PAIN-BACK/SHOULDER
    PHYSIOTHERAPY
    2 PAIN-BACK/SHOULDER
    PHYSIOTHERAPY
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    3 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    4 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    5 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    5 DENTAL CARE
    DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS

    422 05656
    422 05656
    422 05656
    422 05656.1

    1 MUSCULAR PAIN
    PHYSICIAN VISIT-OFFICE
    2 MUSCULAR PAIN
    MISC OUT HOSP-ORAL DRUGS
    3 MUSCULAR PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS

    423 04418
    423 04418
    423 04418
    423 04418
    423 04810
    423 04810
    423 05227
    423 05227
    423 05227
    423 05227
    423 05227
    423 05228
    423 05228

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    421 Total

    422 Total

    423 Total

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    424 07027
    424 07027
    424 07027

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    425 05897
    425 05897
    425 05897
    425 06825
    425 06825
    425 06825

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    426 05896
    426 06039
    426 06039.1
    426 06039.2

    1 DENTAL
    1 DENTAL
    1 DENTAL
    1 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    427 03721
    427 06578

    1 PAIN-BACK/SHOULDER
    1 BACK PAIN

    PHYSIOTHERAPY
    PHYSIOTHERAPY

    428 03720
    428 03720
    428 04259
    428 04260
    428 05785
    428 05785

    1 FEVER
    2 FEVER
    1 DENTAL
    1 DENTAL
    1 DENTAL
    2 DENTAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    429 03722
    429 03722.1
    429 05659
    429 05659
    429 05659
    429 05659
    429 06541
    429 06541
    429 06541
    429 07664
    429 07664
    429 07664
    429 07664
    429 07664

    1
    1 VISION CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 PNEUMONIA
    2 PNEUMONIA
    3 PNEUMONIA
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    5 DENGUE

    PREVENTATIVE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    430 03576
    430 03576.1
    430 03577
    430 03577
    430 03577
    430 04261
    430 04261
    430 05071
    430 05071
    430 05071.1
    430 05071.2
    430 06185

    1 DEVIATED NASAL SEPTUM


    1
    1 DENGUE
    2 DENGUE
    3 DENGUE
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    1
    1 SINUSITIS

    SPECIALIST CNSLT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    EMERGENCY ACCIDENT
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE

    424 Total

    425 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    426 Total

    427 Total

    CARE
    CARE
    CARE
    CARE

    428 Total

    429 Total

    430 06185
    430 06186
    430 06186
    430 07382
    430 07382
    430 07382
    430 07382.1
    430 07384
    430 07384
    430 07385
    430 07385
    430 08170
    430 08170.1

    2 SINUSITIS
    MISC OUT HOSP-ORAL DRUGS
    1 COUGH - AIRWAY OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    2 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS
    1 SINUSITIS
    PHYSICIAN VISIT-OFFICE
    2 SINUSITIS
    MISC OUT HOSP-ORAL DRUGS
    3 SINUSITIS
    DIAGNOSTIC X-RAY
    1 HEART
    DIAGNOSTIC LABORATORY
    1 SINUSITIS
    PHYSICIAN VISIT-OFFICE
    2 SINUSITIS
    MISC OUT HOSP-ORAL DRUGS
    1
    SPECIALIST CNSLT-OFFICE
    2
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    1 AMMENORRHOEA
    SPECIALIST CNSLT-OFFICE

    431 04727
    431 04727
    431 04727
    431 05079
    431 05079
    431 05426
    431 05426
    431 05426
    431 07891
    431 07891
    431 07891

    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1
    PHYSICIAN VISIT-OFFICE
    2
    DIAGNOSTIC X-RAY
    3
    PREVENTATIVE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC X-RAY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY

    432 05070

    1 CERVICAL SPONDYLOSIS

    PHYSICIAN VISIT-OFFICE

    433 05084
    433 05084

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    434 06537

    1 DENTAL CARE

    DENTAL CARE

    435 04726
    435 04726
    435 07434

    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    436 05072
    436 05072
    436 05073
    436 05073
    436 05073
    436 05074
    436 05074
    436 05075
    436 05075
    436 05076
    436 05076
    436 05077
    436 05077
    436 05781
    436 05782
    436 05782

    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    430 Total

    431 Total
    432 Total

    433 Total
    434 Total

    435 Total

    436 05783
    436 05783

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    437 07286
    437 07286

    1 PAINFUL LEGS
    2 PAINFUL LEGS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    438 04417
    438 04417
    438 04417.1
    438 04646
    438 04646
    438 04646

    1
    2
    1 THYROID
    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    439 06532
    439 06532
    439 08603

    1 GASTRIC - PEPTIC ULCER/GERD


    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    VISION CARE

    440 07431

    1 VISION CARE

    VISION CARE

    441 04641
    441 04641
    441 07285
    441 07285
    441 07285

    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    442 07509

    1 DENTAL CARE

    DENTAL CARE

    443 05423
    443 05423
    443 05423
    443 05423
    443 05423

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    444 03919
    444 03919

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    445 04033
    445 06535
    445 06535.1
    445 08231
    445 08231
    445 08231
    445 09154
    445 04033,1

    1
    1 ALOPECIA
    1
    1 GASTRIC 2 GASTRIC 3 GASTRIC 1 GASTRIC 1

    446 03580
    446 03580
    446 03581
    446 03581
    446 03581
    446 03582
    446 03582
    446 03582

    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    3 BREAST DISORDERS

    436 Total

    437 Total

    438 Total

    439 Total
    440 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    441 Total
    442 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    443 Total
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    444 Total

    PEPTIC
    PEPTIC
    PEPTIC
    PEPTIC

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE

    445 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    446 03582
    446 04408
    446 04409
    446 04410
    446 04411
    446 04412
    446 04412
    446 04645
    446 05653
    446 05653
    446 05653
    446 05653
    446 05654
    446 05654
    446 05654
    446 05654.1
    446 05655
    446 07026
    446 07386
    446 07386
    446 07386
    446 07885
    446 07886
    446 07886
    446 07886

    4 BREAST DISORDERS
    1 DENTAL CARE
    1
    1
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 PAINFUL HEEL
    1 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    PREVENTATIVE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    447 05078
    447 05078
    447 05078

    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    448 04487
    448 04487
    448 04487

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    449 07387
    449 07662
    449 07662
    449 07662

    1 MUSCULAR PAIN
    PHYSICIAN VISIT-OFFICE
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    SPECIALIST CNSLT-OFFICE
    3 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS

    450 07245
    450 07245
    450 07245
    450 07246
    450 07246
    450 07246.1
    450 07246.1
    450 07887
    450 07887
    450 07887
    450 07888
    450 07890

    1
    2
    3
    1 THYROID
    2 THYROID
    1
    2
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 SINUSITIS
    1 THYROID

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    451 04142

    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE

    446 Total

    447 Total

    448 Total

    449 Total

    450 Total

    451 04142
    451 04142
    451 04142
    451 04142.1
    451 04142.1
    451 04142.1
    451 04142.1
    451 04142.1
    451 04142.2
    451 04142.2
    451 08604
    451 08604
    451 08604
    451 08604
    451 08604
    451 08604.1
    451 08604.1

    2 DEVIATED
    3 DEVIATED
    4 DEVIATED
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    5 ASTHMA
    1 DEVIATED
    2 DEVIATED
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    5 ASTHMA
    1 ASTHMA
    2 ASTHMA

    NASAL SEPTUM
    NASAL SEPTUM
    NASAL SEPTUM

    452 04422
    452 09006

    1 MISCARRIAGE
    1 DENTAL CARE

    MATERNITY-NORMAL DELIVERY
    DENTAL CARE

    453 03579
    453 03579

    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    454 04140
    454 04140
    454 04140
    454 06531
    454 06531
    454 06531
    454 06531

    1 HEADACHE- MIGRAINE TENSION


    PHYSICIAN VISIT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    DIAGNOSTIC LABORATORY
    3 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-ORAL DRUGS
    1
    PHYSICIAN VISIT-OFFICE
    2
    DIAGNOSTIC X-RAY
    3
    DIAGNOSTIC LABORATORY
    4
    MISC OUT HOSP-ORAL DRUGS

    455 05081
    455 06188
    455 06188
    455 06539
    455 07389

    1 DENTAL CARE
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 DENTAL CARE
    1 EYE DISORDER

    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    SURGICAL OUTPATIENT

    456 05127

    1 DENTAL CARE

    DENTAL CARE

    457 04266

    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE

    458 03918
    458 03918
    458 03918
    458 03918
    458 03918
    458 04263
    458 04263

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    459 04419
    459 04419
    459 05657

    1 PHARYNGITIS
    2 PHARYNGITIS
    1 DENTAL CARE

    NASAL SEPTUM
    NASAL SEPTUM

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    451 Total

    452 Total

    453 Total

    454 Total

    455 Total
    456 Total
    457 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    458 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    459 07510
    459 07510
    459 07510
    459 07510
    459 07510
    459 07510.1

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    460 04423
    460 04424
    460 04424
    460 04647
    460 04648
    460 05786
    460 05786.1

    1 JAUNDICE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 MISCARRIAGE
    1 CERVICAL SPONDYLOSIS
    1 CONSTIPATION
    1

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-NORMAL DELIVERY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE

    461 04407
    461 04407
    461 04407
    461 04407

    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    462 06530
    462 07661

    1
    1

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    463 05126
    463 05126

    1 AMMENORRHOEA
    2 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    464 04031

    1 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE

    465 04649
    465 04649

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    466 03658
    466 03658
    466 03658.1

    1 BASAL CELL CARCINOMA


    2 BASAL CELL CARCINOMA
    1 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    467 04032
    467 04032
    467 04032
    467 08879
    467 08879
    467 08879
    467 08879
    467 08879

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    468 04141
    468 04141
    468 04141
    468 04141
    468 06533
    468 06533
    468 06533
    468 06533
    468 08497

    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 TENDONITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    459 Total

    460 Total

    461 Total

    462 Total

    463 Total
    464 Total

    465 Total

    466 Total

    467 Total

    468 08497
    468 08497
    468 08497

    2 TENDONITIS
    3 TENDONITIS
    4 TENDONITIS

    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    469 03659
    469 03659
    469 03659
    469 03659
    469 06534

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL

    470 07388
    470 07388

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    471 05869

    1 SKIN - LESION

    PHYSICIAN VISIT-OFFICE

    472 07543
    472 07543
    472 08304
    472 08304
    472 08304
    472 08304

    1 VISION CARE
    2 VISION CARE
    1
    2
    3
    4

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER

    473 04642
    473 04642
    473 04642
    473 04642
    473 04642

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    474 05492
    474 05492
    474 05492
    474 05492
    474 05492
    474 05492.1

    1
    2
    3
    4
    5
    1

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL

    475 04420
    475 05424
    475 05425
    475 07834
    475 07834

    1 MISCARRIAGE
    1 CONSTIPATION
    1 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    MATERNITY-NORMAL DELIVERY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    476 04644
    476 06824
    476 06824
    476 06824
    476 06824
    476 06824
    476 07542

    1
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    477 07894

    1 DENTAL CARE

    DENTAL CARE

    478 03657
    478 03657

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    468 Total

    469 Total

    470 Total
    471 Total

    472 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    473 Total

    474 Total

    475 Total

    476 Total
    477 Total

    478 03657
    478 03657
    478 03657
    478 07432

    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    479 06187
    479 06187
    479 06187

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    480 06190
    480 06190
    480 06937
    480 06937
    480 06937
    480 07544
    480 07544

    1 MISCARRIAGE
    2 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE

    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL

    481 05658
    481 05658

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    482 03583
    482 03583
    482 03583
    482 03583
    482 03583
    482 04421
    482 04421
    482 07287
    482 07287
    482 07435

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE

    483 04084
    483 08885

    1 DEVIATED NASAL SEPTUM


    1 FEVER

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    484 05080
    484 05080
    484 06936
    484 06936
    484 06936
    484 07893
    484 07893
    484 07893
    484 07893
    484 07893
    484 08880

    1 EYE DISORDER
    2 EYE DISORDER
    1 FEVER
    2 FEVER
    3 FEVER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    485 06191
    485 06191
    485 08389
    485 08389
    485 08389
    485 08389

    1 DENTAL CARE
    2 DENTAL CARE
    1 HEADACHE- MIGRAINE
    2 HEADACHE- MIGRAINE
    3 HEADACHE- MIGRAINE
    4 HEADACHE- MIGRAINE

    478 Total

    479 Total
    CARE
    CARE

    CARE
    CARE

    480 Total

    481 Total

    482 Total

    483 Total

    484 Total

    485 Total

    DENTAL CARE
    DENTAL CARE
    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    MISC OUT HOSP-ORAL DRUGS
    TENSION
    MISC OUT HOSP-ORAL DRUGS
    TENSION
    MISC OUT HOSP-ORAL DRUGS

    486 03866
    486 03866
    486 03866
    486 05082
    486 05082
    486 05229
    486 05229
    486 05229
    486 05229
    486 08232
    486 08232
    486 08232
    486 08232
    486 08886
    486 08886

    1 SINUSITIS
    PHYSICIAN VISIT-OFFICE
    2 SINUSITIS
    MISC OUT HOSP-ORAL DRUGS
    3 SINUSITIS
    MISC OUT HOSP-ORAL DRUGS
    1 OVARIAN CYST
    PHYSICIAN VISIT-OFFICE
    2 OVARIAN CYST
    SPECIALIST CNSLT-OFFICE
    1 AMMENORRHOEA
    HOSPITAL LOCAL ROOM
    2 AMMENORRHOEA
    HOSPITAL MISC-LOCAL
    3 AMMENORRHOEA
    SURGICAL OUTPATIENT
    4 AMMENORRHOEA
    PHYSICIAN VISIT-HOSPITAL
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    MISC OUT HOSP-ORAL DRUGS
    3 FEVER
    MISC OUT HOSP-OTHER
    4 FEVER
    MISC OUT HOSP-ORAL DRUGS
    1 BONE & CARTILAGE DISORDER
    PHYSICIAN VISIT-OFFICE
    2 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-OTHER

    487 05784
    487 05784
    487 09004
    487 09004
    487 09004

    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 FEVER
    2 FEVER
    3 FEVER

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    488 04406
    488 04406
    488 06184

    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    489 06579
    489 06579
    489 06579
    489 06580
    489 06580

    1 CIRCUMCISION
    2 CIRCUMCISION
    3 CIRCUMCISION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    490 04643
    490 04643

    1 THYROID
    2 THYROID

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    491 03865

    1 DENTAL CARE

    DENTAL CARE

    492 06536
    492 06536
    492 06536

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    493 05226
    493 05226
    493 05226
    493 08883
    493 08883

    1 HEADACHE- MIGRAINE TENSION


    PHYSICIAN VISIT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    DIAGNOSTIC LABORATORY
    3 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-INJECTABLES
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS

    494 08957
    494 08957
    494 08957
    494 08957
    494 08957

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    486 Total

    487 Total

    488 Total

    489 Total

    490 Total
    491 Total

    492 Total

    493 Total

    494 Total

    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    495 04879
    495 04879
    495 04879
    495 05686
    495 05686
    495 05686
    495 05717
    495 05717
    495 05787
    495 07762
    495 07895
    495 07895

    1 KNEE INTERNAL DERANGEMENT


    PHYSICIAN VISIT-OFFICE
    2 KNEE INTERNAL DERANGEMENT
    MISC OUT HOSP-INJECTABLES
    3 KNEE INTERNAL DERANGEMENT
    MISC OUT HOSP-INJECTABLES
    1 KNEE INTERNAL DERANGEMENT
    PHYSICIAN VISIT-OFFICE
    2 KNEE INTERNAL DERANGEMENT
    MISC OUT HOSP-INJECTABLES
    3 KNEE INTERNAL DERANGEMENT
    MISC OUT HOSP-INJECTABLES
    1 EYE DISORDER
    PHYSICIAN VISIT-OFFICE
    2 EYE DISORDER
    SURGICAL OUTPATIENT
    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE
    1 HORMONE REPLACMENT THERAPY
    PHYSICIAN VISIT-OFFICE
    1
    PHYSICIAN VISIT-OFFICE
    2
    SURGICAL OUTPATIENT

    496 08174

    1 CHEST PAIN

    PHYSICIAN VISIT-OFFICE

    497 03585

    PREVENTATIVE

    498 06793
    498 06794
    498 06794

    1 ARTHRITIS
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    499 08175
    499 08175
    499 08175
    499 08175

    1 CYST
    2 CYST
    3 CYST
    4 CYST

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT

    500 04511
    500 04511

    1 COUGH - AIRWAY OBSTRUCTION


    PHYSICIAN VISIT-OFFICE
    2 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS

    501 05001.1
    501 05001.1
    501 05001.1

    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    502 03594
    502 03594
    502 03594
    502 05725
    502 05725
    502 05725
    502 05725

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    503 05726
    503 05726
    503 05726.1
    503 07443
    503 07443.1
    503 07901
    503 07901
    503 07901

    1 ASTHMA
    PHYSICIAN VISIT-OFFICE
    2 ASTHMA
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    MISC OUT HOSP-ORAL DRUGS
    1 BRONCHITIS - ACUTE
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    DIAGNOSTIC X-RAY
    2 GASTRIC - PEPTIC ULCER/GERD
    SPECIALIST CNSLT-OFFICE
    3 GASTRIC - PEPTIC ULCER/GERD
    SURGICAL OUTPATIENT

    504 03586

    1 COUGH - AIRWAY OBSTRUCTION


    PHYSICIAN VISIT-OFFICE

    505 04509

    1 CERVICITIS

    495 Total
    496 Total
    497 Total

    498 Total

    499 Total

    500 Total

    501 Total

    502 Total

    503 Total
    504 Total
    PHYSICIAN VISIT-OFFICE

    505 07897
    505 07897
    505 08958
    505 08958
    505 08958
    505 08958

    1 CERVICITIS
    2 CERVICITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    506 04512
    506 04512

    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    507 04034
    507 04034
    507 04034.1
    507 04034.1
    507 04514
    507 05002
    507 05002
    507 05002
    507 06796
    507 06796
    507 06796
    507 07028
    507 07900

    1 TENDONITIS
    2 TENDONITIS
    1
    2
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE

    PHYSIOTHERAPY
    PHYSIOTHERAPY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    508 06044
    508 06044
    508 06044
    508 06044
    508 07440
    508 07440
    508 07440
    508 07441
    508 07441
    508 07441

    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    509 07898
    509 07898
    509 07898
    509 07898.1

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE

    510 05724
    510 06046

    1 HEART
    1 INTESTINAL COLIC

    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER

    511 05000
    511 05000
    511 06791
    511 06792
    511 06792
    511 07437
    511 07437

    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 AMMENORRHOEA
    PHYSICIAN VISIT-OFFICE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1
    DIAGNOSTIC X-RAY
    2
    MISC OUT HOSP-OTHER

    512 06045
    512 06045

    1 BACK PAIN
    2 BACK PAIN

    505 Total

    506 Total

    507 Total
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    508 Total

    509 Total

    510 Total

    511 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    512 06045
    512 06045.1

    3 BACK PAIN
    1 HYPERTENSION

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    513 03593
    513 03593
    513 03593
    513 03593
    513 05722
    513 05722
    513 05722
    513 05722

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    514 06041
    514 06041
    514 06041
    514 06041
    514 06042
    514 06042
    514 06042
    514 06042
    514 06043

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE

    515 07438
    515 07438
    515 07438

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    516 05718
    516 05718
    516 05718
    516 05718
    516 05718
    516 05718.1

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    517 07439
    517 07439
    517 07439

    1 BURSITIS
    2 BURSITIS
    3 BURSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    518 04999
    518 04999
    518 04999

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    519 03584
    519 03584
    519 08173
    519 08173

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 TONSILLITIS
    2 TONSILLITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    520 03589
    520 03590
    520 04508
    520 04508
    520 04508

    1 VISION CARE
    1 VISION CARE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    521 06782

    1 VISION CARE

    VISION CARE

    512 Total

    513 Total

    514 Total

    515 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    516 Total

    517 Total

    518 Total

    519 Total

    520 Total

    521 06782
    521 06782
    521 06783
    521 06783
    521 06783
    521 06783
    521 06783

    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    522 06797
    522 06797
    522 07442

    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    523 05720

    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE

    524 04507
    524 04507
    524 04507
    524 04507
    524 04507
    524 04507.1
    524 08503
    524 08503

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    525 05870
    525 05870
    525 05870
    525 05870
    525 06795
    525 06795
    525 06795
    525 06795
    525 06795

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    526 08959
    526 08959
    526 08959

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    527 05721
    527 05721
    527 05721

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    528 04506
    528 04506
    528 04997
    528 04997

    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1
    2

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    529 03587
    529 03588
    529 04504
    529 04505
    529 04505
    529 04505
    529 04505

    1 DENTAL CARE
    1 VISION CARE
    1 EPILEPSY
    1 TENDONITIS
    2 TENDONITIS
    3 TENDONITIS
    4 TENDONITIS

    DENTAL CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    521 Total

    522 Total
    523 Total

    524 Total

    525 Total

    526 Total

    527 Total

    528 Total

    529 05307
    529 05307
    529 05307
    529 06786
    529 06787
    529 06787
    529 06789
    529 06789
    529 06789
    529 08501
    529 08501
    529 08501
    529 08501.1
    529 08502
    529 08502
    529 08502

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 EPILEPSY
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 EPILEPSY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    530 05308
    530 05308
    530 05308

    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    531 04513
    531 04513
    531 04513
    531 04513
    531 04513
    531 04998
    531 04998
    531 04998
    531 04998
    531 04998
    531 04998.1
    531 06040
    531 06040
    531 07896
    531 07896
    531 07896

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1
    2
    3
    4
    5
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    532 06790
    532 06790

    1 DIAB'ETES
    2 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    533 03591
    533 03591
    533 03591.1
    533 04510
    533 04510
    533 04510
    533 08960
    533 08960
    533 08960

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 RENAL DYSFUNCTION
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    534 08499
    534 08499

    1 EYE DISORDER
    2 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    529 Total

    530 Total

    531 Total

    532 Total

    533 Total

    534 Total
    535 07899
    535 07899
    535 07899

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    536 04502
    536 04502
    536 04502
    536 04996
    536 04996
    536 06784
    536 06784
    536 06785
    536 07436
    536 07436
    536 07436
    536 07436.1
    536 07436.1

    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    1
    2
    1 THROMBOSIS
    2 THROMBOSIS
    1 CANCER-BREAST
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    1 CANCER-BREAST
    2 CANCER-BREAST

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL

    537 06165
    537 06165
    537 06165
    537 06165
    537 06165

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    538 05582
    538 05582

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    539 04054
    539 04054
    539 04054
    539 04054
    539 04054
    539 04751
    539 04751

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    2 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    540 06615
    540 06615
    540 06616
    540 06617

    1 DENTAL
    2 DENTAL
    1 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    541 08315

    1 DENTAL CARE

    DENTAL CARE

    542 06875
    542 06875
    542 06875
    542 06875
    542 07468
    542 07468
    542 07468

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    543 04744
    543 04744

    1 DENTAL CARE
    2 DENTAL CARE

    535 Total

    536 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    537 Total

    538 Total

    539 Total

    540 Total
    541 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    542 Total
    DENTAL CARE
    DENTAL CARE

    543 04744
    543 04744
    543 04744
    543 04744.1

    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    544 05545
    544 05545
    544 05545
    544 06491
    544 06491
    544 06491

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    545 06881

    1 DENTAL CARE

    DENTAL CARE

    546 07666

    1 INFECTION THUMB

    PHYSICIAN VISIT-OFFICE

    547 03783
    547 03783
    547 05232
    547 05232
    547 05232
    547 05232

    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    548 05236
    548 05236

    1 SINUSITIS
    2 SINUSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    549 07133
    549 07133
    549 07133
    549 07134
    549 07134
    549 07134
    549 07134
    549 07134
    549 07134.1
    549 07134.1
    549 07134.1
    549 07134.1
    549 07134.1
    549 07134.2

    1 RENAL
    2 RENAL
    3 RENAL
    1 RENAL
    2 RENAL
    3 RENAL
    4 RENAL
    5 RENAL
    1 RENAL
    2 RENAL
    3 RENAL
    4 RENAL
    5 RENAL
    1 RENAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL

    550 05794
    550 05794
    550 05970

    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    551 08511
    551 08511.1
    551 08511.1
    551 08511.1

    1 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER

    552 04150
    552 04330
    552 04330

    1 CERVICAL SPONDYLOSIS
    1 ARTHRITIS
    2 ARTHRITIS

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    543 Total

    544 Total
    545 Total
    546 Total

    547 Total

    548 Total
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION

    549 Total

    550 Total

    551 Total

    552 07840

    1 ARTHRITIS

    MISC OUT HOSP-ORAL DRUGS

    553 04151
    553 05806
    553 07088

    1 PROSTATE
    1 PROSTATE
    1 PROSTATE

    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    554 05971
    554 05971
    554 05971
    554 05971
    554 05971
    554 05973
    554 05973
    554 07672
    554 07672
    554 07672

    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    4 CHOSTOCHRONDITIS
    5 CHOSTOCHRONDITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    555 04817
    555 04817
    555 04817
    555 04817
    555 04818
    555 04818
    555 04818.1
    555 04818.1
    555 04818.2

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 CYSTITIS
    2 CYSTITIS
    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    556 03777
    556 05789
    556 05789
    556 05789
    556 05790
    556 05790
    556 05790
    556 05790.1

    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DILATION & CURRETAGE

    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    557 07680
    557 07680

    1 EYE DISORDER
    2 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    558 04035
    558 04035
    558 04035

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    559 06584
    559 06584
    559 06584
    559 06584

    1 OVARIAN
    2 OVARIAN
    3 OVARIAN
    4 OVARIAN

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS

    560 05977

    1 EYE DISORDER

    PHYSICIAN VISIT-OFFICE

    561 03867
    561 03867
    561 03867

    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    552 Total

    553 Total

    554 Total

    555 Total

    556 Total

    557 Total

    558 Total
    CYST
    CYST
    CYST
    CYST

    559 Total
    560 Total

    561 03867
    561 03867
    561 03867.1
    561 05486
    561 05486
    561 05486
    561 05486

    4 ARTHRITIS
    5 ARTHRITIS
    1 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    562 05231
    562 05231
    562 05231
    562 05231
    562 05231

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    563 05233
    563 05233.1
    563 05798
    563 05798
    563 05798
    563 05799
    563 05799
    563 06145
    563 06145
    563 06145
    563 06145
    563 07676
    563 07676

    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 ABDOMINAL PAINS
    MISC OUT HOSP-ORAL DRUGS
    1 CERVICAL SPONDYLOSIS
    SPECIALIST CNSLT-OFFICE
    2 CERVICAL SPONDYLOSIS
    MISC OUT HOSP-ORAL DRUGS
    3 CERVICAL SPONDYLOSIS
    MISC OUT HOSP-ORAL DRUGS
    1 INTESTINAL COLIC
    DIAGNOSTIC LABORATORY
    2 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 CERVICAL SPONDYLOSIS
    DIAGNOSTIC X-RAY
    2 CERVICAL SPONDYLOSIS
    MISC OUT HOSP-ORAL DRUGS
    3 CERVICAL SPONDYLOSIS
    SPECIALIST CNSLT-OFFICE
    4 CERVICAL SPONDYLOSIS
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    PHYSIOTHERAPY
    2 BACK PAIN
    PHYSIOTHERAPY

    564 04828
    564 04828
    564 04828.1

    1 SOFT TISSUE DISORDERS/DISEASE


    PHYSICIAN VISIT-OFFICE
    2 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-INJECTABLES
    1 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS

    565 05796
    565 05797

    1 PAINFUL HEEL
    1 PSORIASIS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    566 08611
    566 08612

    1 DEVIATED NASAL SEPTUM


    1

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    567 03778

    1 PAIN-BACK/SHOULDER

    MISC OUT HOSP-ORAL DRUGS

    568 05230
    568 05230
    568 05230

    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    569 05792
    569 05792
    569 05792
    569 05792.1

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 PROSTATE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    570 07675
    570 07675
    570 07675
    570 07675

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    561 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    562 Total

    563 Total

    564 Total

    565 Total

    566 Total
    567 Total

    568 Total

    569 Total

    570 07675

    5 DIAB'ETES

    MISC OUT HOSP-ORAL DRUGS

    571 04823
    571 04823

    1 ANXIETY
    2 ANXIETY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    572 05805
    572 05805
    572 07683
    572 08517

    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    573 07079
    573 07079
    573 07079
    573 07080
    573 07080

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    574 05801
    574 05801

    1 EYE DISORDER
    2 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    575 06583

    1 PAIN-BACK/SHOULDER

    DIAGNOSTIC X-RAY

    576 04816
    576 04816
    576 04816
    576 04816
    576 04816

    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    5 CANCER-BREAST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    577 04812
    577 04812
    577 04812
    577 04812
    577 07837
    577 07837
    577 08505
    577 08505
    577 08505
    577 08505
    577 08505

    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER

    578 08514
    578 08514
    578 08514
    578 08514.1
    578 08514.1

    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    579 06305
    579 06305
    579 06305
    579 06305
    579 06305
    579 06305.1
    579 06306
    579 06306

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    570 Total

    571 Total

    572 Total

    573 Total

    574 Total
    575 Total

    576 Total

    577 Total

    578 Total

    579 06306
    579 06307
    579 06307

    3 CHEST PAIN
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    580 06144
    580 06304
    580 06304
    580 06304
    580 06304.1
    580 07085
    580 07085
    580 07085
    580 07085
    580 07085
    580 07085.1
    580 07085.1

    1 SOFT TISSUE DISORDERS/DISEASE


    DIAGNOSTIC X-RAY
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1
    DIAGNOSTIC X-RAY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    5 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE

    581 04825
    581 04825
    581 05975
    581 07678
    581 07678

    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERTENSION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    582 05234
    582 05234
    582 05235
    582 05235
    582 05235.1
    582 05235.1
    582 05235.1

    1
    PHYSICIAN VISIT-OFFICE
    2
    MISC OUT HOSP-ORAL DRUGS
    1 ANXIETY
    PHYSICIAN VISIT-OFFICE
    2 ANXIETY
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS

    583 03787
    583 03787
    583 03787
    583 07679
    583 07679
    583 08395
    583 08395
    583 08395

    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 CHEST PAIN
    2 CHEST PAIN
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    584 03788
    584 03788
    584 03788

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    585 03775
    585 03775
    585 03775
    585 03775
    585 03775
    585 05788
    585 05788

    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    5 CATARACT
    1 CATARACT
    2 CATARACT

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL INPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    586 05974

    1 EYE DISORDER

    SPECIALIST CNSLT-OFFICE

    579 Total

    580 Total
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    581 Total

    582 Total

    583 Total

    584 Total

    585 Total

    586 Total
    587 05791
    587 05791
    587 05791
    587 05791

    1 RENAL
    2 RENAL
    3 RENAL
    4 RENAL

    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    588 03925
    588 05803
    588 05978

    1 DEVIATED NASAL SEPTUM


    1 DENTAL CARE
    1 SKIN - LOCAL INFECTION

    589 07084

    1 BONE & CARTILAGE DISORDER


    MISC OUT HOSP-ORAL DRUGS

    590 03789
    590 04827
    590 05804
    590 05804

    1
    1
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PREVENTATIVE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    591 07677
    591 07677
    591 07677

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    592 04328
    592 04328
    592 04328
    592 04328
    592 05795
    592 07082
    592 07082
    592 07082
    592 07082
    592 07082

    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 STONE - URETER
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    5 TONSILLITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    593 06142
    593 07670
    593 07670
    593 07670
    593 07670
    593 07839

    1 SKIN - ATOPIC DERMATITIS


    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PAINFUL HEEL

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS

    594 04821
    594 04821
    594 04821
    594 04821
    594 07081
    594 07081

    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    4 CANDIDIASIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    595 08613

    1 FEVER

    MISC OUT HOSP-ORAL DRUGS

    596 07682
    596 07682
    596 07682
    596 07682

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    587 Total
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS

    588 Total
    589 Total

    590 Total

    591 Total

    592 Total

    593 Total

    594 Total
    595 Total

    596 Total

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    597 04822
    597 08393

    1 RENAL DYSFUNCTION
    1 CONSTIPATION

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    598 07684
    598 07684
    598 07685
    598 07685
    598 07685
    598 07685

    1 SINUSITIS
    2 SINUSITIS
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    599 03921
    599 03921
    599 03921
    599 06582
    599 06582
    599 06582
    599 06582

    1 INTESTINAL COLIC
    PHYSICIAN VISIT-OFFICE
    2 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    3 INTESTINAL COLIC
    MISC OUT HOSP-OTHER
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-OTHER
    3 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    4 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS

    600 06141
    600 06141
    600 06141

    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    601 03920
    601 03920

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    602 03923

    1 RENAL DYSFUNCTION

    DIAGNOSTIC LABORATORY

    603 06622

    1 MUSCULAR PAIN

    PHYSICIAN VISIT-OFFICE

    604 04148
    604 04148
    604 04148
    604 04148.1
    604 04148.1
    604 04149
    604 04149
    604 04149
    604 04811
    604 04811
    604 06618
    604 06618
    604 06618
    604 06619
    604 06619
    604 07078
    604 07078

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 DEVIATED NASAL
    2 DEVIATED NASAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    605 07687
    605 07687
    605 07687
    605 07687

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    606 06621

    1 OVARIAN CYST

    597 Total

    598 Total

    599 Total

    600 Total

    601 Total
    602 Total
    603 Total

    SEPTUM
    SEPTUM
    SEPTUM

    SEPTUM
    SEPTUM

    604 Total
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    605 Total
    PHYSICIAN VISIT-OFFICE

    606 06621

    2 OVARIAN CYST

    DIAGNOSTIC X-RAY

    607 04813
    607 04813
    607 04813
    607 04813
    607 07669

    1 INTESTINAL
    2 INTESTINAL
    3 INTESTINAL
    4 INTESTINAL
    1

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    PREVENTATIVE

    608 03922
    608 03922

    1 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-ORAL DRUGS


    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-ORAL DRUGS

    609 03782

    1 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS

    610 04829
    610 04829
    610 04829

    1
    2
    3

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    611 04830
    611 04830
    611 04830

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    612 08516
    612 08516
    612 08516
    612 08516

    1 CYST
    2 CYST
    3 CYST
    4 CYST

    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS

    613 06699
    613 06699

    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    614 05793
    614 05969
    614 07671
    614 08392

    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1 BACK PAIN

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    615 05851
    615 08606
    615 08606
    615 08606

    1 ALLERGIC REACTION
    1 PHIMOSIS
    2 PHIMOSIS
    3 PHIMOSIS

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    616 04577
    616 04577
    616 04577

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    617 04924
    617 04924
    617 04924
    617 05998
    617 05998

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CATARACT
    2 CATARACT

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER

    618 06698
    618 06698
    618 06698
    618 06698

    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    606 Total
    COLIC
    COLIC
    COLIC
    COLIC

    607 Total

    608 Total
    609 Total

    610 Total

    611 Total

    612 Total

    613 Total

    614 Total

    615 Total

    616 Total

    617 Total

    618 07838
    618 07838
    618 07838
    618 07838
    618 07838

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    619 04578
    619 04578
    619 04652
    619 04653
    619 04654
    619 07135
    619 08009
    619 08009

    1 EYE DISORDER
    2 EYE DISORDER
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 SKIN - LOCAL INFECTION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC

    620 05727
    620 05852
    620 05852
    620 05852
    620 08610
    620 08610
    620 08610.1
    620 08610.1

    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 ANXIETY
    PHYSICIAN VISIT-OFFICE
    2 ANXIETY
    MISC OUT HOSP-INJECTABLES
    3 ANXIETY
    DIAGNOSTIC X-RAY
    1 TENDONITIS
    PHYSICIAN VISIT-OFFICE
    2 TENDONITIS
    MISC OUT HOSP-INJECTABLES
    1 DIAB'ETES
    DIAGNOSTIC LABORATORY
    2 DIAB'ETES
    DIAGNOSTIC LABORATORY

    621 07763
    621 07763
    621 07763

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC X-RAY

    622 05283
    622 05283
    622 07136
    622 07136

    1 HEART2 HEART1 HEART2 HEART-

    623 05728
    623 05728
    623 05728

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    624 07466
    624 07466

    1 PROSTATE
    2 PROSTATE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    625 07512
    625 07512
    625 07512
    625 07512

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    626 07514
    626 07514
    626 07514
    626 07514
    626 07514.1
    626 07514.1
    626 08614
    626 08614

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION

    618 Total
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    619 Total

    620 Total

    621 Total
    ISCHEMIC
    ISCHEMIC
    ISCHEMIC
    ISCHEMIC

    HEART
    HEART
    HEART
    HEART

    DISEASE
    PHYSICIAN VISIT-OFFICE
    DISEASE
    DIAGNOSTIC LABORATORY
    DISEASE
    PHYSICIAN VISIT-OFFICE
    DISEASE
    DIAGNOSTIC X-RAY

    622 Total

    623 Total

    624 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    625 Total
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    626 Total
    627 05856

    1 EYE DISORDER

    PHYSICIAN VISIT-OFFICE

    628 06798
    628 06798

    1 PAINFUL LEGS
    2 PAINFUL LEGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    629 04581
    629 05666
    629 05857
    629 05857
    629 06000
    629 06000
    629 06623
    629 06980
    629 06980
    629 07446

    1 SKIN - ATOPIC DERMATITIS DIAGNOSTIC X-RAY


    1 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    1 SOFT TISSUE DISORDERS/DISEASE
    DIAGNOSTIC X-RAY
    2 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-ORAL DRUGS
    1 CERVICAL STRAIN
    PHYSICIAN VISIT-OFFICE
    2 CERVICAL STRAIN
    MISC OUT HOSP-ORAL DRUGS
    1 BONE & CARTILAGE DISORDER
    DIAGNOSTIC X-RAY
    1
    PHYSICIAN VISIT-OFFICE
    2
    MISC OUT HOSP-ORAL DRUGS
    1 CERVICAL SPONDYLOSIS
    MISC OUT HOSP-ORAL DRUGS

    630 05329

    1 HYPERTENSION

    MISC OUT HOSP-ORAL DRUGS

    631 04658
    631 04658
    631 04658.1
    631 04658.1

    1 GLAUCOMA
    2 GLAUCOMA
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE

    632 04728
    632 04728
    632 05330
    632 05330
    632 05330
    632 05330
    632 05330

    1 SKIN - ATOPIC DERMATITIS


    2 SKIN - ATOPIC DERMATITIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    633 05171
    633 05171
    633 05171
    633 05171

    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    OTHER
    PHYSICIAN VISIT-HOSPITAL

    634 04580
    634 04580
    634 05284
    634 05284
    634 06700
    634 06700
    634 06700

    1 AMMENORRHOEA
    PHYSICIAN VISIT-OFFICE
    2 AMMENORRHOEA
    MISC OUT HOSP-OTHER
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1
    DIAGNOSTIC X-RAY
    2
    MISC OUT HOSP-ORAL DRUGS
    3
    MISC OUT HOSP-ORAL DRUGS

    635 06620
    635 06620

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    636 04211

    1 CHEST PAIN

    DIAGNOSTIC LABORATORY

    637 05665
    637 08010

    1
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS

    627 Total

    628 Total

    629 Total
    630 Total

    631 Total

    632 Total

    633 Total

    634 Total

    635 Total
    636 Total

    637 Total

    638 04579
    638 04579
    638 07445
    638 07445
    638 07445

    1 TONSILLITIS
    2 TONSILLITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    639 05662
    639 05662
    639 05662
    639 05662
    639 05662

    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    640 07029
    640 07029

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    641 03874
    641 03874
    641 03874
    641 03874.1
    641 03874.1
    641 07139
    641 07139
    641 07139
    641 07139
    641 07513
    641 07513
    641 07513
    641 07513
    641 07513.1

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    1 DILATION & CURRETAGE

    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS

    642 05331
    642 05331

    1 GLAUCOMA
    2 GLAUCOMA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    643 03873
    643 03873
    643 03873
    643 03873

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    644 05663
    644 05663
    644 05663
    644 05663
    644 05663
    644 05663.1

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE

    645 05858
    645 07841

    1 MISCARRIAGE
    1 EAR DYSFUNCTION

    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-ORAL DRUGS

    646 06084

    1 FEVER

    MISC OUT HOSP-ORAL DRUGS

    647 05999
    647 05999

    1 GLAUCOMA
    2 GLAUCOMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    638 Total

    639 Total

    640 Total

    641 Total

    642 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    643 Total

    644 Total

    645 Total
    646 Total

    647 Total

    648 07444
    648 07444
    648 07444

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    649 03604

    1 HEMORRHOIDS

    MISC OUT HOSP-ORAL DRUGS

    650 07511
    650 07511
    650 07511

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    651 04655

    1 ALLERGIC REACTION

    PHYSICIAN VISIT-OFFICE

    652 05854
    652 05854

    1 EYE DISORDER
    2 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    653 07836
    653 07836

    1 CHEST PAIN
    2 CHEST PAIN

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    654 04925
    654 08607
    654 08607
    654 08607
    654 08609
    654 08609

    1 BACK PAIN
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    655 05855
    655 06085

    1 DILATION & CURRETAGE


    1 VISION CARE

    DIAGNOSTIC LABORATORY
    VISION CARE

    656 04656
    656 04656
    656 04656
    656 04656
    656 04656
    656 06270

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    657 07835
    657 07835

    1 MUSCULAR PAIN
    2 MUSCULAR PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    658 04329
    658 04329
    658 06143

    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    659 03779
    659 03779
    659 03779
    659 03780
    659 03780
    659 03781
    659 03781

    1 ABDOMINAL
    2 ABDOMINAL
    3 ABDOMINAL
    1 ABDOMINAL
    2 ABDOMINAL
    1 ABDOMINAL
    2 ABDOMINAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    660 04327
    660 04327
    660 04327

    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION

    648 Total
    649 Total

    650 Total
    651 Total

    652 Total

    653 Total

    654 Total

    655 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    656 Total

    657 Total

    658 Total
    PAINS
    PAINS
    PAINS
    PAINS
    PAINS
    PAINS
    PAINS

    659 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    660 04327.1
    660 05968
    660 05968
    660 05968

    1 HYPERTENSION
    1 FEVER
    2 FEVER
    3 FEVER

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    661 03776
    661 03776

    1
    2

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    662 06581

    1 STONE - URETER

    DIAGNOSTIC X-RAY

    663 06148

    DIAGNOSTIC X-RAY

    664 05976

    1 EYE DISORDER

    PHYSICIAN VISIT-OFFICE

    665 05802
    665 05802
    665 05802
    665 05802

    1 CIRCULATORY
    2 CIRCULATORY
    3 CIRCULATORY
    4 CIRCULATORY

    DISORDER
    DISORDER
    DISORDER
    DISORDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    666 03784
    666 03784
    666 03784
    666 03784
    666 06147
    666 07087
    666 07087
    666 07087

    1 SKIN - LOCAL INFECTION


    2 SKIN - LOCAL INFECTION
    3 SKIN - LOCAL INFECTION
    4 SKIN - LOCAL INFECTION
    1 OVARIAN CYST
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY

    667 04819
    667 04819
    667 04819
    667 04820
    667 04820
    667 04820
    667 08513
    667 08513
    667 08513
    667 08513

    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    3 GASTRIC - PEPTIC ULCER/GERD
    DIAGNOSTIC LABORATORY
    1 ABSCESS
    PHYSICIAN VISIT-OFFICE
    2 ABSCESS
    MISC OUT HOSP-ORAL DRUGS
    3 ABSCESS
    DIAGNOSTIC LABORATORY
    4 ABSCESS
    MISC OUT HOSP-ORAL DRUGS

    668 03793
    668 03793
    668 03793
    668 08019
    668 08019

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL

    669 03790

    PHYSICIAN VISIT-OFFICE

    670 08018
    670 08018
    670 08018

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    671 03792
    671 03792

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    660 Total

    661 Total
    662 Total
    663 Total
    664 Total

    665 Total

    666 Total

    667 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    668 Total
    669 Total

    670 Total

    671 03792
    671 03792

    3 DENTAL CARE
    4 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    672 08016
    672 08016
    672 08017

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    673 03791
    673 03791

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    674 08258
    674 08258
    674 08258
    674 08258

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    675 04152
    675 04152
    675 04152

    1 COUGH - AIRWAY OBSTRUCTION


    PHYSICIAN VISIT-OFFICE
    2 COUGH - AIRWAY OBSTRUCTION
    DIAGNOSTIC LABORATORY
    3 COUGH - AIRWAY OBSTRUCTION
    DIAGNOSTIC X-RAY

    676 08259
    676 08259

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    677 06871
    677 06871

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    678 08306
    678 08306
    678 08306

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    679 03986

    1 FEVER

    PHYSICIAN VISIT-OFFICE

    680 06244
    680 06244
    680 06244

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    681 06802
    681 06802
    681 06802

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    682 06803.1
    682 06803.1
    682 06803.1
    682 06803.1
    682 06803.1

    1 DILATION
    2 DILATION
    3 DILATION
    4 DILATION
    5 DILATION

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    DIAGNOSTIC LABORATORY

    683 07338

    1 VISION CARE

    VISION CARE

    684 08519
    684 08519
    684 08519
    684 08519

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    685 04282

    1 DENTAL CARE

    671 Total

    672 Total

    673 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    674 Total

    675 Total

    676 Total

    677 Total

    678 Total
    679 Total

    680 Total

    681 Total
    &
    &
    &
    &
    &

    CURRETAGE
    CURRETAGE
    CURRETAGE
    CURRETAGE
    CURRETAGE

    682 Total
    683 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    684 Total
    DENTAL CARE

    685 04282
    685 04282

    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    686 06272
    686 06272
    686 06272
    686 06273
    686 06273
    686 06273

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    687 03806
    687 03807
    687 03807
    687 04215
    687 04216
    687 06246

    1
    PHYSICIAN VISIT-OFFICE
    1
    PHYSICIAN VISIT-OFFICE
    2
    MISC OUT HOSP-INJECTABLES
    1 FRACTURE - HAND BONES PHYSICIAN VISIT-OFFICE
    1 FRACTURE - HAND BONES PHYSICIAN VISIT-OFFICE
    1 KNEE INTERNAL DERANGEMENT
    PHYSIOTHERAPY

    688 04591

    1 DIAB'ETES

    689 04214
    689 04214
    689 04214
    689 06593
    689 06593
    689 06593.1
    689 06594
    689 06594
    689 06594.1

    1 OVARIAN CYST
    PHYSICIAN VISIT-OFFICE
    2 OVARIAN CYST
    DIAGNOSTIC LABORATORY
    3 OVARIAN CYST
    MISC OUT HOSP-ORAL DRUGS
    1 HORMONE REPLACMENT THERAPY
    PHYSICIAN VISIT-OFFICE
    2 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC X-RAY
    1
    MISC OUT HOSP-ORAL DRUGS
    1 VARICOSE
    SPECIALIST CNSLT-OFFICE
    2 VARICOSE
    DIAGNOSTIC LABORATORY
    1 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC LABORATORY

    690 03513
    690 07999
    690 07999
    690 07999

    1 FEVER
    1
    2
    3

    691 06592
    691 06592

    1 GASTRIC - PEPTIC ULCER/GERD


    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    DIAGNOSTIC LABORATORY

    692 08624
    692 08624

    1 ASTHMA
    2 ASTHMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    693 05362
    693 05362.1
    693 05362.1
    693 05362.2
    693 05362.2

    1
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 BREAST DISORDERS
    2 BREAST DISORDERS

    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    694 05871
    694 05871
    694 05871
    694 05871
    694 05871
    694 05871.1

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    685 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    686 Total

    687 Total
    PHYSICIAN VISIT-OFFICE

    688 Total

    689 Total
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    690 Total

    691 Total

    692 Total

    693 Total

    694 Total

    695 03805.2
    695 03805.2
    695 03805.2
    695 03805.2
    695 03805.2
    695 03805.3
    695 03805.3
    695 04156
    695 04156
    695 04156.1
    695 04156.2
    695 04521
    695 04521

    1 APPENDICITIS
    2 APPENDICITIS
    3 APPENDICITIS
    4 APPENDICITIS
    5 APPENDICITIS
    1 APPENDICITIS
    2 APPENDICITIS
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    696 06245

    1 DENTAL CARE

    DENTAL CARE

    697 04522

    DIAGNOSTIC X-RAY

    698 07449
    698 07449
    698 07449
    698 07449.1

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY

    699 03936
    699 03936
    699 03936
    699 03936
    699 03937
    699 03937
    699 03937
    699 03938
    699 03938

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE

    700 03519
    700 03519
    700 03519
    700 03519
    700 03519
    700 03519.1
    700 03519.1
    700 03519.1
    700 04697
    700 04697
    700 04697
    700 04697
    700 04698
    700 04698
    700 04698
    700 04698
    700 04699
    700 04699
    700 04699
    700 04699

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    695 Total
    696 Total
    697 Total

    698 Total

    699 Total

    700 04700
    700 04700
    700 04700
    700 04700
    700 04700
    700 04701
    700 04701
    700 04701
    700 04701
    700 04701
    700 06705
    700 06705
    700 06705
    700 06705
    700 06705
    700 06705.1

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    5 OVARIAN CYST
    1 OVARIAN CYST

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    701 04080
    701 04080
    701 04080
    701 04080
    701 08967
    701 08967
    701 08967
    701 08968
    701 08968

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    702 04702
    702 04702
    702 04702
    702 04702
    702 04703
    702 04703
    702 04703
    702 04703
    702 04703

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    703 04704
    703 04704
    703 04704
    703 04704

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    704 06711
    704 06711
    704 06711
    704 07215
    704 07216
    704 07216
    704 07217
    704 07217

    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    705 07034
    705 07034

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    700 Total

    701 Total

    702 Total

    703 Total

    704 Total

    705 07034

    3 DENTAL CARE

    DENTAL CARE

    706 08037
    706 08037
    706 08037.1
    706 08038

    1 DIAB'ETES
    2 DIAB'ETES
    1 ARTHRITIS
    1 VISION CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE

    707 04082
    707 04082
    707 04082
    707 04082
    707 05312
    707 05312
    707 05312
    707 05312
    707 05312

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    708 07035
    708 07035
    708 07036
    708 07036
    708 07036
    708 08969

    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 AMMENORRHOEA

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    709 05310
    709 05310
    709 05311
    709 05311
    709 05311

    1
    2
    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    710 07033
    710 07033
    710 07033
    710 08039
    710 08039
    710 08039

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    711 08520
    711 08520
    711 08520

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    712 04696
    712 04696

    1 INFECTION THUMB
    2 INFECTION THUMB

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    713 04079
    713 04079
    713 04079
    713 04079

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    714 04081
    714 04081
    714 04081
    714 04081.1

    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 ANAEMIA

    705 Total

    706 Total

    CARE
    CARE
    CARE
    CARE
    CARE

    707 Total

    708 Total

    709 Total

    710 Total

    711 Total

    712 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    713 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES

    714 04081.1
    714 06709
    714 06709
    714 06709
    714 06710

    2 ANAEMIA
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    1 DENTAL CARE

    MISC OUT HOSP-INJECTABLES


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    715 04705
    715 04706
    715 04706
    715 04706

    1 DENTAL CARE
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    716 05091
    716 05091
    716 05091
    716 08562
    716 08562

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    717 08556
    717 08556

    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER

    PHYSIOTHERAPY
    PHYSIOTHERAPY

    718 04218
    718 04218
    718 04218
    718 04218
    718 04219
    718 04219
    718 04219
    718 06322
    718 06322
    718 06322
    718 06323
    718 06323
    718 07317

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 HEMORRHOIDS
    2 HEMORRHOIDS
    3 HEMORRHOIDS
    1 TONSILLITIS
    2 TONSILLITIS
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    719 07309
    719 07309

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    720 06325
    720 06325
    720 06325.1
    720 06325.1
    720 06325.1
    720 06325.1
    720 06325.2

    1 DEVIATED
    2 DEVIATED
    1 GASTRIC 2 GASTRIC 3 GASTRIC 4 GASTRIC 1 DEVIATED

    721 06986
    721 06986

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    722 06987
    722 06987
    722 06987
    722 06987
    722 06988

    1
    2
    3
    4
    1 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    714 Total

    715 Total

    716 Total

    717 Total

    718 Total

    719 Total
    NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS

    720 Total

    721 Total

    722 06988
    722 06989
    722 06989
    722 06989
    722 06989

    2 INTESTINAL
    1 INTESTINAL
    2 INTESTINAL
    3 INTESTINAL
    4 INTESTINAL

    COLIC
    COLIC
    COLIC
    COLIC
    COLIC

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    723 05431
    723 07315
    723 07315
    723 07315
    723 07316
    723 07316
    723 07316
    723 08561
    723 08561.1

    1 MISCARRIAGE
    MATERNITY-NORMAL DELIVERY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE
    1
    PREVENTATIVE

    724 06317
    724 07848
    724 07848
    724 07848
    724 07848

    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY

    725 05429
    725 05429
    725 05429
    725 05429
    725 05429
    725 05429.1
    725 05430

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE

    726 06320
    726 06320
    726 06320

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    727 03607
    727 03607
    727 05090
    727 07312
    727 07312
    727 07313
    727 07314

    1 SOFT TISSUE DISORDERS/DISEASE


    PHYSICIAN VISIT-OFFICE
    2 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    1
    PHYSICIAN VISIT-OFFICE
    2
    DIAGNOSTIC X-RAY
    1 VISION CARE
    VISION CARE
    1
    PHYSICIAN VISIT-OFFICE

    728 07318
    728 07318
    728 07318
    728 07319
    728 07319
    728 07319
    728 07851

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    729 05088
    729 05088
    729 05089

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 PHARYNGITIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    722 Total

    723 Total

    724 Total

    725 Total

    726 Total

    727 Total

    728 Total

    729 05089
    729 05089
    729 08555
    729 08555
    729 08555

    2 PHARYNGITIS
    3 PHARYNGITIS
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    730 05010
    730 05010
    730 05010
    730 05010
    730 05010

    1 BARTHOLIN'S
    2 BARTHOLIN'S
    3 BARTHOLIN'S
    4 BARTHOLIN'S
    5 BARTHOLIN'S

    731 06319
    731 06319
    731 06319

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    732 05810
    732 05810
    732 05811
    732 05811
    732 06098
    732 06098
    732 06098
    732 07390
    732 07390
    732 07390
    732 07391
    732 07391
    732 07391

    1 BACK PAIN
    2 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    733 08563

    1 DENTAL CARE

    DENTAL CARE

    734 07849
    734 07849
    734 07849
    734 07849

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    735 04222
    735 04222
    735 04222
    735 04222

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    736 05092

    1 DENTAL CARE

    DENTAL CARE

    737 06984
    737 06984
    737 06984
    737 06984
    737 07311
    737 07311

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE

    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL

    738 08554
    738 08554

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    729 Total
    CYST
    CYST
    CYST
    CYST
    CYST

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    730 Total

    731 Total

    732 Total
    733 Total

    734 Total

    735 Total
    736 Total

    737 Total

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    738 08554
    738 08554

    3 DENTAL CARE
    4 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    739 06313
    739 06313
    739 06313
    739 06313
    739 06313

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    740 04217
    740 05087
    740 05087
    740 05087
    740 06315
    740 06982
    740 07308
    740 08558
    740 08558
    740 08558

    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    741 04220
    741 04220
    741 04220
    741 04220
    741 04221
    741 04221
    741 04221
    741 04221

    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE

    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC LABORATORY

    742 04223
    742 04223

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    743 06321
    743 06321
    743 06321
    743 06321
    743 06321

    1 ABDOMINAL
    2 ABDOMINAL
    3 ABDOMINAL
    4 ABDOMINAL
    5 ABDOMINAL

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA

    744 06316
    744 06316
    744 06316

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    745 04224
    745 04224
    745 05094
    745 06324
    745 06324
    745 06324
    745 06324
    745 06324

    1 CHEST PAIN
    2 CHEST PAIN
    1 ALLERGIC REACTION
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-OTHER

    746 05093
    746 05093

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    738 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    739 Total

    740 Total

    741 Total

    742 Total
    PAINS
    PAINS
    PAINS
    PAINS
    PAINS

    743 Total

    744 Total

    745 Total

    746 Total
    747 07850
    747 07850
    747 07850
    747 07850

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    748 06627.2
    748 06627.2
    748 06627.2
    748 06627.2
    748 06627.2
    748 06627.3
    748 06627.3
    748 06627.3
    748 06627.3
    748 06627.3

    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    SURGICAL INPATIENT
    HOSPITAL MISC-LOCAL
    OTHER
    SPECIALIST CNSLT-HOSPITAL

    749 05734
    749 05734
    749 05734

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    750 05735
    750 05735
    750 05735
    750 07037

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    751 05736
    751 05736
    751 05736

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    752 06629
    752 06629
    752 06629

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    753 07552
    753 07552
    753 07552

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    754 08125
    754 08307
    754 08307
    754 08307

    1 PAIN-BACK/SHOULDER
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    755 05558
    755 05558
    755 05558
    755 05558
    755 05558
    755 05558.1
    755 05560
    755 05560
    755 05560
    755 05561

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    747 Total

    748 Total

    749 Total

    750 Total

    751 Total

    752 Total

    753 Total

    754 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    755 05561
    755 05561
    755 07852
    755 07852
    755 07852
    755 07852

    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    756 04044
    756 04044
    756 04044
    756 04044
    756 04044
    756 04588
    756 04588.1
    756 04588.1
    756 04739
    756 04740
    756 05562
    756 05562
    756 05562
    756 05562
    756 05562
    756 05562.1
    756 05564
    756 05565
    756 06502
    756 06503
    756 06713.1
    756 06713.1
    756 06713.1
    756 06713.1
    756 08041
    756 08042
    756 08043
    756 08043
    756 08043
    756 08308
    756 08308
    756 08308.1

    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    5 CANCER-BREAST
    1 PROSTATE
    1 PROSTATE
    2 PROSTATE
    1 CANCER-BREAST
    1 HYPERTENSION
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    5 CANCER-BREAST
    1 CANCER-BREAST
    1 HYPERTENSION
    1 HYPERTENSION
    1 SKIN - ECZEMA
    1 CANCER-BREAST
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    757 07224
    757 07224
    757 07224
    757 07224
    757 07224

    1 FRACTURE
    2 FRACTURE
    3 FRACTURE
    4 FRACTURE
    5 FRACTURE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    OTHER
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY

    758 05566
    758 05566
    758 05566
    758 05567
    758 05567
    758 08702
    758 08704

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    1 VISION CARE

    755 Total

    756 Total
    -

    HAND
    HAND
    HAND
    HAND
    HAND

    BONES
    BONES
    BONES
    BONES
    BONES

    757 Total
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    VISION CARE

    758 08704

    2 VISION CARE

    VISION CARE

    759 04046
    759 04046
    759 04047
    759 04048
    759 04048
    759 04742
    759 05571
    759 06152
    759 06878
    759 07228
    759 07229
    759 07229
    759 07469
    759 08309

    1 EYE DISORDER
    2 EYE DISORDER
    1 PAIN-BACK/SHOULDER
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY

    760 05579
    760 05579

    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    761 04744.2
    761 04744.2
    761 04744.2
    761 04744.2
    761 04744.2
    761 04744.3
    761 04744.3
    761 04744.3
    761 04744.3
    761 05580
    761 05580
    761 05580
    761 06715
    761 06715
    761 06716
    761 06716
    761 08310
    761 08310
    761 08310
    761 08310

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ALOPECIA
    2 ALOPECIA
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    762 05584
    762 05584

    1 PHARYNGITIS
    2 PHARYNGITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    763 05585.1
    763 05585.1
    763 05585.1
    763 05585.1
    763 05585.1

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    764 05587
    764 05587
    764 05588

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 BACK PAIN

    758 Total

    759 Total

    760 Total

    761 Total

    762 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    763 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    764 05588
    764 06879
    764 06879
    764 07856
    764 07856
    764 07856
    764 07856
    764 08706
    764 08706

    2 BACK PAIN
    1 SINUSITIS
    2 SINUSITIS
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    1 CHlCKEN POX
    2 CHlCKEN POX

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    765 06505
    765 06505
    765 06505
    765 06505
    765 06505.1

    1 BARTHOLIN'S
    2 BARTHOLIN'S
    3 BARTHOLIN'S
    4 BARTHOLIN'S
    1

    766 06507
    766 06507
    766 06507
    766 08709
    766 08709

    1 CERVICITIS
    2 CERVICITIS
    3 CERVICITIS
    1
    2

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    767 04053
    767 04053
    767 06718
    767 06718
    767 06881.1
    767 06881.1
    767 07397
    767 07397
    767 07397
    767 07397

    1 EYE DISORDER
    2 EYE DISORDER
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY

    768 05037
    768 05037.1
    768 05037.1
    768 05037.2
    768 05037.2
    768 05037.3
    768 05037.4
    768 05037.5
    768 05592
    768 05592
    768 05592
    768 05592
    768 05593
    768 05593
    768 05593
    768 05593
    768 05594
    768 05594
    768 05594
    768 05594

    1 CANDIDIASIS
    MISC OUT HOSP-ORAL DRUGS
    1 ANAEMIA
    PHYSICIAN VISIT-OFFICE
    2 ANAEMIA
    MISC OUT HOSP-ORAL DRUGS
    1 BARTHOLIN'S CYST
    PHYSICIAN VISIT-OFFICE
    2 BARTHOLIN'S CYST
    DIAGNOSTIC LABORATORY
    1 BREAST DISORDERS
    DIAGNOSTIC X-RAY
    1 CERVICAL SPONDYLOSIS
    DIAGNOSTIC X-RAY
    1 LIVER CIRRHOSIS
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    4 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC X-RAY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE

    764 Total
    CYST
    CYST
    CYST
    CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE

    765 Total

    766 Total

    SEPTUM
    SEPTUM

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    767 Total

    768 05812
    768 05812
    768 06882
    768 06882
    768 06882
    768 06882
    768 08311
    768 08311
    768 08311.1

    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 THYROID
    PHYSICIAN VISIT-OFFICE
    2 THYROID
    SPECIALIST CNSLT-OFFICE
    3 THYROID
    DIAGNOSTIC X-RAY
    4 THYROID
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY

    769 04750
    769 04750
    769 04750

    1 INJURY - OPEN WOUND


    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND

    770 04054.1
    770 04054.1
    770 04054.1
    770 04054.1
    770 04054.1
    770 04054.2
    770 04054.2
    770 04054.2
    770 04055
    770 04055
    770 04055
    770 04055.1
    770 04751.1
    770 04751.1
    770 04751.1
    770 04751.1
    770 08712
    770 08712

    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    5 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 ASTHMA
    PHYSICIAN VISIT-OFFICE
    2 ASTHMA
    MISC OUT HOSP-ORAL DRUGS
    3 ASTHMA
    PHYSICIAN VISIT-OFFICE
    1 CERVICAL SPONDYLOSIS
    DIAGNOSTIC X-RAY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS

    771 04931
    771 04931
    771 04932
    771 04932
    771 04932
    771 05595
    771 06161
    771 06161
    771 06990
    771 06990
    771 06990
    771 06990
    771 08044

    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    DENTAL CARE

    772 08713
    772 08714

    1 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    773 06165.1
    773 06165.1
    773 06165.1

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    768 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER

    769 Total

    770 Total

    771 Total

    772 Total

    773 06165.1
    773 06165.1
    773 06165.2
    773 07471
    773 07471

    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 PAINFUL HEEL
    2 PAINFUL HEEL

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    774 06883
    774 06883
    774 06884
    774 06884
    774 06885
    774 06885
    774 06886
    774 06887
    774 06887
    774 08973
    774 08973
    774 08973

    1 EYE DISORDER
    2 EYE DISORDER
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1
    2
    1 DEVIATED NASAL
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    775 04064
    775 08315.1
    775 08315.1
    775 08974

    1 DILATION & CURRETAGE


    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS

    776 06169
    776 06169

    1 BURSITIS
    2 BURSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    777 04737
    777 04737
    777 04737

    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    778 06875.1
    778 06875.1
    778 06875.1
    778 07468.1
    778 07468.1
    778 07468.1
    778 07468.1
    778 07468.1

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    779 05130
    779 05130
    779 05130
    779 07038
    779 07038
    779 07038
    779 07038
    779 07038
    779 07038.1
    779 07038.1

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1 EYE DISORDER
    2 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    780 05581
    780 05582.1

    1
    1 DENTAL CARE

    DIAGNOSTIC X-RAY
    DENTAL CARE

    773 Total

    SEPTUM
    SEPTUM

    SEPTUM
    SEPTUM
    SEPTUM

    774 Total

    775 Total

    776 Total

    777 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    778 Total

    779 Total

    780 05582.1
    780 05582.1
    780 07854
    780 07854
    780 07854

    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    2 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC X-RAY

    781 04056
    781 04057
    781 04057
    781 04057
    781 06162
    781 06162
    781 06162.1

    1
    DIAGNOSTIC X-RAY
    1 KNEE INTERNAL DERANGEMENT
    PHYSICIAN VISIT-OFFICE
    2 KNEE INTERNAL DERANGEMENT
    DIAGNOSTIC X-RAY
    3 KNEE INTERNAL DERANGEMENT
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE

    782 07234
    782 07234
    782 07234
    782 07234

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    783 04062
    783 04062
    783 04063
    783 05598
    783 07859
    783 07859
    783 07859
    783 07859
    783 07859

    1
    2
    1 HYPERTENSION
    1
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION

    PHYSIOTHERAPY
    PHYSIOTHERAPY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER

    784 05557

    1 EYE DISORDER

    PHYSICIAN VISIT-OFFICE

    785 02244
    785 02244
    785 02244

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    786 07470
    786 07470
    786 07470

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    787 03521
    787 03521
    787 03521
    787 04049
    787 04049
    787 04049
    787 04049
    787 04049
    787 04050
    787 04746
    787 05583
    787 06717

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 CONJUNCTIVITIS - EYE
    1 ALLERGIC REACTION
    1 FEVER
    1 ABDOMINAL PAINS

    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    788 04747

    1 MISCARRIAGE

    MATERNITY-CAESAR/EXTRA UT

    780 Total

    781 Total
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    782 Total

    783 Total
    784 Total

    785 Total

    786 Total

    787 Total

    788 04747
    788 04747
    788 04747
    788 04747
    788 04747.1
    788 06880
    788 06880.1
    788 08707
    788 08707
    788 08707

    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    2
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    MATERNITY-CAESAR/EXTRA
    MATERNITY-CAESAR/EXTRA
    MATERNITY-CAESAR/EXTRA
    MATERNITY-CAESAR/EXTRA
    MATERNITY-CAESAR/EXTRA
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    UT
    UT
    UT
    UT
    UT

    789 04045
    789 04045
    789 07222
    789 07222
    789 07222
    789 07222

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    790 04432
    790 04432
    790 04432
    790 06154
    790 06154
    790 06154
    790 06155
    790 06155
    790 06157

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICITIS
    2 CERVICITIS
    3 CERVICITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 FEVER

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    791 05556
    791 05556.1
    791 05556.2
    791 06874
    791 06874
    791 07221

    1 CERVICAL SPONDYLOSIS
    1 DEVIATED NASAL SEPTUM
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE

    792 05572
    792 05572
    792 05572
    792 05572
    792 06153
    792 06153

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1
    2

    MATERNITY-NORMAL
    MATERNITY-NORMAL
    MATERNITY-NORMAL
    MATERNITY-NORMAL
    PREVENTATIVE
    PREVENTATIVE

    793 03878
    793 03878
    793 03878
    793 04052
    793 04052

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    794 06712
    794 06712
    794 06712

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    795 04058

    1 ANXIETY

    MISC OUT HOSP-ORAL DRUGS

    788 Total

    789 Total

    790 Total

    791 Total
    DELIVERY
    DELIVERY
    DELIVERY
    DELIVERY

    792 Total

    793 Total

    794 Total

    795 04752
    795 05596
    795 06508
    795 08045

    1 HEART- ISCHEMIC HEART DISEASE


    MISC OUT
    1 ANXIETY
    MISC OUT
    1 DEPRESSION
    MISC OUT
    1 DEPRESSION
    MISC OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS

    796 08128
    796 08128
    796 08128
    796 08129
    796 08129
    796 08129
    796 08129
    796 08129
    796 08130

    1 JAUNDICE
    2 JAUNDICE
    3 JAUNDICE
    1 PHIMOSIS
    2 PHIMOSIS
    3 PHIMOSIS
    4 PHIMOSIS
    5 PHIMOSIS
    1 OTITIS - EAR

    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    797 08314
    797 08314
    797 08314
    797 08314

    1 RENAL
    2 RENAL
    3 RENAL
    4 RENAL

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    798 04749

    1 VISION CARE

    VISION CARE

    799 08701

    DIAGNOSTIC LABORATORY

    800 06158
    800 06158
    800 06158

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    801 06511

    DIAGNOSTIC X-RAY

    802 04059
    802 04059
    802 04059
    802 04059
    802 04060
    802 04060

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    803 06167
    803 06167
    803 06167
    803 06167
    803 08715

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    804 04061
    804 04061
    804 06720
    804 06720
    804 08716
    804 08716

    1 VISION CARE
    2 VISION CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 HEMORRHOIDS
    2 HEMORRHOIDS

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    805 06160
    805 06160
    805 06160

    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    795 Total

    796 Total
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION

    797 Total
    798 Total
    799 Total

    800 Total
    801 Total

    802 Total

    803 Total

    804 Total

    805 Total
    806 07800
    806 07800
    806 07800
    806 08453
    806 08453
    806 08453
    806 08453

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    3 SKIN - LOCAL INFECTION
    4 SKIN - LOCAL INFECTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    807 04051
    807 04051.1
    807 05597
    807 05597.1
    807 06719
    807 06719
    807 06719
    807 06719
    807 07857
    807 07857

    1 EYE DISORDER
    1 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    808 08316
    808 08719
    808 08719

    1
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE

    809 05599
    809 05599
    809 05599.1
    809 05599.1
    809 06168
    809 06168
    809 06168

    1 THYROID
    2 THYROID
    1 DEPRESSION
    2 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    810 04748
    810 04748

    1 ANXIETY
    2 ANXIETY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    811 08050
    811 08050
    811 08050

    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    812 08046
    812 08046
    812 08046
    812 08046
    812 08046
    812 08046.1
    812 08046.1
    812 08046.1
    812 08048

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    813 08313
    813 08313
    813 08313

    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA

    806 Total

    807 Total

    808 Total

    809 Total

    810 Total

    811 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    812 Total

    813 Total

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    814 04741
    814 04741
    814 04741
    814 06714
    814 06714
    814 08705
    814 08705

    1 VISION
    2 VISION
    3 VISION
    1 VISION
    2 VISION
    1 VISION
    2 VISION

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    VISION
    VISION
    VISION
    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    815 04753
    815 04753
    815 08717
    815 08717
    815 08717

    1 NASAL POLYP
    2 NASAL POLYP
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    816 07232
    816 07232
    816 07232
    816 07233
    816 07233
    816 07233
    816 07233

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    817 06166

    MISC OUT HOSP-ORAL DRUGS

    818 06151
    818 06151
    818 06151
    818 06151

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    819 07855
    819 07855

    1 AMMENORRHOEA
    2 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    820 04738
    820 04738
    820 04738
    820 07467
    820 07467
    820 07467

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    821 08708
    821 08708
    821 08708
    821 08708

    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    3 HYPERLIPIDERMIA
    4 HYPERLIPIDERMIA

    822 06149
    822 06150

    1 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    VISION CARE

    823 06504
    823 06504
    823 06504
    823 06504

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    824 05600

    1 DENTAL CARE

    814 Total

    815 Total

    816 Total
    817 Total
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    818 Total

    819 Total

    820 Total
    -

    CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    CHOLESTEROL
    DIAGNOSTIC LABORATORY
    CHOLESTEROL
    DIAGNOSTIC X-RAY

    821 Total

    822 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    823 Total
    DENTAL CARE

    824 05600
    824 05600

    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    825 06163
    825 06163
    825 06164
    825 06509
    825 06509
    825 06510

    1 HEADACHE- MIGRAINE TENSION


    PHYSICIAN VISIT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    DIAGNOSTIC LABORATORY
    1 HEMORRHOIDS
    PHYSICIAN VISIT-OFFICE
    1 TONSILLITIS
    PHYSICIAN VISIT-OFFICE
    2 TONSILLITIS
    DIAGNOSTIC LABORATORY
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE

    826 07231
    826 07231
    826 07231
    826 07231

    1 ABDOMINAL
    2 ABDOMINAL
    3 ABDOMINAL
    4 ABDOMINAL

    827 07223
    827 07223
    827 07853

    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    828 08972
    828 08972
    828 08972
    828 08972

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    829 04103
    829 04103

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    830 04104
    830 04104
    830 04104
    830 07473
    830 07473

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 HERPES ZOSTER
    2 HERPES ZOSTER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    831 04934
    831 04934

    1 VARICOSE
    2 VARICOSE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    832 06199
    832 06199
    832 08721
    832 08721
    832 08721
    832 08722
    832 08723
    832 08723

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC RHINITIS
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE

    833 05131
    833 05131
    833 05131
    833 05131
    833 05131
    833 05131.1
    833 05131.1

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    824 Total

    825 Total
    PAINS
    PAINS
    PAINS
    PAINS

    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS

    826 Total

    827 Total

    828 Total

    829 Total

    830 Total

    831 Total

    832 Total

    833 Total

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    834 07576
    834 07576

    1 TENDONITIS
    2 TENDONITIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    835 04433
    835 04433
    835 04433
    835 04592
    835 04592
    835 04592.1
    835 04593
    835 06326
    835 06326
    835 06806
    835 06806
    835 07235
    835 07235
    835 07235
    835 07236
    835 07236
    835 07236
    835 07236
    835 07236

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 CONJUNCTIVITIS - EYE
    1
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    836 06200
    836 06200

    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE

    837 07040
    837 07040
    837 07040
    837 07040

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    838 06327
    838 06327
    838 06327
    838 07860
    838 07860
    838 07860

    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    3 EAR DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    839 05132
    839 05132
    839 08176
    839 08176

    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    840 04105
    840 04105

    1
    2

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    841 05177
    841 05177
    841 05177
    841 05179
    841 05179
    841 05179
    841 07363

    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1 LUNG DISEASE
    2 LUNG DISEASE
    3 LUNG DISEASE
    1 LUNG DISEASE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    834 Total

    835 Total

    836 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    837 Total

    838 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    839 Total

    840 Total

    841 07363
    841 07363
    841 08646
    841 08646
    841 08646
    841 08647
    841 08647

    2 LUNG DISEASE
    3 LUNG DISEASE
    1
    2
    3
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    842 05251
    842 05251

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    843 03548
    843 03548
    843 03548
    843 03996
    843 03996
    843 03996
    843 03996
    843 03996
    843 03996.1
    843 03996.1
    843 06897
    843 06897
    843 06898
    843 06898
    843 06898

    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    3 HYPERLIPIDERMIA
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    4 OTITIS - EAR
    5 OTITIS - EAR
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    3 HYPERLIPIDERMIA

    844 04000
    844 04000

    1
    2

    845 03537
    845 03537
    845 03537
    845 03537

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    846 06409
    846 06409
    846 08415
    846 08415
    846 08415

    1 DIAB'ETES
    2 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE

    847 05255
    847 05255.1
    847 05255.1
    847 05256
    847 05256
    847 05256
    847 05256
    847 05256
    847 05256.1
    847 05256.1
    847 07298
    847 07298

    1
    1 HEART
    2 HEART
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    5 OVARIAN CYST
    1 HEART
    2 HEART
    1 OTITIS - EAR
    2 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    841 Total

    842 Total
    - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS

    843 Total
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    844 Total
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    845 Total

    846 Total

    847 07299
    847 07299

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    848 05635
    848 05635

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    849 03992
    849 03992
    849 03992
    849 05252
    849 05252
    849 05252
    849 05987
    849 05987
    849 05987
    849 05987
    849 06415
    849 06415
    849 06415
    849 07296
    849 07296
    849 07296

    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    OTHER
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY

    850 07301
    850 07301

    1 HEADACHE- MIGRAINE TENSION


    PHYSICIAN VISIT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    DIAGNOSTIC LABORATORY

    851 04293
    851 04293
    851 04293
    851 07561
    851 07561
    851 07561

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE

    852 04291
    852 04291

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    853 03550
    853 03550
    853 03550

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    854 05988
    854 05988

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    855 06903
    855 06903
    855 06903.1
    855 06903.1

    1 BACK PAIN
    2 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    856 07294

    1 CATARACT

    SPECIALIST CNSLT-OFFICE

    857 05989
    857 05989
    857 05989

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    847 Total

    848 Total

    849 Total

    850 Total

    851 Total

    852 Total

    853 Total

    854 Total

    855 Total
    856 Total

    857 Total
    858 04762
    858 04762

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    859 07559

    PHYSICIAN VISIT-OFFICE

    860 07557
    860 07557
    860 07557

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES

    861 04299
    861 04299

    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    862 08416
    862 08416

    1 COUGH - AIRWAY OBSTRUCTION


    PHYSICIAN VISIT-OFFICE
    2 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS

    863 05615
    863 05615

    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    864 05260
    864 05260
    864 05260
    864 06460
    864 06460
    864 06460

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    865 02467.1
    865 02467.1
    865 02467.1

    1
    2
    3

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    866 03616
    866 03616

    1 DIAB'ETES
    2 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    867 06445
    867 06445
    867 07558
    867 07558

    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE

    868 04292
    868 04292

    1 DIAB'ETES
    2 DIAB'ETES

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    869 06900
    869 06900
    869 06900
    869 06901
    869 06902

    1 EYE DISORDER
    PHYSICIAN VISIT-OFFICE
    2 EYE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    3 EYE DISORDER
    SURGICAL OUTPATIENT
    1 BONE & CARTILAGE DISORDER
    PHYSICIAN VISIT-OFFICE
    1 VISION CARE
    VISION CARE

    870 04767
    870 04767
    870 05261
    870 05633
    870 05991
    870 06462

    1 TRAUMA
    2 TRAUMA
    1 BREAST DISORDERS
    1 INJURY - UNSPECIFIED
    1
    1 CYST

    858 Total
    859 Total

    860 Total

    861 Total

    862 Total

    863 Total

    864 Total

    865 Total

    866 Total

    867 Total

    868 Total

    869 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    870 06462

    2 CYST

    SURGICAL OUTPATIENT

    871 03999
    871 03999
    871 03999

    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    872 06444
    872 06444
    872 06444

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    873 03536
    873 03536
    873 03536
    873 03536
    873 03536

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    874 03993
    874 03993
    874 03993

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    875 03822
    875 03822
    875 03822
    875 03822
    875 05253
    875 05253
    875 05253
    875 05253
    875 05506
    875 05506
    875 05506
    875 06033
    875 06033
    875 06033
    875 06033
    875 06033
    875 07554

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    5 ANAEMIA
    1 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE

    876 07293
    876 07293
    876 07293
    876 08413
    876 08413
    876 08413
    876 08414
    876 08414
    876 08414

    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION
    2 VISION
    3 VISION
    1 VISION
    2 VISION
    3 VISION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    877 06414
    877 06414

    1 EYE DISORDER
    2 EYE DISORDER

    878 05990
    878 05990

    1 HEADACHE- MIGRAINE TENSION


    PHYSICIAN VISIT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-ORAL DRUGS

    870 Total

    871 Total

    872 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    873 Total

    874 Total

    875 Total

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    876 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    877 Total

    878 Total
    879 05254
    879 05254.1
    879 07705
    879 07705
    879 07705
    879 07705
    879 07705
    879 07705.1

    1 TENDONITIS
    1 DIAB'ETES
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 AMMENORRHOEA

    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    880 03543
    880 04764
    880 04764
    880 04764
    880 05257
    880 05257

    1 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS

    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    881 03546
    881 03546

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    882 05985
    882 05985

    1 EYE DISORDER
    2 EYE DISORDER

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    883 03544
    883 03544

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    884 03541
    884 03541
    884 03542
    884 03542
    884 05627
    884 06442

    1 DIAB'ETES
    2 DIAB'ETES
    1 URTICARIA
    2 URTICARIA
    1 HYPERTENSION
    1 DIAB'ETES

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    885 06412
    885 06412
    885 06412

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    886 04298
    886 04298
    886 04298
    886 05262
    886 05262
    886 05262
    886 05634

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE

    887 03540
    887 03540
    887 07556
    887 07556
    887 07556.1
    887 07556.1
    887 07556.1

    1 OVARIAN CYST
    2 OVARIAN CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY

    879 Total

    880 Total

    881 Total

    882 Total

    883 Total

    884 Total

    885 Total

    886 Total

    887 Total

    888 05986
    888 05986

    1 TONSILLITIS
    2 TONSILLITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    889 06896
    889 06896

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    890 04763
    890 07297
    890 07297
    890 07297

    1 DEVIATED NASAL SEPTUM


    1 CERVICITIS
    2 CERVICITIS
    3 CERVICITIS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    891 03553
    891 03553
    891 06473
    891 06473
    891 06473
    891 06473
    891 06473.1
    891 06473.1
    891 06473.1

    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    892 03539
    892 03539
    892 03539
    892 03539
    892 06068
    892 06068
    892 06068
    892 06068

    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    893 07555
    893 07555
    893 07555

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    894 03994
    894 03994
    894 03994
    894 06439
    894 06439
    894 06439
    894 06440
    894 06440

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 ANAEMIA
    2 ANAEMIA

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    895 04766
    895 04766
    895 04766
    895 04766
    895 06899
    895 06899
    895 07300
    895 07300
    895 07300
    895 07300

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    4 BRONCHITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    888 Total

    889 Total

    890 Total

    891 Total

    892 Total

    893 Total

    894 Total

    895 Total
    896 05258
    896 05258

    1 ARTHRITIS
    2 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    897 04761
    897 04761
    897 04761

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    898 06999
    898 06999
    898 06999
    898 06999
    898 06999
    898 06999.1
    898 06999.1
    898 06999.1
    898 06999.1
    898 06999.1
    898 06999.2
    898 06999.2

    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 ABSCESS
    2 ABSCESS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    899 06019
    899 06019
    899 06019
    899 06020
    899 06020
    899 06020
    899 06020
    899 06020
    899 06020.1
    899 06020.1

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    900 04381
    900 04381
    900 04381
    900 04381.1
    900 04381.1
    900 04382
    900 04382.1
    900 06729
    900 06729
    900 07413
    900 07413
    900 07413
    900 07413
    900 07413

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 LACERATION TO FOOT
    2 LACERATION TO FOOT
    1 VISION CARE
    1 EYE DISORDER
    1
    2
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    901 03830
    901 04184
    901 04947
    901 04947.1
    901 04948
    901 05182

    1 ABDOMINAL PAINS
    1 GLAUCOMA
    1 HYPERTENSION
    1 HYPERTENSION
    1 GLAUCOMA
    1 DENTAL CARE

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE

    896 Total

    897 Total

    898 Total

    899 Total

    900 Total

    901 05182
    901 05182
    901 05322
    901 05322.1
    901 06432
    901 06432.1
    901 06432.2
    901 06997
    901 06997
    901 07603
    901 08282
    901 08282.1
    901 08648
    901 08648
    901 08649
    901 08649

    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    1 ASTHMA
    1 GLAUCOMA
    1 HYPERTENSION
    1 ASTHMA
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 HYPERTENSION
    1 THYROID
    1 HYPERTENSION
    2 HYPERTENSION
    1 BACK PAIN
    2 BACK PAIN

    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE

    902 05875
    902 05875.1
    902 05875.1
    902 05875.2
    902 07458
    902 07458.1
    902 07458.2

    1 PROSTATE
    MISC
    1
    MISC
    2
    MISC
    1 SKIN - LOCAL INFECTION
    MISC
    1 PROSTATE
    MISC
    1 COUGH - AIRWAY OBSTRUCTION
    MISC
    1
    MISC

    903 08653
    903 08653
    903 08653

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    904 07610
    904 07610

    1 DIAB'ETES
    2 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    905 04203
    905 04203
    905 04962

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DILATION & CURRETAGE

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE

    906 06678
    906 06678

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    907 06413
    907 06413

    1 HYPERTENSION
    2 HYPERTENSION

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    908 05323
    908 05323

    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE


    2 SKIN - ATOPIC DERMATITIS SURGICAL OUTPATIENT

    909 03836
    909 03836
    909 03836
    909 07107
    909 07108
    909 07108
    909 07109

    1 HYPERLIPIDERMIA - CHOLESTEROL
    SPECIALIST CNSLT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 GLAUCOMA
    SPECIALIST CNSLT-OFFICE
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    DIAGNOSTIC LABORATORY
    1 CATARACT
    SPECIALIST CNSLT-OFFICE

    901 Total
    OUT
    OUT
    OUT
    OUT
    OUT
    OUT
    OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    902 Total

    903 Total

    904 Total

    905 Total

    906 Total

    907 Total

    908 Total

    909 Total

    910 05744
    910 05744
    910 05744
    910 06452
    910 06452
    910 06452
    910 06452
    910 06453
    910 06453
    910 06453
    910 06453
    910 06453
    910 06453.1
    910 06454
    910 06455
    910 06455
    910 06455
    910 06455
    910 06455
    910 07004
    910 07004
    910 07004
    910 07004
    910 07004
    910 07005
    910 07005
    910 07005
    910 07005
    910 07006
    910 07006
    910 07006
    910 07009
    910 07009
    910 07009
    910 07009
    910 07009
    910 07009.1

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    4 URTICARIA
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 FEVER
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    4 URTICARIA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1
    2
    3
    4
    5
    1

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    911 04607
    911 04607
    911 04607
    911 04608
    911 04943
    911 04943
    911 04944
    911 04944
    911 05434
    911 05434
    911 05434
    911 05434
    911 05435
    911 05435
    911 05435

    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY

    910 Total

    911 05435
    911 05435
    911 05435.1
    911 06995
    911 06995
    911 06995
    911 07596

    4 CONSTIPATION
    5 CONSTIPATION
    1 FEVER
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 HYPERTENSION

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    912 06436
    912 06436
    912 06436

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    913 03838
    913 03838
    913 03839
    913 03839
    913 03839
    913 03840
    913 04186
    913 04186
    913 04186.1
    913 04548
    913 05439
    913 05440
    913 05440
    913 06443
    913 06443
    913 06443
    913 06443
    913 06857
    913 06857
    913 06858
    913 06858
    913 06858
    913 06858
    913 06858
    913 06858.1
    913 06858.1
    913 06858.1
    913 07365
    913 07366

    1 BACK PAIN
    2 BACK PAIN
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    1 OTITIS - EAR
    1 DIAB'ETES
    1 DIAB'ETES
    1 BACK PAIN
    2 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    5 SKIN - ATOPIC DERMATITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    1 HYPERTENSION
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    914 03820
    914 03820
    914 03820
    914 04609
    914 04610
    914 05613
    914 05613
    914 05613
    914 05613
    914 05613
    914 05613.1

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 FEVER
    1 DENTAL CARE
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    5 CATARACT
    1 CATARACT

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER

    911 Total

    912 Total

    913 Total

    914 07864
    914 07864
    914 07864
    914 07864
    914 08640
    914 08641
    914 08642
    914 08642
    914 08643
    914 08643
    914 08643

    1 HEARING LOSS
    2 HEARING LOSS
    3 HEARING LOSS
    4 HEARING LOSS
    1 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    915 04192
    915 04192
    915 04192
    915 04193
    915 04193
    915 04193.1
    915 04193.2
    915 05632
    915 05632
    915 05632.1
    915 07012
    915 07012.1
    915 07012.1
    915 07013
    915 07953
    915 07953
    915 07953
    915 07953
    915 07953
    915 07953.1
    915 07953.1

    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    3 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 ANXIETY
    MISC OUT HOSP-ORAL DRUGS
    1 ABDOMINAL PAINS
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 PROSTATE
    MISC OUT HOSP-ORAL DRUGS
    1 SKIN - ECZEMA
    PHYSICIAN VISIT-OFFICE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    1 PAINFUL HEEL
    PHYSICIAN VISIT-OFFICE
    2 PAINFUL HEEL
    MISC OUT HOSP-INJECTABLES
    3 PAINFUL HEEL
    MISC OUT HOSP-INJECTABLES
    4 PAINFUL HEEL
    DIAGNOSTIC LABORATORY
    5 PAINFUL HEEL
    DIAGNOSTIC X-RAY
    1 PAINFUL HEEL
    MISC OUT HOSP-ORAL DRUGS
    2 PAINFUL HEEL
    MISC OUT HOSP-ORAL DRUGS

    916 04554
    916 04554
    916 04554
    916 04554
    916 04554
    916 04845
    916 04845.1
    916 04845.2
    916 04956
    916 04956
    916 06449
    916 06675
    916 06675
    916 07002
    916 07608
    916 07608
    916 07608

    1 TONSILLITIS
    PHYSICIAN VISIT-OFFICE
    2 TONSILLITIS
    SPECIALIST CNSLT-OFFICE
    3 TONSILLITIS
    DIAGNOSTIC LABORATORY
    4 TONSILLITIS
    MISC OUT HOSP-ORAL DRUGS
    5 TONSILLITIS
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    HOSPITAL MISC-LOCAL
    1 HEART
    HOSPITAL MISC-LOCAL
    1 HEART
    SURGICAL OUTPATIENT
    1 KNEE INTERNAL DERANGEMENT
    SPECIALIST CNSLT-OFFICE
    2 KNEE INTERNAL DERANGEMENT
    DIAGNOSTIC X-RAY
    1 AMMENORRHOEA
    PHYSICIAN VISIT-OFFICE
    1 EYE DISORDER
    SPECIALIST CNSLT-OFFICE
    2 EYE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    HOSPITAL MISC-LOCAL
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE

    917 04185

    1 GLAUCOMA

    914 Total

    915 Total

    916 Total
    SPECIALIST CNSLT-OFFICE

    917 04185
    917 07993
    917 07993

    2 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    918 04360
    918 04360.1
    918 04365
    918 05892
    918 05892
    918 06104
    918 06104.1
    918 06213
    918 06213.1
    918 06328
    918 06946
    918 07251
    918 07251
    918 07251.1
    918 07251.2
    918 07578
    918 07578.1
    918 08237
    918 08821
    918 08822
    918 08822
    918 08899
    918 08899.1

    1 DIAB'ETES
    1 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS
    1 ABSCESS
    2 ABSCESS
    1 DIAB'ETES
    1 INTESTINAL COLIC
    1 CERVICAL STRAIN
    1 DIAB'ETES
    1 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 CERVICAL SPONDYLOSIS
    1 PROSTATE
    1 CERVICAL SPONDYLOSIS
    1 DIAB'ETES
    1 HYPERTENSION
    1 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 DIAB'ETES
    1 INTESTINAL COLIC

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    919 04180
    919 04180
    919 05622
    919 05622
    919 05622
    919 05622
    919 05622
    919 05623
    919 05623
    919 07354
    919 07354
    919 07355
    919 07355
    919 07355
    919 07355
    919 07355
    919 07355.1
    919 07355.1
    919 07357
    919 07357
    919 07357

    1 FEVER
    2 FEVER
    1
    2
    3
    4
    5
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    5 STONE - URETER
    1 STONE - URETER
    2 STONE - URETER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE

    920 03813
    920 04246
    920 05446

    1 HYPERTENSION
    1 DIAB'ETES
    1 DIAB'ETES

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    917 Total

    918 Total

    919 Total

    920 05747
    920 06247
    920 06247
    920 06851
    920 07612
    920 07612
    920 08281
    920 08645

    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    1 DIAB'ETES

    MISC
    MISC
    MISC
    MISC
    MISC
    MISC
    MISC
    MISC

    OUT
    OUT
    OUT
    OUT
    OUT
    OUT
    OUT
    OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    921 04955
    921 04955
    921 04955
    921 04955
    921 04955.1
    921 04955.1
    921 04955.1
    921 06671
    921 06671
    921 06859
    921 06859

    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    1 CATARACT
    2 CATARACT
    3 CATARACT
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE

    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE

    922 05436
    922 06423
    922 06423
    922 06423
    922 06423
    922 06424
    922 06424
    922 06424
    922 06849
    922 06850
    922 06850
    922 07358
    922 07359
    922 07359
    922 07359.1
    922 07600
    922 07600

    1 VISION CARE
    VISION CARE
    1 INTESTINAL COLIC
    PHYSICIAN VISIT-OFFICE
    2 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    3 INTESTINAL COLIC
    PHYSICIAN VISIT-OFFICE
    4 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    PHYSICIAN VISIT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    3 BACK PAIN
    DIAGNOSTIC X-RAY
    1 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    SPECIALIST CNSLT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    DIAGNOSTIC LABORATORY
    1 ACUTE ENTERITIS
    PHYSICIAN VISIT-OFFICE
    2 ACUTE ENTERITIS
    DIAGNOSTIC X-RAY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 BACK PAIN
    SPECIALIST CNSLT-OFFICE
    2 BACK PAIN
    DIAGNOSTIC X-RAY

    923 05920
    923 05920
    923 05920
    923 05920
    923 05920

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    924 04967
    924 04967
    924 04967

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    925 06456.1
    925 06456.1
    925 06456.1
    925 06456.1

    1 HEART
    2 HEART
    3 HEART
    4 HEART

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    920 Total

    921 Total

    922 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    923 Total

    924 Total

    925 06456.1
    925 06457.1
    925 07011
    925 07950
    925 07950
    925 07950
    925 07951
    925 07951
    925 07952
    925 08654
    925 08655
    925 08655.1

    5 HEART
    MISC OUT HOSP-ORAL DRUGS
    1 PAINFUL LEGS
    PHYSICIAN VISIT-OFFICE
    1 HEART
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    SPECIALIST CNSLT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    3 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    MISC OUT HOSP-ORAL DRUGS
    1 PROSTATE
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS

    926 08089
    926 08089
    926 08089
    926 08089
    926 08089

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    927 04258.1
    927 04258.1
    927 06472
    927 06472

    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS

    928 04443
    928 04937
    928 05134
    928 05134
    928 05134
    928 05134
    928 05296
    928 05296
    928 05368
    928 06078
    928 06101
    928 07994
    928 07994
    928 07994
    928 07994
    928 08178
    928 08730

    1 CONSTIPATION
    1 CONSTIPATION
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 SINUSITIS
    1 DENTAL CARE
    1 SINUSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CONSTIPATION
    1 CONSTIPATION

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    929 04550
    929 04550
    929 04551
    929 04551
    929 04552
    929 04552
    929 05189
    929 05189.1
    929 05629
    929 05630
    929 05630

    1 RECTAL BLEEDING
    2 RECTAL BLEEDING
    1 TONSILLITIS
    2 TONSILLITIS
    1
    2
    1 OTITIS - EAR
    1 EYE DISORDER
    1 FEVER
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS

    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    925 Total
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    926 Total

    927 Total

    928 Total

    929 06447
    929 06447
    929 06863
    929 06863
    929 06863
    929 06864
    929 06864
    929 07939
    929 07939
    929 07939
    929 07940
    929 07940
    929 07940
    929 07941
    929 07941
    929 07941
    929 07941
    929 07942
    929 07942
    929 07942
    929 07942
    929 07942
    929 07943
    929 07943
    929 07944
    929 07944
    929 07945
    929 07945
    929 07946
    929 07946

    1 INGROWING TOE NAIL


    PHYSICIAN VISIT-OFFICE
    2 INGROWING TOE NAIL
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    5 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 TONSILLITIS
    PHYSICIAN VISIT-OFFICE
    2 TONSILLITIS
    MISC OUT HOSP-ORAL DRUGS
    1
    PHYSICIAN VISIT-OFFICE
    2
    SURGICAL OUTPATIENT
    1 KNEE INTERNAL DERANGEMENT
    SPECIALIST CNSLT-OFFICE
    2 KNEE INTERNAL DERANGEMENT
    MISC OUT HOSP-ORAL DRUGS

    930 04244
    930 04244
    930 04244
    930 06418
    930 06418
    930 06418
    930 06418
    930 06418
    930 06418.1
    930 07599

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 EYE DISORDER
    SPECIALIST CNSLT-OFFICE
    2 EYE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    3 EYE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    4 EYE DISORDER
    SURGICAL OUTPATIENT
    5 EYE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 EYE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1
    SPECIALIST CNSLT-OFFICE

    931 05181
    931 05181

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    932 08352
    932 08352
    932 08352

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    933 04537
    933 04539
    933 04539
    933 04539

    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    929 Total

    930 Total

    931 Total

    932 Total

    933 04541
    933 04541
    933 04541
    933 05616
    933 05616
    933 05617
    933 05617
    933 05617.1
    933 05618
    933 05618
    933 05619
    933 05619
    933 05620
    933 05621
    933 05621
    933 06996
    933 07348
    933 07350
    933 07350
    933 07351
    933 07352
    933 07353

    1 ABDOMINAL PAINS
    PHYSICIAN VISIT-OFFICE
    2 ABDOMINAL PAINS
    MISC OUT HOSP-ORAL DRUGS
    3 ABDOMINAL PAINS
    MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 BARTHOLIN'S CYST
    MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    VISION CARE
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 COUGH - AIRWAY OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    2 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS
    1 SINUSITIS
    PHYSICIAN VISIT-OFFICE
    1
    PREVENTATIVE
    1
    MISC OUT HOSP-ORAL DRUGS

    934 06861
    934 06861
    934 06861

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    935 03892.1
    935 03896.1
    935 03896.1
    935 03896.1
    935 03896.1
    935 03897.1
    935 04073
    935 04073
    935 04073
    935 04073.1
    935 04073.2
    935 04968
    935 04969
    935 04969
    935 04969
    935 04971
    935 04971
    935 04971
    935 04971
    935 04971.1
    935 04972
    935 04975
    935 04975
    935 04975
    935 04975
    935 04975

    1 VISION CARE
    VISION CARE
    1
    PHYSIOTHERAPY
    2
    MISC OUT HOSP-ORAL DRUGS
    3
    PHYSICIAN VISIT-OFFICE
    4
    PHYSICIAN VISIT-OFFICE
    1 VISION CARE
    VISION CARE
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1
    DIAGNOSTIC LABORATORY
    1 HEADACHE- MIGRAINE TENSION
    DIAGNOSTIC X-RAY
    1 ALLERGY
    PHYSICIAN VISIT-HOSPITAL
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 ABDOMINAL PAINS
    PHYSICIAN VISIT-HOSPITAL
    2 ABDOMINAL PAINS
    DIAGNOSTIC LABORATORY
    3 ABDOMINAL PAINS
    DIAGNOSTIC X-RAY
    4 ABDOMINAL PAINS
    SPECIALIST CNSLT-OFFICE
    1 HEADACHE- MIGRAINE TENSION
    DIAGNOSTIC X-RAY
    1 DENTAL CARE
    DENTAL CARE
    1 EPIDIDMYITIS
    SPECIALIST CNSLT-OFFICE
    2 EPIDIDMYITIS
    DIAGNOSTIC X-RAY
    3 EPIDIDMYITIS
    PHYSICIAN VISIT-HOSPITAL
    4 EPIDIDMYITIS
    DIAGNOSTIC LABORATORY
    5 EPIDIDMYITIS
    SPECIALIST CNSLT-OFFICE

    933 Total
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    934 Total

    935 04976
    935 04976
    935 04976
    935 04976
    935 04977
    935 04977
    935 06251
    935 06251
    935 06251
    935 06251
    935 06251
    935 06251.1
    935 06252
    935 06598
    935 06598
    935 06599
    935 06599
    935 06607
    935 06607
    935 06607
    935 06749
    935 06749
    935 06749
    935 07044
    935 07408
    935 07408
    935 07409
    935 07409
    935 07409
    935 07410
    935 07524
    935 07524
    935 08096
    935 08096
    935 08096
    935 08181

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1 RECTAL BLEEDING
    2 RECTAL BLEEDING
    3 RECTAL BLEEDING
    4 RECTAL BLEEDING
    5 RECTAL BLEEDING
    1 OTITIS - EAR
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    MISC OUT HOSP-OTHER
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY

    936 06464
    936 06465
    936 06465
    936 06465
    936 06467
    936 06467
    936 06470
    936 06470
    936 06470
    936 06471
    936 06471
    936 06471
    936 08093
    936 08093
    936 08094
    936 08095

    1 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    1 HYPERTENSION
    1 BURSITIS

    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE

    935 Total

    936 08095

    2 BURSITIS

    DIAGNOSTIC LABORATORY

    937 03837
    937 03837
    937 03837
    937 05628
    937 05628
    937 08650
    937 08651
    937 08651
    937 08651
    937 08651

    1 ENDOMETROSIS
    2 ENDOMETROSIS
    3 ENDOMETROSIS
    1 SKIN - LESION
    2 SKIN - LESION
    1 DENTAL CARE
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    4 CIRCULATORY DISORDER

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-OFFICE

    938 04953
    938 04953
    938 04953
    938 04953
    938 06441
    938 06441
    938 06441

    1 GASTRIC - PEPTIC
    2 GASTRIC - PEPTIC
    3 GASTRIC - PEPTIC
    4 GASTRIC - PEPTIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    939 07949
    939 07949

    1
    2

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    940 03842
    940 03842
    940 03842
    940 05389
    940 05389
    940 05389
    940 06672
    940 06672
    940 06672
    940 07000
    940 07000
    940 07000
    940 07000
    940 07104
    940 07104
    940 07104
    940 07105
    940 07105
    940 07106
    940 07106.1
    940 07106.1
    940 07106.1
    940 07367
    940 08283
    940 08283

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 DEVIATED NASAL SEPTUM
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 VISION CARE
    1
    2

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    941 04949
    941 04949
    941 04949

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    936 Total

    937 Total
    ULCER/GERD
    SPECIALIST CNSLT-OFFICE
    ULCER/GERD
    SURGICAL OUTPATIENT
    ULCER/GERD
    HOSPITAL MISC-LOCAL
    ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    938 Total

    939 Total

    940 Total

    941 06667
    941 06667

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    942 03821
    942 03821
    942 03821
    942 05742
    942 05742

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    943 08108.1
    943 08108.1
    943 05756
    943 05756
    943 05756
    943 05756
    943 05756.1
    943 05756.1
    943 06474

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1
    2
    3
    4
    1
    2
    1 ANAEMIA

    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    944 04187
    944 04187
    944 06446
    944 06446
    944 06446
    944 06446

    1 THYROID
    2 THYROID
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    945 06854

    1 DENTAL CARE

    DENTAL CARE

    946 04249
    946 04249
    946 04249
    946 04249
    946 04249
    946 05186
    946 05186
    946 05186
    946 05186
    946 05441
    946 05441
    946 05441
    946 06673
    946 06673
    946 06674
    946 06674
    946 07936
    946 07936
    946 07937
    946 07937
    946 07937
    946 08073
    946 08073
    946 08073
    946 08073

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    941 Total

    942 Total

    943 Total

    944 Total
    945 Total

    946 08073
    946 08074
    946 08075
    946 08075
    946 08075
    946 08076
    946 08076
    946 08076

    5 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL

    947 03829
    947 04545
    947 04546
    947 05625
    947 06430
    947 07602.1
    947 07932

    1 DIAB'ETES
    1 VISION CARE
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES

    MISC OUT HOSP-ORAL


    VISION CARE
    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL

    948 03678
    948 03679
    948 03679
    948 03679
    948 03679
    948 04765
    948 06812
    948 07485
    948 07486

    1 HYPERTENSION
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 FATIGUE

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    949 03850
    949 03850
    949 03850
    949 07615
    949 07615
    949 07615
    949 08290
    949 08290
    949 08290

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 THYROID
    2 THYROID
    3 THYROID
    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS

    950 05318

    PHYSICIAN VISIT-HOSPITAL

    951 04196
    951 04196
    951 04196
    951 04197
    951 04197
    951 04198
    951 04198
    951 04199
    951 04199
    951 04280
    951 04280
    951 04280
    951 04280
    951 04961

    1
    SPECIALIST CNSLT-OFFICE
    2
    MISC OUT HOSP-INJECTABLES
    3
    MISC OUT HOSP-INJECTABLES
    1 SKIN - ATOPIC DERMATITIS SPECIALIST CNSLT-OFFICE
    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-INJECTABLES
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 MISCARRIAGE
    MATERNITY-CAESAR/EXTRA UT
    2 MISCARRIAGE
    MATERNITY-CAESAR/EXTRA UT
    3 MISCARRIAGE
    MATERNITY-CAESAR/EXTRA UT
    4 MISCARRIAGE
    MATERNITY-CAESAR/EXTRA UT
    1 SKIN - LESION
    PHYSICIAN VISIT-OFFICE

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    946 Total
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    947 Total

    948 Total

    949 Total
    950 Total

    951 04961
    951 05437
    951 05437
    951 05437
    951 05751
    951 05751
    951 05752
    951 05752
    951 05752
    951 06459
    951 06459
    951 08085
    951 08086
    951 08656
    951 08656

    2 SKIN - LESION
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1
    2
    1
    2
    3
    1 EYE DISORDER
    2 EYE DISORDER
    1 SKIN - ATOPIC DERMATITIS
    1 ALLERGIC RHINITIS
    1 EYE DISORDER
    2 EYE DISORDER

    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    952 06437
    952 06437
    952 06437
    952 06437
    952 06437
    952 06437

    1 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    3 PSORIASIS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    953 03828
    953 06428
    953 06428

    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY

    954 04179
    954 04179
    954 04860
    954 04860.1
    954 04860.1
    954 05741
    954 05741
    954 07347
    954 07597
    954 07597
    954 07702
    954 07702
    954 07702

    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1
    1 CERVICITIS
    2 CERVICITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    955 03841
    955 03841
    955 05442
    955 05442
    955 07604
    955 07604
    955 07605
    955 07605
    955 07605
    955 07938
    955 07938
    955 08285

    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    1
    2
    1

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES

    951 Total

    952 Total

    953 Total

    954 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    955 08286

    MISC OUT HOSP-INJECTABLES

    956 04617
    956 04617
    956 04618
    956 04618
    956 04618
    956 05107
    956 05107
    956 05107
    956 05748
    956 05748
    956 05748
    956 05749
    956 05749
    956 05749
    956 05749
    956 05749
    956 05750
    956 05750
    956 05750
    956 05750
    956 05750
    956 06458
    956 06458
    956 07014
    956 07014
    956 07014

    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE


    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 BONE & CARTILAGE DISORDER
    SPECIALIST CNSLT-OFFICE
    2 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-INJECTABLES
    3 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-INJECTABLES
    1 INGROWING TOE NAIL
    SPECIALIST CNSLT-OFFICE
    2 INGROWING TOE NAIL
    MISC OUT HOSP-ORAL DRUGS
    3 INGROWING TOE NAIL
    MISC OUT HOSP-ORAL DRUGS
    1 OTITIS - EAR
    SPECIALIST CNSLT-OFFICE
    2 OTITIS - EAR
    MISC OUT HOSP-ORAL DRUGS
    3 OTITIS - EAR
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    SPECIALIST CNSLT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    3 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    4 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    5 BACK PAIN
    DIAGNOSTIC X-RAY
    1 INGROWING TOE NAIL
    PHYSICIAN VISIT-OFFICE
    2 INGROWING TOE NAIL
    MISC OUT HOSP-ORAL DRUGS
    3 INGROWING TOE NAIL
    MISC OUT HOSP-OTHER
    4 INGROWING TOE NAIL
    SURGICAL OUTPATIENT
    5 INGROWING TOE NAIL
    SURGICAL OUTPATIENT
    1 FEVER
    SPECIALIST CNSLT-OFFICE
    2 FEVER
    MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    3 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS

    957 05636

    DIAGNOSTIC LABORATORY

    958 05326
    958 05326
    958 05326

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    959 04544
    959 04544
    959 04544

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    960 08652
    960 08652

    1
    2

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    961 04557
    961 04557
    961 04557
    961 04557

    1 ALLERGIC
    2 ALLERGIC
    3 ALLERGIC
    4 ALLERGIC

    962 04542
    962 04542
    962 04542
    962 04543
    962 04543
    962 04543

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    3 FRACTURE - HAND BONES

    955 Total

    956 Total
    957 Total

    958 Total

    959 Total

    960 Total
    REACTION
    REACTION
    REACTION
    REACTION

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER

    961 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    962 04543
    962 04543
    962 04543.1
    962 04543.1
    962 06416
    962 06416
    962 06417
    962 06417
    962 06417

    4 FRACTURE - HAND BONES DIAGNOSTIC X-RAY


    5 FRACTURE - HAND BONES SPECIALIST CNSLT-OFFICE
    1 FRACTURE - HAND BONES SURGICAL OUTPATIENT
    2 FRACTURE - HAND BONES MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 FRACTURE - HAND BONES SPECIALIST CNSLT-OFFICE
    2 FRACTURE - HAND BONES DIAGNOSTIC X-RAY
    3 FRACTURE - HAND BONES MISC OUT HOSP-OTHER

    963 08644
    963 08644
    963 08644

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    964 04189
    964 04189
    964 04190
    964 04190
    964 04190
    964 06450
    964 06450
    964 06450
    964 06451

    1 DENTAL CARE
    2 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 INTESTINAL COLIC

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE

    965 03831
    965 03831
    965 03831
    965 03831
    965 03832
    965 04547
    965 04547
    965 04547
    965 04547
    965 04547
    965 04547.1
    965 04547.1
    965 04547.1
    965 04614
    965 04614
    965 06433
    965 06433
    965 06433
    965 06433
    965 06433
    965 07933
    965 07933
    965 07933
    965 07933
    965 07933

    1
    2
    3
    4
    1 LIVER CIRRHOSIS
    1
    2
    3
    4
    5
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    5
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    OTHER
    DENTAL CARE
    DENTAL CARE
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    966 06448

    1 VISION CARE

    VISION CARE

    967 03834

    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE

    962 Total

    963 Total

    964 Total

    965 Total
    966 Total

    967 03834
    967 03834

    2 MISCARRIAGE
    3 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    968 06664
    968 06664
    968 06664

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    969 07954
    969 07954
    969 07954

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    970 08287

    1 DENTAL CARE

    DENTAL CARE

    971 06668
    971 06668
    971 06668
    971 08072
    971 08072
    971 08072
    971 08072

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    972 06435
    972 06435
    972 06435
    972 06998.1
    972 06998.3
    972 06998.3
    972 06998.3
    972 06998.3
    972 07934
    972 07934

    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    1 CONSTIPATION
    2 CONSTIPATION

    973 08097
    973 08097
    973 08185
    973 08185
    973 08185

    1 INTESTINAL COLIC
    SPECIALIST CNSLT-OFFICE
    2 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    SURGICAL OUTPATIENT
    2 GASTRIC - PEPTIC ULCER/GERD
    DIAGNOSTIC LABORATORY
    3 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-OTHER

    974 08084
    974 08084

    1 OTITIS - EAR
    2 OTITIS - EAR

    975 04001
    975 04001
    975 04001
    975 06971
    975 06971
    975 06971
    975 06971.1
    975 06971.1
    975 06971.1

    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 INTESTINAL COLIC
    MISC OUT HOSP-OTHER
    2 INTESTINAL COLIC
    DIAGNOSTIC LABORATORY
    3 INTESTINAL COLIC
    SURGICAL OUTPATIENT
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC X-RAY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY

    976 03995
    976 04718

    1 DIAB'ETES
    1 ARTHRITIS

    967 Total

    968 Total

    969 Total
    970 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    971 Total
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    972 Total

    973 Total
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    974 Total

    975 Total
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    976 04718
    976 04719
    976 05919
    976 06642
    976 06643
    976 06643
    976 06643
    976 06643
    976 07147
    976 08147

    2 ARTHRITIS
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    1 DEVIATED NASAL
    1 DIAB'ETES

    977 04243
    977 04243

    1 DENTAL CARE
    2 DENTAL CARE

    978 04896
    978 04896.1
    978 04896.1
    978 05045
    978 05045
    978 05325
    978 05325
    978 05325
    978 05679
    978 05679
    978 07327
    978 07327
    978 07327
    978 07327.1
    978 07560
    978 07560

    1 DEVIATED NASAL
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    1
    1 OVARIAN CYST
    2 OVARIAN CYST

    979 04615
    979 04615

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    980 05443
    980 05443
    980 05443
    980 05443

    1
    2
    3
    4

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    981 03891
    981 03891
    981 03891
    981 07459

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL

    982 03552
    982 04897
    982 06970
    982 06970
    982 06970

    1 BACK PAIN
    1 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE

    983 07015
    983 07015
    983 07015.1

    1 BLOOD DISORDER
    2 BLOOD DISORDER
    1 DENTAL CARE

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    976 Total
    DENTAL CARE
    DENTAL CARE

    977 Total
    SEPTUM
    SEPTUM
    SEPTUM

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    978 Total

    979 Total

    980 Total
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    981 Total

    982 Total

    983 07015.1
    983 07015.1
    983 07015.2
    983 07015.2
    983 07015.2

    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS

    984 05447

    1 BACK PAIN

    SPECIALIST CNSLT-OFFICE

    985 05184
    985 05184
    985 06852
    985 06852
    985 06852
    985 06852
    985 06852

    1 CHEST PAIN
    2 CHEST PAIN
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT

    986 04250
    986 04250
    986 04250
    986 04616
    986 04616

    1 HEART
    2 HEART
    3 HEART
    1 HEART
    2 HEART

    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    987 07368
    987 07368

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    988 03847
    988 03847
    988 03848
    988 03848
    988 03849
    988 03849
    988 03849
    988 04963
    988 04963
    988 04964
    988 04964
    988 05327
    988 05327
    988 05327
    988 07613
    988 07613
    988 07614
    988 07614
    988 07614
    988 07614.1
    988 07614.1

    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    989 04253
    989 04253
    989 04253
    989 04253
    989 04966
    989 04966

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    983 Total
    984 Total

    985 Total

    986 Total

    987 Total

    988 Total
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    989 05328
    989 06463
    989 07370
    989 07370
    989 07371
    989 07371
    989 07371
    989 07371

    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    990 04191
    990 04191
    990 04191
    990 04553
    990 04553
    990 05191
    990 05745
    990 05746
    990 05746
    990 05746
    990 05746
    990 05746
    990 07010
    990 07010
    990 07010.1

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 VISION CARE
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    991 03823
    991 03823
    991 03823
    991 04183
    991 04183.1
    991 05432
    991 05433
    991 05433

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 PAIN-BACK/SHOULDER
    1 BARTHOLIN'S CYST
    1 THYROID
    1 FATIGUE
    2 FATIGUE

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    992 03844
    992 03845
    992 04201
    992 04201
    992 04201
    992 04201.1
    992 06865
    992 06865.1
    992 08088
    992 08088
    992 08088
    992 08088

    1 DENTAL CARE
    1 DENTAL CARE
    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    1
    1 DIAB'ETES
    1 AMMENORRHOEA
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT

    993 04965

    1 DENTAL CARE

    DENTAL CARE

    994 04535
    994 04535
    994 04535
    994 04535

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    989 Total

    990 Total

    991 Total

    992 Total
    993 Total
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    994 04535

    5 DENTAL CARE

    DENTAL CARE

    995 06662
    995 06662
    995 06662
    995 06662
    995 06662.1
    995 06663
    995 06663
    995 06663
    995 07598

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    4 SKIN - ECZEMA
    1 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART
    1 ALOPECIA

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    996 03846
    996 03846
    996 04202
    996 04202
    996 04202.1
    996 06461
    996 06461
    996 06461
    996 06461

    1 DIAB'ETES
    2 DIAB'ETES
    1 HEMORRHOIDS
    2 HEMORRHOIDS
    1 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    997 04182
    997 04182
    997 04182

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    998 03825
    998 03825
    998 03826
    998 03826
    998 04613
    998 04613
    998 06427
    998 06666
    998 06666
    998 06666
    998 06666

    1
    2
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    1 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 FEVER

    PHYSICIAN VISIT-OFFICE

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER

    1 ALLERGIC REACTION

    SPECIALIST CNSLT-OFFICE

    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DEVIATED NASAL SEPTUM

    SPECIALIST CNSLT-OFFICE

    994 Total

    995 Total

    996 Total

    997 Total

    998 Total
    999 04195
    999 Total
    1000 06855
    1000 06855
    1000 06855
    1000 06855.1
    1000 06855.1
    1000 06855.1
    1000 Total
    1001 07595
    1001 Total
    1002 06679
    1002 06679
    1002 Total
    1003 06676

    1003

    1004

    1005
    1006

    1007

    1008

    1009
    1010

    1011

    1003 06676
    1003 06677
    Total
    1004 04181
    1004 04181
    1004 04181
    1004 04181
    Total
    1005 05631
    1005 05631
    1005 05631
    1005 05631.1
    1005 05631.2
    1005 05631.2
    1005 05631.2
    Total
    1006 05626
    Total
    1007 05678
    1007 05678
    1007 06669
    1007 06669
    Total
    1008 05324
    1008 05324
    Total
    1009 05319
    1009 05319
    1009 05319
    1009 05321
    1009 06411
    1009 06411
    1009 06411
    1009 07346
    1009 07346
    1009 07346
    1009 07592
    Total
    1010 07369
    Total
    1011 03890
    1011 03890
    1011 03890
    1011 04444
    1011 04444
    1011 04444
    1011 04444
    1011 07404
    1011 07404
    1011 07404
    1011 07404
    Total
    1012 08468

    2 DEVIATED NASAL SEPTUM


    1 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    SPECIALIST CNSLT-OFFICE

    1 ALLERGIC
    2 ALLERGIC
    3 ALLERGIC
    4 ALLERGIC

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    RHINITIS
    RHINITIS
    RHINITIS
    RHINITIS

    1
    2
    3
    1 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE

    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 PAINFUL HEEL
    2 PAINFUL HEEL

    PHYSICIAN VISIT-OFFICE
    OTHER

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DENTAL CARE
    1
    2
    3
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE

    HOSPITAL MISC-LOCAL

    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    4 GLAUCOMA

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION

    PHYSICIAN VISIT-HOME

    1012

    1013

    1014

    1015

    1012 08468
    1012 08468
    1012 08468
    1012 08468
    Total
    1013 04549
    1013 04549
    1013 04549.1
    1013 06860
    1013 06860
    1013 06860.1
    1013 06860.1
    1013 06860.2
    1013 07606
    1013 07606
    1013 07607
    1013 07607
    Total
    1014 03534
    1014 03534
    1014 03534
    1014 04941
    1014 04941
    1014 04941
    1014 06519
    1014 06519
    1014 06520
    1014 06520
    1014 06521
    1014 06521
    1014 06521.1
    1014 08070
    1014 08070
    Total
    1015 03640
    1015 04251.1
    1015 04251.1
    1015 04251.1
    1015 04251.1
    1015 04252.1
    1015 04252.1
    1015 04252.1
    1015 05390
    1015 05390
    1015 05754
    1015 05754
    1015 05754
    1015 05754
    1015 05755
    Total
    1016 03494
    1016 03494
    1016 03494

    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION

    HOSPITAL LOCAL ROOM


    PHYSICIAN VISIT-HOSPITAL
    PRIVATE DUTY NURSING CARE
    HOSPITAL MISC-LOCAL

    1
    2
    1 PROSTATE
    1 VISION CARE
    2 VISION CARE
    1
    2
    1 EYE DISORDER
    1
    2
    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    1 CIRCULATORY DISORDER
    PHYSICIAN VISIT-OFFICE
    2 CIRCULATORY DISORDER
    MISC OUT HOSP-ORAL DRUGS
    3 CIRCULATORY DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 GLAUCOMA
    SPECIALIST CNSLT-OFFICE
    2 GLAUCOMA
    MISC OUT HOSP-ORAL DRUGS
    1 HEARING LOSS
    SPECIALIST CNSLT-OFFICE
    2 HEARING LOSS
    DIAGNOSTIC LABORATORY
    1 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    2 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    1 HEADACHE- MIGRAINE TENSION
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    2 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    1 PAIN-BACK/SHOULDER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    4 SKIN - LESION
    1 DIAB'ETES

    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1016 03494
    1016 03494.1
    1016 03494.1
    1016 03494.1
    1016 03494.1
    1016 03494.2
    1016 03494.2
    1016 03494.3
    1016 03494.3
    1016 03494.3
    1016 04093
    1016 04093.1
    1016 04093.1
    1016 04093.1
    1016 05020
    1016 05020
    1016 05020
    1016 05020
    1016 05020
    1016 05020.1
    1016 05020.1
    1016 06176
    1016 07001
    1016 08077
    1016 08077
    1016 08077
    1016 08078
    1016 08078
    1016 08078
    1016 08079
    1016 08079.1
    1016 08079.1
    1016 Total
    1017 06109
    1017 06109
    1017 06109.1
    1017 06109.1
    1017 06109.2
    1017 06109.2
    1017 06109.3
    1017 06109.3
    1017 08146
    1017 08146.1
    1017 08146.1
    1017 Total
    1018 04241
    1018 04241
    1018 04241
    1018 04241
    1018 04241
    1018 04241.1
    1018 04241.1
    1018 04241.1

    4 BACK PAIN
    PHYSICIAN VISIT-OFFICE
    1 MUSCULAR PAIN
    MISC OUT HOSP-ORAL DRUGS
    2 MUSCULAR PAIN
    MISC OUT HOSP-ORAL DRUGS
    3 MUSCULAR PAIN
    MISC OUT HOSP-ORAL DRUGS
    4 MUSCULAR PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    2 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1 INTESTINAL COLIC
    PHYSICIAN VISIT-OFFICE
    2 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    3 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    DIAGNOSTIC X-RAY
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    3 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    HOSPITAL LOCAL ROOM
    2 BACK PAIN
    HOSPITAL LOCAL ROOM
    3 BACK PAIN
    HOSPITAL MISC-LOCAL
    4 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    5 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    SURGICAL INPATIENT
    2 BACK PAIN
    SURGICAL ANAESTHESIA
    1 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1 CERVICAL STRAIN
    MISC OUT HOSP-ORAL DRUGS
    1 INTESTINAL COLIC
    PHYSICIAN VISIT-OFFICE
    2 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    3 INTESTINAL COLIC
    PREVENTATIVE
    1
    SPECIALIST CNSLT-OFFICE
    2
    MISC OUT HOSP-ORAL DRUGS
    3
    MISC OUT HOSP-ORAL DRUGS
    1 ACUTE ENTERITIS
    MISC OUT HOSP-ORAL DRUGS
    1 ALLERGIC RHINITIS
    PHYSICIAN VISIT-OFFICE
    2 ALLERGIC RHINITIS
    MISC OUT HOSP-ORAL DRUGS
    1 BREAST DISORDERS
    PHYSICIAN VISIT-OFFICE
    2 BREAST DISORDERS
    DIAGNOSTIC X-RAY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    1
    DIAGNOSTIC LABORATORY
    2
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 THYROID
    DIAGNOSTIC LABORATORY
    2 THYROID
    MISC OUT HOSP-ORAL DRUGS
    1
    2
    3
    4
    5
    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-INJECTABLES

    1018

    1019

    1020
    1021
    1022

    1023

    1024

    1025

    1026

    1027
    1028

    1018 04241.1
    1018 04942
    1018 04942
    1018 04942
    1018 04942
    Total
    1019 07723
    1019 07723
    Total
    1020 07717
    1020 07717
    1020 07717
    Total
    1021 03549
    Total
    1022 04676
    Total
    1023 06224
    1023 06224
    1023 07714
    1023 07715
    Total
    1024 03961
    1024 03961
    1024 03961
    Total
    1025 05185
    1025 05185
    1025 05185
    1025 06220
    1025 06220
    1025 06221
    1025 06221
    1025 06222
    1025 06222
    1025 06222
    Total
    1026 05194
    1026 05194
    1026 05194
    Total
    1027 08071
    1027 08071
    1027 08071
    Total
    1028 05438
    Total
    1029 07593
    1029 07593
    1029 07593
    1029 07594
    1029 07594.1
    1029 07594.1

    4
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA

    MISC OUT HOSP-INJECTABLES


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE

    DENTAL CARE

    1 ACUTE ENTERITIS

    DIAGNOSTIC X-RAY

    1 DENTAL CARE
    2 DENTAL CARE
    1 MUSCULAR PAIN
    1 BACK PAIN

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE

    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE

    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 ABDOMINAL PAINS

    DIAGNOSTIC X-RAY

    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DIAB'ETES
    1 BACK PAIN
    2 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1029

    1030

    1031

    1032

    1033

    1034

    1035

    1029 07594.1
    1029 07594.1
    Total
    1030 04256
    1030 04257
    1030 06236
    1030 06236
    1030 06525
    1030 06969
    1030 06969
    1030 06969
    1030 08289
    Total
    1031 03962
    1031 03962
    1031 04960
    1031 04960
    1031 04960.1
    1031 07164
    1031 07164
    1031 07164.1
    Total
    1032 04675
    1032 06233
    1032 06233
    1032 06233
    1032 07720
    1032 07720
    1032 07720
    Total
    1033 03957
    1033 03957
    1033 03957
    1033 03957
    1033 03957
    1033 03957.1
    1033 03957.1
    Total
    1034 03547
    1034 03547
    1034 03547
    1034 07160
    1034 07161
    1034 07161
    1034 07161
    Total
    1035 04717
    1035 05820
    1035 06856
    1035 06856
    1035 06856
    Total
    1036 03952

    3 BACK PAIN
    4 BACK PAIN

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS

    1 EYE DISORDER
    1 HYPERTENSION
    1 EYE DISORDER
    2 EYE DISORDER
    1 EYE DISORDER
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    1
    PHYSICIAN VISIT-OFFICE
    2
    MISC OUT HOSP-ORAL DRUGS
    1 OVARIAN CYST
    SPECIALIST CNSLT-OFFICE
    2 OVARIAN CYST
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 FATIGUE
    PHYSICIAN VISIT-OFFICE
    2 FATIGUE
    DIAGNOSTIC LABORATORY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    1 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DIAGNOSTIC LABORATORY

    1
    2
    3
    4
    5
    1
    2

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE

    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 EYE DISORDER
    SPECIALIST CNSLT-OFFICE
    1 SOFT TISSUE DISORDERS/DISEASE
    PHYSICIAN VISIT-HOSPITAL
    2 SOFT TISSUE DISORDERS/DISEASE
    DIAGNOSTIC X-RAY
    3 SOFT TISSUE DISORDERS/DISEASE
    SPECIALIST CNSLT-OFFICE
    1 BARTHOLIN'S CYST
    1 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    DIAGNOSTIC LABORATORY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 VISION CARE

    VISION CARE

    1036

    1037

    1038

    1039

    1036 03952
    1036 03953
    1036 03953
    Total
    1037 04670
    1037 04670
    1037 04670.1
    1037 04670.2
    1037 04945
    Total
    1038 03538
    1038 03538
    1038 03538
    1038 03955
    1038 03955
    1038 03955
    1038 03956
    1038 03956
    1038 03956
    1038 04247
    1038 04247
    1038 05183
    1038 05183
    1038 05183
    1038 05183.1
    1038 06522
    1038 06522
    1038 06523
    1038 06523
    1038 06523
    1038 07706
    1038 07706
    1038 07706
    1038 07707
    1038 07707
    1038 07707
    Total
    1039 03965
    1039 03965
    1039 03965
    Total
    1040 04200
    1040 04200
    1040 04245
    1040 04245
    1040 06034
    1040 06034
    1040 06034
    1040 06034
    1040 06175
    1040 06175
    1040 06175.1
    1040 06175.1

    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 ABDOMINAL PAINS
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    1 RADICULOPATHY INFLAME NERVE
    PHYSICIAN
    ROOTVISIT-OFFICE
    2 RADICULOPATHY INFLAME NERVE
    MISC ROOT
    OUT HOSP-ORAL DRUGS
    3 RADICULOPATHY INFLAME NERVE
    MISC ROOT
    OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    3 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    3 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 TONSILLITIS
    PHYSICIAN VISIT-OFFICE
    2 TONSILLITIS
    MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 EYE DISORDER
    DIAGNOSTIC X-RAY
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1
    PHYSICIAN VISIT-OFFICE
    2
    SPECIALIST CNSLT-OFFICE
    3
    MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    3 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    3 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    1 HYPERTENSION
    2 HYPERTENSION
    1
    2

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    1040

    1041
    1042
    1043

    1044

    1045

    1046

    1047

    1040 06175.1
    1040 06175.2
    1040 06175.2
    1040 06175.3
    1040 06175.3
    1040 06175.3
    1040 06175.3
    1040 06175.3
    1040 06175.4
    1040 06219
    1040 07362
    1040 07362
    1040 07704
    1040 07704
    Total
    1041 04248
    1041 04248
    1041 04248
    Total
    1042 06217
    Total
    1043 07716
    Total
    1044 03551
    1044 03551
    1044 03551
    Total
    1045 04672
    1045 04673
    1045 05188
    1045 05188
    1045 05188
    1045 05188
    1045 05188
    Total
    1046 03991
    1046 03991
    1046 03991
    Total
    1047 05174
    1047 05174
    1047 05174
    Total
    1048 04254
    1048 04254
    1048 04254
    1048 04254
    1048 04254
    1048 04255
    1048 04255
    1048 06235
    1048 06235
    1048 06235

    3
    1
    2
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    3 EAR DYSFUNCTION
    4 EAR DYSFUNCTION
    5 EAR DYSFUNCTION
    1 EAR DYSFUNCTION
    1 DEVIATED NASAL SEPTUM
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 INJURY - UNSPECIFIED
    2 INJURY - UNSPECIFIED

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE

    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE

    1 CHlCKEN POX
    2 CHlCKEN POX
    3 CHlCKEN POX

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DIAB'ETES
    1 ACUTE ENTERITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT

    1048

    1049

    1050

    1051

    1052

    1053

    1054

    1048 06235
    1048 06235
    1048 06235.1
    Total
    1049 07158
    1049 07158
    1049 07700
    Total
    1050 05187
    1050 06223
    1050 06524
    1050 06524
    1050 06524
    1050 07709
    1050 07709
    1050 07709
    1050 07709
    Total
    1051 06234
    1051 06234
    1051 06234
    Total
    1052 03954
    1052 03954
    1052 03954
    1052 04671
    Total
    1053 05175
    1053 05175
    1053 05176
    1053 05176
    1053 06215
    1053 06215
    1053 06215
    1053 06215
    1053 06216
    1053 07701
    Total
    1054 04895.1
    1054 04895.1
    1054 04895.1
    1054 04895.1
    Total
    1055 03963
    1055 03963
    1055 03964
    1055 03964
    1055 03964
    1055 03964
    1055 03964
    1055 07721
    1055 07721
    1055 07721

    4 EYE DISORDER
    5 EYE DISORDER
    1 EYE DISORDER

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    SURGICAL ANAESTHESIA

    1 STROKE
    2 STROKE
    1 STROKE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    1
    1 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 EYE DISORDER
    2 EYE DISORDER
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1
    1 INJURY - UNSPECIFIED

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE

    1 THYROID
    2 THYROID
    3 THYROID
    4 THYROID

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1055

    1056

    1057

    1058

    1059

    1060

    1055 08090
    1055 08091
    1055 08091
    Total
    1056 06357
    1056 06357
    1056 07935
    1056 07935
    Total
    1057 03959
    1057 03959
    1057 03960
    1057 03960
    1057 04957
    1057 04957
    1057 04958
    1057 04959
    1057 04959
    1057 04959
    1057 06229
    1057 06229
    1057 06230
    1057 06230
    1057 07162
    1057 07162
    1057 07163
    1057 07163
    1057 08080
    1057 08080
    1057 08081
    1057 08081
    Total
    1058 02813.4
    1058 02813.5
    1058 02813.5
    1058 06225
    1058 06225
    1058 06225
    1058 06225
    Total
    1059 03545.1
    1059 03545.1
    1059 08284
    1059 08284
    1059 08284
    Total
    1060 04946
    1060 04946
    1060 04946
    Total
    1061 04072
    1061 04072
    1061 04072

    1
    1 DENTAL CARE
    2 DENTAL CARE

    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE

    1 FEVER
    2 FEVER
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE

    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    1 HEART
    2 HEART
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    1 HEART
    1 HEART
    1 HEART
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 PHARYNGITIS
    2 PHARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1061

    1062

    1063
    1064

    1065

    1066

    1067

    1068

    1061 06226
    1061 06226
    1061 06226
    1061 06226
    Total
    1062 03535
    1062 03535
    1062 03535
    Total
    1063 07703
    1063 07703
    Total
    1064 07159
    Total
    1065 06231
    1065 06231
    1065 06231
    1065 07719
    1065 07719.1
    1065 07719.1
    Total
    1066 05190
    1066 05190
    Total
    1067 04950.1
    1067 04951
    1067 04951
    1067 04951
    1067 07454
    1067 07454
    1067 07454
    1067 07455
    1067 07455
    1067 07455
    1067 07455
    1067 07455
    1067 07455.1
    Total
    1068 03863
    1068 03863
    1068 03863
    1068 03863
    1068 03863
    1068 03863.1
    1068 04901
    1068 04901
    1068 05451
    1068 05451
    1068 06613
    1068 06613
    Total
    1069 03641.1
    1069 03641.1

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE

    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL

    CARE
    CARE
    CARE
    CARE

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 MISCARRIAGE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1
    PREVENTATIVE
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    3 HYPERTENSION
    DIAGNOSTIC LABORATORY
    1 HORMONE REPLACMENT THERAPY
    SPECIALIST CNSLT-OFFICE
    2 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC X-RAY
    3 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC LABORATORY
    1 HEART
    SPECIALIST CNSLT-OFFICE
    2 HEART
    DIAGNOSTIC X-RAY
    3 HEART
    MISC OUT HOSP-ORAL DRUGS
    4 HEART
    MISC OUT HOSP-ORAL DRUGS
    5 HEART
    PHYSICIAN VISIT-OFFICE
    1 HEART
    MISC OUT HOSP-ORAL DRUGS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1069 Total
    1070 04388
    1070 04388
    1070 04388
    1070 04388
    1070 04388
    1070 05640
    1070 05640
    1070 08149
    1070 08149
    1070 08149
    1070 Total
    1071 08005
    1071 08005
    1071 Total
    1072 06255
    1072 06255
    1072 Total
    1073 05216
    1073 05216
    1073 05216
    1073 05216
    1073 05216
    1073 05216.1
    1073 06076
    1073 06076
    1073 06738
    1073 06738
    1073 06975
    1073 06975
    1073 06975
    1073 06975
    1073 06975
    1073 06975.1
    1073 06975.1
    1073 Total
    1074 05706
    1074 05706
    1074 05706
    1074 07377
    1074 07377
    1074 07377
    1074 08156
    1074 08156
    1074 08156
    1074 08156.1
    1074 08156.1
    1074 Total
    1075 05826
    1075 05826
    1075 05826
    1075 Total
    1076 04391

    1 SKIN - LOCAL
    2 SKIN - LOCAL
    3 SKIN - LOCAL
    4 SKIN - LOCAL
    5 SKIN - LOCAL
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    INFECTION
    INFECTION
    INFECTION
    INFECTION
    INFECTION

    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 ARTHRITIS
    2 ARTHRITIS

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HORMONE REPLACMENT
    2 HORMONE REPLACMENT
    3 HORMONE REPLACMENT
    4 HORMONE REPLACMENT
    5 HORMONE REPLACMENT
    1 HORMONE REPLACMENT
    2 HORMONE REPLACMENT

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    THERAPY
    SPECIALIST CNSLT-OFFICE
    THERAPY
    SPECIALIST CNSLT-OFFICE
    THERAPY
    PHYSICIAN VISIT-OFFICE
    THERAPY
    PHYSICIAN VISIT-OFFICE
    THERAPY
    MISC OUT HOSP-INJECTABLES
    THERAPY
    MISC OUT HOSP-INJECTABLES
    THERAPY
    DIAGNOSTIC X-RAY

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 BACK PAIN
    2 BACK PAIN

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 GLAUCOMA

    SPECIALIST CNSLT-OFFICE

    1076 Total
    1077 04558
    1077 06904
    1077 06905
    1077 Total
    1078 04623
    1078 Total
    1079 05891
    1079 05891
    1079 05891
    1079 05891
    1079 06239
    1079 06239
    1079 06239
    1079 06239
    1079 06483
    1079 06483
    1079 06483
    1079 07025
    1079 07240
    1079 07240
    1079 07240
    1079 07240
    1079 07240
    1079 Total
    1080 03554
    1080 03554
    1080 06477
    1080 06477
    1080 06732
    1080 06732
    1080 06732
    1080 06732
    1080 06732
    1080 06732.1
    1080 Total
    1081 06737
    1081 06737
    1081 Total
    1082 04115
    1082 04115.1
    1082 05197
    1082 05197
    1082 05637
    1082 05638
    1082 05701
    1082 05702
    1082 05702
    1082 05821
    1082 05821.1
    1082 06475
    1082 06608
    1082 06608

    1 HYPERTENSION
    1 EYE DISORDER
    1 EYE DISORDER

    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE

    1 HEART

    DIAGNOSTIC X-RAY

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    4 SKIN - ECZEMA
    1 INFECTION THUMB
    2 INFECTION THUMB
    3 INFECTION THUMB
    4 INFECTION THUMB
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    5 SKIN - ATOPIC DERMATITIS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 INFECTION THUMB
    2 INFECTION THUMB
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 BURSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT

    1 INTESTINAL COLIC
    2 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DIAB'ETES
    1 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 PROSTATE
    1 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 DEPRESSION
    1 EYE DISORDER
    1 DIAB'ETES
    2 DIAB'ETES

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1082 08580
    1082 Total
    1083 03555
    1083 03555
    1083 03555
    1083 04120
    1083 04120
    1083 04625
    1083 05641
    1083 05641
    1083 05641
    1083 05641
    1083 05641
    1083 05642
    1083 05642
    1083 05642
    1083 06072
    1083 06072
    1083 06073
    1083 06073
    1083 06569
    1083 06569
    1083 06569
    1083 06569
    1083 06569.1
    1083 06569.2
    1083 07866
    1083 07866
    1083 Total
    1084 04112
    1084 04112
    1084 04112
    1084 04112
    1084 04113
    1084 04113.1
    1084 04114
    1084 05448
    1084 05448
    1084 05449
    1084 05449
    1084 05884
    1084 05884
    1084 05884
    1084 05884
    1084 05884
    1084 05884.1
    1084 05889
    1084 05889
    1084 07019
    1084 07019
    1084 Total
    1085 06238
    1085 Total

    1 DIAB'ETES

    MISC OUT HOSP-ORAL DRUGS

    1 HEART
    2 HEART
    3 HEART
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 EPILEPSY
    2 EPILEPSY
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 EPILEPSY
    1 HEART
    1 AMMENORRHOEA
    2 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    1 HYPERTENSION
    1 RENAL DYSFUNCTION
    1 ANXIETY
    2 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    4 ANXIETY
    5 ANXIETY
    1 ANXIETY
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 BARTHOLIN'S CYST

    DIAGNOSTIC X-RAY

    1086 04622
    1086 Total
    1087 03851
    1087 03851
    1087 03851
    1087 03851
    1087 03852
    1087 03852
    1087 03853
    1087 03853
    1087 03853
    1087 05703
    1087 05703
    1087 05703
    1087 07628
    1087 07628
    1087 07629
    1087 07629
    1087 Total
    1088 07376
    1088 07376
    1088 07376
    1088 07646
    1088 07646
    1088 Total
    1089 05452
    1089 05452
    1089 05452
    1089 05823
    1089 06237
    1089 06735
    1089 06735
    1089 06735
    1089 06735
    1089 Total
    1090 06556
    1090 06730
    1090 06731
    1090 07814
    1090 07814
    1090 07815
    1090 07816
    1090 08354
    1090 Total
    1091 03854
    1091 03854
    1091 03854
    1091 03856
    1091 03856
    1091 04624
    1091 04624
    1091 07462
    1091 07462

    1 BONE & CARTILAGE DISORDER


    SPECIALIST CNSLT-OFFICE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 HERPES ZOSTER
    2 HERPES ZOSTER
    3 HERPES ZOSTER
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 INTESTINAL COLIC
    SPECIALIST CNSLT-OFFICE
    2 INTESTINAL COLIC
    SURGICAL OUTPATIENT
    3 INTESTINAL COLIC
    HOSPITAL LOCAL ROOM
    4 INTESTINAL COLIC
    HOSPITAL MISC-LOCAL
    1 CHEST PAIN
    1 DENTAL CARE
    1 DENTAL CARE
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE

    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE

    1 CHEST PAIN
    SPECIALIST CNSLT-OFFICE
    2 CHEST PAIN
    DIAGNOSTIC X-RAY
    3 CHEST PAIN
    DIAGNOSTIC LABORATORY
    1
    PHYSICIAN VISIT-OFFICE
    2
    MISC OUT HOSP-ORAL DRUGS
    1 ARTHRITIS
    PHYSICIAN VISIT-OFFICE
    2 ARTHRITIS
    MISC OUT HOSP-ORAL DRUGS
    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE
    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-ORAL DRUGS

    1091
    1092

    1093

    1094

    1095

    1096

    1097

    1091 07463
    1091 07463
    1091 08001
    1091 08001
    1091 08001.1
    1091 08002
    Total
    1092 05822
    Total
    1093 04390
    1093 04390
    1093 04900
    1093 04900
    1093 04900.1
    1093 04900.2
    1093 06074
    1093 06074
    1093 06074.1
    1093 06479
    1093 06479
    1093 06479.1
    1093 06479.1
    1093 07374
    1093 07374.1
    Total
    1094 08003
    1094 08003
    1094 08004
    Total
    1095 03557
    1095 03557
    1095 03557
    1095 03557
    Total
    1096 04121
    1096 04121
    1096 04121
    1096 04121
    1096 04121
    1096 04121.1
    Total
    1097 04395
    1097 04395
    1097 04395
    Total
    1098 05453
    1098 05453
    1098 05453
    1098 05453
    1098 05454
    1098 05454
    1098 05890
    1098 05890

    1 HEART
    2 HEART
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    1

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    1 FEVER

    MISC OUT HOSP-ORAL DRUGS

    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE


    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 SINUSITIS
    PHYSICIAN VISIT-OFFICE
    2 SINUSITIS
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 ARTHRITIS
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    PHYSICIAN VISIT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 BACK PAIN
    DIAGNOSTIC X-RAY
    2 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 BACK PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 URTICARIA
    2 URTICARIA
    1 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    1 BACK PAIN
    2 BACK PAIN
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE

    1098 05890
    1098 08153
    1098 08153
    1098 08153
    1098 08153
    1098 08153
    1098 Total
    1099 04385
    1099 04385
    1099 04385
    1099 05825
    1099 05825
    1099 05825
    1099 05825
    1099 05825
    1099 05825.1
    1099 05825.1
    1099 05825.1
    1099 05825.1
    1099 Total
    1100 03860
    1100 03860
    1100 03860
    1100 03860
    1100 03861
    1100 03861
    1100 03861
    1100 03861
    1100 03861
    1100 04389
    1100 05704
    1100 05704
    1100 05704.1
    1100 05704.1
    1100 05704.1
    1100 05704.1
    1100 06071
    1100 06071
    1100 07021
    1100 07021
    1100 07504
    1100 07865
    1100 07865
    1100 07865.1
    1100 08148
    1100 08148
    1100 08148
    1100 08148
    1100 08148.1
    1100 08148.1
    1100 08585
    1100 Total
    1101 04384

    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 ARTHRITIS
    SPECIALIST CNSLT-OFFICE
    2 ARTHRITIS
    MISC OUT HOSP-INJECTABLES
    3 ARTHRITIS
    MISC OUT HOSP-INJECTABLES
    1 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    2 PAIN-BACK/SHOULDER
    MISC OUT HOSP-INJECTABLES
    3 PAIN-BACK/SHOULDER
    MISC OUT HOSP-INJECTABLES
    4 PAIN-BACK/SHOULDER
    DIAGNOSTIC LABORATORY
    5 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-INJECTABLES
    4 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-INJECTABLES
    1 EPILEPSY
    SPECIALIST CNSLT-OFFICE
    2 EPILEPSY
    DIAGNOSTIC X-RAY
    3 EPILEPSY
    MISC OUT HOSP-ORAL DRUGS
    4 EPILEPSY
    DIAGNOSTIC X-RAY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    5 DENTAL CARE
    DENTAL CARE
    1 REMOVAL OF MOLE
    SPECIALIST CNSLT-OFFICE
    1
    HOSPITAL LOCAL ROOM
    2
    HOSPITAL MISC-LOCAL
    1
    SURGICAL ANAESTHESIA
    2
    SURGICAL INPATIENT
    3
    OTHER
    4
    HOSPITAL MISC-LOCAL
    1 EPILEPSY
    MISC OUT HOSP-ORAL DRUGS
    2 EPILEPSY
    MISC OUT HOSP-ORAL DRUGS
    1 EPILEPSY
    PHYSICIAN VISIT-OFFICE
    2 EPILEPSY
    DIAGNOSTIC LABORATORY
    1 HEART
    SPECIALIST CNSLT-OFFICE
    1 EPILEPSY
    MISC OUT HOSP-ORAL DRUGS
    2 EPILEPSY
    MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    3 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    4 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 HORMONE REPLACMENT THERAPY
    MISC OUT HOSP-ORAL DRUGS
    2 HORMONE REPLACMENT THERAPY
    MISC OUT HOSP-ORAL DRUGS
    1
    SPECIALIST CNSLT-OFFICE
    1 DENTAL CARE

    DENTAL CARE

    1101

    1102

    1103

    1104
    1105

    1106

    1107

    1108

    1109

    1101 04384
    1101 04384
    1101 04384
    1101 04384
    1101 04384.1
    1101 04384.1
    1101 04384.1
    1101 07460
    1101 07460
    1101 08000
    Total
    1102 03857
    1102 03857
    1102 03857
    1102 06973
    1102 06973
    1102 06973
    1102 06973
    Total
    1103 05450
    1103 05450
    Total
    1104 06549
    1104 06550
    Total
    1105 04904
    Total
    1106 04392
    1106 04393
    1106 04393
    1106 04393
    1106 04393.1
    1106 04559
    Total
    1107 04394
    1107 04394
    Total
    1108 05207
    1108 05207
    1108 07022
    1108 07022
    1108 07023
    1108 08586
    1108 08586
    1108 08587
    1108 08587
    1108 08587
    Total
    1109 04129
    1109 04129.1
    Total
    1110 06481
    1110 06481

    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    5 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 RETINOPATY
    SPECIALIST CNSLT-OFFICE
    2 RETINOPATY
    DIAGNOSTIC X-RAY
    1 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    4 URTICARIA

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 ABDOMINAL PAINS
    1 OVARIAN CYST

    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE

    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE

    1 OTITIS - EAR
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    1 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 SKIN - ATOPIC DERMATITIS


    2 SKIN - ATOPIC DERMATITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 SKIN - LOCAL INFECTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    1 HYPERTENSION
    1 THYROID

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 FEVER
    2 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    1110

    1111

    1112

    1113
    1114

    1115

    1116

    1117

    1118

    1110 06481
    1110 06570
    1110 06570
    1110 06570
    1110 06570
    1110 06570
    1110 06736
    Total
    1111 03556
    1111 03556
    1111 07375
    1111 07375
    1111 07375
    1111 08152
    1111 08152
    Total
    1112 07372
    1112 07372
    1112 07372
    1112 07372
    1112 07372
    Total
    1113 04620
    1113 04620
    1113 04621
    Total
    1114 08155
    Total
    1115 07373
    1115 07373
    1115 07373
    Total
    1116 06069
    1116 06069
    1116 06069
    1116 06478
    1116 06478
    Total
    1117 03754
    1117 03754
    1117 03754
    1117 05771
    1117 05771
    1117 07824
    1117 07824
    Total
    1118 03747
    1118 03747
    1118 03747
    1118 03747
    Total
    1119 06291
    1119 06291

    3 FEVER
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    MISC OUT HOSP-INJECTABLES


    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    1 FEVER
    2 FEVER
    1 SKIN - LOCAL INFECTION

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE

    DENTAL CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    2

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 MUSCULAR PAIN
    2 MUSCULAR PAIN

    DRUGS
    DRUGS
    DRUGS
    DRUGS

    CARE
    CARE
    CARE
    CARE

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS

    1119

    1120

    1121

    1122

    1123

    1124

    1125

    1126

    1127

    1119 06291
    1119 06291
    1119 06292
    1119 06292
    1119 06292
    1119 06293
    Total
    1120 08364
    1120 08364
    1120 08364
    1120 08364
    1120 08364
    1120 08364.1
    1120 08364.1
    1120 08364.1
    Total
    1121 04006
    1121 04006
    1121 05705
    Total
    1122 07527
    1122 07527
    1122 07527
    1122 07527
    1122 07527
    1122 07527.1
    Total
    1123 08355
    1123 08355
    1123 08355.1
    Total
    1124 07020
    1124 07020
    1124 07020.1
    1124 07020.1
    Total
    1125 07641
    1125 07641
    1125 07641
    1125 07642
    1125 07642
    1125 07642
    1125 07643
    Total
    1126 06294
    1126 06294
    1126 06294
    Total
    1127 05770
    1127 05770
    1127 05770
    Total
    1128 07653

    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1

    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-HOSPITAL

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA

    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA

    1 HYPERTENSION
    2 HYPERTENSION
    1 BEHAVIOURIAL PROBLEMS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION
    2 VISION
    3 VISION
    4 VISION
    5 VISION
    1 VISION

    VISION
    VISION
    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 HEART
    2 HEART
    1

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    1 BRONCHITIS
    SPECIALIST CNSLT-OFFICE
    2 BRONCHITIS
    MISC OUT HOSP-OTHER
    3 BRONCHITIS
    MISC OUT HOSP-ORAL DRUGS
    1 ABDOMINAL PAINS
    SPECIALIST CNSLT-OFFICE
    2 ABDOMINAL PAINS
    MISC OUT HOSP-INJECTABLES
    3 ABDOMINAL PAINS
    MISC OUT HOSP-INJECTABLES
    1 HEADACHE- MIGRAINE TENSION
    SPECIALIST CNSLT-OFFICE
    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 BLOOD DISORDER

    DIAGNOSTIC LABORATORY

    1128 Total
    1129 07631
    1129 07631
    1129 07631
    1129 08360
    1129 08360
    1129 08360
    1129 Total
    1130 05046
    1130 05639
    1130 05680
    1130 06476.1
    1130 06821
    1130 06821.1
    1130 07116
    1130 Total
    1131 07076
    1131 Total
    1132 04009
    1132 04009
    1132 04009.1
    1132 Total
    1133 07645
    1133 07645
    1133 Total
    1134 08362
    1134 08363
    1134 08363
    1134 08363
    1134 08363
    1134 Total
    1135 04204
    1135 04204
    1135 04204
    1135 04204
    1135 04204
    1135 04898
    1135 04898
    1135 06359
    1135 06359
    1135 06359
    1135 06359
    1135 07525
    1135 07525
    1135 07525
    1135 Total
    1136 04796
    1136 04796
    1136 04796
    1136 Total
    1137 03755
    1137 03755
    1137 03756

    1 BARTHOLIN'S
    2 BARTHOLIN'S
    3 BARTHOLIN'S
    1 BARTHOLIN'S
    2 BARTHOLIN'S
    3 BARTHOLIN'S

    CYST
    CYST
    CYST
    CYST
    CYST
    CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 DEPRESSION
    1 OVARIAN CYST
    1 DEPRESSION
    1 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    1
    1 ANAEMIA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC X-RAY

    1 DIAB'ETES
    2 DIAB'ETES
    1 PROSTATE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1
    1 VISION
    2 VISION
    3 VISION
    4 VISION

    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    CARE
    CARE
    CARE
    CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HEART
    2 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1
    2
    3

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 ENDOCRINE DISORDERS
    2 ENDOCRINE DISORDERS
    1 DENTAL CARE

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE

    1137

    1138

    1139

    1140

    1137 07072
    1137 07072
    Total
    1138 04772
    1138 04772
    1138 04772
    1138 05760
    1138 05760
    1138 06557
    1138 06557
    1138 06557
    1138 06557.1
    1138 06557.1
    1138 06557.1
    1138 06557.2
    1138 06557.3
    1138 06557.3
    1138 06557.3
    1138 06557.3
    1138 06557.3
    1138 06557.4
    1138 07617
    1138 07617
    1138 07617
    1138 07618
    1138 07618
    1138 07618
    1138 07619
    1138 07619
    1138 07619
    1138 08476
    1138 08476
    1138 08476
    1138 08476
    1138 08476
    Total
    1139 07616
    1139 07616
    1139 07616
    1139 08474
    1139 08474
    1139 08474
    Total
    1140 04314
    1140 04314
    1140 04314
    1140 04315
    1140 04315
    1140 04315
    Total
    1141 07640
    1141 07640
    1141 07640

    1 HYPERLIPIDERMIA - CHOLESTEROL
    SPECIALIST CNSLT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    3 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    1 HORMONE REPLACMENT THERAPY
    PHYSICIAN VISIT-OFFICE
    2 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC LABORATORY
    3 HORMONE REPLACMENT THERAPY
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 ANAEMIA
    PHYSICIAN VISIT-OFFICE
    2 ANAEMIA
    DIAGNOSTIC LABORATORY
    3 ANAEMIA
    MISC OUT HOSP-INJECTABLES
    4 ANAEMIA
    MISC OUT HOSP-ORAL DRUGS
    5 ANAEMIA
    MISC OUT HOSP-ORAL DRUGS
    1 ANAEMIA
    DIAGNOSTIC LABORATORY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-INJECTABLES
    3 RENAL DYSFUNCTION
    PREVENTATIVE
    4 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    5 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    1 VISION
    2 VISION
    3 VISION
    1 VISION
    2 VISION
    3 VISION

    VISION
    VISION
    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1141 07640
    1141 Total
    1142 03745
    1142 03745
    1142 05763
    1142 05763
    1142 05763
    1142 06563
    1142 06564
    1142 06564
    1142 06564
    1142 08359
    1142 08359
    1142 Total
    1143 04010
    1143 04010
    1143 04010
    1143 04788
    1143 04788
    1143 05772
    1143 05772
    1143 07648
    1143 07648
    1143 08367
    1143 Total
    1144 05933
    1144 Total
    1145 05206
    1145 05206
    1145 07637
    1145 Total
    1146 08361
    1146 08361
    1146 Total
    1147 03746
    1147 07820
    1147 Total
    1148 04303
    1148 04303
    1148 04303
    1148 04303
    1148 04304
    1148 04304
    1148 05209
    1148 05209
    1148 05209
    1148 06124
    1148 06124
    1148 06124
    1148 06124
    1148 Total
    1149 05215
    1149 05215

    4 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS

    1 ANXIETY
    SPECIALIST CNSLT-OFFICE
    2 ANXIETY
    MISC OUT HOSP-ORAL DRUGS
    1 ANXIETY
    MISC OUT HOSP-ORAL DRUGS
    2 ANXIETY
    MISC OUT HOSP-ORAL DRUGS
    3 ANXIETY
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 ANXIETY
    SPECIALIST CNSLT-OFFICE
    2 ANXIETY
    MISC OUT HOSP-ORAL DRUGS
    3 ANXIETY
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    MISC OUT HOSP-ORAL DRUGS
    2 HEART
    MISC OUT HOSP-ORAL DRUGS
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE
    1 SKIN - LESION

    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS

    1 ABSCESS
    2 ABSCESS

    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE

    1 HYPERTENSION
    1 HYPERTENSION

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1
    2
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    3 PAINFUL LEGS
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA

    1 PAINFUL LEGS
    2 PAINFUL LEGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    1149 05215
    1149 Total
    1150 04720
    1150 04720
    1150 04720
    1150 04720
    1150 04720
    1150 Total
    1151 07111
    1151 07111
    1151 07111
    1151 07111
    1151 07111
    1151 07112
    1151 07112.1
    1151 07112.1
    1151 07112.1
    1151 07113
    1151 07113.1
    1151 07113.1
    1151 07113.1
    1151 07114
    1151 Total
    1152 04005
    1152 Total
    1153 08486
    1153 08487
    1153 08487
    1153 08487
    1153 Total
    1154 05926
    1154 05926
    1154 05926
    1154 06560
    1154 06560
    1154 Total
    1155 04117
    1155 04117
    1155 07620
    1155 08581
    1155 08581
    1155 Total
    1156 07819
    1156 07819
    1156 07819
    1156 Total
    1157 06568
    1157 Total
    1158 03617
    1158 03617
    1158 03617
    1158 03617
    1158 03617

    3 PAINFUL LEGS

    MISC OUT HOSP-INJECTABLES

    1 ABDOMINAL
    2 ABDOMINAL
    3 ABDOMINAL
    4 ABDOMINAL
    5 ABDOMINAL

    PAINS
    PAINS
    PAINS
    PAINS
    PAINS

    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 INSECT STING
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 SKIN - LESION
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 FEVER

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE

    1 DIAB'ETES

    DIAGNOSTIC LABORATORY

    1 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE

    1 HEART
    2 HEART
    3 HEART
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    MISC
    MISC
    MISC
    MISC
    MISC

    1 HEART
    2 HEART
    3 HEART

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 GLAUCOMA

    SPECIALIST CNSLT-OFFICE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    OUT
    OUT
    OUT
    OUT
    OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    CARE
    CARE
    CARE
    CARE
    CARE

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    1158 Total
    1159 07639
    1159 07639
    1159 07639
    1159 Total
    1160 05212
    1160 05213
    1160 05213
    1160 05213
    1160 05213.1
    1160 05213.1
    1160 05769
    1160 05769
    1160 06125
    1160 06125
    1160 07644
    1160 Total
    1161 06562
    1161 06562.1
    1161 06562.2
    1161 07772
    1161 07772
    1161 Total
    1162 04125
    1162 04125
    1162 05932
    1162 05932
    1162 05932
    1162 06290
    1162 06290
    1162 06290
    1162 06290
    1162 06290.1
    1162 06290.1
    1162 06290.1
    1162 Total
    1163 03862
    1163 03862
    1163 04003
    1163 04004
    1163 04004
    1163 04118
    1163 04899
    1163 04899
    1163 04899
    1163 04899
    1163 04899
    1163 06118
    1163 06118
    1163 06119
    1163 06119
    1163 06120
    1163 06120

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 GLAUCOMA
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 GLAUCOMA
    2 GLAUCOMA
    1 HYPERTENSION

    MISC OUT HOSP-ORAL DRUGS


    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC
    1 PROSTATE
    DIAGNOSTIC
    1 CHOSTOCHRONDITIS
    DIAGNOSTIC
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC
    1
    2
    1 HEART
    2 HEART
    3 HEART
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 CATARACT
    2 CATARACT
    1
    1 GLAUCOMA
    2 GLAUCOMA
    1 HYPERTENSION
    1 BONE & CARTILAGE
    2 BONE & CARTILAGE
    3 BONE & CARTILAGE
    4 BONE & CARTILAGE
    5 BONE & CARTILAGE
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 GLAUCOMA
    2 GLAUCOMA

    LABORATORY
    LABORATORY
    LABORATORY
    LABORATORY
    LABORATORY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DISORDER
    PHYSICIAN VISIT-OFFICE
    DISORDER
    PHYSICIAN VISIT-OFFICE
    DISORDER
    MISC OUT HOSP-INJECTABLES
    DISORDER
    MISC OUT HOSP-INJECTABLES
    DISORDER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1163

    1164
    1165

    1166

    1163 06178
    1163 06178
    1163 06178.1
    1163 06178.1
    1163 06178.1
    1163 06178.1
    1163 06178.1
    1163 06178.2
    1163 06178.2
    1163 06974
    1163 06974
    1163 06974
    1163 06974
    1163 06974
    1163 06974.1
    1163 06974.1
    1163 06974.1
    1163 07528
    1163 07528
    1163 07528
    1163 07528
    1163 07528
    Total
    1164 04312
    1164 05217
    1164 05217
    1164 05217
    1164 07071
    1164 07071
    1164 07071
    Total
    1165 07062
    Total
    1166 03904
    1166 03904
    1166 03904
    1166 04778
    1166 06123
    1166 06123
    1166 07065
    1166 07065
    1166 07635
    1166 07636
    1166 07636
    1166 08480
    1166 08481
    1166 08481
    1166 08482
    1166 08482
    Total
    1167 02057.1
    1167 03741
    1167 03741

    1 DIAB'ETES
    2 DIAB'ETES
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    5 DEPRESSION
    1 DEPRESSION
    2 DEPRESSION
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    3 HEART
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    5 DEPRESSION

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE

    1 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE

    1 ALLERGIC REACTION
    PHYSICIAN VISIT-HOSPITAL
    2 ALLERGIC REACTION
    MISC OUT HOSP-ORAL DRUGS
    3 ALLERGIC REACTION
    MISC OUT HOSP-ORAL DRUGS
    1 ABDOMINAL PAINS
    DIAGNOSTIC X-RAY
    1 COUGH - AIRWAY OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    2 COUGH - AIRWAY OBSTRUCTION
    DIAGNOSTIC LABORATORY
    1 HEADACHE- MIGRAINE TENSION
    SPECIALIST CNSLT-OFFICE
    2 HEADACHE- MIGRAINE TENSION
    DIAGNOSTIC X-RAY
    1 HEADACHE- MIGRAINE TENSION
    SPECIALIST CNSLT-OFFICE
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 DEPRESSION
    SPECIALIST CNSLT-OFFICE
    1 EYE DISORDER
    SPECIALIST CNSLT-OFFICE
    2 EYE DISORDER
    MISC OUT HOSP-ORAL DRUGS
    1 ENDOMETROSIS
    SPECIALIST CNSLT-OFFICE
    2 ENDOMETROSIS
    DIAGNOSTIC X-RAY
    1
    1 VISION CARE
    2 VISION CARE

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE

    1167

    1168

    1169

    1170

    1171

    1172

    1173

    1174

    1175

    1176
    1177

    1167 03741
    1167 04774
    1167 07622
    1167 07623
    1167 07623
    1167 07624
    Total
    1168 03740
    1168 03740
    1168 03740
    1168 03740
    1168 03740
    1168 04300
    1168 06558
    1168 06558
    1168 06558
    1168 06612
    1168 07049
    1168 07049
    Total
    1169 04116
    1169 04116
    1169 04116
    Total
    1170 07634
    1170 07634
    Total
    1171 06117
    1171 06117
    Total
    1172 05766
    1172 05766
    1172 05766
    1172 07066
    1172 07066
    Total
    1173 03764
    1173 06680
    1173 06680
    Total
    1174 04776
    1174 04777
    1174 04777
    1174 06295
    Total
    1175 06554
    1175 06554
    Total
    1176 04780
    1176 04780
    Total
    1177 04313
    Total

    3 VISION CARE
    1
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE

    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PREVENTATIVE
    DENTAL CARE

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 BRONCHITIS - ACUTE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 DEPRESSION
    2 DEPRESSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 FEVER
    2 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 HEADACHE2 HEADACHE3 HEADACHE1 HEADACHE2 HEADACHE-

    MIGRAINE
    MIGRAINE
    MIGRAINE
    MIGRAINE
    MIGRAINE

    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    MISC OUT HOSP-ORAL DRUGS
    TENSION
    MISC OUT HOSP-ORAL DRUGS
    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    MISC OUT HOSP-ORAL DRUGS

    1 ABDOMINAL PAINS
    PHYSICIAN VISIT-OFFICE
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC LABORATORY
    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE

    DENTAL CARE

    1178

    1179

    1180

    1181

    1182

    1183

    1178 06113
    1178 06113
    1178 06113
    1178 06116
    1178 06116
    Total
    1179 05018
    1179 05214
    1179 05214
    1179 06614
    1179 06614
    1179 06614
    1179 06614
    1179 06614
    Total
    1180 06112
    1180 06112
    1180 06112
    Total
    1181 05297
    1181 05297
    1181 05297
    1181 07868
    1181 07868
    Total
    1182 03757
    1182 03757
    1182 03757
    Total
    1183 03750
    1183 03750
    1183 03751
    1183 03751
    1183 05203
    1183 05927
    1183 05927
    1183 05927
    1183 05928
    Total
    1184 04305
    1184 04305
    1184 04305
    1184 04305
    1184 04306
    1184 04306
    1184 04306
    1184 04306
    1184 04306
    1184 04306.1
    1184 04308
    1184 04308
    1184 04308
    1184 04308

    1 HEART
    2 HEART
    3 HEART
    1
    2

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    MISC OUT HOSP-INJECTABLES

    1 HYPERTENSION
    1 SINUSITIS
    2 SINUSITIS
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BREAST DISORDERS
    2 BREAST DISORDERS

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 KNEE INTERNAL DERANGEMENT


    PHYSIOTHERAPY
    2 KNEE INTERNAL DERANGEMENT
    MISC OUT HOSP-OTHER
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 MISCARRIAGE
    MATERNITY-PRENATAL CARE
    1 MISCARRIAGE
    MATERNITY-NORMAL DELIVERY
    2 MISCARRIAGE
    MATERNITY-NORMAL DELIVERY
    3 MISCARRIAGE
    MATERNITY-NORMAL DELIVERY
    1 DEVIATED NASAL SEPTUM SPECIALIST CNSLT-OFFICE
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1184

    1185

    1186

    1187

    1188

    1189

    1190

    1191

    1192
    1193

    1194

    1184 04309
    1184 05768
    1184 05768
    1184 05768
    1184 07067
    Total
    1185 08472
    1185 08472
    Total
    1186 03742
    1186 03742
    1186 03901
    1186 04775
    Total
    1187 04119
    1187 04119
    1187 04119
    Total
    1188 03905
    1188 03905
    1188 04781
    1188 04781
    1188 05765
    1188 08484
    1188 08484
    Total
    1189 05221
    1189 05221
    1189 07649
    1189 07649
    1189 07649
    1189 08368
    1189 08369
    Total
    1190 03752
    1190 03752
    1190 08493
    1190 08493
    Total
    1191 05195
    1191 05757
    1191 05757
    Total
    1192 06565
    1192 06565
    1192 06565
    Total
    1193 04316
    Total
    1194 07632
    1194 07632
    1194 07632
    Total

    1
    SPECIALIST CNSLT-OFFICE
    1 BEHAVIOURIAL PROBLEMS PHYSICIAN VISIT-OFFICE
    2 BEHAVIOURIAL PROBLEMS PHYSICIAN VISIT-OFFICE
    3 BEHAVIOURIAL PROBLEMS PHYSICIAN VISIT-OFFICE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1
    2
    1
    1

    PHYSIOTHERAPY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL
    1 DENTAL
    1 DENTAL
    2 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1 DENTAL CARE

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    DENTAL CARE

    1 THYROID
    2 THYROID
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 MISCARRIAGE
    1 ANAEMIA
    2 ANAEMIA

    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 CERVICAL STRAIN

    DIAGNOSTIC X-RAY

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1195

    1196

    1197

    1198

    1199

    1200

    1201

    1202

    1195 07817
    1195 07817
    1195 07817
    Total
    1196 03739
    1196 03739
    1196 06551
    1196 06551
    1196 06551
    1196 06551
    1196 06551
    1196 06552
    1196 06552
    1196 06552
    1196 06552
    Total
    1197 04768
    1197 04768
    1197 04768
    1197 04768
    1197 04768
    1197 04769.1
    1197 04769.1
    1197 08470
    1197 08470
    Total
    1198 06566
    1198 06567
    1198 06567
    1198 06567
    Total
    1199 05924
    1199 05924
    Total
    1200 07823
    1200 07823
    1200 07823
    1200 07823
    Total
    1201 05196
    1201 05196.1
    1201 05196.1
    Total
    1202 06111
    1202 07047
    Total
    1203 03759
    1203 03760
    1203 03760
    1203 03761
    1203 05774
    1203 05775
    1203 05775

    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 SKIN - LOCAL INFECTION


    2 SKIN - LOCAL INFECTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    1 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE

    1 FEVER
    2 FEVER

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    1 DEVIATED
    2 DEVIATED
    3 DEVIATED
    4 DEVIATED

    NASAL
    NASAL
    NASAL
    NASAL

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 CERVICAL STRAIN
    1 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY

    1 EAR DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 VISION CARE
    VISION CARE
    1 BONE & CARTILAGE DISORDER
    SPECIALIST CNSLT-OFFICE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE

    1203 05775
    1203 Total
    1204 04773
    1204 04773
    1204 05925
    1204 05925
    1204 Total
    1205 05147
    1205 05147
    1205 05147
    1205 08588
    1205 08588
    1205 08589
    1205 Total
    1206 04383
    1206 04383
    1206 04383
    1206 07265
    1206 07265
    1206 07265
    1206 07265
    1206 07266
    1206 07267
    1206 07267
    1206 07267
    1206 07267
    1206 07268
    1206 07268
    1206 Total
    1207 07269
    1207 Total
    1208 04386
    1208 Total
    1209 05145
    1209 05145
    1209 05145
    1209 05145
    1209 05146
    1209 05146
    1209 05146
    1209 Total
    1210 04094
    1210 Total
    1211 06572
    1211 06572
    1211 Total
    1212 04096
    1212 Total
    1213 07272
    1213 07272
    1213 07272
    1213 07272
    1213 Total

    3 DENTAL CARE

    DENTAL CARE

    1 THYROID
    2 THYROID
    1
    2

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE

    1 HEART
    2 HEART
    3 HEART
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 ASTHMA
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 ASTHMA
    2 ASTHMA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 BACK PAIN

    PHYSICIAN VISIT-OFFICE

    1 FATIGUE

    PHYSICIAN VISIT-OFFICE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1
    2
    3

    CARE
    CARE
    CARE
    CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    1214

    1215

    1216

    1217

    1218

    1219

    1220

    1214 03899
    1214 03899
    1214 04770
    1214 04770
    1214 04771
    1214 04771
    Total
    1215 07050
    1215 08357
    1215 08357
    1215 08357
    Total
    1216 06289
    1216 06289
    Total
    1217 08483
    1217 08483
    1217 08483
    Total
    1218 09860.1
    1218 09860.1
    1218 09860.1
    1218 09860.1
    1218 09860.1
    1218 09860.2
    1218 06131
    1218 06131
    1218 06575
    1218 06575
    1218 07073
    1218 07073
    1218 07073
    Total
    1219 04310
    1219 04310
    1219 04310
    1219 04310
    1219 04310
    1219 06126
    1219 06126
    Total
    1220 07627
    1220 07627
    Total
    1221 06571
    1221 06571
    1221 06571
    1221 06571
    1221 06571
    1221 07638
    1221 07638
    1221 07638
    1221 07638

    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    1 HORMONE REPLACMENT THERAPY


    SPECIALIST CNSLT-OFFICE
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DILATION & CURRETAGE


    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    5 DILATION & CURRETAGE
    1 DILATION & CURRETAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    HOSPITAL LOCAL ROOM


    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 CANCER-BREAST
    2 CANCER-BREAST

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1221

    1222

    1223

    1224

    1221 08485
    1221 08485
    Total
    1222 05761
    1222 05761
    1222 05761
    1222 05761
    1222 05762
    1222 05762
    1222 08353
    1222 08353
    Total
    1223 08475
    1223 08475
    1223 08475
    Total
    1224 05201
    1224 05201
    1224 05201
    1224 05201
    1224 06297
    1224 06297
    1224 06561
    1224 06561
    1224 06561
    1224 06561
    1224 07055
    1224 07055
    1224 07055
    1224 07055
    1224 07055.1
    1224 07625
    1224 08479
    1224 08479
    1224 08479
    Total
    1225 04122
    1225 04122
    1225 04122
    1225 04122
    1225 04122
    1225 04783
    1225 04783
    1225 04783
    1225 04783
    1225 04783
    1225 04784
    1225 04784
    1225 05021
    1225 05021
    1225 05021
    1225 05021
    1225 05021

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 RETINOPATY
    2 RETINOPATY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    3 HYPERLIPIDERMIA
    4 HYPERLIPIDERMIA
    1 THYROID
    1 THYROID
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 HEART
    2 HEART
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    CHOLESTEROL
    DIAGNOSTIC X-RAY
    CHOLESTEROL
    DIAGNOSTIC X-RAY
    CHOLESTEROL
    DIAGNOSTIC LABORATORY
    CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1225

    1226

    1227

    1228

    1229

    1230

    1225 05021.1
    1225 05021.1
    1225 05022
    1225 05022
    1225 05022
    1225 06482
    1225 06482
    1225 06482
    1225 06482
    1225 07068
    1225 07068
    1225 07068
    1225 07068
    1225 07068
    Total
    1226 04795
    1226 04795
    Total
    1227 06574
    1227 06574
    Total
    1228 03907
    1228 03907
    1228 03907
    1228 05931
    1228 05931
    1228 05931
    1228 05931
    1228 05931
    1228 06128
    1228 06128
    1228 06128
    1228 06128
    1228 06128
    1228 06128.1
    1228 06129
    1228 06129
    1228 06129
    1228 06130
    1228 06130
    1228 06130
    1228 06130
    Total
    1229 05200
    1229 05200
    Total
    1230 04317
    1230 04317
    Total
    1231 07654
    1231 07654
    1231 07654
    1231 08371

    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    1 HEART
    2 HEART

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    5 CHEST PAIN
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 THYROID
    2 THYROID
    3 THYROID
    4 THYROID

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 SOFT TISSUE DISORDERS/DISEASE


    DIAGNOSTIC X-RAY
    2 SOFT TISSUE DISORDERS/DISEASE
    SPECIALIST CNSLT-OFFICE
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE

    1231

    1232

    1233

    1234

    1235

    1236

    1237

    1231 08371
    1231 08371
    1231 08371
    1231 08371.1
    1231 08371.2
    Total
    1232 04782
    1232 06075
    1232 06075
    1232 06075
    Total
    1233 07822
    1233 07822
    1233 08591
    Total
    1234 03900
    1234 03900
    1234 03900
    Total
    1235 07053
    1235 07053.1
    1235 07053.1
    1235 07053.1
    1235 07053.1
    1235 07053.2
    1235 07053.2
    1235 07053.2
    1235 07053.2
    1235 07053.2
    1235 07053.3
    1235 07053.4
    1235 07053.4
    1235 07053.5
    1235 07053.6
    1235 07053.6
    Total
    1236 04792
    1236 04792
    1236 04794
    1236 04794
    Total
    1237 04785
    1237 04785
    1237 04785
    1237 04785
    Total
    1238 03758
    1238 03758
    1238 08291
    1238 08291
    1238 08291
    1238 08291
    1238 08291

    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 RENAL DYSFUNCTION
    1 THYROID

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    1 URTICARIA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE

    1
    2
    1 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    1 GASTRIC - PEPTIC ULCER/GERD


    SPECIALIST CNSLT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    SURGICAL OUTPATIENT
    3 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 BONE & CARTILAGE DISORDER
    DIAGNOSTIC X-RAY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    4 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM DIAGNOSTIC LABORATORY
    3 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    4 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    5 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERTENSION
    DIAGNOSTIC X-RAY
    1 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 CERVICAL SPONDYLOSIS
    DIAGNOSTIC X-RAY
    2 CERVICAL SPONDYLOSIS
    PHYSICIAN VISIT-OFFICE
    1 DEVIATED
    2 DEVIATED
    1 DEVIATED
    2 DEVIATED

    NASAL
    NASAL
    NASAL
    NASAL

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    1 GASTRIC
    2 GASTRIC
    3 GASTRIC
    4 GASTRIC

    PEPTIC
    PEPTIC
    PEPTIC
    PEPTIC

    ULCER/GERD
    SPECIALIST CNSLT-OFFICE
    ULCER/GERD
    DIAGNOSTIC LABORATORY
    ULCER/GERD
    MISC OUT HOSP-OTHER
    ULCER/GERD
    SURGICAL OUTPATIENT

    1 OTITIS - EAR
    2 OTITIS - EAR
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL INPATIENT

    1238

    1239

    1240

    1241

    1242

    1243

    1244

    1238 08291.1
    1238 08291.1
    1238 08291.1
    1238 08291.1
    1238 08291.1
    Total
    1239 06121
    1239 06121
    Total
    1240 03738
    1240 03738
    1240 03738
    1240 07810
    1240 07810
    1240 07810
    1240 07810
    1240 07810
    1240 07812
    1240 07812
    Total
    1241 07821
    1241 07821
    1241 07821
    Total
    1242 03748
    1242 03748
    1242 03748.1
    1242 03749
    1242 07064
    Total
    1243 03908
    1243 03908
    1243 03908
    Total
    1244 04311
    1244 04786
    1244 04786
    1244 04786
    1244 04787
    1244 04787
    1244 04787
    Total
    1245 05218
    1245 05218
    1245 05218.1
    1245 05219
    1245 05219
    1245 05219
    1245 05220
    1245 05220
    1245 05220
    1245 05220
    1245 06573

    1 RENAL
    2 RENAL
    3 RENAL
    4 RENAL
    5 RENAL

    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION
    DYSFUNCTION

    1
    2

    SURGICAL ANAESTHESIA
    SURGICAL ANAESTHESIA
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    2 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    3 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1 DIAB'ETES
    PHYSICIAN VISIT-OFFICE
    2 DIAB'ETES
    DIAGNOSTIC LABORATORY
    3 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    4 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    5 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 COUGH - AIRWAY OBSTRUCTION


    DIAGNOSTIC X-RAY
    2 COUGH - AIRWAY OBSTRUCTION
    DIAGNOSTIC LABORATORY
    1 THYROID
    DIAGNOSTIC LABORATORY
    1 BREAST DISORDERS
    MISC OUT HOSP-ORAL DRUGS
    1 FATIGUE
    DIAGNOSTIC LABORATORY
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DEVIATED NASAL SEPTUM


    1
    2
    3
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 OVARIAN CYST
    PHYSICIAN VISIT-OFFICE
    2 OVARIAN CYST
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    SPECIALIST CNSLT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    HOSPITAL LOCAL ROOM

    1245

    1246

    1247

    1248

    1249

    1250

    1251

    1245 06573
    1245 06573
    1245 06573
    Total
    1246 07110
    1246 07110
    Total
    1247 07626
    1247 07626
    1247 07626
    1247 07626
    1247 07818
    1247 07818
    Total
    1248 06288
    1248 07048
    1248 07048
    1248 07048
    1248 07048
    Total
    1249 05929
    1249 05929
    1249 05929
    1249 05929
    1249 08492
    1249 08492
    Total
    1250 05210
    1250 05210
    1250 05210
    1250 05210
    1250 05211
    1250 05211
    1250 05211
    1250 05211
    1250 05211
    1250 05211.1
    Total
    1251 04128
    1251 04128
    1251 04128
    1251 04128.1
    1251 04128.1
    1251 07074
    1251 07074
    1251 07650
    1251 07650
    1251 07651
    1251 07825
    Total
    1252 04302
    1252 04302
    1252 04302

    2 GASTRIC - PEPTIC ULCER/GERD


    HOSPITAL MISC-LOCAL
    3 GASTRIC - PEPTIC ULCER/GERD
    SURGICAL INPATIENT
    4 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 VISION CARE
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL
    2 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1
    2
    3
    1
    2
    1 HEADACHE- MIGRAINE
    2 HEADACHE- MIGRAINE
    1 VISION CARE
    2 VISION CARE
    1 HEADACHE- MIGRAINE
    1 HEADACHE- MIGRAINE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    MISC OUT HOSP-ORAL


    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL
    MISC OUT HOSP-ORAL
    TENSION
    MISC OUT HOSP-ORAL
    TENSION
    MISC OUT HOSP-ORAL
    VISION CARE
    VISION CARE
    TENSION
    DIAGNOSTIC X-RAY
    TENSION
    MISC OUT HOSP-ORAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    DRUGS

    1252

    1253
    1254

    1255

    1256

    1257

    1258

    1259

    1260

    1261

    1262

    1252 04302
    1252 04302
    1252 04302.1
    Total
    1253 05773
    1253 05773
    1253 05773
    1253 07652
    1253 07652
    1253 07652
    Total
    1254 07061
    Total
    1255 05202
    1255 05202
    Total
    1256 05198
    1256 05198
    1256 05198
    1256 05198
    Total
    1257 06559
    1257 07621
    1257 07621
    Total
    1258 03763
    1258 03763
    1258 05222
    1258 06132
    1258 06132
    1258 06287
    1258 06287
    1258 06287
    Total
    1259 07075
    1259 07075
    1259 07075
    Total
    1260 08370
    1260 08370
    Total
    1261 07063
    1261 07063
    Total
    1262 05758
    1262 05758
    1262 05758.1
    1262 07813
    Total
    1263 05759
    1263 05759
    1263 05759
    1263 06555

    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 OTITIS - EAR

    MISC OUT HOSP-ORAL DRUGS

    1 ENDOMETROSIS
    2 ENDOMETROSIS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1 CHEST
    2 CHEST
    3 CHEST
    4 CHEST

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PAIN
    PAIN
    PAIN
    PAIN

    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 PROSTATE
    2 PROSTATE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 INGROWING TOE NAIL


    1 INGROWING TOE NAIL
    1 OVARIAN CYST
    1 BACK PAIN

    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE

    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE

    1263
    1264

    1265

    1266

    1267

    1268

    1269

    1263 06555
    1263 06555
    1263 06611
    Total
    1264 08473
    Total
    1265 05767
    1265 05767
    Total
    1266 04126
    1266 04126
    1266 04126
    1266 04127
    1266 04127
    Total
    1267 04007
    1267 04007
    1267 04008
    1267 04008
    1267 04008
    1267 07070
    1267 07070
    1267 07070
    1267 07070
    1267 08366
    1267 08366
    1267 08366
    1267 08366.1
    Total
    1268 03903
    1268 03903
    1268 04002
    1268 04002
    1268 04002
    Total
    1269 06296
    1269 06296
    1269 06296
    1269 07633
    1269 07633
    1269 07633
    1269 07633
    Total
    1270 04560
    1270 04561
    1270 04561
    1270 04561
    1270 05263
    1270 05263
    1270 05263
    1270 05263
    1270 05263
    1270 05263.1

    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM

    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE

    VISION CARE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 FEVER
    2 FEVER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY

    1 DEVIATED
    2 DEVIATED
    1 DEVIATED
    2 DEVIATED
    3 DEVIATED

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    NASAL
    NASAL
    NASAL
    NASAL
    NASAL

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PREVENTATIVE
    DIAGNOSTIC LABORATORY

    1 HEMORRHOIDS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY

    1270

    1271

    1272

    1273

    1274

    1275

    1270 05263.1
    1270 05263.1
    1270 05264
    1270 05264
    1270 05475
    1270 05475
    1270 07117
    1270 07117
    1270 07117
    Total
    1271 06906
    1271 06906
    1271 06906
    Total
    1272 04564
    1272 04564
    1272 04564
    Total
    1273 03646
    1273 03646
    1273 03646
    1273 03647
    1273 03647
    1273 03647
    Total
    1274 04397
    1274 04397
    1274 04397
    1274 07873
    1274 07873
    1274 07873
    Total
    1275 04398
    1275 04398
    1275 04398
    1275 04399
    1275 05996
    1275 05996
    1275 05996
    1275 05996
    1275 05996
    1275 08105
    1275 08105
    Total
    1276 03618
    1276 03618
    1276 03618
    1276 03618
    1276 03618
    1276 03618.1
    1276 03618.1
    1276 03618.1
    1276 03618.1

    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 TENDONITIS
    2 TENDONITIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE

    DIAGNOSTIC LABORATORY
    HOSPITAL LOCAL ROOM
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 VISION
    2 VISION
    3 VISION
    1 VISION
    2 VISION
    3 VISION

    VISION
    VISION
    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    1
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    4 PROSTATE
    5 PROSTATE
    1
    2

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 KNEE
    2 KNEE
    3 KNEE
    4 KNEE
    5 KNEE
    1 KNEE
    2 KNEE
    3 KNEE
    4 KNEE

    INTERNAL
    INTERNAL
    INTERNAL
    INTERNAL
    INTERNAL
    INTERNAL
    INTERNAL
    INTERNAL
    INTERNAL

    DERANGEMENT
    PHYSICIAN VISIT-OFFICE
    DERANGEMENT
    PHYSICIAN VISIT-OFFICE
    DERANGEMENT
    SPECIALIST CNSLT-OFFICE
    DERANGEMENT
    SPECIALIST CNSLT-OFFICE
    DERANGEMENT
    DIAGNOSTIC X-RAY
    DERANGEMENT
    MISC OUT HOSP-ORAL DRUGS
    DERANGEMENT
    HOSPITAL LOCAL ROOM
    DERANGEMENT
    HOSPITAL LOCAL ROOM
    DERANGEMENT
    HOSPITAL MISC-LOCAL

    1276 Total
    1277 04563
    1277 04563
    1277 04563
    1277 04563
    1277 05477
    1277 05477
    1277 05477
    1277 05478
    1277 05478
    1277 05478
    1277 05478
    1277 05478
    1277 07329
    1277 07329
    1277 07329
    1277 07329
    1277 07869
    1277 07869
    1277 07869
    1277 Total
    1278 05994
    1278 05994
    1278 05994
    1278 05994
    1278 05994
    1278 Total
    1279 06753
    1279 06753
    1279 Total
    1280 04562
    1280 04562
    1280 04562
    1280 04562
    1280 04562
    1280 04562.1
    1280 04562.1
    1280 05476
    1280 05476
    1280 Total
    1281 03648
    1281 03648
    1281 04396
    1281 04396
    1281 04396
    1281 Total
    1282 03558
    1282 03558
    1282 03558
    1282 03558.1
    1282 03558.1
    1282 03558.1
    1282 03558.1

    1 SKIN - ATOPIC DERMATITIS


    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    5 BRONCHITIS - ACUTE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    4 PROSTATE
    5 PROSTATE

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 FEVER
    2 FEVER
    3 FEVER
    1 KNEE INTERNAL
    2 KNEE INTERNAL
    3 KNEE INTERNAL
    4 KNEE INTERNAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DERANGEMENT
    PHYSICIAN VISIT-OFFICE
    DERANGEMENT
    PHYSICIAN VISIT-OFFICE
    DERANGEMENT
    MISC OUT HOSP-INJECTABLES
    DERANGEMENT
    MISC OUT HOSP-INJECTABLES

    1282

    1283

    1284

    1285

    1286

    1287

    1288

    1282 04626
    1282 04626
    1282 04626
    1282 04626
    1282 07870
    1282 07870
    1282 07870
    1282 07870.1
    Total
    1283 04677
    1283 04677
    1283 04677
    1283 04677
    1283 04677
    1283 04677.1
    1283 04678
    1283 04678
    1283 04679
    1283 04679
    1283 05266
    1283 05266
    1283 07119
    1283 07119
    1283 07119
    1283 07119
    1283 07120
    1283 07120
    Total
    1284 05298
    1284 05298
    1284 05298
    1284 05298.1
    1284 05298.1
    1284 05298.1
    Total
    1285 06866
    1285 06866
    Total
    1286 04680
    1286 04680
    Total
    1287 06010
    1287 06257
    1287 06257
    1287 07330
    1287 07330
    Total
    1288 06484
    1288 06484
    Total
    1289 08321.1
    1289 08321.1
    1289 08321.1

    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    5 DEVIATED NASAL
    1 DEVIATED NASAL
    1
    2
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 ALOPECIA
    2 ALOPECIA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    2 HEART

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 DEPRESSION
    2 DEPRESSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1
    PREVENTATIVE
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE
    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1289 08321.1
    1289 Total
    1290 03911
    1290 Total
    1291 08102
    1291 08102
    1291 08102
    1291 Total
    1292 08098
    1292 08098
    1292 08099
    1292 08099
    1292 08099
    1292 08099
    1292 Total
    1293 07871
    1293 07872
    1293 07872
    1293 Total
    1294 05480
    1294 05480
    1294 05480
    1294 05995
    1294 05995
    1294 05995
    1294 Total
    1295 05268
    1295 05268
    1295 05268
    1295 Total
    1296 03559
    1296 03559
    1296 04565
    1296 04565
    1296 04565
    1296 04566
    1296 04566
    1296 04566
    1296 05479
    1296 08103
    1296 08103
    1296 08103
    1296 08104
    1296 08104
    1296 08104
    1296 Total
    1297 05993
    1297 05993
    1297 Total
    1298 06009
    1298 Total
    1299 03910
    1299 03910

    4 VISION CARE

    VISION CARE

    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 BACK PAIN
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION
    2 VISION
    3 VISION
    1 VISION
    2 VISION
    3 VISION

    VISION
    VISION
    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 MISCARRIAGE
    PHYSICIAN VISIT-OFFICE
    2 MISCARRIAGE
    DIAGNOSTIC LABORATORY
    1 BONE & CARTILAGE DISORDER
    PHYSICIAN VISIT-OFFICE
    2 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-INJECTABLES
    3 BONE & CARTILAGE DISORDER
    MISC OUT HOSP-INJECTABLES
    1 ALLERGIC RHINITIS
    PHYSICIAN VISIT-OFFICE
    2 ALLERGIC RHINITIS
    MISC OUT HOSP-INJECTABLES
    3 ALLERGIC RHINITIS
    MISC OUT HOSP-INJECTABLES
    1 BONE & CARTILAGE DISORDER
    SPECIALIST CNSLT-OFFICE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS SPECIALIST CNSLT-OFFICE
    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-INJECTABLES
    3 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-INJECTABLES
    1 MISCARRIAGE
    2 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    1 EYE DISORDER

    SPECIALIST CNSLT-OFFICE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1299

    1300

    1301

    1302

    1303

    1304

    1305

    1306

    1299 03910
    1299 03910
    1299 03910
    1299 05269
    1299 05269
    Total
    1300 04906
    1300 04906
    1300 04906
    1300 04906
    1300 07414
    1300 07414
    Total
    1301 03912
    1301 05682
    Total
    1302 05023
    1302 07529
    1302 08006
    1302 08006
    1302 08006.1
    1302 08006.1
    Total
    1303 03495
    1303 03495
    1303 03495
    1303 03909
    1303 03909
    1303 03909
    1303 06752
    1303 06752
    1303 06752
    Total
    1304 04318
    1304 04907
    1304 07077
    1304 07077
    1304 07077
    Total
    1305 06867
    1305 06867.1
    1305 06867.2
    1305 06867.2
    Total
    1306 04447
    1306 04447
    1306 04447
    1306 06750
    1306 06751
    1306 06751
    Total
    1307 08374
    1307 08374

    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1
    2

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 BACK PAIN
    PHYSICIAN VISIT-OFFICE
    2 BACK PAIN
    MISC OUT HOSP-INJECTABLES
    3 BACK PAIN
    MISC OUT HOSP-INJECTABLES
    4 BACK PAIN
    DIAGNOSTIC X-RAY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1
    MISC OUT HOSP-ORAL DRUGS
    1 SKIN - ATOPIC DERMATITIS SPECIALIST CNSLT-OFFICE
    1 ARTHRITIS
    1 BACK PAIN
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 RECTAL ABCESS
    2 RECTAL ABCESS
    3 RECTAL ABCESS

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY

    1
    PHYSICIAN VISIT-OFFICE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 ALLERGIC REACTION
    PHYSICIAN VISIT-OFFICE
    2 ALLERGIC REACTION
    MISC OUT HOSP-OTHER
    3 ALLERGIC REACTION
    MISC OUT HOSP-ORAL DRUGS
    1 DIAB'ETES
    1 CANDIDIASIS
    1 ANXIETY
    2 ANXIETY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1307 08374
    1307 Total
    1308 08008
    1308 Total
    1309 05299
    1309 05299
    1309 05299
    1309 05299.1
    1309 05299.1
    1309 Total
    1310 04097
    1310 Total
    1311 05827
    1311 05827
    1311 05827
    1311 05828
    1311 05829
    1311 05829
    1311 05829
    1311 05829
    1311 Total
    1312 05267
    1312 05681
    1312 06526
    1312 06527
    1312 06527
    1312 06527
    1312 06527
    1312 06527.1
    1312 06527.1
    1312 07562
    1312 07563
    1312 Total
    1313 06528
    1313 06528
    1313 06528
    1313 06528
    1313 06528
    1313 Total
    1314 05997
    1314 05997
    1314 05997
    1314 Total
    1315 08158
    1315 08158
    1315 Total
    1316 03561
    1316 06241
    1316 Total
    1317 06242
    1317 06242
    1317 06242
    1317 Total

    3 VISION CARE

    VISION CARE

    1 DENTAL CARE

    DENTAL CARE

    1
    PHYSICIAN VISIT-OFFICE
    2
    MISC OUT HOSP-OTHER
    3
    MISC OUT HOSP-INJECTABLES
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-OTHER
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1
    2
    3
    4

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 CHEST PAIN
    PHYSICIAN VISIT-OFFICE
    2 CHEST PAIN
    MISC OUT HOSP-ORAL DRUGS
    3 CHEST PAIN
    MISC OUT HOSP-ORAL DRUGS
    4 CHEST PAIN
    MISC OUT HOSP-INJECTABLES
    1 DIAB'ETES
    DIAGNOSTIC LABORATORY
    2 DIAB'ETES
    DIAGNOSTIC LABORATORY
    1 MISCARRIAGE
    MATERNITY-PRENATAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE


    1
    PHYSICIAN VISIT-OFFICE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1318

    1319

    1320

    1321

    1318 04681
    1318 04681
    Total
    1319 03560
    1319 03560
    1319 03560
    1319 03560
    1319 04682
    1319 04682
    1319 04682
    1319 04991
    1319 04991
    1319 04991
    1319 08292
    1319 08292
    1319 08292
    Total
    1320 03563
    1320 03563
    1320 03563.1
    1320 03564
    1320 03564
    1320 03564
    1320 03564.1
    1320 03564.1
    1320 03564.1
    1320 03564.1
    1320 03564.2
    Total
    1321 04801
    1321 04802
    1321 04802
    1321 04802
    1321 07128
    1321 07128
    1321 07128
    Total
    1322 05645
    1322 05645
    1322 05645
    1322 05645
    1322 05645
    1322 05645.1
    1322 05645.1
    1322 05645.1
    1322 05645.1
    1322 05645.1
    1322 07122
    1322 07122
    1322 07123
    1322 07123
    1322 07123
    1322 05645,2

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE

    1 DIAB'ETES
    2 DIAB'ETES
    1 CHOSTOCHRONDITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 INFECTION THUMB
    2 INFECTION THUMB
    3 INFECTION THUMB
    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    OTHER
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    1322 05645,2
    1322 Total
    1323 03967
    1323 07124
    1323 07124
    1323 07124
    1323 07125
    1323 Total
    1324 05393
    1324 05393
    1324 05393
    1324 05393.1
    1324 05393.1
    1324 05393.2
    1324 05393.2
    1324 05393.2
    1324 05393.2
    1324 05393.23
    1324 05393.23
    1324 Total
    1325 05392
    1325 05392
    1325 05392
    1325 08108
    1325 08108
    1325 Total
    1326 03562
    1326 03562
    1326 04797
    1326 04798
    1326 04798
    1326 04798
    1326 08106
    1326 08106
    1326 08106
    1326 08106
    1326 08107
    1326 08107
    1326 08107
    1326 Total
    1327 03567
    1327 03567
    1327 Total
    1328 07126
    1328 07126
    1328 07126
    1328 Total
    1329 08113
    1329 08113
    1329 08113
    1329 Total
    1330 04076
    1330 04076

    2 DIAB'ETES

    DIAGNOSTIC X-RAY

    1 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 GLAUCOMA

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS

    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    1 HYPERTENSION
    2 HYPERTENSION
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    4 ANXIETY
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FATIGUE
    2 FATIGUE

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 HYPERTENSION
    2 HYPERTENSION
    1
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1330 04076
    1330 Total
    1331 03620
    1331 03620
    1331 04074
    1331 04074
    1331 04800
    1331 04800
    1331 07127
    1331 07276
    1331 07276
    1331 07276
    1331 Total
    1332 03568
    1332 03569
    1332 03569
    1332 03569
    1332 03569
    1332 Total
    1333 04075
    1333 04075
    1333 04075.1
    1333 04804
    1333 04804
    1333 04804
    1333 05650
    1333 05650
    1333 05651
    1333 05651
    1333 07279
    1333 07279
    1333 08117
    1333 08117
    1333 08118
    1333 08119
    1333 Total
    1334 05395
    1334 05395
    1334 Total
    1335 08120
    1335 08120
    1335 08120
    1335 Total
    1336 05401
    1336 05401
    1336 05401
    1336 Total
    1337 03566
    1337 03566
    1337 03566
    1337 03566
    1337 Total
    1338 08299

    3 VISION CARE

    VISION CARE

    1 DENTAL CARE
    2 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 OVARIAN
    1 OVARIAN
    2 OVARIAN
    3 OVARIAN
    4 OVARIAN

    CYST
    CYST
    CYST
    CYST
    CYST

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1
    2
    1 HEARING LOSS
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    1 CANDIDIASIS
    2 CANDIDIASIS
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 SKIN - LOCAL INFECTION
    1 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 DENTAL CARE

    CARE
    CARE
    CARE
    CARE

    DENTAL CARE

    1338 Total
    1339 03968
    1339 03968
    1339 03968
    1339 03968
    1339 Total
    1340 06485
    1340 06485
    1340 06485
    1340 06485
    1340 06485
    1340 Total
    1341 03970
    1341 03970
    1341 05396
    1341 05396
    1341 05396
    1341 05396
    1341 05396.1
    1341 05396.1
    1341 08494
    1341 08494
    1341 08494
    1341 Total
    1342 03570
    1342 03570
    1342 Total
    1343 05648
    1343 05648
    1343 05648
    1343 05648
    1343 05648
    1343 05648.1
    1343 08293
    1343 08293
    1343 08293
    1343 08293
    1343 08294
    1343 08294
    1343 08295
    1343 08295
    1343 08295
    1343 08295
    1343 08295.1
    1343 08295.1
    1343 Total
    1344 03573
    1344 08112
    1344 08112
    1344 08112
    1344 Total
    1345 07121
    1345 07121

    1 HEADACHE2 HEADACHE3 HEADACHE4 HEADACHE-

    MIGRAINE
    MIGRAINE
    MIGRAINE
    MIGRAINE

    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    MISC OUT HOSP-INJECTABLES
    TENSION
    MISC OUT HOSP-INJECTABLES
    TENSION
    DIAGNOSTIC LABORATORY

    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    4 CANDIDIASIS
    5 CANDIDIASIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY

    1 MUSCULAR PAIN
    PHYSICIAN VISIT-OFFICE
    2 MUSCULAR PAIN
    DIAGNOSTIC LABORATORY
    1 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    2 PAIN-BACK/SHOULDER
    DIAGNOSTIC LABORATORY
    3 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    4 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    DIAGNOSTIC LABORATORY
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    3 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    1 HERPES ZOSTER
    2 HERPES ZOSTER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 SOFT TISSUE DISORDERS/DISEASE


    PHYSICIAN VISIT-OFFICE
    2 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-INJECTABLES
    3 SOFT TISSUE DISORDERS/DISEASE
    PHYSICIAN VISIT-OFFICE
    4 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-INJECTABLES
    5 SOFT TISSUE DISORDERS/DISEASE
    DIAGNOSTIC X-RAY
    1 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-OTHER
    3 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    4 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 PAIN-BACK/SHOULDER
    PHYSICIAN VISIT-OFFICE
    2 PAIN-BACK/SHOULDER
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    MISC OUT HOSP-INJECTABLES
    3 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    4 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 ASTHMA
    MISC OUT HOSP-ORAL DRUGS
    2 ASTHMA
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1345 Total
    1346 03966
    1346 03966
    1346 03966
    1346 03966
    1346 Total
    1347 03976
    1347 03977
    1347 03977
    1347 03977
    1347 03977.1
    1347 03977.1
    1347 05402
    1347 08300
    1347 08300
    1347 08300
    1347 Total
    1348 05643
    1348 05643
    1348 05643
    1348 Total
    1349 03571
    1349 03571
    1349 03571
    1349 03571
    1349 Total
    1350 03574
    1350 03575
    1350 03575
    1350 03971
    1350 03971
    1350 03971.1
    1350 03973
    1350 03974
    1350 03975
    1350 03975
    1350 04803
    1350 04803
    1350 04803
    1350 05397
    1350 05397
    1350 05397
    1350 05397.1
    1350 05397.1
    1350 05649
    1350 05649
    1350 07129
    1350 07129
    1350 08114
    1350 08115
    1350 08115
    1350 08115.1
    1350 Total

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 SKIN - ATOPIC DERMATITIS


    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE


    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 THYROID
    DIAGNOSTIC LABORATORY
    2 THYROID
    PHYSICIAN VISIT-OFFICE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 BREAST DISORDERS
    DIAGNOSTIC X-RAY
    1 SKIN - LOCAL INFECTION
    PHYSICIAN VISIT-OFFICE
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    MISC OUT HOSP-ORAL DRUGS
    1 CHEST PAIN
    PHYSICIAN VISIT-HOSPITAL
    2 CHEST PAIN
    DIAGNOSTIC X-RAY
    3 CHEST PAIN
    MISC OUT HOSP-ORAL DRUGS
    1 CHOSTOCHRONDITIS
    PHYSICIAN VISIT-OFFICE
    2 CHOSTOCHRONDITIS
    MISC OUT HOSP-ORAL DRUGS
    3 CHOSTOCHRONDITIS
    PHYSICIAN VISIT-OFFICE
    1 THYROID
    SPECIALIST CNSLT-OFFICE
    2 THYROID
    DIAGNOSTIC LABORATORY
    1 THYROID
    SPECIALIST CNSLT-OFFICE
    2 THYROID
    MISC OUT HOSP-ORAL DRUGS
    1 THYROID
    SPECIALIST CNSLT-OFFICE
    2 THYROID
    DIAGNOSTIC LABORATORY
    1 THYROID
    DIAGNOSTIC LABORATORY
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 FEVER
    DIAGNOSTIC X-RAY
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE

    1351 05391
    1351 Total
    1352 04799
    1352 04799
    1352 04799
    1352 Total
    1353 08109
    1353 Total
    1354 05047
    1354 05047
    1354 05509
    1354 05509
    1354 05509
    1354 05509
    1354 07278
    1354 07379
    1354 08116
    1354 08116
    1354 Total
    1355 06079
    1355 Total
    1356 04319
    1356 04319
    1356 04319
    1356 04319
    1356 04319
    1356 04319.1
    1356 07416
    1356 07416
    1356 07416
    1356 07416
    1356 07416
    1356 Total
    1357 03765
    1357 03765
    1357 03766
    1357 03766
    1357 04320
    1357 04805
    1357 07883
    1357 Total
    1358 04993
    1358 04993
    1358 04993
    1358 04993
    1358 04994
    1358 04994
    1358 04994
    1358 04994
    1358 04994
    1358 Total
    1359 03916
    1359 03916

    1 CHOSTOCHRONDITIS

    PHYSICIAN VISIT-OFFICE

    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC X-RAY

    1 DENTAL CARE
    2 DENTAL CARE
    1 HEADACHE- MIGRAINE
    2 HEADACHE- MIGRAINE
    3 HEADACHE- MIGRAINE
    4 HEADACHE- MIGRAINE
    1 DENTAL CARE
    1 LARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    PHYSICIAN VISIT-OFFICE
    TENSION
    DIAGNOSTIC LABORATORY
    TENSION
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    1 GLAUCOMA

    SPECIALIST CNSLT-OFFICE

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 DIAB'ETES
    2 DIAB'ETES
    1
    2
    1 SKIN - LOCAL INFECTION
    1 DIAB'ETES
    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1359

    1360

    1361

    1362

    1363
    1364

    1359 03916
    1359 03917
    1359 03917
    1359 03917
    Total
    1360 05024
    1360 05024
    1360 05024
    1360 05024
    1360 05024
    1360 05025
    1360 05025
    1360 05025
    1360 05025
    1360 05025
    1360 05025.1
    1360 05125
    1360 05125
    1360 05125
    1360 05125
    Total
    1361 03913.1
    1361 03913.1
    Total
    1362 03914
    1362 03914
    1362 03914
    1362 03915
    1362 03915
    1362 04321
    1362 04321
    1362 06341
    1362 06341
    1362 06907
    1362 06907
    1362 06907
    Total
    1363 03767
    1363 03767
    1363 03767
    Total
    1364 07419
    Total
    1365 03501
    1365 03501
    1365 03501
    1365 03501
    1365 03502
    1365 03502
    1365 03502
    1365 03502
    1365 03502
    1365 06913

    3 VISION CARE
    1 LARYNGITIS
    2 LARYNGITIS
    3 LARYNGITIS

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL
    1
    2
    3
    4

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 RENAL DYSFUNCTION

    DIAGNOSTIC LABORATORY

    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1365

    1366
    1367
    1368

    1369

    1370

    1371

    1372

    1373

    1365 06913.1
    1365 06913.2
    Total
    1366 04590
    1366 04590
    1366 04590.1
    1366 04590.1
    1366 06179
    1366 06179
    1366 06179
    1366 06179
    1366 07995
    1366 07995
    Total
    1367 06868
    Total
    1368 08536
    Total
    1369 03505
    1369 03505
    1369 03505
    1369 06488
    1369 06488.2
    1369 06488.2
    1369 06488.3
    Total
    1370 04571
    1370 04571
    1370 04571
    Total
    1371 05964
    1371 05964
    1371 05964
    Total
    1372 07787
    1372 07787
    Total
    1373 04922
    1373 04922
    1373 05967
    1373 05967
    1373 05967
    1373 05967
    Total
    1374 04012
    1374 04012
    1374 04012
    1374 04012.1
    1374 04012.2
    1374 04012.3
    1374 07418
    1374 07418
    1374 07418

    1 HYPERTENSION
    1 ARTHRITIS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    PHYSICIAN VISIT-OFFICE
    2 HEART
    DIAGNOSTIC LABORATORY
    3 HEART
    DIAGNOSTIC LABORATORY
    4 HEART
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-OTHER
    1 ANAEMIA

    PHYSICIAN VISIT-OFFICE

    PHYSICIAN VISIT-OFFICE

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 ENDOCRINE DISORDERS
    2 ENDOCRINE DISORDERS
    3 ENDOCRINE DISORDERS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 PROSTATE
    PHYSICIAN VISIT-OFFICE
    2 PROSTATE
    MISC OUT HOSP-ORAL DRUGS
    3 PROSTATE
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 KIDNEY DISEASE
    MISC OUT HOSP-ORAL DRUGS
    1 KIDNEY DISEASE
    PHYSICIAN VISIT-OFFICE
    2 KIDNEY DISEASE
    MISC OUT HOSP-ORAL DRUGS
    3 KIDNEY DISEASE
    DIAGNOSTIC LABORATORY

    1374 07418
    1374 Total
    1375 04913
    1375 04913
    1375 04913
    1375 05543
    1375 05543
    1375 06979
    1375 06979
    1375 07421
    1375 07421
    1375 07421
    1375 07422
    1375 07422
    1375 07779
    1375 Total
    1376 04017
    1376 04017
    1376 04017.1
    1376 04017.1
    1376 04914
    1376 04914
    1376 04914
    1376 04914
    1376 04914
    1376 06921.1
    1376 06921.1
    1376 06921.1
    1376 06922.1
    1376 06922.1
    1376 Total
    1377 05835
    1377 05836
    1377 05836
    1377 05836
    1377 05837
    1377 05837
    1377 Total
    1378 07796
    1378 07796
    1378 07796
    1378 07796
    1378 Total
    1379 03497
    1379 03497
    1379 03497
    1379 03497
    1379 05707
    1379 05707
    1379 05707
    1379 05707
    1379 05707
    1379 06038

    4 KIDNEY DISEASE

    MISC OUT HOSP-ORAL DRUGS

    1 CHOSTOCHRONDITIS
    PHYSICIAN VISIT-OFFICE
    2 CHOSTOCHRONDITIS
    MISC OUT HOSP-ORAL DRUGS
    3 CHOSTOCHRONDITIS
    DIAGNOSTIC LABORATORY
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    1 HYPERTENSION
    PHYSICIAN VISIT-HOSPITAL
    2 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC X-RAY
    3 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 CHEST PAIN
    SPECIALIST CNSLT-OFFICE
    2 CHEST PAIN
    DIAGNOSTIC X-RAY
    1 ARTHRITIS
    PHYSICIAN VISIT-OFFICE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1
    2
    1 THROMBOSIS
    2 THROMBOSIS
    3 THROMBOSIS
    4 THROMBOSIS
    5 THROMBOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 LARYNGITIS
    2 LARYNGITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 EYE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DILATION & CURRETAGE


    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    4 SKIN - ECZEMA
    5 SKIN - ECZEMA
    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    1379

    1380

    1381

    1382

    1383

    1384

    1379 06038
    1379 06038.1
    1379 06038.1
    1379 06038.2
    1379 06038.2
    1379 06908
    1379 06908
    1379 07776
    1379 07776
    1379 07776
    1379 08031
    1379 08031
    1379 08031
    1379 08031.1
    1379 08031.1
    1379 08597
    1379 08597
    1379 08597
    1379 08597
    1379 08597.1
    Total
    1380 04011
    1380 04011
    1380 04011
    Total
    1381 07788.2
    1381 07788.2
    1381 07788.2
    1381 07788.3
    1381 07788.3
    Total
    1382 05965
    1382 08301
    Total
    1383 04568
    1383 04568
    Total
    1384 04567
    1384 04567
    1384 05403
    1384 05403
    1384 05403
    1384 06909
    1384 06909
    1384 06909
    1384 07417
    1384 07417
    1384 07417.1
    1384 07955
    1384 08566
    1384 08566
    Total
    1385 05407

    2 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE


    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE
    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    3 VISION CARE
    VISION CARE
    1 COUGH - AIRWAY OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    2 COUGH - AIRWAY OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    3 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    3 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    4 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 CHOSTOCHRONDITIS
    MISC OUT HOSP-ORAL DRUGS
    2 CHOSTOCHRONDITIS
    DIAGNOSTIC LABORATORY
    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 GLAUCOMA
    2 GLAUCOMA
    1 CATARACT
    2 CATARACT
    3 CATARACT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    2 EYE DISORDER
    2 EYE DISORDER
    1 ANAEMIA
    2 ANAEMIA

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 BACK PAIN

    PHYSICIAN VISIT-OFFICE

    1385

    1386
    1387

    1388

    1389

    1390

    1391

    1392

    1393

    1385 05407
    1385 05407
    1385 05407
    Total
    1386 04572
    1386 04572
    1386 04572
    1386 04572
    1386 04572
    1386 05415
    1386 07425
    1386 07425
    Total
    1387 05417
    Total
    1388 04020
    1388 04020
    1388 04020
    Total
    1389 04919
    1389 04919
    Total
    1390 04019
    1390 04019
    1390 04019
    Total
    1391 03082
    1391 03082
    1391 03082
    1391 03082
    1391 03082
    1391 03082.1
    1391 06893
    1391 06893.1
    Total
    1392 06925
    1392 06925
    1392 06926
    1392 06926
    Total
    1393 03500
    1393 03500
    1393 04013
    1393 04014
    1393 04912
    1393 06260
    1393 06911
    1393 07420
    1393 07778
    1393 07778
    Total
    1394 07828
    1394 07828

    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DIAB'ETES
    1 CATARACT
    2 CATARACT

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE

    VISION CARE

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1
    2
    3
    4
    5
    1
    2 SKIN - ECZEMA
    2 SKIN - ECZEMA

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    1 VISION
    2 VISION
    1 VISION
    2 VISION

    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    1 VISION CARE
    1 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 BACK PAIN
    2 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1394

    1395

    1396
    1397

    1398

    1394 07828
    1394 07828.1
    1394 07828.1
    1394 07828.1
    1394 07828.1
    Total
    1395 07429
    1395 07430
    1395 07430
    1395 07430
    1395 08537
    Total
    1396 05419
    1396 05419
    1396 05419
    1396 05419
    1396 05419
    1396 05419.1
    1396 05419.1
    1396 05419.1
    1396 05419.1
    1396 05844
    1396 05844
    1396 05844
    1396 05844
    1396 05844
    1396 05844.1
    1396 05844.1
    1396 05844.1
    1396 05844.1
    1396 05844.1
    Total
    1397 03504
    Total
    1398 04918
    1398 04918
    1398 04918
    1398 04918
    1398 04918
    1398 04918.1
    1398 05839
    1398 05839
    1398 05839
    1398 05839
    1398 05839.1
    1398 06263
    1398 06263
    1398 06263
    1398 07830
    1398 07830.1
    1398 07830.2
    1398 07830.2
    Total

    3 BACK PAIN
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION

    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE

    1 CIRCULATORY
    2 CIRCULATORY
    3 CIRCULATORY
    4 CIRCULATORY
    5 CIRCULATORY
    1 CIRCULATORY
    2 CIRCULATORY
    3 CIRCULATORY
    4 CIRCULATORY
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS

    DISORDER
    DISORDER
    DISORDER
    DISORDER
    DISORDER
    DISORDER
    DISORDER
    DISORDER
    DISORDER

    1 OTITIS - EAR
    1 BONE & CARTILAGE
    2 BONE & CARTILAGE
    3 BONE & CARTILAGE
    4 BONE & CARTILAGE
    5 BONE & CARTILAGE
    1 DIAB'ETES
    1
    2
    3
    4
    1 DIAB'ETES
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 MUSCULAR PAIN
    1 BURSITIS
    1 DIAB'ETES
    2 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    DISORDER
    PHYSICIAN VISIT-OFFICE
    DISORDER
    MISC OUT HOSP-INJECTABLES
    DISORDER
    MISC OUT HOSP-INJECTABLES
    DISORDER
    MISC OUT HOSP-ORAL DRUGS
    DISORDER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1399

    1400

    1401
    1402

    1403
    1404

    1405

    1406
    1407

    1408

    1409

    1399 05410
    1399 05411
    1399 06261
    1399 06261
    1399 07884
    1399 07884
    1399 07884
    1399 07884
    1399 07884
    1399 07884.1
    Total
    1400 04910
    1400 04910
    1400 04910
    1400 04910
    1400 05405
    1400 06259
    1400 06259
    Total
    1401 06927
    1401 06927
    1401 06927
    1401 06927
    Total
    1402 04016
    Total
    1403 05414
    1403 05414
    1403 05414
    1403 06264
    1403 06264
    Total
    1404 05830
    Total
    1405 05833
    1405 05833
    1405 05833
    Total
    1406 03498
    1406 03499
    1406 03499
    1406 03499
    Total
    1407 05843
    Total
    1408 04921
    1408 04921
    Total
    1409 04569
    1409 04569
    Total
    1410 04025
    1410 04025

    1 DILATION & CURRETAGE


    1 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE

    DENTAL CARE

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 ARTHRITIS
    2 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    1 DENTAL CARE

    DENTAL CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE

    1 BACK PAIN
    2 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1410

    1411

    1412

    1413

    1414

    1415
    1416

    1417
    1418

    1419

    1420

    1421

    1422

    1423

    1410 04025
    1410 06928
    Total
    1411 04015
    1411 04015
    Total
    1412 07423
    1412 07423
    1412 07423
    Total
    1413 05404
    1413 05404
    1413 07775
    Total
    1414 04576
    1414 04576
    Total
    1415 07780
    1415 07780
    Total
    1416 06269
    Total
    1417 06919
    1417 06919
    1417 06919
    1417 06919
    1417 06919
    Total
    1418 05832
    Total
    1419 04023
    1419 05416
    1419 05416
    1419 07786
    1419 07786
    Total
    1420 04920
    1420 04920
    1420 07785
    Total
    1421 07795
    1421 07795
    Total
    1422 05418
    1422 05418
    Total
    1423 06258
    1423 06258
    1423 06258
    Total
    1424 06918
    1424 06918
    1424 06918

    3 VISION CARE
    1 DENTAL CARE

    VISION CARE
    DENTAL CARE

    1 HEART
    2 HEART

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE

    1 BREAST DISORDERS
    2 BREAST DISORDERS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 VISION CARE

    VISION CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    CARE
    CARE
    CARE
    CARE
    CARE

    DIAGNOSTIC LABORATORY

    1 EYE DISORDER
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1424 Total
    1425 03506
    1425 04209
    1425 04209
    1425 04209
    1425 04209
    1425 04209.1
    1425 04209.1
    1425 04209.1
    1425 04401
    1425 04401
    1425 04401
    1425 04401
    1425 04402
    1425 04402
    1425 04402
    1425 04402
    1425 05482
    1425 05482
    1425 05483
    1425 05484
    1425 06267
    1425 06268
    1425 06298
    1425 06298
    1425 07532
    1425 07532
    1425 07532
    1425 07532.1
    1425 07791
    1425 07791
    1425 07791.1
    1425 07791.1
    1425 07791.2
    1425 07793
    1425 07794
    1425 08303
    1425 Total
    1426 03768
    1426 03768
    1426 03768
    1426 Total
    1427 05225
    1427 05225
    1427 Total
    1428 05840
    1428 05840
    1428 Total
    1429 04573
    1429 04573
    1429 04573
    1429 04574
    1429 04755

    1 BEHAVIOURIAL PROBLEMS PHYSICIAN VISIT-OFFICE


    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    3 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    4 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS
    2 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS
    3 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-ORAL DRUGS
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    1 VISION CARE
    VISION CARE
    2 VISION CARE
    VISION CARE
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    3 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 DILATION & CURRETAGE
    MISC OUT HOSP-ORAL DRUGS
    1 ABDOMINAL PAINS
    PHYSICIAN VISIT-OFFICE
    2 ABDOMINAL PAINS
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 PROSTATE
    DIAGNOSTIC LABORATORY
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 HEART
    SPECIALIST CNSLT-OFFICE
    2 HEART
    DIAGNOSTIC X-RAY
    3 HEART
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    PHYSICIAN VISIT-HOSPITAL

    1429

    1430

    1431
    1432
    1433

    1434

    1435

    1436

    1437

    1429 04755
    1429 07426
    1429 07426
    1429 07426
    1429 07426
    1429 07426
    1429 07426.1
    1429 07426.1
    1429 07427
    1429 07427
    1429 07427
    Total
    1430 06923
    1430 06923
    1430 06923
    Total
    1431 06910
    1431 06910
    Total
    1432 07424
    Total
    1433 04911
    Total
    1434 04018
    1434 04018
    1434 04018
    1434 04018
    Total
    1435 04862
    1435 04862
    1435 04862.1
    1435 05412
    1435 05412
    1435 05412.1
    Total
    1436 06912
    1436 06912
    Total
    1437 05831
    1437 05831
    1437 05831
    1437 05831
    Total
    1438 04024
    1438 04024
    1438 04630
    1438 04630
    1438 04630
    1438 05841
    1438 05841
    1438 05841.1
    1438 05841.1
    1438 05842

    2 HEART
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    5 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 MISCARRIAGE

    MATERNITY-NORMAL DELIVERY

    1 ABSCESS

    PHYSICIAN VISIT-OFFICE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    1 HYPERTENSION
    2 HYPERTENSION
    1 DEPRESSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE

    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 DIAB'ETES
    2 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ANXIETY
    2 ANXIETY
    1 DIAB'ETES
    2 DIAB'ETES
    1 BARTHOLIN'S CYST

    CARE
    CARE
    CARE
    CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    1438

    1439

    1440

    1441

    1442

    1443

    1444

    1445

    1446

    1447

    1438 05842
    1438 06688
    Total
    1439 07783
    1439 07783
    Total
    1440 05966
    1440 05966
    1440 06487
    1440 06487
    1440 06487
    1440 06487
    Total
    1441 07826
    1441 07826
    1441 08030
    1441 08030
    1441 08030
    1441 08030
    1441 08030
    1441 08030.1
    Total
    1442 06686
    1442 06686
    1442 06686
    Total
    1443 06924
    1443 07957
    1443 07957
    Total
    1444 04864
    1444 04864
    1444 04864
    Total
    1445 05406
    1445 05406
    1445 05406
    Total
    1446 05224
    1446 05224
    Total
    1447 06687
    1447 07781
    Total
    1448 03769
    1448 04570
    1448 04570
    1448 04683
    1448 04683
    1448 04683
    1448 04684
    1448 04684
    1448 04684

    2 BARTHOLIN'S CYST
    1 OVARIAN CYST

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 EYE DISORDER
    2 EYE DISORDER
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    4 GLAUCOMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    1 PHARYNGITIS
    2 PHARYNGITIS
    1 BRONCHITIS 2 BRONCHITIS 3 BRONCHITIS 4 BRONCHITIS 5 BRONCHITIS 1

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE

    ACUTE
    ACUTE
    ACUTE
    ACUTE
    ACUTE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 HYPERTENSION
    1 HYPERTENSION

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    1 DEPRESSION
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    1448

    1449

    1450

    1451

    1452

    1453

    1454
    1455

    1456

    1448 04861
    1448 05408
    1448 05408
    1448 06917
    Total
    1449 03770
    1449 03770
    1449 03770
    1449 03770
    1449 03770
    1449 03770.1
    1449 04400
    1449 04400
    1449 04400
    1449 04400
    Total
    1450 04629
    1450 04629
    1450 04629
    Total
    1451 06266
    1451 06266
    1451 06266
    Total
    1452 04130
    1452 04130
    1452 04130
    1452 04130
    Total
    1453 07784
    1453 08538
    Total
    1454 05413
    1454 05413
    Total
    1455 04863
    Total
    1456 04636
    1456 04636
    1456 04636
    1456 04636
    1456 04637
    1456 04637
    1456 06932
    1456 06932
    1456 06932
    1456 06933
    1456 06933
    1456 06933
    1456 06933
    Total
    1457 04806
    1457 04806

    1 DEPRESSION
    1 DEPRESSION
    2 DEPRESSION
    1 DEPRESSION

    MISC
    MISC
    MISC
    MISC

    1 CERVICAL
    2 CERVICAL
    3 CERVICAL
    4 CERVICAL
    5 CERVICAL
    1 CERVICAL
    1
    2
    3
    4

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS
    SPONDYLOSIS

    OUT
    OUT
    OUT
    OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS

    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 VISION
    2 VISION
    3 VISION
    4 VISION

    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    1 MISCARRIAGE
    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1 DENTAL CARE

    DENTAL CARE

    1 GASTRIC 2 GASTRIC 3 GASTRIC 4 GASTRIC 1


    2
    1 DEVIATED
    2 DEVIATED
    3 DEVIATED
    1 DEVIATED
    2 DEVIATED
    3 DEVIATED
    4 DEVIATED

    PEPTIC
    PEPTIC
    PEPTIC
    PEPTIC

    NASAL
    NASAL
    NASAL
    NASAL
    NASAL
    NASAL
    NASAL

    ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SEPTUM PHYSICIAN VISIT-OFFICE
    SEPTUM MISC OUT HOSP-INJECTABLES
    SEPTUM MISC OUT HOSP-INJECTABLES
    SEPTUM PHYSICIAN VISIT-OFFICE
    SEPTUM MISC OUT HOSP-INJECTABLES
    SEPTUM MISC OUT HOSP-INJECTABLES
    SEPTUM DIAGNOSTIC LABORATORY

    1 INGROWING TOE NAIL


    2 INGROWING TOE NAIL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1457

    1458

    1459

    1460

    1457 05066
    1457 07658
    1457 07996
    1457 07996
    1457 08160
    1457 08160
    Total
    1458 04807
    1458 04807
    1458 04807
    1458 04807
    1458 07489
    Total
    1459 04635
    1459 04635
    1459 04635
    1459 05164
    1459 05164
    1459 05164
    1459 05164
    1459 05849
    1459 05849
    1459 06014
    1459 06014
    1459 06014
    1459 06014
    1459 06014
    1459 06689
    1459 06689
    1459 06689
    1459 06691
    1459 06691
    1459 06691
    1459 06691
    1459 06934
    1459 06934
    1459 06934
    1459 06934
    1459 07660
    1459 07660
    1459 07660
    1459 07833
    1459 07833
    1459 07997
    1459 07997
    1459 08601
    1459 08601
    Total
    1460 05067
    1460 05067
    1460 05067
    1460 05067
    Total

    1 INGROWING TOE NAIL


    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE

    SURGICAL OUTPATIENT
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    1
    2
    3
    1 INFECTION - MALE GENITAL
    2 INFECTION - MALE GENITAL
    3 INFECTION - MALE GENITAL
    4 INFECTION - MALE GENITAL
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1
    2
    3
    4
    5
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    1 GENERAL PAIN
    2 GENERAL PAIN
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER

    1461 05345
    1461 05345
    1461 05345
    1461 05345
    1461 Total
    1462 05343
    1462 05343
    1462 05343
    1462 05344
    1462 05344
    1462 05344
    1462 Total
    1463 04026
    1463 04026
    1463 04027
    1463 04027
    1463 04027
    1463 04029
    1463 04029
    1463 04029
    1463 04029
    1463 04631
    1463 04631
    1463 04631
    1463 04631.1
    1463 04631.1
    1463 04631.1
    1463 04631.2
    1463 04631.2
    1463 04631.2
    1463 04724
    1463 04724
    1463 04724
    1463 04724
    1463 04724
    1463 04724.1
    1463 04724.1
    1463 05458
    1463 05458
    1463 05458
    1463 05458
    1463 Total
    1464 04865
    1464 04865
    1464 04865
    1464 04865
    1464 04865
    1464 05026
    1464 05026
    1464 05026
    1464 05026
    1464 05026
    1464 05457

    1 GASTRIC
    2 GASTRIC
    3 GASTRIC
    4 GASTRIC

    PEPTIC
    PEPTIC
    PEPTIC
    PEPTIC

    ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    ULCER/GERD
    MISC OUT HOSP-OTHER
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 CHEST PAIN
    PHYSICIAN VISIT-OFFICE
    2 CHEST PAIN
    DIAGNOSTIC X-RAY
    3 CHEST PAIN
    DIAGNOSTIC LABORATORY
    1 MUSCULAR PAIN
    PHYSICIAN VISIT-OFFICE
    2 MUSCULAR PAIN
    MISC OUT HOSP-INJECTABLES
    3 MUSCULAR PAIN
    MISC OUT HOSP-INJECTABLES
    4 MUSCULAR PAIN
    DIAGNOSTIC LABORATORY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    1 TONSILLITIS
    PHYSICIAN VISIT-OFFICE
    2 TONSILLITIS
    MISC OUT HOSP-ORAL DRUGS
    3 TONSILLITIS
    MISC OUT HOSP-ORAL DRUGS
    4 TONSILLITIS
    PHYSICIAN VISIT-OFFICE
    5 TONSILLITIS
    MISC OUT HOSP-ORAL DRUGS
    1 SINUSITIS
    MISC OUT HOSP-ORAL DRUGS
    2 SINUSITIS
    MISC OUT HOSP-ORAL DRUGS
    1 ANAEMIA
    PHYSICIAN VISIT-OFFICE
    2 ANAEMIA
    DIAGNOSTIC LABORATORY
    3 ANAEMIA
    MISC OUT HOSP-ORAL DRUGS
    4 ANAEMIA
    MISC OUT HOSP-ORAL DRUGS
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    5 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE

    1464

    1465

    1466

    1467

    1464 05457
    1464 06301
    1464 06301
    1464 06301
    1464 06301
    1464 06931
    1464 07381
    1464 08272
    Total
    1465 03773
    1465 03773
    1465 03773
    1465 03773
    1465 06013
    1465 06013
    1465 06013
    1465 06739
    1465 06739
    1465 06739
    1465 06739
    1465 06739
    Total
    1466 04322
    1466 04324
    1466 04324
    1466 06302
    1466 06302
    1466 06302
    1466 07130
    1466 07130
    1466 07130
    1466 07130
    1466 07131
    1466 07131
    1466 07131
    1466 07131
    Total
    1467 05346
    1467 05346
    1467 05346
    1467 05346
    1467 05346
    1467 05346.1
    1467 05346.2
    1467 07132
    1467 07659
    Total
    1468 04995
    1468 04995
    1468 05274
    1468 05274
    1468 05274
    1468 07832

    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 DENTAL CARE
    1 DENTAL CARE
    1 DIAB'ETES
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 OBESITY
    1 HEMATURIA
    2 HEMATURIA
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 OBESITY
    2 OBESITY
    3 OBESITY
    4 OBESITY

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT

    1
    2
    3
    4
    5
    1
    1 DIAB'ETES
    1
    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 HERPES ZOSTER
    2 HERPES ZOSTER
    1 PNEUMONIA
    2 PNEUMONIA
    3 PNEUMONIA
    1 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SURGICAL OUTPATIENT

    1468

    1469

    1470

    1471

    1472

    1473

    1474

    1468 07832
    1468 07832
    1468 07832
    1468 07832
    1468 07832.1
    Total
    1469 04632
    1469 04632
    1469 04632
    1469 04632
    1469 04633
    1469 04633
    1469 04633
    1469 04634
    1469 04634
    1469 04634
    1469 05848
    1469 05848
    1469 05848
    1469 08161
    1469 08162
    Total
    1470 04030
    1470 04030
    1470 04030
    1470 04030
    1470 06741
    1470 06741
    1470 06741
    Total
    1471 05068
    1471 05068
    1471 05068
    Total
    1472 05064
    1472 05064
    1472 05064
    Total
    1473 05065
    1473 05065
    1473 05065
    1473 05456
    1473 05456
    1473 05456
    Total
    1474 06299
    1474 06299
    1474 06299
    1474 06299
    1474 06935
    1474 06935
    1474 06935
    Total

    2 ABDOMINAL
    3 ABDOMINAL
    4 ABDOMINAL
    5 ABDOMINAL
    1 ABDOMINAL

    PAINS
    PAINS
    PAINS
    PAINS
    PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ASTHMA
    1 SINUSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 VISION
    2 VISION
    3 VISION
    1 VISION
    2 VISION
    3 VISION

    VISION
    VISION
    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1
    2
    3
    4
    1 NASAL POLYP
    2 NASAL POLYP
    3 NASAL POLYP

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    1475

    1476

    1477

    1478

    1479
    1480

    1481

    1482

    1483

    1484

    1485

    1486

    1475 07657
    1475 07657
    1475 07657
    1475 07657
    Total
    1476 05846
    1476 05846
    1476 05846
    Total
    1477 08600
    1477 08600
    1477 08600
    Total
    1478 07488
    1478 07488
    Total
    1479 07831
    1479 07831
    1479 07831
    1479 07831
    Total
    1480 03771
    Total
    1481 07331
    1481 07331
    1481 07331
    Total
    1482 03599
    1482 03599
    1482 03599
    Total
    1483 05354
    1483 05354
    1483 07336
    1483 07336
    1483 08391
    1483 08391
    Total
    1484 05352
    1484 05352
    1484 05352
    Total
    1485 04651
    1485 04651
    Total
    1486 04325
    1486 04325
    1486 04325
    1486 05351
    1486 05351
    1486 05351
    1486 05351
    Total

    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER

    1 DENTAL CARE

    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 GASTRIC
    2 GASTRIC
    1 GASTRIC
    2 GASTRIC
    1 GASTRIC
    2 GASTRIC

    PEPTIC
    PEPTIC
    PEPTIC
    PEPTIC
    PEPTIC
    PEPTIC

    ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES

    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1487

    1488
    1489

    1490

    1491

    1492

    1493

    1487 08033
    1487 08033
    1487 08033
    1487 08033
    Total
    1488 04144
    1488 04144
    1488 04144
    1488 06826
    1488 06827
    1488 06827
    1488 06827
    1488 08390
    Total
    1489 05353
    Total
    1490 06082
    1490 06082
    Total
    1491 04146
    1491 04146
    1491 04146
    1491 04146
    Total
    1492 03601
    1492 03601
    1492 03601
    1492 07247
    1492 07247
    1492 07248
    1492 07248
    1492 07248
    1492 07248
    1492 07334
    1492 07334
    1492 07334
    1492 07334
    1492 07334.1
    1492 07334.1
    1492 07334.1
    Total
    1493 04326
    1493 04326
    1493 04326
    1493 07332
    1493 07332
    1493 07333
    1493 07333
    1493 07333
    1493 07333
    Total
    1494 06830
    1494 06830

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    1 FEVER
    2 FEVER
    3 FEVER
    1 HORMONE REPLACMENT
    1 HORMONE REPLACMENT
    2 HORMONE REPLACMENT
    3 HORMONE REPLACMENT
    1 MISCARRIAGE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    THERAPY
    PHYSICIAN VISIT-OFFICE
    THERAPY
    PHYSICIAN VISIT-OFFICE
    THERAPY
    DIAGNOSTIC X-RAY
    THERAPY
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE

    PREVENTATIVE

    1 AMMENORRHOEA
    2 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE

    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL

    CARE
    CARE
    CARE
    CARE

    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    3 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    1 TONSILLITIS
    PHYSICIAN VISIT-OFFICE
    2 TONSILLITIS
    MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    2 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE
    3 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    4 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 AMMENORRHOEA
    PHYSICIAN VISIT-OFFICE
    2 AMMENORRHOEA
    SPECIALIST CNSLT-OFFICE
    3 AMMENORRHOEA
    DIAGNOSTIC X-RAY
    4 AMMENORRHOEA
    SURGICAL INPATIENT
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1494 06830
    1494 Total
    1495 04650
    1495 04650
    1495 04650
    1495 Total
    1496 05349
    1496 05349
    1496 05350
    1496 05350
    1496 05350
    1496 05350
    1496 Total
    1497 03602
    1497 Total
    1498 03603
    1498 03603
    1498 03603
    1498 03603
    1498 06083
    1498 Total
    1499 04147
    1499 04147
    1499 04147
    1499 04147
    1499 04147
    1499 07337
    1499 07337
    1499 Total
    1500 03597
    1500 03597
    1500 03597
    1500 03598
    1500 03598
    1500 06489
    1500 06489
    1500 06489
    1500 06490
    1500 06490
    1500 06490
    1500 Total
    1501 03595
    1501 03595
    1501 03596
    1501 03596
    1501 03596
    1501 Total
    1502 05485
    1502 05485
    1502 05485
    1502 05485
    1502 Total
    1503 04926

    3 VISION CARE

    VISION CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 CERVICAL SPONDYLOSIS

    PHYSIOTHERAPY

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    1 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1
    2
    1 CYSTITIS
    2 CYSTITIS
    3 CYSTITIS
    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS

    1 VISION
    2 VISION
    1 VISION
    2 VISION
    3 VISION

    VISION
    VISION
    VISION
    VISION
    VISION

    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    1
    2
    3
    4

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    1 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE

    1503

    1504

    1505

    1506

    1507

    1508

    1503 04926
    1503 04926
    1503 04926
    1503 04926.1
    1503 04926.1
    Total
    1504 04832
    1504 04832
    1504 04832
    Total
    1505 03926
    1505 03926
    1505 06309
    1505 06309
    1505 06310
    1505 06310
    1505 06310
    1505 06310
    1505 06310
    1505 07302
    1505 07303
    1505 07303
    1505 07303
    Total
    1506 07304
    1506 07304
    1506 07304
    1506 07304
    1506 08015
    1506 08015
    Total
    1507 05333
    1507 05333
    Total
    1508 03660
    1508 03660
    1508 03660
    1508 03660
    1508 03661
    1508 03661
    1508 03662
    1508 03662
    Total
    1509 06585
    1509 06585
    1509 06585
    1509 06585
    1509 06588
    1509 06588
    1509 06588
    1509 06588
    1509 07564
    1509 07564

    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 FEVER
    2 FEVER

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 HEART
    2 HEART
    1 CHEST PAIN
    2 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    5 CHEST PAIN
    1 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC X-RAY
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY

    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    4 SKIN - LESION
    1 EYE DISORDER
    2 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 KNEE INTERNAL DERANGEMENT


    PHYSICIAN VISIT-OFFICE
    2 KNEE INTERNAL DERANGEMENT
    PHYSICIAN VISIT-OFFICE
    3 KNEE INTERNAL DERANGEMENT
    PHYSIOTHERAPY
    4 KNEE INTERNAL DERANGEMENT
    PHYSIOTHERAPY
    1 INTESTINAL COLIC
    PHYSICIAN VISIT-OFFICE
    2 INTESTINAL COLIC
    PHYSICIAN VISIT-OFFICE
    3 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    4 INTESTINAL COLIC
    MISC OUT HOSP-ORAL DRUGS
    1 PAINFUL LEGS
    PHYSICIAN VISIT-OFFICE
    2 PAINFUL LEGS
    PHYSICIAN VISIT-OFFICE

    1509

    1510

    1511

    1512

    1513

    1514

    1515

    1516

    1509 07564
    1509 07564
    1509 07564
    1509 07564.1
    1509 07564.1
    1509 07564.1
    1509 07564.1
    Total
    1510 08011
    1510 08012
    1510 08012
    1510 08012
    1510 08012
    1510 08012.1
    1510 08012.1
    Total
    1511 05030
    1511 05031
    1511 05031
    Total
    1512 06590
    1512 06590
    1512 06590
    1512 06590
    1512 06590
    1512 06590.1
    1512 08014
    1512 08014
    1512 08014
    Total
    1513 03663
    1513 04834
    1513 04834
    1513 04834
    1513 06308
    1513 07799
    Total
    1514 04078
    1514 04078
    1514 07305
    Total
    1515 07288
    1515 07288
    1515 07288.1
    1515 07288.1
    Total
    1516 03664
    1516 03664
    1516 03664
    Total
    1517 06002
    1517 06002
    1517 06002

    3 PAINFUL
    4 PAINFUL
    5 PAINFUL
    1 PAINFUL
    2 PAINFUL
    3 PAINFUL
    4 PAINFUL

    LEGS
    LEGS
    LEGS
    LEGS
    LEGS
    LEGS
    LEGS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    1 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 BASAL CELL CARCINOMA
    2 BASAL CELL CARCINOMA

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 CONJUNCTIVITIS - EYE
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE

    1 BONE & CARTILAGE


    2 BONE & CARTILAGE
    3 BONE & CARTILAGE
    4 BONE & CARTILAGE
    5 BONE & CARTILAGE
    1 BONE & CARTILAGE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    DISORDER
    PHYSICIAN VISIT-OFFICE
    DISORDER
    MISC OUT HOSP-ORAL DRUGS
    DISORDER
    MISC OUT HOSP-ORAL DRUGS
    DISORDER
    MISC OUT HOSP-ORAL DRUGS
    DISORDER
    SPECIALIST CNSLT-OFFICE
    DISORDER
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE

    1 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    1 DENTAL CARE
    2 DENTAL CARE
    1
    2

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1517

    1518

    1519

    1520
    1521
    1522

    1523

    1524

    1525

    1526

    1517 06002
    1517 06002
    Total
    1518 03509
    1518 03509
    1518 03927
    1518 03927
    1518 03927
    1518 03927
    1518 03927
    1518 03928
    1518 03928
    1518 03928
    1518 03928
    1518 05332
    1518 05332
    1518 05332
    Total
    1519 03930
    1519 04833
    1519 06311
    1519 07798
    Total
    1520 05029
    1520 05029
    Total
    1521 04426
    Total
    1522 06801
    Total
    1523 06001
    1523 06001
    1523 06001
    1523 06800
    1523 06800
    1523 06800
    1523 06800
    Total
    1524 03508
    1524 04425
    Total
    1525 04333
    1525 04333
    1525 04334
    1525 04334
    1525 04334
    1525 04334
    Total
    1526 05355
    1526 06086
    Total
    1527 05669
    1527 05669

    4 DEVIATED NASAL SEPTUM


    5 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    1 PROSTATE
    2 PROSTATE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION

    MISC
    MISC
    MISC
    MISC

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 DENTAL CARE

    DENTAL CARE

    PHYSICIAN VISIT-OFFICE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    OUT
    OUT
    OUT
    OUT

    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL
    HOSP-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS

    1 SKIN - ATOPIC DERMATITIS PHYSICIAN VISIT-OFFICE


    2 SKIN - ATOPIC DERMATITIS MISC OUT HOSP-ORAL DRUGS
    1 DIAB'ETES
    PHYSICIAN VISIT-OFFICE
    2 DIAB'ETES
    MISC OUT HOSP-INJECTABLES
    3 DIAB'ETES
    MISC OUT HOSP-INJECTABLES
    4 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1 CANCER-BREAST
    1 CANCER-BREAST

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY

    1527 Total
    1528 05907
    1528 05907
    1528 Total
    1529 03794
    1529 04331
    1529 04331
    1529 05667
    1529 05668
    1529 05668
    1529 05668
    1529 05668
    1529 Total
    1530 05902
    1530 05902
    1530 Total
    1531 06192
    1531 06192
    1531 Total
    1532 05085
    1532 05085
    1532 Total
    1533 05309
    1533 05309
    1533 Total
    1534 07567
    1534 07567
    1534 07567
    1534 07567
    1534 07568
    1534 07568
    1534 07568
    1534 07568
    1534 07568
    1534 07568.1
    1534 07568.1
    1534 07568.1
    1534 07568.1
    1534 07568.1
    1534 07568.2
    1534 Total
    1535 03932
    1535 03932
    1535 03932
    1535 06091
    1535 06091
    1535 06091
    1535 Total
    1536 03801
    1536 03801
    1536 03801
    1536 03801
    1536 03801

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 STONE - URETER
    1
    2
    1 STONE - URETER
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    OTHER

    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 AMMENORRHOEA
    2 AMMENORRHOEA

    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY

    1 SOFT TISSUE DISORDERS/DISEASE


    PHYSICIAN VISIT-HOSPITAL
    2 SOFT TISSUE DISORDERS/DISEASE
    DIAGNOSTIC LABORATORY
    1 GASTRIC
    2 GASTRIC
    3 GASTRIC
    4 GASTRIC
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART

    PEPTIC
    PEPTIC
    PEPTIC
    PEPTIC

    ULCER/GERD
    SURGICAL OUTPATIENT
    ULCER/GERD
    DIAGNOSTIC LABORATORY
    ULCER/GERD
    DIAGNOSTIC X-RAY
    ULCER/GERD
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    EMERGENCY ACCIDENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-HOSPITAL

    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1536 Total
    1537 07904
    1537 07904
    1537 Total
    1538 05356
    1538 Total
    1539 03931
    1539 03931
    1539 03931
    1539 04335
    1539 04335
    1539 04335
    1539 04335
    1539 Total
    1540 05670
    1540 05670.1
    1540 05670.1
    1540 05670.1
    1540 07249
    1540 07249
    1540 07249
    1540 07250
    1540 07250
    1540 07250
    1540 07250
    1540 07250
    1540 07250.1
    1540 07250.1
    1540 Total
    1541 04837
    1541 06942
    1541 Total
    1542 05909
    1542 Total
    1543 05359
    1543 05359
    1543 05359
    1543 Total
    1544 07572
    1544 07572
    1544 Total
    1545 03798
    1545 03798
    1545 03798
    1545 03798
    1545 03798
    1545 03800
    1545 03980
    1545 03980
    1545 04835
    1545 04836
    1545 05903
    1545 05903

    1 HEART
    2 HEART

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1 DENTAL CARE

    DENTAL CARE

    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    1 COUGH - AIRWAY
    2 COUGH - AIRWAY
    3 COUGH - AIRWAY
    4 COUGH - AIRWAY

    SEPTUM PHYSICIAN VISIT-OFFICE


    SEPTUM DIAGNOSTIC X-RAY
    SEPTUM MISC OUT HOSP-ORAL DRUGS
    OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    OBSTRUCTION
    DIAGNOSTIC X-RAY
    OBSTRUCTION
    DIAGNOSTIC LABORATORY
    OBSTRUCTION
    DIAGNOSTIC LABORATORY

    1 CATARACT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CYSTITIS
    2 CYSTITIS
    3 CYSTITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 DENTAL CARE
    1

    DENTAL CARE
    DIAGNOSTIC LABORATORY

    1 MISCARRIAGE

    MATERNITY-PRENATAL CARE

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 OVARIAN CYST
    2 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1 DIAB'ETES
    PHYSICIAN VISIT-OFFICE
    2 DIAB'ETES
    PHYSICIAN VISIT-OFFICE
    3 DIAB'ETES
    DIAGNOSTIC LABORATORY
    4 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    5 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1
    PREVENTATIVE
    1 HEART
    MISC OUT HOSP-ORAL DRUGS
    2 HEART
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1 HEART
    MISC OUT HOSP-ORAL DRUGS
    2 HEART
    MISC OUT HOSP-ORAL DRUGS

    1545
    1546

    1547

    1548

    1549

    1550

    1545 06938
    1545 06938
    1545 06938
    1545 06938
    1545 06938
    1545 06939
    1545 06939
    1545 07843
    1545 07843
    Total
    1546 06088
    Total
    1547 03796
    1547 03796
    1547 03796
    1547 06343
    1547 06343
    1547 06343
    1547 07905
    1547 07905
    1547 07905
    1547 07905
    1547 07905
    1547 07905.1
    Total
    1548 07844
    1548 07844
    1548 07844
    1548 07844
    Total
    1549 08618
    1549 08618
    1549 08618
    Total
    1550 04344
    1550 04344
    1550 04345
    1550 04345
    1550 04345
    1550 04345
    1550 04345
    1550 04345.1
    1550 05360
    1550 05360
    1550 05361
    1550 05361
    1550 07575
    1550 07575
    Total
    1551 04659
    1551 04659
    1551 04659
    1551 04659

    1 ABDOMINAL
    2 ABDOMINAL
    3 ABDOMINAL
    4 ABDOMINAL
    5 ABDOMINAL
    1 HEART
    2 HEART
    1 DIAB'ETES
    2 DIAB'ETES

    PAINS
    PAINS
    PAINS
    PAINS
    PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE

    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSIOTHERAPY

    1 ALLERGIC
    2 ALLERGIC
    3 ALLERGIC
    4 ALLERGIC

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    REACTION
    REACTION
    REACTION
    REACTION

    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 HEART
    2 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEART
    2 HEART

    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    1
    2
    3
    4

    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE

    1551

    1552

    1553

    1554

    1555

    1556

    1557

    1551 04659
    1551 04659.1
    Total
    1552 06090
    1552 06090
    1552 06090
    1552 06090
    Total
    1553 03978
    1553 03978
    1553 03979
    Total
    1554 07573
    1554 07573
    1554 07573
    1554 07573
    1554 07573
    Total
    1555 03983
    1555 03983
    1555 03983.1
    1555 03983.1
    1555 05908
    1555 05908
    1555 05908.1
    Total
    1556 03982
    1556 03982
    Total
    1557 07571
    1557 07571
    1557 07571
    Total
    1558 03795
    1558 03795
    1558 03795
    1558 03795
    1558 03795
    1558 03795.1
    1558 05899
    1558 05899
    1558 05899
    1558 05899
    1558 05899
    1558 05899.1
    1558 05899.1
    1558 05900
    1558 05900
    1558 05900
    1558 05901
    1558 05901
    1558 05901
    1558 05901

    5
    1
    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    PREVENTATIVE
    PREVENTATIVE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 DENTAL CARE
    2 DENTAL CARE
    1 ALLERGIC RHINITIS

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    5 VARICOSE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    OTHER
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 OTITIS - EAR

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    4 PSORIASIS
    5 PSORIASIS
    1 PSORIASIS
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    5 ANAEMIA
    1 DEPRESSION
    2 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1558 Total
    1559 03803
    1559 03803
    1559 03803
    1559 03804
    1559 03804
    1559 03804
    1559 04348
    1559 04348
    1559 04348
    1559 04348
    1559 04349
    1559 04349
    1559 04349
    1559 04349
    1559 04350
    1559 04350
    1559 04350
    1559 04351
    1559 04351
    1559 04351
    1559 04351
    1559 04352
    1559 04352
    1559 04352
    1559 04838
    1559 04838
    1559 04838
    1559 05086
    1559 05086
    1559 05086
    1559 06543
    1559 06543
    1559 06543
    1559 Total
    1560 03797
    1560 Total
    1561 04685
    1561 04685
    1561 07515
    1561 07515
    1561 Total
    1562 07912
    1562 07912
    1562 07912.1
    1562 Total
    1563 04336
    1563 04336
    1563 04336
    1563 04336
    1563 04337
    1563 04337
    1563 04337

    1 FEVER
    2 FEVER
    3 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    1 VISION CARE

    VISION CARE

    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER

    1563

    1564

    1565

    1566

    1567

    1568

    1569

    1563 04337
    1563 07306
    1563 07306
    1563 07306
    1563 07306
    1563 07306.1
    1563 07306.2
    1563 07306.2
    1563 07306.2
    Total
    1564 03510
    1564 03510
    1564 03510
    1564 03510
    1564 04427
    1564 04427
    1564 04427
    1564 04427
    1564 06400
    1564 06400
    1564 06400
    1564 07448
    1564 07448
    1564 07448
    1564 07448
    Total
    1565 06087
    1565 06087
    Total
    1566 07574
    1566 07574
    1566 07574
    Total
    1567 05898
    1567 05898
    1567 05898
    Total
    1568 04339
    1568 04339
    1568 06089
    1568 06089
    Total
    1569 05906
    1569 05906.1
    1569 05906.1
    1569 05906.1
    1569 05906.1
    1569 07447
    1569 07447
    1569 07447
    1569 07447
    1569 07447
    Total

    4 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 CHEST PAIN
    1 FATIGUE
    2 FATIGUE
    3 FATIGUE

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER

    1 SINUSITIS
    2 SINUSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 HYPERTENSION
    2 HYPERTENSION
    1 HEART
    2 HEART

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    1 RETINOPATY
    2 RETINOPATY
    3 RETINOPATY
    4 RETINOPATY
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER

    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SURGICAL OUTPATIENT

    1570
    1571
    1572

    1573
    1574

    1575
    1576

    1577

    1570 05357
    1570 05357
    1570 05357
    1570 05357
    1570 05357
    1570 05604
    1570 05604
    1570 05604
    1570 05604
    Total
    1571 04343
    Total
    1572 04341
    Total
    1573 03802
    1573 03802
    1573 03802
    1573 04342
    1573 04342
    1573 04342
    1573 04342
    1573 04342
    Total
    1574 04927
    Total
    1575 03511
    1575 03511
    1575 03511.1
    1575 04729
    1575 04730
    1575 05490
    1575 05490
    1575 05491
    1575 05491
    1575 05491
    1575 05491.1
    1575 06492
    1575 06947
    1575 06947
    1575 07916
    1575 07916
    Total
    1576 04428
    Total
    1577 06003
    1577 06003
    1577 06003
    1577 06003
    Total
    1578 08621
    1578 08621
    1578 08621
    1578 08621

    1
    2
    3
    4
    5
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT

    1 BACK PAIN

    PHYSICIAN VISIT-OFFICE

    1 VISION CARE

    VISION CARE

    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    5 STONE - URETER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE

    DENTAL CARE

    1 ALLERGIC REACTION
    PHYSICIAN VISIT-OFFICE
    2 ALLERGIC REACTION
    MISC OUT HOSP-ORAL DRUGS
    1 EAR DYSFUNCTION
    MISC OUT HOSP-OTHER
    1 GLAUCOMA
    MISC OUT HOSP-ORAL DRUGS
    1 BONE & CARTILAGE DISORDER
    PHYSICIAN VISIT-HOSPITAL
    1 GLAUCOMA
    SPECIALIST CNSLT-OFFICE
    2 GLAUCOMA
    MISC OUT HOSP-ORAL DRUGS
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL DRUGS
    3 RENAL DYSFUNCTION
    DIAGNOSTIC LABORATORY
    1 DIAB'ETES
    DIAGNOSTIC LABORATORY
    1 GLAUCOMA
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    PHYSICIAN VISIT-OFFICE
    2 HYPERTENSION
    DIAGNOSTIC LABORATORY
    1 GLAUCOMA
    SPECIALIST CNSLT-OFFICE
    2 GLAUCOMA
    MISC OUT HOSP-ORAL DRUGS
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    1
    2
    3
    4

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1578

    1579

    1580

    1581

    1582

    1578 08621
    1578 08621.1
    Total
    1579 05285
    1579 05285
    Total
    1580 06869
    1580 06869
    1580 06869
    1580 06869
    1580 06870
    1580 06870
    1580 06870
    1580 06870
    1580 06870
    1580 06870.1
    1580 06870.1
    Total
    1581 05286
    1581 05286
    Total
    1582 07140
    1582 07140
    Total
    1583 03665
    1583 03665
    1583 03665
    1583 03665
    1583 03665
    1583 04583
    1583 04583
    1583 04583
    1583 04583
    1583 04584
    1583 04584
    1583 04584
    1583 04584
    1583 05034
    1583 05034
    1583 05034
    1583 05034
    1583 05034
    1583 05034.1
    1583 05034.1
    1583 05034.1
    1583 05034.1
    1583 05034.1
    1583 05034.2
    1583 05034.2
    1583 05034.2
    1583 05034.2
    1583 05034.2
    1583 05034.3

    5 HYPERTENSION
    1 ANAEMIA

    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    2 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    5 ALLERGIC REACTION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    4 ALLERGIC RHINITIS
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT

    1583

    1584

    1585

    1586

    1587

    1588

    1589

    1583 05487
    1583 05487
    1583 05487
    1583 06271
    1583 06271.1
    1583 06493
    1583 06493
    1583 07917
    1583 07917
    Total
    1584 05239
    1584 07845
    Total
    1585 05807
    1585 05807
    1585 05807
    1585 05807
    Total
    1586 05237
    1586 05237
    1586 05237.1
    1586 05237.1
    1586 05237.1
    1586 06494
    1586 06494.1
    1586 06494.1
    1586 08549
    1586 08549
    1586 08549.1
    Total
    1587 07289
    1587 07289
    1587 07289
    Total
    1588 04690
    1588 06701
    1588 06701
    1588 06701
    Total
    1589 04267
    1589 04267.1
    Total
    1590 04734
    1590 04734
    1590 04734
    1590 04734
    1590 04734
    1590 04734.1
    1590 06194
    1590 06194.1
    1590 06194.1
    1590 06495
    1590 06495

    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    1 VISION CARE
    2 VISION CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    1 DIAB'ETES
    1 DIAB'ETES

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    1 ASTHMA
    PHYSICIAN VISIT-OFFICE
    2 ASTHMA
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERTENSION
    DIAGNOSTIC LABORATORY
    2 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    3 HYPERTENSION
    MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    1 ASTHMA
    MISC OUT HOSP-ORAL DRUGS
    2 ASTHMA
    MISC OUT HOSP-ORAL DRUGS
    1 ASTHMA
    MISC OUT HOSP-ORAL DRUGS
    2 ASTHMA
    MISC OUT HOSP-ORAL DRUGS
    1 DIAB'ETES
    MISC OUT HOSP-ORAL DRUGS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE

    1 GLAUCOMA
    1 VISION CARE

    SURGICAL OUTPATIENT
    VISION CARE

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 DIAB'ETES
    1 ARTHRITIS
    2 ARTHRITIS
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE

    1590 Total
    1591 03667
    1591 03667
    1591 03667
    1591 03668
    1591 03668
    1591 03668
    1591 03668
    1591 04268
    1591 04268
    1591 04268
    1591 04268
    1591 04268
    1591 04268.1
    1591 04353
    1591 04353
    1591 04353
    1591 04353.1
    1591 04354
    1591 04354
    1591 04354.1
    1591 04354.2
    1591 04518
    1591 04518
    1591 05240
    1591 05240
    1591 05240.1
    1591 05241
    1591 05241
    1591 05461
    1591 05461
    1591 05461.1
    1591 05461.2
    1591 05462
    1591 05462
    1591 06835
    1591 06835
    1591 06835
    1591 06835.1
    1591 06835.1
    1591 06835.1
    1591 Total
    1592 05242
    1592 07846
    1592 07846
    1592 07846
    1592 Total
    1593 07692
    1593 07692
    1593 07692
    1593 08552
    1593 08552
    1593 08552

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    3 HEART- ISCHEMIC HEART
    4 HEART- ISCHEMIC HEART
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 DEPRESSION
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 HYPERTENSION
    1 DEPRESSION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DIAB'ETES
    2 DIAB'ETES
    1 ASTHMA
    1 HYPERTENSION
    2 HYPERTENSION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 ALLERGIC RHINITIS
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL

    CARE
    CARE
    CARE
    CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DISEASE
    PHYSICIAN VISIT-OFFICE
    DISEASE
    MISC OUT HOSP-ORAL DRUGS
    DISEASE
    PHYSICIAN VISIT-OFFICE
    DISEASE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1593

    1594

    1595

    1596
    1597

    1598

    1599

    1600
    1601

    1602

    1593 08552
    1593 08552
    1593 08552.1
    Total
    1594 04693
    1594 04693
    1594 06496
    1594 06496
    1594 06496
    1594 06496
    1594 06496
    1594 08034
    1594 08034
    1594 08034
    1594 08034
    1594 08034
    1594 08034.1
    Total
    1595 04736
    1595 04736
    1595 04736
    1595 04736
    1595 04736
    Total
    1596 08965
    1596 08965
    1596 08965
    Total
    1597 06198
    Total
    1598 05554
    1598 05554
    Total
    1599 04519
    1599 04519
    1599 04519
    1599 04520
    1599 04520
    1599 04520
    1599 05555
    Total
    1600 05464
    1600 05464
    Total
    1601 03669
    Total
    1602 06195
    1602 06195
    Total
    1603 04040
    1603 04040
    1603 04040
    1603 04040

    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    5 DEVIATED NASAL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 HYPERTENSION

    PHYSICIAN VISIT-OFFICE

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 LUNG DISEASE
    2 LUNG DISEASE
    3 LUNG DISEASE
    1 HEART

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE

    VISION CARE

    1 ANXIETY
    2 ANXIETY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1603

    1604

    1605

    1606

    1607

    1608

    1603 04040
    1603 04040.1
    1603 04040.1
    1603 04040.1
    1603 04040.1
    1603 06834
    1603 07096
    1603 07096
    1603 07096
    1603 08964
    1603 08964
    Total
    1604 04036
    1604 04735
    1604 05463
    1604 05551
    1604 05552
    1604 05552
    1604 05808
    1604 05808
    1604 05809
    1604 06049
    1604 06050
    Total
    1605 05465
    1605 05465
    1605 05465
    Total
    1606 04270
    1606 04271
    1606 04271
    1606 05546
    1606 05546
    1606 05546.1
    Total
    1607 06703
    1607 06703
    1607 06703
    1607 06704
    1607 06704
    1607 06704
    1607 07094
    1607 07095
    1607 07095
    1607 08963
    Total
    1608 04516
    1608 04516
    1608 04517
    1608 04517
    Total
    1609 03875
    1609 03875

    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE

    1 BACK PAIN
    1 PAINFUL LEGS
    1 VARICOSE
    1 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY

    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    1 CERVICAL SPONDYLOSIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 BACK PAIN
    2 BACK PAIN
    1 RENAL DYSFUNCTION

    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    1 GASTRIC - PEPTIC
    2 GASTRIC - PEPTIC
    3 GASTRIC - PEPTIC
    1 GASTRIC - PEPTIC
    2 GASTRIC - PEPTIC
    3 GASTRIC - PEPTIC
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA

    ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    ULCER/GERD
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 ENDOCRINE DISORDERS
    PHYSICIAN VISIT-OFFICE
    2 ENDOCRINE DISORDERS
    DIAGNOSTIC LABORATORY
    1 GLAUCOMA
    2 GLAUCOMA

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1609
    1610

    1611

    1612
    1613

    1609 03935
    1609 03935
    1609 03935
    1609 03935
    1609 03935
    1609 04695
    1609 04695
    1609 04695
    1609 04695
    1609 04928
    1609 04928
    1609 04928
    1609 04928
    Total
    1610 02539.1
    Total
    1611 03512
    1611 03512
    1611 03512
    1611 03512
    1611 03512
    1611 04038
    1611 04038
    1611 04038
    1611 04880
    1611 04880
    1611 04880
    1611 04880
    1611 04880
    1611 04880.1
    1611 04880.1
    1611 05035
    1611 05035
    1611 05035
    1611 05035
    1611 05035
    1611 05035.1
    1611 06047
    1611 06093
    1611 06094
    1611 06095
    1611 06193
    1611 06833
    1611 06833
    1611 06833
    Total
    1612 04731
    1612 04731
    1612 04731
    Total
    1613 04355
    Total
    1614 04691

    1 VISION
    2 VISION
    3 VISION
    4 VISION
    5 VISION
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 CYST
    2 CYST
    3 CYST
    4 CYST

    CARE
    CARE
    CARE
    CARE
    CARE

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER

    1 VISION CARE
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    5 DEVIATED NASAL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    5 DEVIATED NASAL
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    5 DEVIATED NASAL
    1 DEVIATED NASAL
    1 PAINFUL LEGS
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 PAINFUL LEGS
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS

    VISION CARE
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 FEVER

    PHYSICIAN VISIT-OFFICE

    1 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE

    1614

    1615

    1616

    1617

    1618

    1619

    1620

    1621

    1622

    1624

    1625

    1614 04691
    1614 04691
    Total
    1615 05243
    1615 05243
    Total
    1616 03623
    1616 03623
    1616 07693
    1616 07693
    Total
    1617 06197
    1617 06197
    1617 06197
    Total
    1618 05861
    1618 05861
    1618 05861
    1618 08961
    1618 08961
    1618 08962
    1618 08962
    1618 08962
    1618 08962
    Total
    1619 05549
    1619 05549
    1619 06702
    1619 06702
    Total
    1620 07847
    1620 07847
    1620 07847
    Total
    1621 05860
    1621 05860
    Total
    1622 04732
    1622 04732
    1622 04732
    1622 04732
    Total
    1624 05003
    1624 05004
    1624 05004
    1624 08550
    1624 08550
    Total
    1625 06832
    1625 06832
    Total
    1626 06051
    1626 06051

    2 DEVIATED NASAL SEPTUM


    3 DEVIATED NASAL SEPTUM

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 SKIN - ATOPIC
    2 SKIN - ATOPIC
    3 SKIN - ATOPIC
    4 SKIN - ATOPIC

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    DERMATITIS
    DERMATITIS
    DERMATITIS
    DERMATITIS

    1 TONSILLITIS
    2 TONSILLITIS
    1 TONSILLITIS
    2 TONSILLITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 BONE & CARTILAGE DISORDER


    PHYSICIAN VISIT-OFFICE
    2 BONE & CARTILAGE DISORDER
    SPECIALIST CNSLT-OFFICE
    1 ABDOMINAL
    2 ABDOMINAL
    3 ABDOMINAL
    4 ABDOMINAL

    PAINS
    PAINS
    PAINS
    PAINS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1 RENAL DYSFUNCTION
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE

    PHYSICIAN VISIT-OFFICE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1626

    1627

    1628

    1629

    1630

    1631

    1632

    1633

    1634

    1635

    1626 06051
    1626 06051
    Total
    1627 04692
    1627 04692
    Total
    1628 06943
    1628 06943
    Total
    1629 08966
    1629 08966
    Total
    1630 04515
    1630 04515
    Total
    1631 07290
    1631 07290
    1631 07290
    1631 07290
    Total
    1632 04039
    1632 04039
    1632 04039
    1632 07688
    1632 07688
    1632 07688
    Total
    1633 06048
    1633 06048
    1633 06048
    1633 07689
    1633 07689
    1633 07689
    1633 07689
    1633 07689
    1633 07690
    1633 07690
    1633 07690
    1633 07690.1
    1633 07690.1
    Total
    1634 07691
    1634 07691
    1634 07691
    Total
    1635 05553
    1635 05553
    1635 05553
    Total
    1636 05238
    1636 05238
    1636 05238
    1636 05550

    3 DENTAL CARE
    4 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 DILATION & CURRETAGE


    2 DILATION & CURRETAGE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1
    2

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE

    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    3

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 FEVER
    2 FEVER
    3 FEVER
    1 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE

    CARE
    CARE
    CARE
    CARE

    1636 05550
    1636 Total
    1637 04689
    1637 04689
    1637 04689
    1637 05547
    1637 05547
    1637 05547
    1637 05548
    1637 05548
    1637 05548
    1637 Total
    1638 03625
    1638 03625
    1638 03625
    1638 03626
    1638 03626
    1638 03626
    1638 03626
    1638 03626
    1638 03626.1
    1638 03626.1
    1638 03626.1
    1638 03626.1
    1638 03626.2
    1638 03626.2
    1638 03628
    1638 03628
    1638 03628
    1638 Total
    1639 05165
    1639 05165
    1639 05165
    1639 05427
    1639 05427
    1639 Total
    1640 06497
    1640 06497
    1640 06497
    1640 Total
    1641 03624
    1641 03624
    1641 03624
    1641 Total
    1642 05166
    1642 05166
    1642 05166
    1642 05166
    1642 Total
    1643 03632
    1643 03632
    1643 03632
    1643 03632

    2 OVARIAN CYST

    MISC OUT HOSP-ORAL DRUGS

    1 FEVER
    2 FEVER
    3 FEVER
    1 INTESTINAL
    2 INTESTINAL
    3 INTESTINAL
    1 INTESTINAL
    2 INTESTINAL
    3 INTESTINAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    COLIC
    COLIC
    COLIC
    COLIC
    COLIC
    COLIC

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    5 STONE - URETER
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGY
    2 ALLERGY

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 HORMONE REPLACMENT THERAPY


    PHYSICIAN VISIT-OFFICE
    2 HORMONE REPLACMENT THERAPY
    DIAGNOSTIC LABORATORY
    3 HORMONE REPLACMENT THERAPY
    MISC OUT HOSP-ORAL DRUGS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1643

    1644

    1645

    1646

    1647
    1648

    1649

    1643 03632
    1643 06053
    1643 06499
    1643 08124
    1643 08124
    1643 08124
    Total
    1644 03631
    1644 04041
    1644 04041.1
    1644 04041.1
    1644 04041.1
    1644 04041.1
    1644 04042
    1644 04154
    1644 04155
    1644 04155
    1644 05167
    1644 05862
    1644 05863
    1644 06498
    1644 07546
    1644 07546
    1644 07547
    1644 07547
    1644 07547
    1644 07547
    1644 07548
    1644 07548
    1644 07549
    1644 07694
    1644 07695
    1644 07695
    1644 07695
    1644 07696
    1644 07696
    Total
    1645 08123
    1645 08123
    Total
    1646 06052
    1646 06052
    Total
    1647 04585
    1647 04585
    1647 04585.1
    Total
    1648 03984
    Total
    1649 05428
    1649 05864
    Total
    1650 05488

    5 DENTAL
    1 DENTAL
    1 DENTAL
    1 DENTAL
    2 DENTAL
    3 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 DEPRESSION
    1 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    1 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    1 DEPRESSION
    1 DENTAL CARE
    1 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DEPRESSION
    1
    2
    3
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS

    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE

    1 BACK PAIN
    2 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DEVIATED NASAL SEPTUM PHYSICIAN VISIT-OFFICE


    2 DEVIATED NASAL SEPTUM MISC OUT HOSP-ORAL DRUGS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 BACK PAIN

    PHYSICIAN VISIT-OFFICE

    1 ALLERGIC REACTION
    1 ANXIETY

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 DENTAL CARE

    DENTAL CARE

    1650

    1651

    1652

    1653

    1654

    1655

    1656

    1657

    1658

    1650 05488
    1650 05488
    1650 05488
    1650 07031
    1650 07031
    Total
    1651 06981
    1651 06981
    1651 06981
    1651 06981
    Total
    1652 07919
    1652 07919
    1652 07919
    Total
    1653 04523
    1653 04523
    1653 04523
    1653 05363
    1653 05363
    1653 05363
    1653 07960
    1653 07960
    1653 07960
    1653 07960
    Total
    1654 03940
    1654 03940
    1654 03940
    Total
    1655 06635
    1655 06635
    Total
    1656 08724
    1656 08724
    1656 08724
    1656 08725
    1656 08725
    1656 08725.1
    Total
    1657 04283
    1657 04283
    Total
    1658 04524
    1658 04524
    1658 04524
    1658 04525
    1658 04525
    1658 08052
    1658 08052
    1658 08052
    1658 08052
    Total

    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CYST
    2 CYST

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HEMATURIA
    2 HEMATURIA
    3 HEMATURIA
    4 HEMATURIA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 GLAUCOMA
    2 GLAUCOMA

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1659

    1660

    1661

    1662

    1663

    1664

    1665
    1666

    1659 06278
    1659 06278
    Total
    1660 03941
    1660 03941
    1660 03941
    Total
    1661 08564
    1661 08564.1
    Total
    1662 07962
    1662 07962
    Total
    1663 03634
    1663 03634
    1663 03634
    1663 03634
    1663 03634
    1663 03635
    1663 03635
    1663 03635
    1663 03635
    1663 07238
    1663 07238
    1663 07238
    1663 08521
    1663 08521
    1663 08521
    1663 08522
    1663 08522
    1663 08522
    Total
    1664 08726
    1664 08726
    1664 08726
    1664 08726
    Total
    1665 03636
    1665 05012
    1665 05012
    1665 05012
    1665 05602
    1665 05602
    1665 07398
    1665 07398
    Total
    1666 03637
    Total
    1667 07965
    1667 07965
    1667 07965
    1667 07965
    1667 07965

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 CHOSTOCHRONDITIS
    1 THYROID

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 CHOSTOCHRONDITIS
    PHYSICIAN VISIT-OFFICE
    2 CHOSTOCHRONDITIS
    MISC OUT HOSP-INJECTABLES
    3 CHOSTOCHRONDITIS
    MISC OUT HOSP-INJECTABLES
    4 CHOSTOCHRONDITIS
    DIAGNOSTIC LABORATORY
    5 CHOSTOCHRONDITIS
    DIAGNOSTIC LABORATORY
    1 COUGH - AIRWAY OBSTRUCTION
    PHYSICIAN VISIT-OFFICE
    2 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-INJECTABLES
    3 COUGH - AIRWAY OBSTRUCTION
    MISC OUT HOSP-INJECTABLES
    4 COUGH - AIRWAY OBSTRUCTION
    DIAGNOSTIC LABORATORY
    1 AMMENORRHOEA
    PHYSICIAN VISIT-OFFICE
    2 AMMENORRHOEA
    DIAGNOSTIC X-RAY
    3 AMMENORRHOEA
    MISC OUT HOSP-ORAL DRUGS
    1 ALLERGIC RHINITIS
    PHYSICIAN VISIT-OFFICE
    2 ALLERGIC RHINITIS
    MISC OUT HOSP-INJECTABLES
    3 ALLERGIC RHINITIS
    MISC OUT HOSP-INJECTABLES
    1 ALLERGIC RHINITIS
    PHYSICIAN VISIT-OFFICE
    2 ALLERGIC RHINITIS
    MISC OUT HOSP-INJECTABLES
    3 ALLERGIC RHINITIS
    MISC OUT HOSP-INJECTABLES
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY

    1 AMMENORRHOEA
    PHYSICIAN VISIT-OFFICE
    1 SOFT TISSUE DISORDERS/DISEASE
    PHYSICIAN VISIT-OFFICE
    2 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-ORAL DRUGS
    3 SOFT TISSUE DISORDERS/DISEASE
    MISC OUT HOSP-ORAL DRUGS
    1 AMMENORRHOEA
    PHYSICIAN VISIT-OFFICE
    2 AMMENORRHOEA
    MISC OUT HOSP-ORAL DRUGS
    1 AMMENORRHOEA
    PHYSICIAN VISIT-OFFICE
    2 AMMENORRHOEA
    MISC OUT HOSP-OTHER
    1 VISION CARE

    VISION CARE

    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY

    1667

    1668

    1669

    1670

    1671

    1672

    1673

    1667 07965.1
    1667 07965.1
    1667 08053
    1667 08053
    1667 08053
    Total
    1668 04285
    1668 04285
    1668 07097
    1668 08054
    1668 08054
    1668 08054.1
    1668 08054.1
    1668 08054.1
    1668 08054.1
    Total
    1669 03943
    1669 03943
    1669 07968
    1669 07968
    1669 07968
    1669 07968
    Total
    1670 07969
    1670 07969
    1670 07969.1
    1670 07969.1
    1670 07970
    1670 07970
    1670 07971
    1670 07971
    1670 08565
    1670 08565
    1670 08565
    Total
    1671 03522
    1671 03522
    1671 05036
    1671 05036
    1671 05036
    Total
    1672 05364
    1672 06807
    1672 06807
    Total
    1673 06015
    1673 06015
    1673 06016
    1673 06016
    Total
    1674 04284
    1674 04284
    1674 04284

    1 ARTHRITIS
    2 ARTHRITIS
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES

    1
    PHYSICIAN VISIT-OFFICE
    2
    DIAGNOSTIC LABORATORY
    1 DENTAL CARE
    DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 ABDOMINAL PAINS
    MISC OUT HOSP-INJECTABLES
    2 ABDOMINAL PAINS
    MISC OUT HOSP-ORAL DRUGS
    3 ABDOMINAL PAINS
    DIAGNOSTIC LABORATORY
    4 ABDOMINAL PAINS
    MISC OUT HOSP-INJECTABLES
    1 GASTRIC - PEPTIC ULCER/GERD
    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    DIAGNOSTIC LABORATORY
    1 CERVICAL SPONDYLOSIS
    PHYSICIAN VISIT-OFFICE
    2 CERVICAL SPONDYLOSIS
    DIAGNOSTIC X-RAY
    3 CERVICAL SPONDYLOSIS
    MISC OUT HOSP-ORAL DRUGS
    4 CERVICAL SPONDYLOSIS
    MISC OUT HOSP-ORAL DRUGS
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    SEPTUM
    SEPTUM

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1
    2
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    VISION CARE
    VISION CARE
    VISION CARE

    1 BREAST DISORDERS
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 DENTAL
    2 DENTAL
    1 DENTAL
    2 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    CARE
    CARE
    CARE
    CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1674

    1675

    1676

    1677

    1678

    1679

    1680

    1681

    1682

    1683

    1674 04284
    1674 04284
    Total
    1675 07963
    1675 07964
    1675 07964
    Total
    1676 04989
    1676 04989
    Total
    1677 08324
    1677 08594
    1677 08594
    Total
    1678 06576
    1678 06576
    1678 08323
    1678 08323
    1678 08323
    Total
    1679 04205
    1679 04206
    1679 04206.1
    1679 07773
    1679 07773
    Total
    1680 04207
    1680 07774
    1680 07774
    1680 08534
    Total
    1681 05683
    1681 05683
    1681 06240
    1681 06240
    1681 06240
    1681 06340
    Total
    1682 05935
    1682 05936
    1682 05936
    Total
    1683 03605
    1683 03605
    1683 03605
    1683 03606
    Total
    1684 03723
    1684 03723
    1684 03723
    1684 03724
    1684 05729
    1684 05729

    4 DENTAL CARE
    5 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 HEART
    1 SINUSITIS
    2 SINUSITIS

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER

    1 MISCARRIAGE
    2 MISCARRIAGE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    1 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE

    1 INFECTION THUMB
    2 INFECTION THUMB
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 REMOVAL OF MOLE
    1 DEVIATED NASAL SEPTUM
    1
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 ALLERGIC RHINITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    1
    2
    1 INJURY
    2 INJURY
    3 INJURY
    1 INJURY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    OPEN
    OPEN
    OPEN
    OPEN

    WOUND
    WOUND
    WOUND
    WOUND

    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE

    1 LUPUS
    2 LUPUS
    3 LUPUS
    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1684

    1685

    1686

    1687

    1688

    1684 05729
    1684 07089
    1684 07089
    1684 07089
    1684 07089
    Total
    1685 03725
    1685 03726
    1685 06624
    1685 06624
    1685 06625
    1685 08233
    Total
    1686 05032
    1686 05730
    1686 05730
    1686 05730
    Total
    1687 06092
    1687 06092
    1687 06092
    1687 06092
    1687 06626
    1687 06626
    1687 06626
    1687 08518
    1687 08518
    1687 08518
    1687 08518
    Total
    1688 04687
    1688 04687
    1688 04687
    1688 04687
    1688 04687
    1688 04687.1
    1688 04687.1
    1688 04687.1
    1688 04687.2
    1688 04687.2
    1688 04688
    1688 04688
    1688 05671
    1688 05671
    1688 07093
    Total
    1689 03933
    1689 03933
    1689 03933
    1689 07090
    1689 07090
    1689 07090
    1689 08305

    3 BARTHOLIN'S CYST
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 HYPERTENSION
    1 PAIN-BACK/SHOULDER
    1
    2
    1 HYPERTENSION
    1 HYPERTENSION

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1
    1
    2
    3

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    1 INJURY
    2 INJURY
    3 INJURY
    4 INJURY
    1 HEART
    2 HEART
    3 HEART
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER

    OPEN
    OPEN
    OPEN
    OPEN

    WOUND
    WOUND
    WOUND
    WOUND

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1
    2
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    3 EAR DYSFUNCTION
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    3 PAINFUL HEEL
    1 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    1689 08305
    1689 Total
    1690 04686
    1690 04686.1
    1690 04686.2
    1690 07091
    1690 07091
    1690 07092
    1690 07092
    1690 07092
    1690 07092
    1690 Total
    1691 03934
    1691 03934
    1691 03934
    1691 Total
    1692 06591
    1692 07030
    1692 07030
    1692 Total
    1693 06096
    1693 06096
    1693 06096
    1693 06872
    1693 06872
    1693 Total
    1694 06873
    1694 06873
    1694 Total
    1695 03876
    1695 03876
    1695 03876
    1695 03876
    1695 07918
    1695 Total
    1696 04881
    1696 04881
    1696 Total
    1697 04882
    1697 04882
    1697 04882
    1697 Total
    1698 04212
    1698 04213
    1698 04213
    1698 04213
    1698 Total
    1699 06944
    1699 06944
    1699 06944
    1699 Total
    1700 07032
    1700 Total

    2 DENTAL CARE

    DENTAL CARE

    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    1 FEVER
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 BARTHOLIN'S CYST
    PHYSICIAN VISIT-OFFICE
    2 BARTHOLIN'S CYST
    PREVENTATIVE
    3 BARTHOLIN'S CYST
    PREVENTATIVE
    4 BARTHOLIN'S CYST
    DIAGNOSTIC X-RAY
    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 FEVER
    1 BURSITIS
    2 BURSITIS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 INGROWING TOE NAIL


    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST

    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE

    1 EYE DISORDER
    2 EYE DISORDER

    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ALLERGIC RHINITIS

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    1 FEVER
    2 FEVER
    3 FEVER

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    1 DENTAL CARE
    1 CYST
    2 CYST
    3 CYST

    DENTAL CARE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE

    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY

    1 DENTAL CARE

    DENTAL CARE

    1701

    1702
    1703

    1704

    1705

    1706
    1707

    1708

    1709

    1710

    1701 04157
    1701 04157
    1701 04157
    1701 04157
    1701 04157
    1701 06097
    Total
    1702 07213
    1702 07213
    Total
    1703 06274
    Total
    1704 05731
    1704 05731
    1704 06275
    1704 06277
    1704 06277
    1704 06277.1
    1704 06277.1
    1704 06804
    1704 06805
    1704 06805
    1704 06805
    Total
    1705 07450
    1705 07450
    1705 07450
    Total
    1706 07214
    1706 07214
    1706 07214
    Total
    1707 05334
    Total
    1708 05732
    1708 05732
    1708 05732
    Total
    1709 07958
    1709 07958
    1709 07958
    Total
    1710 05128
    1710 05128
    1710 05129
    1710 05129
    1710 05129
    1710 07496
    Total
    1711 03514
    1711 03514
    1711 03514
    1711 03514

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL
    1 DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE
    CARE

    1 VISION CARE
    2 VISION CARE

    VISION CARE
    VISION CARE

    1 DENTAL CARE

    DENTAL CARE

    1 DEPRESSION
    2 DEPRESSION
    1 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    1 DIAB'ETES
    2 DIAB'ETES
    1
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY

    1 DENTAL CARE

    DENTAL CARE

    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    1 DENGUE
    2 DENGUE
    3 DENGUE

    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY

    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE

    1711 Total
    1712 06595
    1712 06595
    1712 06595
    1712 08036
    1712 08036
    1712 08036
    1712 Total
    1713 03515
    1713 03515
    1713 03515
    1713 03515
    1713 05007
    1713 05008
    1713 05008
    1713 05016
    1713 05016
    1713 06332
    1713 07551
    1713 07551
    1713 Total
    1714 08035
    1714 Total
    1715 07495
    1715 07495
    1715 07495
    1715 07495
    1715 Total
    1716 06345
    1716 06345
    1716 06345
    1716 06345
    1716 Total
    1717 06501
    1717 07395
    1717 07396
    1717 Total
    1718 07392
    1718 08235
    1718 08235
    1718 08236
    1718 08236
    1718 08236
    1718 08236
    1718 Total
    1719 06500
    1719 06500
    1719 06500
    1719 06500.1
    1719 Total
    1720 08234
    1720 08234
    1720 Total

    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 OVARIAN CYST
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 BACK PAIN
    2 BACK PAIN
    1 MUSCULAR PAIN
    1 BACK PAIN
    2 BACK PAIN

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE

    PREVENTATIVE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL

    CARE
    CARE
    CARE
    CARE

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE

    1 DEVIATED NASAL SEPTUM


    1 EYE DISORDER
    1 ALLERGIC RHINITIS

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1721
    1722

    1723

    1724

    1725

    1726

    1727

    1728

    1721 07394
    1721 07394
    1721 07394
    Total
    1722 08040
    Total
    1723 04100
    1723 04100
    1723 04100
    Total
    1724 07218
    1724 07218
    1724 07218
    Total
    1725 04102
    1725 04102
    1725 04102
    1725 04102
    1725 04102
    1725 07220
    1725 07220
    1725 07220
    1725 07220.1
    1725 07220.1
    1725 07220.1
    Total
    1726 04839
    1726 04839
    1726 04839
    Total
    1727 07497
    1727 07497
    1727 07497
    Total
    1728 04429
    1728 04429
    1728 04430
    1728 04430
    1728 04430.1
    1728 04431
    1728 05095
    1728 05095
    1728 05095
    1728 05095
    1728 05096
    1728 08626
    Total
    1729 03520
    1729 03520
    1729 06630
    1729 06630
    1729 06630
    1729 06631

    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    1 VISION CARE

    VISION CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    3 DENTAL CARE
    DENTAL CARE
    4 DENTAL CARE
    DENTAL CARE
    5 DENTAL CARE
    DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    PHYSICIAN VISIT-OFFICE
    2 HYPERLIPIDERMIA - CHOLESTEROL
    MISC OUT HOSP-ORAL DRUGS
    3 HYPERLIPIDERMIA - CHOLESTEROL
    DIAGNOSTIC LABORATORY
    1 TENDONITIS
    DIAGNOSTIC X-RAY
    2 TENDONITIS
    MISC OUT HOSP-ORAL DRUGS
    3 TENDONITIS
    PHYSICIAN VISIT-OFFICE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DEVIATED NASAL SEPTUM
    1 ALLERGIC REACTION
    1
    2
    3
    4
    1 DEPRESSION
    1 DEPRESSION

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    1 VISION CARE
    2 VISION CARE
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    1 BACK PAIN

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    1729

    1730

    1731

    1732

    1733
    1734

    1735

    1736

    1737

    1729 06631
    1729 06631
    Total
    1730 03939
    1730 03939
    1730 03939
    1730 05097
    1730 05097
    1730 05097
    1730 05097
    1730 05098
    1730 05098
    1730 05100
    1730 05100
    1730 05100
    1730 05100
    1730 05737
    1730 05737
    1730 06836
    1730 06836
    1730 08627
    1730 08627.1
    1730 08627.1
    Total
    1731 04929
    1731 04929
    1731 04929
    1731 08625
    Total
    1732 08720
    1732 08720
    Total
    1733 06512
    1733 06512
    1733 06512
    1733 06512
    1733 06512
    Total
    1734 05911
    Total
    1735 06401
    1735 06401
    Total
    1736 05006.1
    1736 05006.1
    1736 05006.1
    1736 05006.1
    Total
    1737 04098
    1737 05865
    1737 05865
    1737 05865
    Total

    2 BACK PAIN
    3 BACK PAIN

    MISC OUT HOSP-INJECTABLES


    DIAGNOSTIC LABORATORY

    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 TONSILLITIS
    2 TONSILLITIS
    1 EYE DISORDER
    2 EYE DISORDER
    1 EYE DISORDER
    1 VISION CARE
    2 VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE

    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 ALLERGIC REACTION

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 DENTAL
    2 DENTAL
    3 DENTAL
    4 DENTAL
    5 DENTAL

    DENTAL
    DENTAL
    DENTAL
    DENTAL
    DENTAL

    CARE
    CARE
    CARE
    CARE
    CARE

    CARE
    CARE
    CARE
    CARE
    CARE

    1 FEVER

    PHYSICIAN VISIT-OFFICE

    1 DENTAL CARE
    2 DENTAL CARE

    DENTAL CARE
    DENTAL CARE

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE

    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL
    MATERNITY-PRENATAL

    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE

    CARE
    CARE
    CARE
    CARE

    1738 05733.1
    1738 Total
    1739 04099
    1739 04099
    1739 04099
    1739 05011
    1739 05011
    1739 Total
    1740 06346
    1740 Total
    1741 05287
    1741 Total
    1742 06842
    1742 06842
    1742 Total
    Grand Total

    1 BACK PAIN

    DIAGNOSTIC X-RAY

    1 GASTRIC - PEPTIC ULCER/GERD


    PHYSICIAN VISIT-OFFICE
    2 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-ORAL DRUGS
    3 GASTRIC - PEPTIC ULCER/GERD
    MISC OUT HOSP-OTHER
    1 DENTAL CARE
    DENTAL CARE
    2 DENTAL CARE
    DENTAL CARE
    1 DIAB'ETES

    PHYSICIAN VISIT-OFFICE

    1 HEART- ISCHEMIC HEART DISEASE


    PHYSICIAN VISIT-OFFICE
    1 DIAB'ETES
    2 DIAB'ETES

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    PROCEDURE DESCRIPTION
    P-ORAL DRUGS

    PROV1
    P104

    Amount
    $598.00
    $598.00
    COMPLETE EXAMINATION
    O076
    $50.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,885.50
    $1,935.50
    P-ORAL DRUGS
    P001
    $607.02
    M695
    $350.00
    P-ORAL DRUGS
    P215
    $58.85
    P-ORAL DRUGS
    M695
    $150.00
    SLT-OFFICE
    S049
    $350.00
    P-ORAL DRUGS
    P090
    $159.88
    P-ORAL DRUGS
    P090
    $39.53
    P-ORAL DRUGS
    P090
    $324.95
    P-ORAL DRUGS
    P215
    $358.50
    P-ORAL DRUGS
    P005
    $1,116.33
    P-ORAL DRUGS
    P090
    $646.15
    L96
    $600.00
    ABORATORY
    L001
    $490.50
    P-ORAL DRUGS
    P215
    $789.10
    SLT-OFFICE
    S191
    $600.00
    SLT-OFFICE
    S049
    $650.00
    O061
    $100.00
    P-ORAL DRUGS
    P090
    $290.20
    S069
    $950.00
    P-ORAL DRUGS
    P215
    $300.90
    P-ORAL DRUGS
    P090
    $290.20
    P-ORAL DRUGS
    P090
    $343.30
    M215
    $250.00
    P-ORAL DRUGS
    P215
    $176.40
    P-ORAL DRUGS
    P090
    $554.20
    P-ORAL DRUGS
    P215
    $479.90
    PROSTATE: TRANSURETHRAL RESECTION
    S296
    $2,400.00
    S296
    $840.00
    S296
    $210.00
    P-ORAL DRUGS
    P090
    $343.30
    P-ORAL DRUGS
    P001
    $625.80
    SLT-OFFICE
    S049
    $350.00
    ABORATORY
    L001
    $167.00
    SLT-OFFICE
    S191
    $300.00
    P-ORAL DRUGS
    P090
    $396.00
    P-ORAL DRUGS
    P005
    $1,116.33
    P-ORAL DRUGS
    P215
    $479.90
    P-ORAL DRUGS
    P090
    $57.35
    P-ORAL DRUGS
    P090
    $399.40
    $18,710.99
    PREVENTIVE: DENTAL PROPHYLAXIS
    D90
    $250.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D90
    TIMES$150.00
    (EXCLUDE PROPHYLAXIS)
    M297
    $370.00
    M297
    $200.00
    P-INJECTABLES
    M297
    $150.00
    P-ORAL DRUGS
    P115
    $16.60
    P-ORAL DRUGS
    P435
    $34.44

    P-ORAL DRUGS

    P014

    $130.90
    $1,301.94
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $930.75
    MATERIALS: LENS, EACH-BI-FOCALO001
    $1,207.00
    $2,247.75
    COMPLETE EXAMINATION
    O001
    $300.00
    MATERIALS: FRAMES
    O001
    $795.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $810.00
    $1,905.00
    M035
    $200.00
    P-ORAL DRUGS
    P416
    $27.50
    P-ORAL DRUGS
    P416
    $20.50
    $248.00
    DIAGNOSTIC: INITIAL ORAL EXAM D119
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D119
    $350.00
    $400.00
    M842
    $400.00
    P-ORAL DRUGS
    P353
    $834.40
    P-ORAL DRUGS
    P353
    $841.00
    P-ORAL DRUGS
    P353
    $303.40
    P-ORAL DRUGS
    P353
    $1,520.40
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,495.00
    MATERIALS: LENS, EACH-BI-FOCALO001
    $1,770.00
    $7,274.20
    SLT-OFFICE
    S217
    $340.00
    P-INJECTABLES
    S217
    $50.00
    P-INJECTABLES
    S217
    $150.00
    P-ORAL DRUGS
    P427
    $228.91
    M037
    $180.00
    M037
    $180.00
    ABORATORY
    H005
    $266.00
    ABORATORY
    L033
    $240.00
    M037
    $180.00
    ABORATORY
    L033
    $670.00
    P-ORAL DRUGS
    P427
    $440.00
    SLT-OFFICE
    S286
    $300.00
    S286
    $150.00
    SLT-OFFICE
    S118
    $300.00
    $3,674.91
    COMPLETE EXAMINATION
    O033
    $100.00
    M089
    $260.00
    ABORATORY
    L070
    $120.00
    L046
    $2,185.00
    $2,665.00
    M666
    $80.00
    ABORATORY
    M666
    $20.00
    M666
    $160.00
    P-INJECTABLES
    M666
    $100.00
    P-INJECTABLES
    M666
    $20.00
    P-ORAL DRUGS
    P131
    $240.00
    P-ORAL DRUGS
    P005
    $317.50

    P-ORAL DRUGS
    P005
    $317.50
    PREVENTIVE: DENTAL PROPHYLAXIS
    D191
    $350.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D191
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D191
    TIMES (EXCLUDE
    $30.00
    PROPHYLAXIS)
    P-ORAL DRUGS
    P005
    $317.50
    P-ORAL DRUGS
    P005
    $317.50
    M762
    $100.00
    P-ORAL DRUGS
    P472
    $80.00
    P-ORAL DRUGS
    P394
    $744.00
    $3,264.00
    M229
    $160.00
    P-INJECTABLES
    M229
    $25.00
    P-INJECTABLES
    M229
    $175.00
    M229
    $160.00
    P-ORAL DRUGS
    P031
    $161.86
    M229
    $200.00
    L001
    $320.00
    M229
    $200.00
    $1,401.86
    M542
    $150.00
    P-INJECTABLES
    M542
    $25.00
    P-INJECTABLES
    M542
    $75.00
    ABSCESSES, BOILS & CARBUNCLES:
    M542
    INCISION FOR
    $4,300.00
    DRAINAGE W/O HOSPITAL
    M542
    $1,050.00
    P-ORAL DRUGS
    P014
    $12.00
    $5,612.00
    M629
    $240.00
    P-INJECTABLES
    M629
    $25.00
    P-INJECTABLES
    M629
    $35.00
    P-ORAL DRUGS
    P426
    $180.50
    M581
    $200.00
    ABORATORY
    L025
    $451.00
    ABORATORY
    L025
    $257.00
    $1,388.50
    M225
    $480.00
    ABORATORY
    M225
    $120.00
    ABORATORY
    L001
    $865.00
    ABORATORY
    M225
    $50.00
    P-ORAL DRUGS
    P031
    $251.89
    $1,766.89
    M763
    $100.00
    $100.00
    M104
    $400.00
    P-ORAL DRUGS
    P427
    $500.10
    M089
    $200.00
    ABORATORY
    L070
    $200.00
    P-ORAL DRUGS
    P122
    $68.40
    M089
    $180.00
    P-ORAL DRUGS
    P122
    $425.50
    M089
    $180.00
    P-ORAL DRUGS
    P122
    $121.50
    M089
    $180.00
    ABORATORY
    H005
    $690.00

    L006
    L006

    $275.00
    $275.00
    $3,695.50
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D125CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D125CAVITY $160.00
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    $380.00
    M298
    $240.00
    P-ORAL DRUGS
    P435
    $524.57
    P-ORAL DRUGS
    P435
    $26.49
    M298
    $200.00
    ABORATORY
    H005
    $1,760.00
    $2,751.06
    M821
    $185.00
    P-ORAL DRUGS
    P360
    $474.60
    ABORATORY
    M304
    $680.00
    M411
    $130.00
    P-ORAL DRUGS
    P104
    $400.00
    M870
    $300.00
    P-ORAL DRUGS
    P447
    $83.50
    M304
    $200.00
    ABORATORY
    M304
    $395.00
    P-ORAL DRUGS
    P360
    $474.60
    $3,322.70
    M769
    $150.00
    ABORATORY
    L070
    $295.00
    L164
    $400.00
    M229
    $200.00
    P-ORAL DRUGS
    P122
    $373.80
    $1,418.80
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D60 SURFACE $170.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D60 SURFACE $130.00
    CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $60.00
    VIEW
    CROWN & BRIDGE: ACRYLIC JACKET
    D60
    CROWN
    $2,500.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D60
    $300.00
    M053
    $280.00
    P-ORAL DRUGS
    P081
    $278.40
    P-ORAL DRUGS
    P081
    $38.40
    M053
    $140.00
    P-ORAL DRUGS
    P342
    $220.60
    P-ORAL DRUGS
    P215
    $129.60
    $4,247.00
    M327
    $140.00
    P-ORAL DRUGS
    P039
    $75.00
    P-ORAL DRUGS
    P039
    $41.85
    H066
    $1,500.00
    PROSTATE: TRANSURETHRAL RESECTION
    S295
    $3,500.00
    S295
    $300.00
    P-ORAL DRUGS
    P014
    $159.30
    M327
    $140.00
    P-ORAL DRUGS
    P039
    $112.50
    M327
    $140.00
    P-ORAL DRUGS
    P039
    $39.95

    $140.00
    $50.25
    $6,338.85
    M326
    $250.00
    P-ORAL DRUGS
    P343
    $77.70
    $327.70
    P-ORAL DRUGS
    P215
    $110.40
    P-ORAL DRUGS
    P215
    $110.00
    P-ORAL DRUGS
    P215
    $90.00
    P-ORAL DRUGS
    P215
    $100.00
    $410.40
    P-ORAL DRUGS
    P122
    $840.00
    P-ORAL DRUGS
    P122
    $819.00
    M060
    $200.00
    P-ORAL DRUGS
    P122
    $87.50
    P-ORAL DRUGS
    P122
    $25.95
    P-ORAL DRUGS
    P122
    $750.50
    P-ORAL DRUGS
    P122
    $840.00
    P-ORAL DRUGS
    P122
    $840.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $100.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    P-ORAL DRUGS
    P122
    $840.00
    $5,592.95
    M624
    $100.00
    P-ORAL DRUGS
    P049
    $14.25
    H006
    $3,300.00
    ABORATORY
    H006
    $50.00
    S130
    $340.00
    P-ORAL DRUGS
    P076
    $216.50
    DIAGNOSTIC: INITIAL ORAL EXAM D48
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D48X-RAY, SINGLE
    $160.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D48
    $330.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D48
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM D48
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D48X-RAY, SINGLE
    $160.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D48
    $330.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D48
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D48 CAVITY $1,100.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D420
    BITEWING X-RAYS
    $300.00
    S077
    $300.00
    P-ORAL DRUGS
    P014
    $61.00
    P-ORAL DRUGS
    P014
    $40.00
    M811
    $200.00
    $7,241.75
    M756
    $100.00
    ABORATORY
    M756
    $100.00
    P-INJECTABLES
    M756
    $90.00
    P-INJECTABLES
    M756
    $10.00
    P-ORAL DRUGS
    P426
    $81.00
    P-ORAL DRUGS
    P426
    $9.00
    P-ORAL DRUGS
    P426
    $52.00
    ABORATORY
    M756
    $300.00

    P-ORAL DRUGS

    M327
    P014

    ABORATORY

    L065
    M581

    $240.00
    $150.00
    $1,132.00
    P-ORAL DRUGS
    P182
    $134.95
    M304
    $185.00
    P-ORAL DRUGS
    P182
    $27.95
    M304
    $185.00
    P-ORAL DRUGS
    P182
    $159.60
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $556.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O004
    $1,516.00
    $2,864.50
    M304
    $140.00
    ABORATORY
    M304
    $635.00
    $775.00
    OTHER SERVICES: EMERGENCY TREATMENT
    D01
    OF DENTAL
    $385.00
    PAIN
    OTHER SERVICES: EMERGENCY TREATMENT
    D01
    OF DENTAL
    $115.00
    PAIN
    M184
    $200.00
    $700.00
    M101
    $150.00
    P-ORAL DRUGS
    P166
    $248.85
    P-ORAL DRUGS
    P166
    $296.00
    P-ORAL DRUGS
    P166
    $217.25
    $912.10
    P-ORAL DRUGS
    P435
    $645.36
    P-ORAL DRUGS
    P097
    $189.00
    P-ORAL DRUGS
    P122
    $122.85
    P-ORAL DRUGS
    P256
    $282.00
    P-ORAL DRUGS
    P073
    $4,654.55
    P-ORAL DRUGS
    P005
    $4,478.64
    P-ORAL DRUGS
    P256
    ($282.00)
    P-ORAL DRUGS
    P256
    $282.00
    P-ORAL DRUGS
    P435
    $386.15
    P-ORAL DRUGS
    P005
    $3,104.36
    P-ORAL DRUGS
    P435
    $86.14
    P-ORAL DRUGS
    P318
    $1,491.55
    P-ORAL DRUGS
    P005
    $5,500.68
    P-ORAL DRUGS
    P318
    $424.30
    P-ORAL DRUGS
    P318
    $259.90
    P-ORAL DRUGS
    P318
    $212.15
    P-ORAL DRUGS
    P005
    $1,052.52
    P-ORAL DRUGS
    P005
    $2,315.18
    P-ORAL DRUGS
    P005
    $376.04
    $25,581.37
    P-ORAL DRUGS
    P014
    $451.70
    P-ORAL DRUGS
    P014
    $35.00
    SLT-OFFICE
    S277
    $200.00
    P-ORAL DRUGS
    P215
    $84.00
    ABORATORY
    H006
    $327.00
    P-ORAL DRUGS
    P215
    $517.60
    P-ORAL DRUGS
    P014
    $201.00
    SLT-OFFICE
    S220
    $220.00
    P-ORAL DRUGS
    P014
    $117.25

    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    ABORATORY
    SLT-OFFICE

    UN01
    P215
    P215
    P215
    P014
    P215
    H006
    S220

    $165.00
    $61.40
    $94.10
    $55.00
    $117.25
    $423.10
    $327.00
    $220.00
    $3,616.40
    COMPLETE EXAMINATION
    O004
    $200.00
    SLT-OFFICE
    S290
    $400.00
    L034
    $1,700.00
    H003
    $400.00
    ABORATORY
    H003
    $265.00
    H003
    $150.00
    P-ORAL DRUGS
    P373
    $145.25
    P-ORAL DRUGS
    P373
    $103.80
    P-ORAL DRUGS
    P373
    $11.50
    SLT-OFFICE
    S231
    $300.00
    P-ORAL DRUGS
    P373
    $148.05
    L034
    $1,093.00
    T075
    $225.00
    H003
    $200.00
    T076
    $200.00
    $5,541.60
    M556
    $120.00
    $120.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D104
    ROOT$600.00
    PLANING, SCALING, EACH
    DIAGNOSTIC: INITIAL ORAL EXAM D104
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D104
    X-RAY, SINGLE
    $200.00
    VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D104 SURFACE $400.00
    CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM D104
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D104
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D104
    TIMES (EXCLUDE
    $80.00
    PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D104
    $280.00
    COMPLETE EXAMINATION
    O065
    $150.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O065
    $1,638.00
    MATERIALS: FRAMES
    O065
    $765.00
    $4,343.00
    P-ORAL DRUGS
    P256
    $225.90
    P-ORAL DRUGS
    P094
    $352.50
    M087
    $260.00
    P-ORAL DRUGS
    P094
    $11.20
    P-ORAL DRUGS
    P094
    $108.75
    M229
    $200.00
    M229
    $160.00
    P-ORAL DRUGS
    P011
    $65.00
    ABORATORY
    L001
    $465.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: CONTACT, WHEN NOTO004
    MEDICALLY REQUIRED
    $216.00
    $2,264.35
    SLT-OFFICE
    S136
    $200.00
    PROSTATE: TRANSURETHRAL RESECTION
    S089
    $650.00

    SLT-OFFICE
    S301
    $300.00
    SLT-OFFICE
    S301
    $300.00
    SLT-OFFICE
    S275
    $300.00
    SLT-OFFICE
    S136
    $200.00
    DIAGNOSTIC: INITIAL ORAL EXAM D104
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D104
    X-RAY, SINGLE
    $70.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D104
    X-RAY, SINGLE
    $60.00
    VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D104CAVITY $250.00
    ENDODONTICS: EXTIRPATION OF PULP
    D104& FILL 3 $2,100.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D104 SURFACE $340.00
    CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D104CAVITY $340.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D104
    ROOT$600.00
    PLANING, SCALING, EACH
    $5,790.00
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $190.00
    COMPLETE EXAMINATION
    O001
    $110.00
    COMPLETE EXAMINATION
    O001
    $200.00
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $190.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D04 CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D04 CAVITY $285.00
    $1,315.00
    COMPLETE EXAMINATION
    O007
    $100.00
    MATERIALS: FRAMES
    O007
    $1,440.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O007
    $2,325.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: CONTACT, WHEN NOTO004
    MEDICALLY REQUIRED
    $1,408.00
    $5,473.00
    COMPLETE EXAMINATION
    O002
    $35.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O002
    $1,944.00
    MATERIALS: FRAMES
    O002
    $1,516.00
    $3,495.00
    COMPLETE EXAMINATION
    O015
    $120.00
    MATERIALS: FRAMES
    O015
    $1,980.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O015
    $3,805.00
    S296
    $800.00
    ABORATORY
    S296
    $400.00
    ABDOMEN: GASTROSCOPY, OPERATIVE
    S296
    $1,500.00
    M692
    $700.00
    ABORATORY
    H005
    $1,330.00
    $10,635.00
    M056
    $150.00
    P-ORAL DRUGS
    M056
    $50.00
    P-ORAL DRUGS
    M056
    $70.00
    $270.00
    M190
    $100.00
    P-INJECTABLES
    M190
    $25.00
    P-INJECTABLES
    M190
    $75.00
    PERIODONTICS: GINGIVECTOMY, SURGICAL,
    D330
    PER QUADRANT
    $780.00
    W POST OPER
    PERIODONTICS: GINGIVECTOMY, SURGICAL,
    D330
    PER QUADRANT
    $220.00
    W POST OPER
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D330CAVITY $450.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D330
    CROWN
    $2,800.00
    $4,450.00

    M186
    L143
    M186
    L032

    $200.00
    $150.00
    $120.00
    $350.00
    $820.00
    OTHER SERVICES: SPECIAL CONSULTATION
    D143
    (ADVISE
    $175.00
    OTHER DENTISTS/PHYS)
    OTHER SERVICES: SPECIAL CONSULTATION
    D143
    (ADVISE
    $25.00
    OTHER DENTISTS/PHYS)
    M030
    $160.00
    M030
    $50.00
    M030
    $110.00
    P-ORAL DRUGS
    P343
    $321.03
    P-ORAL DRUGS
    P155
    $148.59
    P-ORAL DRUGS
    P155
    $152.41
    COMPLETE EXAMINATION
    O033
    $100.00
    MATERIALS: FRAMES
    O033
    $1,327.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O033
    $1,341.00
    $3,910.53
    M556
    $120.00
    P-ORAL DRUGS
    P435
    $77.10
    P-ORAL DRUGS
    P435
    $46.99
    M304
    $200.00
    SLT-OFFICE
    S356
    $300.00
    S356
    $1,400.00
    ABORATORY
    L025
    $285.00
    M556
    $120.00
    L97
    $180.00
    M189
    $140.00
    $2,869.09
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D342CAVITY $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D342CAVITY $840.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D342
    $300.00
    DIAGNOSTIC: INITIAL ORAL EXAM D342
    (EXCLUDE X-RAY)
    $120.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D342
    X-RAY, SINGLE
    $120.00
    VIEW
    CROWN & BRIDGE: ACRYLIC JACKET
    D342
    CROWN W METAL
    $8,000.00
    THIMBLE
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,258.00
    $11,048.00
    SLT-OFFICE
    S219
    $450.00
    DIAGNOSTIC: INITIAL ORAL EXAM D23
    (EXCLUDE X-RAY)
    $100.00
    SLT-OFFICE
    S217
    $500.00
    H048
    $232.00
    L075
    $3,182.25
    L075
    $47.75
    M124
    $250.00
    H011
    $5,500.00
    H011
    $14,307.00
    IT-HOSPITAL
    H011
    $2,850.00
    SLT-HOSPITAL
    S192
    $8,500.00
    M124
    $250.00
    ABORATORY
    L070
    $80.00
    ABORATORY
    L065
    $585.00
    L149
    $2,200.00
    ABORATORY
    M124
    $50.00

    S426
    M657
    P-ORAL DRUGS
    P022
    M657
    H006
    ABORATORY
    H006
    P-ORAL DRUGS
    P011
    H006
    S426
    ABORATORY
    L065
    COMPLETE EXAMINATION
    O004
    MATERIALS: FRAMES
    O004
    MATERIALS: LENS, EACH-TRI-FOCAL
    O004

    ABORATORY

    L046

    H047
    H047
    PROSTATE: TRANSURETHRAL RESECTION
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    IT-HOSPITAL
    H047
    IT-HOSPITAL
    H047
    H047
    H047
    IT-HOSPITAL
    H047
    M436
    M124
    ABORATORY
    L041
    ABORATORY
    M124
    P-ORAL DRUGS
    P430
    P-ORAL DRUGS
    P416
    P-ORAL DRUGS
    P014
    H047
    S199
    H027
    P-ORAL DRUGS
    P245
    P245
    P-ORAL DRUGS
    P430
    P-ORAL DRUGS
    P430
    P-ORAL DRUGS
    P430
    P-ORAL DRUGS
    P430
    P-ORAL DRUGS
    P430
    P-ORAL DRUGS
    P430
    P-ORAL DRUGS
    P430
    P-ORAL DRUGS
    P430
    COMPLETE EXAMINATION

    O136

    $39,084.00
    $300.00
    $100.00
    $245.70
    $200.00
    $150.00
    $70.00
    $174.00
    $490.00
    $600.00
    $918.00
    $100.00
    $858.19
    $596.25
    $4,802.14
    $300.00
    $300.00
    $33,550.00
    $22,050.00
    $17,527.00
    $5,873.00
    $18,000.00
    ($3,427.00)
    $3,427.00
    ($10,983.36)
    $10,983.36
    ($1,282.00)
    $1,282.00
    $3,427.00
    $10,983.36
    $1,282.00
    $300.00
    $250.00
    $280.00
    $100.00
    $2,601.50
    $210.00
    $1,987.75
    $1,000.00
    $300.00
    $150.00
    $85.40
    $595.00
    $1,947.20
    ($1,947.20)
    $1,947.20
    $1,504.30
    ($1,504.30)
    $1,504.30
    $1,224.60
    $63.00
    $125,291.11
    $300.00

    MATERIALS: LENS, EACH-SINGLE VISION


    O136
    MATERIALS: FRAMES
    O136

    $1,405.50
    $797.50
    $2,503.00
    M534
    $200.00
    L164
    $150.00
    P-ORAL DRUGS
    P476
    $180.50
    $530.50
    M034
    $50.00
    P-ORAL DRUGS
    P011
    $93.50
    $143.50
    COMPLETE EXAMINATION
    O001
    $250.00
    $250.00
    H006
    $2,200.00
    H006
    $2,600.00
    M246
    $2,000.00
    ABDOMEN: CUTTING ABDOMINAL CAVITY
    S089 EXCEPT
    $8,900.00
    AS OTHERWISE SPECIFIED
    ABORATORY
    L020
    $340.00
    M341
    $140.00
    P-INJECTABLES
    M341
    $25.00
    P-INJECTABLES
    M341
    $135.00
    P-ORAL DRUGS
    P104
    $361.20
    $16,701.20
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    ORAL SURGERY: SURGICAL REMOVAL
    D125
    OF TOOTH W
    $210.00
    SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D125
    OF TOOTH W
    $190.00
    SOFT TISSUE IMPACTION
    $480.00
    COMPLETE EXAMINATION
    O019
    $120.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O019
    $680.00
    MATERIALS: FRAMES
    O019
    $715.00
    $1,515.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $225.60
    MATERIALS: FRAMES
    O001
    $425.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,425.90
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $335.75
    MATERIALS: FRAMES
    O001
    $425.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,292.00
    DIAGNOSTIC: INITIAL ORAL EXAM D59
    (EXCLUDE X-RAY)
    $80.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D59 CAVITY $400.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D59 CAVITY $100.00
    OTHER
    D59
    $400.00
    OTHER
    D59
    $100.00
    ENDODONTICS: EXTIRPATION OF PULP
    D59 & FILL 1 $2,200.00
    ROOT CANAL (EX RESTOR)
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D59X-RAY, SINGLE
    $240.00
    VIEW
    SLT-OFFICE
    S114
    $60.01
    SLT-OFFICE
    S114
    $339.99
    SLT-OFFICE
    S120
    $300.00
    M597
    $100.00
    M597
    $100.00
    ABORATORY
    M597
    $250.00
    P-ORAL DRUGS
    P115
    $366.00
    P-ORAL DRUGS
    P115
    $91.50

    DIAGNOSTIC: INITIAL ORAL EXAM D171


    (EXCLUDE X-RAY)
    $100.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D171CAVITY $245.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D171CAVITY $105.00
    COMPLETE EXAMINATION
    O001
    $110.00
    COMPLETE EXAMINATION
    O001
    $99.00
    MATERIALS: FRAMES
    O001
    $706.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $859.14
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $220.86
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D125
    X-RAY, SINGLE
    $35.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D125
    X-RAY, SINGLE
    $45.00
    VIEW
    M019
    $84.00
    M019
    $216.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D125
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D125
    $200.00
    ORAL SURGERY: SURGICAL REMOVAL
    D125
    OF ERUPTED
    $350.00
    TOOTH
    $13,132.25
    COMPLETE EXAMINATION
    O168
    $180.00
    MATERIALS: FRAMES
    O168
    $1,135.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O168
    $2,270.00
    $3,585.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D291CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D291CAVITY $210.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D291
    $300.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D291CAVITY $400.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D291 SURFACE $400.00
    CAVITY
    $1,410.00
    M067
    $160.00
    P-ORAL DRUGS
    P003
    $87.00
    P-ORAL DRUGS
    P003
    $12.50
    M346
    $200.00
    P-INJECTABLES
    M346
    $260.00
    P-ORAL DRUGS
    P478
    $380.00
    $1,099.50
    P-ORAL DRUGS
    P458
    $70.30
    M120
    $140.00
    P-ORAL DRUGS
    P491
    $70.00
    P-ORAL DRUGS
    P491
    $50.00
    M120
    $240.00
    P-ORAL DRUGS
    P125
    $35.00
    M646
    $300.00
    P-ORAL DRUGS
    P458
    $303.55
    P-ORAL DRUGS
    P458
    $70.30
    SLT-OFFICE
    S151
    $400.00
    S151
    $350.00
    M120
    $140.00
    P-ORAL DRUGS
    P491
    $274.00
    $2,443.15
    MATERIALS: FRAMES
    O004
    $1,196.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,116.00
    $2,312.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,081.00

    MATERIALS: FRAMES
    O001
    MATERIALS: LENS, EACH-SINGLE VISION
    O001

    $1,124.75
    $573.75
    $2,889.50
    ENATAL CARE
    S089
    $1,300.00
    ENATAL CARE
    M083
    $400.00
    $1,700.00
    S275
    $750.00
    $750.00
    IT-HOSPITAL
    H023
    $375.00
    $375.00
    H034
    $300.00
    H034
    $500.00
    P-ORAL DRUGS
    H034
    $144.20
    $944.20
    DIAGNOSTIC: INITIAL ORAL EXAM D241
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D241
    $135.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D241
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D241
    TIMES$165.00
    (EXCLUDE PROPHYLAXIS)
    ENDODONTICS: EXTIRPATION OF PULP
    D241& FILL 1 $2,000.00
    ROOT CANAL (EX RESTOR)
    OTHER
    P435
    $193.44
    OTHER
    P427
    $30.47
    MATERIALS: FRAMES
    UN02
    $275.75
    MATERIALS: LENS, EACH-SINGLE VISION
    UN02
    $193.02
    M304
    $200.00
    M304
    $160.00
    ABORATORY
    H005
    $780.00
    P-ORAL DRUGS
    P435
    $134.75
    P-ORAL DRUGS
    P435
    $33.69
    $4,471.12
    M248
    $180.00
    P-ORAL DRUGS
    P458
    $17.50
    P-ORAL DRUGS
    P458
    $44.45
    $241.95
    IT-HOSPITAL
    M821
    $300.00
    H005
    $1,038.40
    M473
    $120.00
    P-ORAL DRUGS
    P508
    $211.50
    ABORATORY
    L070
    $640.00
    M473
    $280.00
    P-ORAL DRUGS
    P094
    $351.30
    P-ORAL DRUGS
    P508
    $343.47
    M473
    $150.00
    P-ORAL DRUGS
    P508
    $384.09
    P-ORAL DRUGS
    P508
    $25.60
    ABORATORY
    L070
    $640.00
    M473
    $150.00
    P-ORAL DRUGS
    P508
    $32.68
    M473
    $150.00
    P-ORAL DRUGS
    P508
    $102.38
    M473
    $240.00
    $5,159.42
    M388
    $100.00
    P-INJECTABLES
    M388
    $25.00

    P-INJECTABLES

    M388
    S052
    L013

    $75.00
    $550.00
    $3,582.00
    $4,332.00
    M693
    $250.00
    PROSTATE: TRANSURETHRAL RESECTION
    M693
    $500.00
    M120
    $140.00
    P-INJECTABLES
    M120
    $25.00
    P-INJECTABLES
    M120
    $55.00
    DIAGNOSTIC: INITIAL ORAL EXAM D379
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D379
    $500.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D379VIEW
    $120.00
    M693
    $150.00
    P-ORAL DRUGS
    P154
    $84.80
    P-ORAL DRUGS
    P154
    $21.20
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,796.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D244
    $300.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D244
    X-RAY, SINGLE
    $70.00
    VIEW
    $5,422.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D171
    $280.00
    M204
    $200.00
    ABSCESSES, BOILS & CARBUNCLES:
    M204
    INCISION FOR$300.00
    DRAINAGE W/O HOSPITAL
    $780.00
    M251
    $200.00
    P-INJECTABLES
    M251
    $50.00
    P-INJECTABLES
    M251
    $150.00
    P-ORAL DRUGS
    M251
    $280.00
    M251
    $200.00
    P-INJECTABLES
    M251
    $50.00
    P-INJECTABLES
    M251
    $150.00
    P-ORAL DRUGS
    M251
    $320.00
    M251
    $400.00
    P-INJECTABLES
    M251
    $100.00
    P-INJECTABLES
    M251
    $700.00
    P-ORAL DRUGS
    M251
    $1,215.00
    P-ORAL DRUGS
    P430
    $86.10
    P-ORAL DRUGS
    P462
    $125.00
    M693
    ($150.00)
    M693
    $150.00
    P-ORAL DRUGS
    P430
    ($250.00)
    P-ORAL DRUGS
    P430
    $250.00
    M693
    $150.00
    P-ORAL DRUGS
    P430
    $202.00
    P-ORAL DRUGS
    P430
    $48.00
    $4,426.10
    P-ORAL DRUGS
    P167
    $1,938.60
    S201
    $300.00
    L013
    $330.00
    ABORATORY
    L013
    $800.00
    L013
    $300.00
    PROSTATE: TRANSURETHRAL RESECTION
    H008
    $2,000.00

    DIAGNOSTIC: INITIAL ORAL EXAM D125


    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D125
    X-RAY, SINGLE
    $35.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D125
    X-RAY, SINGLE
    $45.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D125
    $300.00
    OTHER SERVICES: SPECIAL CONSULTATION
    D346
    (ADVISE
    $150.00
    OTHER DENTISTS/PHYS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D346VIEW
    $100.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D346 SURFACE $400.00
    CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET
    D346
    CROWN
    $6,500.00
    ENDODONTICS: EXTIRPATION OF PULP
    D346& FILL 2 $3,000.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D346 SURFACE $900.00
    CAVITY
    P-ORAL DRUGS
    P167
    $1,938.60
    P-ORAL DRUGS
    P167
    $2,165.85
    P-ORAL DRUGS
    P167
    $2,165.85
    $23,448.90
    H048
    $900.00
    H048
    $1,350.00
    H048
    $14,480.00
    M755
    $5,500.00
    JOINT: INCISION FOR DIAG OR TREATMNT-INTRA-ARTICULAR
    S217
    $22,450.00 STRUCTURES
    H048
    $12,068.00
    H048
    $4,884.00
    P-ORAL DRUGS
    H005
    $1,143.60
    M607
    $75.00
    M607
    $180.00
    ABORATORY
    H048
    $398.00
    H048
    $438.00
    MM06
    $465.50
    S217
    $340.00
    P-ORAL DRUGS
    P231
    $591.90
    S217
    $340.00
    P-ORAL DRUGS
    P020
    $189.00
    SLT-OFFICE
    S217
    $340.00
    S217
    $413.00
    MM07
    $530.00
    M483
    $120.00
    P-ORAL DRUGS
    P020
    $120.00
    SLT-OFFICE
    S217
    $340.00
    $67,656.00
    M607
    ($300.00)
    M607
    $300.00
    ABORATORY
    M607
    ($350.00)
    ABORATORY
    M607
    $350.00
    P-ORAL DRUGS
    P073
    $1,343.64
    M607
    $300.00
    ABORATORY
    M607
    $50.00
    M607
    $300.00
    M607
    ($200.00)
    M607
    $200.00
    ABORATORY
    M607
    ($2,046.00)
    ABORATORY
    M607
    $2,046.00
    M607
    ($300.00)
    M607
    $300.00
    ABORATORY
    M607
    ($300.00)

    ABORATORY
    ABORATORY
    ABORATORY

    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607

    $300.00
    ($240.00)
    $240.00
    $200.00
    ABORATORY
    $2,046.00
    $300.00
    ABORATORY
    $300.00
    ABORATORY
    $240.00
    $250.00
    $5,329.64
    M795
    $150.00
    P-ORAL DRUGS
    M795
    $120.00
    P-ORAL DRUGS
    M795
    $60.00
    M795
    $150.00
    P-ORAL DRUGS
    M795
    $90.00
    M795
    $410.00
    M754
    $150.00
    P-INJECTABLES
    M754
    $100.00
    P-ORAL DRUGS
    M754
    $50.00
    M795
    $470.00
    P-INJECTABLES
    M795
    $120.00
    M795
    $150.00
    P-ORAL DRUGS
    M795
    $150.00
    P-ORAL DRUGS
    M795
    $100.00
    $2,270.00
    S115
    $300.00
    P-ORAL DRUGS
    P011
    $201.00
    P-ORAL DRUGS
    P011
    $150.00
    S292
    $400.00
    P-ORAL DRUGS
    P351
    $149.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,356.00
    MATERIALS: LENS, EACH-BI-FOCALO004
    $2,056.00
    DIAGNOSTIC: INITIAL ORAL EXAM D90
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D90X-RAY, SINGLE
    $70.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D90X-RAY, SINGLE
    $30.00
    VIEW
    OTHER
    D90
    $40.00
    $4,952.00
    M120
    $140.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    M120
    $460.00
    P-ORAL DRUGS
    M120
    $80.00
    $680.00
    MATERIALS: CONTACT, MEDICALLYO004
    REQUIRED
    $324.00
    SLT-OFFICE
    S060
    $780.00
    S060
    $200.00
    P-INJECTABLES
    S060
    $200.00
    P-ORAL DRUGS
    P019
    $152.55
    P-ORAL DRUGS
    P435
    $547.62
    ABORATORY
    S060
    $20.00
    DIAGNOSTIC: INITIAL ORAL EXAM D89
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D89
    $150.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D89
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D89
    TIMES (EXCLUDE
    $55.00
    PROPHYLAXIS)

    DIAGNOSTIC: COMPLETE SERIES OF


    D89
    BITEWING X-RAYS
    $225.00
    M072
    $100.00
    M693
    $150.00
    P-INJECTABLES
    M693
    $120.00
    P-ORAL DRUGS
    M693
    $100.00
    ABORATORY
    M693
    $100.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: CONTACT, WHEN NOTO004
    MEDICALLY REQUIRED
    $200.00
    O004
    $66.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $396.00
    $4,306.17
    M205
    $240.00
    T060
    $670.00
    UN01
    $2,070.00
    $2,980.00
    M089
    $180.00
    ABORATORY
    M089
    $400.00
    P-ORAL DRUGS
    P055
    $69.00
    S458
    $300.00
    $949.00
    M205
    $240.00
    P-ORAL DRUGS
    P094
    $532.50
    M205
    $240.00
    P-ORAL DRUGS
    P094
    $532.50
    M205
    $240.00
    P-ORAL DRUGS
    P094
    $532.50
    PREVENTIVE: DENTAL PROPHYLAXIS
    D152
    $500.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D152VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D152VIEW
    $230.00
    M205
    $240.00
    P-INJECTABLES
    M205
    $100.00
    P-ORAL DRUGS
    M205
    $80.00
    P-ORAL DRUGS
    P094
    $553.50
    $4,091.00
    L006
    $400.00
    M769
    $150.00
    P-INJECTABLES
    M769
    $400.00
    P-ORAL DRUGS
    P435
    $83.27
    M769
    $150.00
    P-INJECTABLES
    M769
    $400.00
    T041
    $1,150.00
    UN01
    $790.00
    T041
    $2,825.00
    $6,348.27
    DIAGNOSTIC: INITIAL ORAL EXAM D191
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D191
    X-RAY, SINGLE
    $35.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D191
    X-RAY, SINGLE
    $15.00
    VIEW
    $150.00
    M312
    $100.00
    $100.00
    COMPLETE EXAMINATION
    O008
    $80.00
    MATERIALS: FRAMES
    O008
    $1,300.00

    MATERIALS: LENS, EACH-TRI-FOCAL


    O008
    $750.00
    DIAGNOSTIC: INITIAL ORAL EXAM D120
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D120
    $300.00
    $2,500.00
    M225
    $240.00
    ABORATORY
    M225
    $60.00
    ABORATORY
    L001
    $795.00
    L006
    $400.00
    T034
    $2,050.00
    T034
    $425.00
    $3,970.00
    M089
    $200.00
    ABORATORY
    H005
    $815.00
    P-ORAL DRUGS
    P122
    $37.50
    ABORATORY
    H005
    $200.00
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D125
    X-RAY, SINGLE
    $35.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D125
    X-RAY, SINGLE
    $35.00
    VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D125
    W ANESTHESIA
    $200.00
    & POST OPER
    P-ORAL DRUGS
    P122
    $173.00
    P-ORAL DRUGS
    P487
    $87.30
    SLT-OFFICE
    S239
    $200.00
    L006
    $500.00
    L006
    $120.00
    M089
    $200.00
    P-ORAL DRUGS
    P435
    $81.15
    M630
    $160.00
    P-ORAL DRUGS
    P122
    $183.00
    P-ORAL DRUGS
    P122
    $173.00
    P-ORAL DRUGS
    P122
    $173.00
    P-ORAL DRUGS
    P122
    $173.00
    P-ORAL DRUGS
    P122
    $153.75
    P-ORAL DRUGS
    P122
    $102.50
    $4,082.20
    M317
    $120.00
    P-ORAL DRUGS
    M317
    $30.00
    $150.00
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D38
    OR CEPHALOMETRIC
    $85.00
    X-RAY)
    $85.00
    M053
    $140.00
    P-ORAL DRUGS
    P256
    $124.40
    $264.40
    M018
    $200.00
    P-ORAL DRUGS
    M018
    $300.00
    P-ORAL DRUGS
    P115
    $219.80
    P-ORAL DRUGS
    P031
    $59.43
    P-ORAL DRUGS
    P215
    $1,312.50
    $2,091.73
    SLT-OFFICE
    S114
    $400.00
    P-INJECTABLES
    S114
    $50.00
    P-ORAL DRUGS
    P106
    $246.75
    M422
    $320.00
    P-ORAL DRUGS
    M422
    $100.00

    P-ORAL DRUGS
    P-ORAL DRUGS
    SLT-OFFICE

    M422
    M422
    S114

    $80.00
    $30.00
    $1,200.00
    $2,426.75
    M630
    $180.00
    ABORATORY
    P093
    $560.00
    P-ORAL DRUGS
    P066
    $487.31
    P-ORAL DRUGS
    P066
    $3,271.25
    P-ORAL DRUGS
    P005
    $947.94
    P-ORAL DRUGS
    P005
    $631.96
    $6,078.46
    P-ORAL DRUGS
    P011
    $56.00
    M473
    $120.00
    P-ORAL DRUGS
    P435
    $151.78
    P-ORAL DRUGS
    P435
    $108.01
    M473
    $120.00
    P-ORAL DRUGS
    P435
    $285.94
    P-ORAL DRUGS
    P435
    $108.41
    P-ORAL DRUGS
    P435
    $285.94
    COMPLETE EXAMINATION
    O033
    $230.00
    MATERIALS: FRAMES
    O033
    $625.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O033
    $373.50
    MATERIALS: CONTACT, WHEN NOTO033
    MEDICALLY REQUIRED
    $1,015.00
    M473
    $120.00
    P-ORAL DRUGS
    P435
    $306.36
    ABORATORY
    L001
    $640.00
    L046
    $140.00
    $4,686.44
    M030
    $160.00
    P-ORAL DRUGS
    P115
    $88.80
    $248.80
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $575.00
    MATERIALS: LENS, EACH-BI-FOCALO001
    $1,050.00
    $1,735.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D343
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D343
    $210.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D343
    X-RAY, SINGLE
    $70.00
    VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D343CAVITY $260.00
    DIAGNOSTIC: INITIAL ORAL EXAM D343
    (EXCLUDE X-RAY)
    $80.00
    OTHER
    P094
    $156.75
    PREVENTIVE: DENTAL PROPHYLAXIS
    D343
    $290.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D343
    X-RAY, SINGLE
    $70.00
    VIEW
    IT-HOSPITAL
    H005
    $455.00
    P-ORAL DRUGS
    H005
    $13.95
    IT-HOSPITAL
    H005
    $300.00
    H005
    $585.31
    DIAGNOSTIC: COMPLETE INTRAORAL
    D143
    SERIES OF PERIAPICAL
    $250.00 X-RAYS
    OTHER SERVICES: SPECIAL CONSULTATION
    S452
    (ADVISE
    $300.00
    OTHER DENTISTS/PHYS)
    M473
    $140.00
    P-ORAL DRUGS
    P256
    $192.50
    M473
    $160.00
    ABORATORY
    H005
    $150.00

    $3,883.51
    $475.00
    SLT-OFFICE
    $400.00
    $875.00
    SLT-OFFICE
    S361
    $300.00
    $300.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D31 CAVITY $1,140.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D31 VIEW
    $150.00
    SLT-OFFICE
    S220
    $600.00
    O156
    $150.00
    S220
    $150.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D31 CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D31 CAVITY $430.00
    M019
    $300.00
    P-ORAL DRUGS
    P049
    $25.35
    P-ORAL DRUGS
    P049
    $488.45
    COMPLETE EXAMINATION
    O007
    $100.00
    SLT-OFFICE
    M019
    $75.00
    M019
    $225.00
    P-ORAL DRUGS
    P049
    $11.16
    P-ORAL DRUGS
    P049
    $10.95
    P-ORAL DRUGS
    P049
    $2.79
    ENDODONTICS: PULP CAPPING (EXCLUDE
    D31
    RESTORATION)
    $540.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D31 CAVITY $595.00
    M638
    $140.00
    L143
    $500.00
    M638
    $280.00
    L006
    $200.00
    M638
    $140.00
    ABORATORY
    M638
    $1,240.00
    M638
    $300.00
    M638
    $280.00
    ABORATORY
    M638
    $660.00
    MATERIALS: FRAMES
    O001
    $775.00
    MATERIALS: FRAMES
    O001
    $1,515.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $475.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $987.00
    $12,626.45
    SLT-OFFICE
    S255
    $200.00
    SLT-OFFICE
    S255
    $200.00
    $400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D125VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D125VIEW
    $105.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D125
    ROOT$600.00
    PLANING, SCALING, EACH
    $855.00
    M123
    $150.00
    P-INJECTABLES
    M123
    $40.00
    ABORATORY
    M123
    $60.00
    M123
    $150.00
    M144
    $200.00
    P-ORAL DRUGS
    P427
    $149.25
    P-ORAL DRUGS
    P195
    $120.00
    H025
    S278

    $869.25
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D264
    W ANESTHESIA
    $600.00
    & POST OPER
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D264CAVITY $1,140.00
    $1,740.00
    M693
    $150.00
    P-INJECTABLES
    M693
    $25.00
    P-INJECTABLES
    M693
    $75.00
    $250.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: CONTACT, WHEN NOTO004
    MEDICALLY REQUIRED
    $500.00
    $700.00
    M248
    $160.00
    P-ORAL DRUGS
    P458
    $46.50
    M248
    $160.00
    ABORATORY
    L97
    $405.00
    $771.50
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,200.00
    MATERIALS: FRAMES
    O076
    $730.75
    SLT-OFFICE
    S084
    $300.00
    H006
    $600.00
    $2,830.75
    SLT-OFFICE
    S209
    $200.00
    M144
    $200.00
    P-ORAL DRUGS
    P467
    $31.00
    P-ORAL DRUGS
    P467
    $51.90
    P-ORAL DRUGS
    P467
    $64.10
    PREVENTIVE: DENTAL PROPHYLAXIS
    D253
    $300.00
    $847.00
    DIAGNOSTIC: INITIAL ORAL EXAM D104
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D104
    X-RAY, SINGLE
    $70.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D104
    X-RAY, SINGLE
    $60.00
    VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D104
    ROOT$500.00
    PLANING, SCALING, EACH
    OTHER
    D104
    $80.00
    $790.00
    P-ORAL DRUGS
    P435
    $27.60
    P-ORAL DRUGS
    P203
    $74.67
    P-ORAL DRUGS
    P303
    $8.00
    P-ORAL DRUGS
    P436
    $53.33
    P-ORAL DRUGS
    P436
    $53.33
    P-ORAL DRUGS
    P203
    $101.33
    P-ORAL DRUGS
    P303
    $16.00
    $334.26
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $125.00
    ENDODONTICS: PULP CAPPING (EXCLUDE
    D04
    RESTORATION)
    $70.00
    ENDODONTICS: PULP CAPPING (EXCLUDE
    D04
    RESTORATION)
    $55.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D04X-RAY, SINGLE
    $80.00
    VIEW
    $330.00
    UN01
    $200.00
    UN01
    $250.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $956.25
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $782.00
    S302
    $360.00

    ABORATORY
    SLT-OFFICE
    P-INJECTABLES

    S302
    S137
    S137
    UN01

    $140.00
    $450.00
    $350.00
    $300.00
    $3,898.25
    M657
    $200.00
    ABORATORY
    L006
    $800.00
    P-ORAL DRUGS
    P318
    $178.35
    P-ORAL DRUGS
    P318
    $120.75
    M657
    $100.00
    P-ORAL DRUGS
    P031
    $167.16
    SLT-OFFICE
    S279
    $500.00
    L075
    $3,420.00
    P-ORAL DRUGS
    P508
    $340.74
    SLT-OFFICE
    S279
    $400.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D66 CAVITY $280.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D66 CAVITY $340.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D66 SURFACE $610.00
    CAVITY
    T061
    $1,840.00
    SLT-OFFICE
    S279
    $400.00
    $9,697.00
    S312
    $150.00
    ABORATORY
    S312
    $450.00
    ABORATORY
    L065
    $225.00
    SLT-OFFICE
    S277
    $300.00
    M310
    $150.00
    ABORATORY
    M310
    $320.00
    P-ORAL DRUGS
    P306
    $86.00
    P-ORAL DRUGS
    P399
    $101.30
    SLT-OFFICE
    S363
    $300.00
    ABORATORY
    L070
    $690.00
    ABORATORY
    L070
    $200.00
    S363
    $400.00
    S277
    $300.00
    ABORATORY
    L070
    $1,330.00
    SLT-OFFICE
    S363
    $200.00
    ABORATORY
    L070
    $40.00
    $5,242.30
    SLT-OFFICE
    S239
    $300.00
    ABORATORY
    S376
    $450.00
    ABORATORY
    S376
    $515.00
    P-ORAL DRUGS
    P435
    $122.43
    $1,387.43
    S369
    $400.00
    P-ORAL DRUGS
    P491
    $147.50
    $547.50
    M534
    $200.00
    P-INJECTABLES
    M534
    $100.00
    P-ORAL DRUGS
    M534
    $60.00
    L164
    $400.00
    L164
    $360.00
    $1,120.00
    M331
    $140.00

    P-INJECTABLES
    P-INJECTABLES

    M331
    M331
    L174
    P179

    $25.00
    $175.00
    $340.00
    P-ORAL DRUGS
    $209.00
    $889.00
    M076
    $500.00
    M076
    $1,250.00
    $1,750.00
    M727
    $400.00
    ABORATORY
    L068
    $750.00
    $1,150.00
    COMPLETE EXAMINATION
    O001
    $270.00
    $270.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $876.00
    $1,076.00
    M657
    $200.00
    P-ORAL DRUGS
    P337
    $98.00
    P-ORAL DRUGS
    P337
    $315.70
    $613.70
    ENATAL CARE
    L151
    $300.00
    ENATAL CARE
    S005
    $300.00
    M818
    $260.00
    $860.00
    S231
    $300.00
    P-ORAL DRUGS
    P031
    $134.70
    P-ORAL DRUGS
    P011
    $388.50
    P-ORAL DRUGS
    P031
    $251.72
    T034
    $1,800.00
    $2,874.92
    S041
    $400.00
    L006
    $550.00
    M657
    $200.00
    ABORATORY
    L140
    $1,275.00
    M657
    $200.00
    ABORATORY
    M657
    $585.00
    ABORATORY
    L140
    $535.00
    L140
    $180.00
    L140
    $400.00
    L140
    $120.00
    P-ORAL DRUGS
    P215
    $305.05
    SLT-OFFICE
    S367
    $300.00
    P-ORAL DRUGS
    P215
    $206.90
    DIAGNOSTIC: INITIAL ORAL EXAM D183
    (EXCLUDE X-RAY)
    $250.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D183
    $400.00
    S367
    $300.00
    P-ORAL DRUGS
    P215
    $65.40
    PREVENTIVE: DENTAL PROPHYLAXIS
    D77
    $250.00
    $6,522.35
    DIAGNOSTIC: INITIAL ORAL EXAM D77
    (EXCLUDE X-RAY)
    $60.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D77
    $250.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D77
    $150.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D77 CAVITY $200.00

    OPERATIVE: AMALGAM FILL 2 SURFACE


    D77 CAVITY $200.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D77 SURFACE $400.00
    CAVITY
    L018
    $660.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D77 CAVITY $300.00
    M375
    $280.00
    $2,500.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,355.75
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,581.00
    M089
    $180.00
    $3,226.75
    PREVENTIVE: DENTAL PROPHYLAXIS
    D266
    $360.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D266VIEW
    $40.00
    OTHER
    P247
    $86.00
    $486.00
    DIAGNOSTIC: INITIAL ORAL EXAM D148
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D148
    $600.00
    PREVENTIVE: TOPICAL STANNOUS D148
    FLUORIDE, ONE$180.00
    (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D148 SURFACE
    $1,000.00
    CAVITY
    SLT-OFFICE
    S089
    $450.00
    ABORATORY
    H006
    $180.00
    H006
    $360.00
    P-ORAL DRUGS
    P512
    $169.75
    SLT-OFFICE
    S089
    $450.00
    S089
    $225.00
    $3,714.75
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D353CAVITY $220.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,820.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,320.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D353CAVITY $220.00
    $3,690.00
    M633
    $200.00
    L034
    $400.00
    M633
    $100.00
    P-ORAL DRUGS
    P155
    $175.00
    M633
    $100.00
    M633
    $300.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $796.00
    MATERIALS: LENS, EACH-BI-FOCALO004
    $1,656.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $796.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,016.00
    M633
    $100.00
    P-ORAL DRUGS
    P155
    $452.20
    $6,291.20
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $952.88
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,057.87
    M352
    $310.00
    H006
    $700.00
    P-ORAL DRUGS
    M352
    $320.00

    P-ORAL DRUGS

    M352
    S301

    $40.00
    $200.00
    $3,670.75
    H047
    $8,000.00
    ENSIVE CARE
    H047
    $4,800.00
    H047
    $80,503.10
    H047
    $27,312.12
    H047
    $12,484.78
    $133,100.00
    S250
    $200.00
    H006
    $400.00
    $600.00
    IT-HOSPITAL
    H005
    $90.00
    IT-HOSPITAL
    H005
    $335.00
    ABORATORY
    H005
    $130.00
    H005
    $200.00
    P-ORAL DRUGS
    H005
    $82.95
    P-INJECTABLES
    H005
    $208.50
    P-INJECTABLES
    H005
    $52.13
    $1,098.58
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $150.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $90.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D133CAVITY $700.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D113CAVITY $450.00
    M020
    $180.00
    P-ORAL DRUGS
    P337
    $284.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D424
    ROOT$500.00
    PLANING, SCALING, EACH
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D242CAVITY $400.00
    $2,834.00
    M215
    $250.00
    ABORATORY
    L070
    $1,400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D13
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D13
    $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D13 CAVITY $1,500.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D13 CAVITY $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D13 CAVITY $300.00
    M215
    $250.00
    $4,300.00
    S007
    $240.00
    P-ORAL DRUGS
    P435
    $150.08
    S159
    $2,550.00
    S159
    $17,423.24
    S159
    $6,000.00
    S159
    $30,000.00
    S159
    $20,629.30
    DIAGNOSTIC: INITIAL ORAL EXAM D375
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D375
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D375
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $200.00 AFTER 1ST 6 MONTHS
    $77,592.62
    MATERIALS: FRAMES
    O076
    $3,095.00
    MATERIALS: LENS, EACH-BI-FOCALO076
    $1,970.00

    $5,065.00
    $140.00
    $160.00
    P-ORAL DRUGS
    $289.10
    $589.10
    ABORATORY
    H006
    $220.00
    S277
    $75.00
    S277
    $225.00
    M630
    $180.00
    M654
    $160.00
    P-ORAL DRUGS
    P122
    $87.99
    P-ORAL DRUGS
    P435
    $288.15
    P-ORAL DRUGS
    P435
    $76.31
    M654
    $160.00
    S264
    $75.00
    S264
    $325.00
    ABORATORY
    S264
    $150.00
    ABORATORY
    L071
    $150.00
    MATERIALS: FRAMES
    O169
    $2,155.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O169
    $1,485.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D424
    X-RAY, SINGLE
    $44.80
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D424
    X-RAY, SINGLE
    $11.20
    VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D424 SURFACE $232.80
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D424 SURFACE $183.20
    CAVITY
    $6,284.45
    M140
    $150.00
    L065
    $390.00
    $540.00
    M060
    $400.00
    M060
    $200.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $50.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    M549
    $100.00
    P-ORAL DRUGS
    P081
    $394.50
    M060
    $200.00
    M060
    $300.00
    $1,894.50
    M099
    $120.00
    P-ORAL DRUGS
    P011
    $78.00
    $198.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O025
    $950.00
    MATERIALS: FRAMES
    O025
    $795.00
    M045
    $150.00
    P-ORAL DRUGS
    P090
    $73.50
    ABORATORY
    L001
    $50.00
    M045
    $150.00
    P-ORAL DRUGS
    P090
    $78.75
    M045
    $150.00
    P-INJECTABLES
    M045
    $50.00
    $2,447.25
    COMPLETE EXAMINATION
    O001
    $110.00
    $110.00
    M067
    M067
    P014

    M707
    M707
    M707
    S379
    M707
    M707

    $300.00
    $100.00
    $140.00
    SLT-OFFICE
    $400.00
    $250.00
    $270.00
    $1,460.00
    DIAGNOSTIC: INITIAL ORAL EXAM D41
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D41
    $500.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D41 VIEW
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D41 VIEW
    $100.00
    ORAL SURGERY: SURGICAL REMOVAL
    D41OF TOOTH W
    $900.00
    SOFT TISSUE IMPACTION
    DIAGNOSTIC: COMPLETE SERIES OF
    S433
    BITEWING X-RAYS
    $300.00
    $2,000.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D264
    $360.00
    COMPLETE EXAMINATION
    O002
    $200.00
    MATERIALS: CONTACT, WHEN NOTO002
    MEDICALLY REQUIRED
    $275.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $786.25
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $527.00
    ABORATORY
    L001
    $164.00
    ABORATORY
    L001
    $241.00
    ABORATORY
    M068
    $16.00
    $2,679.25
    M707
    $520.00
    M772
    $120.00
    P-ORAL DRUGS
    P474
    $528.75
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $2,495.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $960.00
    $4,733.75
    IT-HOSPITAL
    H005
    $380.00
    ABORATORY
    H005
    $44.68
    P-ORAL DRUGS
    H005
    $105.23
    $529.91
    S115
    $600.00
    P-ORAL DRUGS
    P154
    $127.30
    S115
    $4,000.00
    M357
    $1,500.00
    H066
    $600.00
    H066
    $3,900.00
    $10,727.30
    M100
    $160.00
    P-ORAL DRUGS
    P106
    $135.00
    P-ORAL DRUGS
    P106
    $45.00
    $340.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D104CAVITY $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D104CAVITY $140.00
    $340.00
    DIAGNOSTIC: INITIAL ORAL EXAM D58
    (EXCLUDE X-RAY)
    $60.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D58 VIEW
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D58
    $350.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D58 CAVITY $850.00

    $1,360.00
    $240.00
    $240.00
    COMPLETE EXAMINATION
    O001
    $110.00
    DIAGNOSTIC: INITIAL ORAL EXAM D59
    (EXCLUDE X-RAY)
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D59 VIEW
    $150.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D59 VIEW
    $90.00
    ENDODONTICS: EXTIRPATION OF PULP
    D59 & FILL 1 $1,400.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D59 CAVITY $540.00
    $2,360.00
    DIAGNOSTIC: INITIAL ORAL EXAM D77
    (EXCLUDE X-RAY)
    $60.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D77
    $250.00
    M353
    $150.00
    O001
    $200.00
    M637
    $120.00
    P-ORAL DRUGS
    P003
    $126.00
    P-ORAL DRUGS
    P003
    $50.00
    M637
    $270.00
    P-ORAL DRUGS
    P003
    $491.00
    $1,717.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,970.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,450.00
    $3,600.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D283
    $400.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D283
    $400.00
    COMPLETE EXAMINATION
    O004
    $36.00
    MATERIALS: CONTACT, WHEN NOTO004
    MEDICALLY REQUIRED
    $656.00
    $1,492.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $786.25
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $527.00
    $1,423.25
    M060
    $200.00
    M060
    $200.00
    P-INJECTABLES
    M060
    $340.00
    M060
    $200.00
    $940.00
    IT-HOSPITAL
    H023
    $375.00
    P-ORAL DRUGS
    H023
    $40.00
    S313
    $300.00
    P-ORAL DRUGS
    P066
    $360.75
    IT-HOSPITAL
    H023
    $375.00
    S313
    $300.00
    P-ORAL DRUGS
    P031
    $264.48
    S046
    $350.00
    S313
    $400.00
    S313
    $400.00
    P-ORAL DRUGS
    P435
    $29.39
    $3,194.62
    M638
    $140.00
    ABORATORY
    M638
    $300.00
    M818

    P-INJECTABLES
    P-INJECTABLES
    P-ORAL DRUGS

    M638
    M638
    P488
    M638
    M638
    M638

    $25.00
    $55.00
    $239.00
    $140.00
    ABORATORY
    $140.00
    P-ORAL DRUGS
    $100.00
    $1,139.00
    M230
    $300.00
    P-INJECTABLES
    M230
    $25.00
    P-INJECTABLES
    M230
    $175.00
    M230
    $1,100.00
    P-ORAL DRUGS
    P475
    $95.00
    $1,695.00
    DIAGNOSTIC: INITIAL ORAL EXAM D104
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D104
    $280.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D104CAVITY $340.00
    $700.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,036.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,773.00
    O076
    $65.00
    $2,964.00
    M374
    $200.00
    P-ORAL DRUGS
    P435
    $100.80
    P-ORAL DRUGS
    P435
    $57.83
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D125VIEW
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D125VIEW
    $30.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D125
    $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D125CAVITY $360.00
    $1,228.63
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $716.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,656.00
    DIAGNOSTIC: INITIAL ORAL EXAM D439
    (EXCLUDE X-RAY)
    $110.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D439
    X-RAY, SINGLE
    $100.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D439
    X-RAY, SINGLE
    $90.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D439
    $480.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D59 CAVITY $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D59 CAVITY $290.00
    $3,742.00
    M549
    $100.00
    P-ORAL DRUGS
    P256
    $278.30
    P-ORAL DRUGS
    P031
    $230.49
    M692
    $500.00
    SLT-OFFICE
    S046
    $400.00
    ABORATORY
    S046
    $100.00
    L162
    $300.00
    P-ORAL DRUGS
    P256
    $1,135.55
    DIAGNOSTIC: INITIAL ORAL EXAM D119
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D119
    X-RAY, SINGLE
    $100.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D119
    X-RAY, SINGLE
    $30.00
    VIEW
    ENDODONTICS: EXTIRPATION OF PULP
    D119& FILL 1 $2,000.00
    ROOT CANAL (EX RESTOR)

    OPERATIVE: AMALGAM FILL 3 OR MORE


    D119 SURFACE $450.00
    CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    D119
    $400.00
    $6,074.34
    M215
    $1,000.00
    P-INJECTABLES
    M215
    $600.00
    P-ORAL DRUGS
    P435
    $489.00
    M215
    $250.00
    $2,339.00
    COMPLETE EXAMINATION
    O177
    $100.00
    MATERIALS: FRAMES
    O177
    $2,125.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O177
    $2,700.00
    $4,925.00
    S165
    $300.00
    P-ORAL DRUGS
    P031
    $67.99
    S019
    $50.00
    S019
    $210.00
    $627.99
    M049
    $120.00
    P-ORAL DRUGS
    P155
    $117.40
    OTHER SERVICES: EMERGENCY TREATMENT
    D192
    OF DENTAL
    $50.00
    PAIN
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D192VIEW
    $110.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D192CAVITY $500.00
    ENDODONTICS: EXTIRPATION OF PULP
    D192& FILL 1 ROOT
    $350.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D192& FILL 1 $1,050.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D192 SURFACE
    $1,000.00
    CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D192CAVITY $500.00
    $3,797.40
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $807.74
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $848.26
    $1,746.00
    M046
    $100.00
    ABORATORY
    L074
    $60.00
    P-ORAL DRUGS
    P150
    $48.00
    M814
    $140.00
    ABORATORY
    M814
    $155.00
    $503.00
    M156
    $200.00
    ABORATORY
    M156
    $40.00
    P-ORAL DRUGS
    P501
    $2,772.00
    M156
    $200.00
    P-ORAL DRUGS
    P501
    $1,611.00
    M156
    $300.00
    M156
    $300.00
    ABORATORY
    H066
    $250.00
    P-ORAL DRUGS
    P501
    $5,571.00
    $11,244.00
    S253
    $300.00
    S253
    $350.00
    M346
    $200.00
    P-INJECTABLES
    M346
    $200.00
    P-ORAL DRUGS
    P247
    $127.75
    DIAGNOSTIC: INITIAL ORAL EXAM D09
    (EXCLUDE X-RAY)
    $75.00

    DIAGNOSTIC: BITEWING X-RAY, SINGLE


    D09 VIEW
    $25.00
    ORAL SURGERY: SURGICAL REMOVAL
    D09OF TOOTH W
    $300.00
    SOFT TISSUE IMPACTION
    $1,577.75
    M285
    $120.00
    P-INJECTABLES
    M285
    $130.00
    P-ORAL DRUGS
    P057
    $487.50
    M285
    $120.00
    P-INJECTABLES
    M285
    $80.00
    M285
    $80.00
    P-INJECTABLES
    M285
    $70.00
    P-ORAL DRUGS
    P057
    $483.00
    $1,570.50
    M007
    $100.00
    P-ORAL DRUGS
    P450
    $652.50
    P-ORAL DRUGS
    M007
    $20.00
    P-ORAL DRUGS
    P450
    $191.40
    M786
    $100.00
    P-ORAL DRUGS
    P450
    $508.50
    P-ORAL DRUGS
    P450
    $16.00
    $1,588.40
    S130
    $300.00
    $300.00
    M108
    ($150.00)
    M108
    $150.00
    P-ORAL DRUGS
    P031
    ($223.44)
    P-ORAL DRUGS
    P031
    $223.44
    M108
    $150.00
    L006
    $550.00
    P-ORAL DRUGS
    P031
    $223.44
    $923.44
    M190
    $80.00
    P-INJECTABLES
    M190
    $60.00
    M584
    $600.00
    P-ORAL DRUGS
    M584
    $191.00
    P-ORAL DRUGS
    P483
    $141.60
    M190
    $100.00
    P-INJECTABLES
    M190
    $100.00
    $1,272.60
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D59 CAVITY $375.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D59 CAVITY $1,975.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D59 CAVITY $590.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D59 SURFACE
    $1,160.00
    CAVITY
    $4,100.00
    M694
    $100.00
    P-ORAL DRUGS
    M694
    $140.00
    P-INJECTABLES
    M694
    $200.00
    M694
    $100.00
    DIAGNOSTIC: INITIAL ORAL EXAM D239
    (EXCLUDE X-RAY)
    $90.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D239
    X-RAY, SINGLE
    $25.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D239
    X-RAY, SINGLE
    $50.00
    VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D239 SURFACE $120.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D239 SURFACE $575.00
    CAVITY
    $1,400.00

    M164

    $120.00
    $120.00
    M171
    $300.00
    P-ORAL DRUGS
    P011
    $78.50
    P-ORAL DRUGS
    P011
    $120.00
    M230
    $300.00
    P-ORAL DRUGS
    M230
    $200.00
    P-ORAL DRUGS
    P014
    $88.00
    $1,086.50
    M176
    $160.00
    M176
    $480.00
    P-INJECTABLES
    M176
    $120.00
    $760.00
    M304
    $185.00
    $185.00
    M700
    $140.00
    P-ORAL DRUGS
    P413
    $214.80
    L089
    $128.00
    $482.80
    M248
    $160.00
    P-ORAL DRUGS
    P014
    $99.00
    $259.00
    P-ORAL DRUGS
    P369
    $193.45
    P-ORAL DRUGS
    P369
    $270.45
    P-ORAL DRUGS
    P369
    $270.45
    M647
    $160.00
    P-INJECTABLES
    M647
    $280.00
    SUTURING SURFACE WOUNDS: ONE
    M647
    OR MORE W 5$500.00
    OR FEWER STITCHES
    M647
    $100.00
    SLT-OFFICE
    S174
    $300.00
    PROSTATE: TRANSURETHRAL RESECTION
    S174
    $1,200.00
    H027
    $1,000.00
    P-ORAL DRUGS
    P369
    $163.99
    M647
    $80.00
    P-INJECTABLES
    M647
    $160.00
    SLT-OFFICE
    S159
    $300.00
    SLT-OFFICE
    S265
    $300.00
    $5,278.34
    S004
    $400.00
    P-ORAL DRUGS
    P167
    $190.50
    $590.50
    M786
    $80.00
    ABORATORY
    M786
    $20.00
    P-ORAL DRUGS
    P140
    $29.50
    P-ORAL DRUGS
    M786
    $40.00
    $169.50
    DIAGNOSTIC: INITIAL ORAL EXAM D74
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D74X-RAY, SINGLE
    $50.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D74X-RAY, SINGLE
    $120.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D74
    $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D74 CAVITY $600.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D74 CAVITY $1,200.00
    ENDODONTICS: EXTIRPATION OF PULP
    D74 & FILL 1 $1,700.00
    ROOT CANAL (EX RESTOR)

    $4,020.00
    $400.00
    P-INJECTABLES
    $150.00
    $700.00
    $200.00
    P-INJECTABLES
    $150.00
    $400.00
    ABORATORY
    $400.00
    $150.00
    ABORATORY
    $170.00
    $400.00
    P-ORAL DRUGS
    $417.75
    $300.00
    P-ORAL DRUGS
    $385.90
    $300.00
    P-ORAL DRUGS
    $726.00
    P-ORAL DRUGS
    $457.32
    $5,706.97
    M597
    $200.00
    P-ORAL DRUGS
    P435
    $206.31
    $406.31
    ORAL SURGERY: SURGICAL REMOVAL
    D82OF TOOTH W
    $400.00
    SOFT TISSUE IMPACTION
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $2,600.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $600.00 AFTER 1ST 6 MONTHS
    S400
    $300.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $600.00 AFTER 1ST 6 MONTHS
    P-INJECTABLES
    S400
    $300.00
    S400
    $350.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $600.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $600.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $600.00 AFTER 1ST 6 MONTHS
    $6,950.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D77
    $300.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D77
    W ANESTHESIA
    $60.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D77
    W ANESTHESIA
    $60.00
    & POST OPER
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D232CAVITY $560.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D232CAVITY $520.00
    $1,500.00
    M501
    $200.00
    M501
    $200.00
    M501
    $200.00
    $600.00
    M501
    $200.00
    M501
    $200.00
    M501
    $200.00
    $600.00
    S220
    $80.00
    S220
    $200.00
    $280.00
    M055
    $200.00
    P-ORAL DRUGS
    P246
    $358.20
    P-ORAL DRUGS
    P031
    $69.39
    P-ORAL DRUGS
    P435
    $39.74
    M858
    M858
    H006
    M858
    M858
    S001
    L081
    L006
    L021
    L006
    P066
    S001
    P005
    S001
    P511
    P066

    $667.33
    $120.00
    P-ORAL DRUGS
    $270.00
    $240.00
    P-ORAL DRUGS
    $140.00
    ABORATORY
    $90.00
    P-ORAL DRUGS
    $1,120.00
    ABORATORY
    $170.00
    $120.00
    P-ORAL DRUGS
    $182.00
    $2,452.00
    M215
    $250.00
    P-ORAL DRUGS
    P372
    $635.00
    P-ORAL DRUGS
    P343
    $319.20
    ENDODONTICS: EXTIRPATION OF PULP
    D224& FILL 2 ROOT
    $900.00
    CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D224CAVITY $100.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D224CAVITY $250.00
    $2,454.20
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D38
    OR CEPHALOMETRIC
    $100.00
    X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D38
    OR$1,700.00
    CEPHALOMETRIC X-RAY)
    OTHER SERVICES: SPECIAL CONSULTATION
    D194
    (ADVISE
    $200.00
    OTHER DENTISTS/PHYS)
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D38
    $10,700.00
    TREATMENT AFTER 1ST 6 MONTHS
    M237
    $120.00
    P-ORAL DRUGS
    M237
    $1,030.00
    P-INJECTABLES
    M237
    $60.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D38
    TREATMENT
    $900.00 AFTER 1ST 6 MONTHS
    $14,810.00
    M514
    $200.00
    P-ORAL DRUGS
    P179
    $100.00
    $300.00
    SLT-OFFICE
    S250
    $400.00
    P-ORAL DRUGS
    P286
    $407.75
    P-ORAL DRUGS
    P011
    $288.75
    S250
    $200.00
    P-ORAL DRUGS
    P435
    $428.14
    S020
    $200.00
    P-ORAL DRUGS
    P022
    $167.65
    L176
    $1,100.00
    SLT-OFFICE
    S093
    $350.00
    S020
    $200.00
    ABORATORY
    S020
    $150.00
    S020
    $350.00
    P-ORAL DRUGS
    P022
    $412.05
    IT-HOSPITAL
    S093
    $500.00
    S093
    $750.00
    S093
    $300.00
    S250
    $200.00
    S250
    $200.00
    P-ORAL DRUGS
    P286
    $169.57
    $6,773.91
    M375
    $160.00
    ABORATORY
    M375
    $160.00
    P-ORAL DRUGS
    P068
    $33.39
    M189
    P059
    M189
    P059
    L065
    P059
    L065
    M189
    P059

    $160.00
    $70.00
    $100.00
    $683.39
    M068
    $260.00
    ABORATORY
    L081
    $725.00
    M068
    $240.00
    ABORATORY
    M068
    $40.00
    L006
    $400.00
    M068
    $250.00
    L006
    $200.00
    M038
    $400.00
    $2,515.00
    M346
    $200.00
    P-INJECTABLES
    M346
    $280.00
    P-ORAL DRUGS
    P003
    $137.20
    $617.20
    M067
    ($160.00)
    M067
    $160.00
    H006
    ($1,800.00)
    H006
    $1,800.00
    M067
    $160.00
    H006
    $1,800.00
    $1,960.00
    M138
    $120.00
    P-INJECTABLES
    M138
    $120.00
    P-ORAL DRUGS
    P170
    $480.00
    M215
    $100.00
    P-ORAL DRUGS
    P170
    $1,470.00
    M138
    $120.00
    ABORATORY
    L124
    $150.00
    P-ORAL DRUGS
    P170
    $472.50
    M138
    $100.00
    P-ORAL DRUGS
    P170
    $367.00
    M138
    $100.00
    P-ORAL DRUGS
    P170
    $1,530.00
    $5,129.50
    Missing
    $750.00
    Missing
    $300.00
    ABORATORY
    Missing
    $337.00
    $1,387.00
    H066
    $800.00
    ABSCESSES, BOILS & CARBUNCLES:
    S133
    CUTTING OPERATION,
    $3,000.00 HOSPITALIZATION
    L151
    $300.00
    $4,100.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,464.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $536.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $484.00
    $2,594.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $2,173.38
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $618.37

    ABORATORY
    ABORATORY

    M375
    L070
    L023

    $2,881.75
    PREVENTIVE: DENTAL PROPHYLAXIS
    D180
    $450.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D180
    $350.00
    DIAGNOSTIC: INITIAL ORAL EXAM D180
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D180VIEW
    $25.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D180VIEW
    $135.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D180CAVITY $920.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D180CAVITY $300.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D180
    $400.00
    $2,680.00
    P-ORAL DRUGS
    P106
    $413.25
    $413.25
    M183
    $150.00
    ABORATORY
    M183
    $280.00
    P-ORAL DRUGS
    P014
    $330.00
    $760.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,475.00
    MATERIALS: FRAMES
    O001
    $925.00
    $2,490.00
    M002
    $410.00
    P-ORAL DRUGS
    M002
    $225.00
    P-INJECTABLES
    M002
    $100.00
    M002
    $130.00
    P-ORAL DRUGS
    M002
    $200.00
    $1,065.00
    M202
    $200.00
    $200.00
    ABORATORY
    H026
    $1,500.00
    $1,500.00
    M461
    $300.00
    P-INJECTABLES
    M461
    $460.00
    ABORATORY
    L070
    $580.00
    M638
    $280.00
    P-ORAL DRUGS
    M638
    $280.00
    M461
    $300.00
    P-INJECTABLES
    M461
    $540.00
    ABORATORY
    L070
    $900.00
    P-ORAL DRUGS
    P115
    $169.25
    M461
    $150.00
    P-INJECTABLES
    M461
    $260.00
    $4,219.25
    COMPLETE EXAMINATION
    O011
    $80.00
    MATERIALS: FRAMES
    O011
    $620.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O011
    $2,000.00
    $2,700.00
    M104
    $160.00
    P-ORAL DRUGS
    P479
    $555.00
    $715.00
    M371
    $60.00
    P-INJECTABLES
    M371
    $60.00
    P-ORAL DRUGS
    M371
    $70.00
    P-ORAL DRUGS
    P057
    $84.00

    $274.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D244 SURFACE $240.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D244 SURFACE
    $1,010.00
    CAVITY
    $1,250.00
    S149
    $80.00
    M285
    $160.00
    P-INJECTABLES
    M285
    $60.00
    P-ORAL DRUGS
    M285
    $60.00
    $360.00
    S114
    $1,200.00
    P-INJECTABLES
    S114
    $150.00
    $1,350.00
    S173
    $360.00
    S136
    $310.00
    ABORATORY
    H006
    $240.00
    M451
    $300.00
    P-INJECTABLES
    M451
    $200.00
    $1,410.00
    M310
    $150.00
    M310
    $250.00
    P-ORAL DRUGS
    M310
    $60.00
    $460.00
    DIAGNOSTIC: INITIAL ORAL EXAM D217
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D217
    $800.00
    $850.00
    M514
    $300.00
    ABORATORY
    H034
    $360.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $895.00
    MATERIALS: LENS, EACH-BI-FOCALO001
    $750.00
    DIAGNOSTIC: INITIAL ORAL EXAM D389
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D389
    X-RAY, SINGLE
    $150.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D389
    X-RAY, SINGLE
    $400.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D389
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D389
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    $3,465.00
    COMPLETE EXAMINATION
    O004
    $100.00
    COMPLETE EXAMINATION
    O004
    $100.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $947.88
    MATERIALS: LENS, EACH-BI-FOCALO076
    $1,152.87
    $2,390.75
    M726
    $100.00
    P-INJECTABLES
    M726
    $40.00
    P-ORAL DRUGS
    P450
    $68.50
    PROSTHETICS: ADD TOOTH TO PRTD188
    DENT REPL EXTR
    $300.00
    TOOTH W/O CLSP
    MATERIALS: FRAMES
    O076
    $1,525.50
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,375.00
    $3,409.00
    M346
    $100.00
    P-INJECTABLES
    M346
    $100.00
    P-ORAL DRUGS
    P179
    $168.00
    $368.00

    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    O061
    O061
    P066
    O061
    P066

    $190.00
    $190.00
    $71.79
    $190.00
    $215.37
    $857.16
    COMPLETE EXAMINATION
    O002
    $70.00
    MATERIALS: FRAMES
    O002
    $1,355.75
    MATERIALS: LENS, EACH-TRI-FOCAL
    O002
    $2,422.50
    $3,848.25
    M248
    $140.00
    P-ORAL DRUGS
    P422
    $111.25
    M248
    $140.00
    M248
    $100.00
    L97
    $180.00
    ABORATORY
    L97
    $265.00
    M758
    $180.00
    M248
    $140.00
    P-ORAL DRUGS
    P422
    $226.80
    $1,483.05
    M001
    $200.00
    ABORATORY
    M001
    $20.00
    $220.00
    S192
    $300.00
    ABORATORY
    L061
    $70.00
    L149
    $150.00
    P-ORAL DRUGS
    P435
    $439.39
    SLT-OFFICE
    S192
    $300.00
    P-ORAL DRUGS
    P435
    $1,032.08
    $2,291.47
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,036.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $776.00
    $1,912.00
    MATERIALS: FRAMES
    O001
    $1,525.00
    MATERIALS: LENS, EACH-BI-FOCALO001
    $810.00
    $2,335.00
    M388
    $240.00
    P-ORAL DRUGS
    P223
    $224.00
    $464.00
    M225
    $440.00
    ABORATORY
    M225
    $260.00
    L006
    $1,100.00
    P-ORAL DRUGS
    P055
    $81.99
    P-ORAL DRUGS
    P055
    $118.50
    $2,000.49
    S265
    $300.00
    S265
    $280.00
    $580.00
    ENDODONTICS: EXTIRPATION OF PULP
    D337& FILL 1 ROOT
    $350.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D337& FILL 1 $1,250.00
    ROOT CANAL (EX RESTOR)
    $1,600.00
    M018
    $200.00

    P-INJECTABLES
    P-ORAL DRUGS

    M018
    S296
    H003
    SLT-OFFICE
    H003
    ABORATORY
    H003
    H003
    P-ORAL DRUGS
    H003
    P-ORAL DRUGS
    P115
    PREVENTIVE: DENTAL PROPHYLAXIS
    D371
    P-ORAL DRUGS
    S296
    P-ORAL DRUGS
    P115
    M018
    P-INJECTABLES
    M018
    P-ORAL DRUGS
    S296
    ABORATORY
    L065
    P-ORAL DRUGS
    S296
    P-ORAL DRUGS
    S296
    ABORATORY
    L065

    $60.00
    $500.00
    $120.00
    $300.00
    $180.00
    $150.00
    $670.00
    $118.45
    $300.00
    $500.00
    $149.45
    $200.00
    $100.00
    $500.00
    $625.00
    $500.00
    $500.00
    $115.00
    $5,787.90
    M138
    $120.00
    P-INJECTABLES
    M138
    $80.00
    M230
    $300.00
    M230
    $300.00
    P-ORAL DRUGS
    P167
    $187.15
    $987.15
    PREVENTIVE: DENTAL PROPHYLAXIS
    D79
    $140.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D79X-RAY, SINGLE
    $25.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D79X-RAY, SINGLE
    $45.00
    VIEW
    $210.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,036.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,970.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $876.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,770.00
    P-ORAL DRUGS
    P167
    $564.00
    M104
    $360.00
    P-ORAL DRUGS
    P167
    $174.00
    $6,930.00
    S232
    $250.00
    L006
    $400.00
    $650.00
    OTHER SERVICES: EMERGENCY TREATMENT
    D114
    OF DENTAL
    $50.00
    PAIN
    OTHER SERVICES: EMERGENCY TREATMENT
    D114
    OF DENTAL
    $70.00
    PAIN
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D114VIEW
    $50.00
    ORAL SURGERY: SURGICAL REMOVAL
    D114
    OF TOOTH W
    $400.00
    SOFT TISSUE IMPACTION
    $570.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D22
    $200.00
    $200.00
    M758
    $200.00
    P-ORAL DRUGS
    P016
    $142.50
    $342.50
    ABORATORY
    L003
    $620.00

    $620.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D257
    W ANESTHESIA
    $120.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D257
    W ANESTHESIA
    $280.00
    & POST OPER
    PROSTHETICS: PARTIAL UPPER/LOWER
    D257ACRYLIC $2,000.00
    BASE DENTURE W/O CLASP
    $2,400.00
    M864
    $100.00
    P-INJECTABLES
    M864
    $20.00
    P-ORAL DRUGS
    M864
    $20.00
    P-ORAL DRUGS
    P240
    $45.15
    $185.15
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: LENS, EACH-BI-FOCALO076
    $563.35
    MATERIALS: FRAMES
    O076
    $1,122.38
    $1,775.73
    COMPLETE EXAMINATION
    O108
    $85.00
    MATERIALS: FRAMES
    O108
    $1,395.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O108
    $1,220.00
    $2,700.00
    P-ORAL DRUGS
    P340
    $863.00
    $863.00
    M346
    $200.00
    P-INJECTABLES
    M346
    $200.00
    M346
    $100.00
    P-INJECTABLES
    M346
    $100.00
    P-ORAL DRUGS
    P115
    $24.15
    P-ORAL DRUGS
    P115
    $49.00
    M346
    $100.00
    P-INJECTABLES
    M346
    $100.00
    P-ORAL DRUGS
    P115
    $67.55
    M346
    $200.00
    P-INJECTABLES
    M346
    $200.00
    P-ORAL DRUGS
    P115
    $46.80
    $1,387.50
    ABSCESSES, BOILS & CARBUNCLES:
    S370
    CUTTING OPERATION,
    $3,000.00 HOSPITALIZATION
    $3,000.00
    M505
    $180.00
    ABORATORY
    L152
    $310.00
    $490.00
    P-ORAL DRUGS
    P477
    $172.75
    O054
    $120.00
    S174
    $300.00
    M814
    $100.00
    P-INJECTABLES
    M814
    $32.00
    P-INJECTABLES
    M814
    $8.00
    P-ORAL DRUGS
    P318
    $7.20
    P-ORAL DRUGS
    P318
    $1.80
    M138
    $100.00
    P-INJECTABLES
    M138
    $100.00
    P-ORAL DRUGS
    P195
    $51.00
    L046
    $160.00
    $1,152.75
    M441
    $200.00
    P-INJECTABLES
    M441
    $450.00

    P-ORAL DRUGS

    P014

    IT-HOSPITAL

    H006
    H006
    H006

    ABORATORY
    P-ORAL DRUGS

    L065
    P246

    P-INJECTABLES

    P-ORAL DRUGS

    P-ORAL DRUGS

    M067
    M067
    L117
    P478
    S004
    M795
    M795
    M795

    P-ORAL DRUGS

    M213
    M213
    P332

    P-ORAL DRUGS

    M049
    P246

    P-INJECTABLES
    ABORATORY

    M461
    M461
    M461
    L070

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES

    M461
    M461
    M461
    P468
    H033
    M694
    M694
    M694
    M213
    M213
    M213

    P-INJECTABLES

    M647
    M647

    ABORATORY

    S004

    ABORATORY
    ABORATORY

    L079
    L150
    L079

    $183.35
    $833.35
    $100.00
    $1,130.00
    $150.00
    $1,380.00
    $960.00
    $997.40
    $1,957.40
    $460.00
    $60.00
    $1,044.00
    $190.00
    $300.00
    $2,054.00
    $150.00
    $150.00
    $120.00
    $420.00
    $100.00
    $100.00
    $170.50
    $370.50
    $120.00
    $144.20
    $264.20
    $150.00
    $290.00
    $200.00
    $1,540.00
    $2,180.00
    $100.00
    $300.00
    $60.00
    $200.00
    $700.00
    $1,360.00
    $100.00
    $100.00
    $100.00
    $300.00
    $200.00
    $20.00
    $290.00
    $510.00
    $160.00
    $300.00
    $460.00
    $400.00
    $400.00
    $250.00
    $400.00
    $15.00

    L071

    $400.00
    $1,065.00
    M285
    $200.00
    P-INJECTABLES
    M285
    $65.00
    P-ORAL DRUGS
    M285
    $68.00
    M285
    $100.00
    $433.00
    M020
    $400.00
    ABORATORY
    M020
    $80.00
    P-INJECTABLES
    M020
    $70.00
    M020
    $180.00
    P-INJECTABLES
    M020
    $90.00
    P-ORAL DRUGS
    P468
    $90.00
    $910.00
    S384
    $400.00
    ABORATORY
    S384
    $200.00
    $600.00
    M505
    $360.00
    P-INJECTABLES
    M505
    $100.00
    COMPLETE EXAMINATION
    O011
    $80.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O011
    $220.00
    MATERIALS: FRAMES
    O011
    $710.00
    $1,470.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D82 CAVITY $120.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D82 CAVITY $330.00
    S281
    $400.00
    S281
    $400.00
    P-ORAL DRUGS
    P115
    $1,037.40
    M317
    $120.00
    P-INJECTABLES
    M317
    $40.00
    P-ORAL DRUGS
    P465
    $294.00
    $2,741.40
    L034
    $400.00
    $400.00
    M046
    $60.00
    P-ORAL DRUGS
    P150
    $56.70
    H033
    $400.00
    $516.70
    COMPLETE EXAMINATION
    O030
    $80.00
    MATERIALS: FRAMES
    O030
    $535.80
    MATERIALS: LENS, EACH-SINGLE VISION
    O030
    $288.20
    $904.00
    M007
    $100.00
    P-INJECTABLES
    M007
    $20.00
    $120.00
    S170
    $300.00
    S170
    $300.00
    $600.00
    M647
    $80.00
    P-INJECTABLES
    M647
    $120.00
    P-ORAL DRUGS
    P504
    $200.00
    $400.00
    COMPLETE EXAMINATION
    O170
    $90.00

    MATERIALS: LENS, EACH-SINGLE VISION


    O170
    MATERIALS: FRAMES
    O170
    SLT-OFFICE
    S403
    S076
    PREVENTIVE: DENTAL PROPHYLAXIS
    D133

    $700.00
    $800.00
    $400.00
    $350.00
    $500.00
    $2,840.00
    MATERIALS: FRAMES
    O008
    $650.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O008
    $320.00
    $970.00
    M694
    $100.00
    P-INJECTABLES
    M694
    $300.00
    $400.00
    M029
    $100.00
    M029
    $100.00
    P-ORAL DRUGS
    M029
    $75.00
    COMPLETE EXAMINATION
    S354
    $300.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O008
    $2,190.00
    $2,765.00
    M200
    $120.00
    ABORATORY
    L074
    $265.00
    M200
    $60.00
    P-ORAL DRUGS
    M200
    $30.00
    $475.00
    S020
    $200.00
    ABORATORY
    S020
    $500.00
    S020
    $50.00
    $750.00
    ABORATORY
    S384
    $400.00
    $400.00
    M792
    $100.00
    M792
    $200.00
    P-INJECTABLES
    M792
    $50.00
    P-ORAL DRUGS
    P191
    $56.50
    M647
    $80.00
    P-INJECTABLES
    M647
    $100.00
    ABSCESSES, BOILS & CARBUNCLES:
    M647
    INCISION FOR$500.00
    DRAINAGE W/O HOSPITAL
    $1,086.50
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,036.63
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,216.62
    $2,343.25
    M769
    $150.00
    M769
    $150.00
    P-INJECTABLES
    M769
    $50.00
    $350.00
    M104
    $400.00
    $400.00
    M188
    $290.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D312
    BITEWING X-RAYS
    $25.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D312
    BITEWING X-RAYS
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D312VIEW
    $250.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D312CAVITY $450.00
    $1,065.00

    ABORATORY

    L152

    ENATAL CARE
    ENATAL CARE

    S179
    P497

    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS

    H005
    H005
    S356
    M673
    S356
    H052
    P256
    P094
    P382

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE
    MATERIALS: LENS, EACH-SINGLE
    MATERIALS: FRAMES

    O065
    VISION
    O065
    VISION
    O065
    O065

    COMPLETE EXAMINATION
    O004
    MATERIALS: FRAMES
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    COMPLETE EXAMINATION
    O076
    MATERIALS: FRAMES
    O076
    MATERIALS: FRAMES
    O076
    MATERIALS: LENS, EACH-BI-FOCALO076
    MATERIALS: LENS, EACH-BI-FOCALO076
    M304
    M304

    ABORATORY

    P-ORAL DRUGS

    M662
    M662
    M644
    P411
    M644
    M644

    S301
    COMPLETE EXAMINATION
    O023
    MATERIALS: FRAMES
    O023
    MATERIALS: LENS, EACH-TRI-FOCAL
    O023

    M216
    P-INJECTABLES
    M216
    ABORATORY
    M216
    PREVENTIVE: DENTAL PROPHYLAXIS
    D77
    ORAL SURGERY: SURGICAL REMOVAL
    D77OF

    ABORATORY

    S296
    S296

    $500.00
    $500.00
    $300.00
    $234.25
    $534.25
    $850.00
    $3,609.28
    $12,000.00
    $2,000.00
    $600.00
    $140.00
    $55.00
    $634.00
    $255.18
    $20,143.46
    $350.00
    $1,500.00
    $400.00
    $320.00
    $2,570.00
    $100.00
    $1,395.00
    $365.00
    $130.00
    $90.00
    $800.00
    $476.00
    $400.00
    $923.00
    $75.00
    $110.00
    $4,864.00
    $100.00
    $20.00
    $120.00
    $200.00
    $89.60
    $300.00
    $100.00
    $689.60
    $300.00
    $150.00
    $1,850.00
    $2,475.00
    $4,775.00
    $80.00
    $40.00
    $275.00
    $250.00
    TOOTH W
    $240.00
    SOFT TISSUE IMPACTION
    $885.00
    $1,050.00
    $400.00

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    S296
    M053
    M053
    ABORATORY
    L001

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES

    P-ORAL DRUGS
    ABORATORY

    M119
    M119
    P154
    M647
    M647
    M647
    P504
    L070

    PREVENTIVE: DENTAL PROPHYLAXIS


    D301
    PREVENTIVE: DENTAL PROPHYLAXIS
    D301
    M341
    L174
    ABORATORY
    L174
    M341

    P-INJECTABLES

    ABORATORY

    ABORATORY

    M792
    M792
    M792
    M792
    M792
    L070

    COMPLETE EXAMINATION
    O162
    MATERIALS: FRAMES
    O162
    MATERIALS: LENS, EACH-SINGLE VISION
    O162

    P-INJECTABLES

    P-INJECTABLES

    M346
    M346
    M346
    M346

    M647
    P-INJECTABLES
    M647
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    M647
    M647
    M732
    P-ORAL DRUGS
    M732
    ABORATORY
    M732
    P-ORAL DRUGS
    P140
    P-ORAL DRUGS
    P140
    M647
    P-INJECTABLES
    M647
    P-ORAL DRUGS
    P504
    P-ORAL DRUGS
    P445
    M647
    P-INJECTABLES
    M647
    P-ORAL DRUGS
    P504

    $3,900.00
    $140.00
    $280.00
    $172.00
    $5,942.00
    $60.00
    $60.00
    $160.40
    $160.00
    $100.00
    $100.00
    $90.00
    $470.00
    $1,200.40
    $160.00
    $90.00
    $140.00
    $160.00
    $190.00
    $140.00
    $880.00
    $100.00
    $140.00
    $715.00
    $80.00
    $600.00
    $360.00
    $1,995.00
    $75.00
    $150.00
    $200.00
    $425.00
    $800.00
    $800.00
    $300.00
    $300.00
    $2,200.00
    $240.00
    $460.00
    $1,000.00
    $200.00
    $100.00
    $20.00
    $70.00
    $567.50
    $226.10
    $80.00
    $160.00
    $250.00
    $164.00
    $80.00
    $160.00
    $114.00

    $3,891.60
    $100.00
    $100.00
    M864
    $100.00
    P-INJECTABLES
    M864
    $20.00
    P-ORAL DRUGS
    M864
    $10.00
    M864
    $100.00
    P-ORAL DRUGS
    M864
    $90.00
    M232
    $100.00
    P-ORAL DRUGS
    M232
    $40.00
    $460.00
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D38
    OR CEPHALOMETRIC
    $60.00
    X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D38
    OR CEPHALOMETRIC
    $440.00
    X-RAY)
    M647
    $80.00
    P-INJECTABLES
    M647
    $160.00
    $740.00
    M123
    $150.00
    ABORATORY
    M123
    $60.00
    P-INJECTABLES
    M123
    $80.00
    M123
    $150.00
    M233
    $100.00
    P-ORAL DRUGS
    M233
    $20.00
    $560.00
    M028
    $100.00
    ABORATORY
    M028
    $10.00
    M456
    $140.00
    P-INJECTABLES
    M456
    $60.00
    $310.00
    DIAGNOSTIC: INITIAL ORAL EXAM D300
    (EXCLUDE X-RAY)
    $150.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D300
    BITEWING X-RAYS
    $262.50
    DIAGNOSTIC: COMPLETE SERIES OF
    D300
    BITEWING X-RAYS
    $95.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D300
    BITEWING X-RAYS
    $17.50
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D300CAVITY $350.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D300CAVITY $150.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D300CAVITY $400.00
    M353
    $150.00
    $1,575.00
    M804
    $120.00
    P-ORAL DRUGS
    M804
    $360.00
    ABORATORY
    M804
    $50.00
    P-ORAL DRUGS
    P094
    $154.50
    $684.50
    M089
    $119.00
    M089
    $441.00
    $560.00
    M007
    $80.00
    SLT-OFFICE
    S355
    $300.00
    P-ORAL DRUGS
    P497
    $60.00
    P-ORAL DRUGS
    P191
    $63.00
    $503.00
    M187
    $300.00
    ABORATORY
    L074
    $200.00
    $500.00
    M327

    DIAGNOSTIC: INITIAL ORAL EXAM D379


    (EXCLUDE X-RAY)
    $160.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D379
    X-RAY, SINGLE
    $50.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D379
    X-RAY, SINGLE
    $110.00
    VIEW
    PERIODONTICS: GINGIVECTOMY, SURGICAL,
    D379
    PER$1,200.00
    QUADRANT W POST OPER
    $1,520.00
    M200
    $60.00
    P-ORAL DRUGS
    M200
    $20.00
    $80.00
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    S052
    $400.00
    L96
    $150.00
    L075
    $3,800.00
    UN01
    $450.00
    $5,260.00
    M167
    $140.00
    P-INJECTABLES
    M167
    $60.00
    COMPLETE EXAMINATION
    O076
    $280.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $846.00
    MATERIALS: FRAMES
    O076
    $1,345.50
    $2,671.50
    COMPLETE EXAMINATION
    O131
    $70.00
    MATERIALS: FRAMES
    O131
    $2,000.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O131
    $850.00
    $2,920.00
    S071
    $470.00
    P-ORAL DRUGS
    P497
    $230.00
    $700.00
    M795
    $150.00
    P-ORAL DRUGS
    M795
    $230.00
    M795
    $350.00
    ABORATORY
    M795
    $1,040.00
    $1,770.00
    P-ORAL DRUGS
    S432
    $2,500.00
    $2,500.00
    H011
    $900.00
    H011
    $1,800.00
    H011
    $600.00
    PROSTATE: TRANSURETHRAL RESECTION
    S312
    $3,700.00
    S312
    $250.00
    ABORATORY
    S312
    $150.00
    ABORATORY
    S312
    $20.00
    S312
    $350.00
    $7,770.00
    M388
    $100.00
    P-INJECTABLES
    M388
    $100.00
    P-ORAL DRUGS
    P154
    $228.00
    $428.00
    ENDODONTICS: EXTIRPATION OF PULP
    D27 & FILL 1 ROOT
    $350.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D27 & FILL 1 $1,650.00
    ROOT CANAL (EX RESTOR)
    $2,000.00
    S053
    $300.00
    EYE: OTHER CUTTING OPERATION S053
    $6,000.00

    P-ORAL DRUGS

    S053

    $125.00
    $6,425.00
    M213
    $100.00
    P-INJECTABLES
    M213
    $20.00
    P-ORAL DRUGS
    P415
    $165.00
    $285.00
    M754
    $140.00
    P-ORAL DRUGS
    M754
    $100.00
    M238
    $100.00
    P-ORAL DRUGS
    M238
    $75.00
    M754
    $140.00
    P-ORAL DRUGS
    M754
    $98.00
    P-ORAL DRUGS
    M754
    $45.00
    $698.00
    S187
    $50.00
    P-ORAL DRUGS
    P154
    $59.99
    $109.99
    M461
    $150.00
    M461
    $200.00
    $350.00
    DIAGNOSTIC: INITIAL ORAL EXAM M304
    (EXCLUDE X-RAY)
    $125.00
    OTHER
    P337
    $260.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D132
    W ANESTHESIA
    $60.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D132
    W ANESTHESIA
    $340.00
    & POST OPER
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D132VIEW
    $100.00
    DIAGNOSTIC: INITIAL ORAL EXAM D132
    (EXCLUDE X-RAY)
    $100.00
    $985.00
    M853
    $400.00
    $400.00
    M662
    $60.00
    P-INJECTABLES
    M662
    $40.00
    M662
    $60.00
    P-INJECTABLES
    M662
    $40.00
    P-INJECTABLES
    M662
    $40.00
    M662
    $100.00
    P-ORAL DRUGS
    P428
    $194.90
    M662
    $100.00
    P-ORAL DRUGS
    P139
    $300.00
    P-ORAL DRUGS
    P428
    $295.80
    P-ORAL DRUGS
    P458
    $10.00
    P-ORAL DRUGS
    P428
    $36.85
    M662
    $100.00
    P-ORAL DRUGS
    P011
    $41.00
    M662
    $200.00
    P-INJECTABLES
    M662
    $200.00
    COMPLETE EXAMINATION
    O001
    $110.00
    COMPLETE EXAMINATION
    O001
    $110.00
    M662
    $280.00
    M002
    $130.00
    P-ORAL DRUGS
    M002
    $120.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,316.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $379.00
    MATERIALS: FRAMES
    O004
    $184.00

    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:

    FRAMES
    LENS, EACH-SINGLE
    LENS, EACH-SINGLE
    FRAMES
    FRAMES

    O004
    VISION
    O004
    VISION
    O004
    O004
    O004

    COMPLETE EXAMINATION
    O076
    MATERIALS: FRAMES
    O076
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    S152
    S152
    S152
    S152
    S152
    S152

    P-INJECTABLES

    P-INJECTABLES

    COMPLETE EXAMINATION
    O077
    MATERIALS: FRAMES
    O077
    MATERIALS: LENS, EACH-TRI-FOCAL
    O077
    COMPLETE EXAMINATION
    O163
    MATERIALS: FRAMES
    O163
    MATERIALS: LENS, EACH-SINGLE VISION
    O163
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE

    O076
    O076
    O076
    VISION
    O076

    COMPLETE EXAMINATION
    O136
    MATERIALS: FRAMES
    O047
    MATERIALS: LENS, EACH-SINGLE VISION
    O047
    M514
    M189
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:

    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM

    FILL
    FILL
    FILL
    FILL
    FILL

    ABORATORY
    ABORATORY

    P-INJECTABLES
    P-ORAL DRUGS
    P-ORAL DRUGS
    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    2
    2
    2
    1
    1

    SURFACE
    D90
    SURFACE
    D90
    SURFACE
    D90
    SURFACE
    D90
    SURFACE
    D90

    CAVITY
    CAVITY
    CAVITY
    CAVITY
    CAVITY

    S400
    L065
    L006
    M310
    M310
    M310
    M310
    O024
    O024

    $465.00
    $1,236.00
    $359.00
    $264.00
    $331.00
    $7,102.55
    $80.00
    $716.00
    $1,100.00
    $1,896.00
    $300.00
    $200.00
    $400.00
    $4,000.00
    $100.00
    $100.00
    $5,100.00
    $300.00
    $1,120.00
    $1,480.00
    $2,900.00
    $70.00
    $1,100.00
    $570.00
    $1,740.00
    $90.00
    $1,500.00
    $1,095.00
    $1,935.50
    $4,620.50
    $100.00
    $995.00
    $1,050.00
    $2,145.00
    $260.00
    $260.00
    $140.00
    $140.00
    $480.00
    $100.00
    $20.00
    $640.00
    $160.00
    $1,400.00
    $300.00
    $1,500.00
    $500.00
    $150.00
    $350.00
    $528.00
    $300.00
    $100.00
    $1,276.00

    MATERIALS: LENS, EACH-SINGLE VISION


    O024
    COMPLETE EXAMINATION
    O076
    MATERIALS: FRAMES
    O076
    MATERIALS: LENS, EACH-SINGLE VISION
    O076

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES

    P-ORAL DRUGS
    P-ORAL DRUGS

    P-INJECTABLES
    P-ORAL DRUGS
    P-ORAL DRUGS

    P-INJECTABLES

    ABORATORY
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION

    M388
    M388
    P140
    M388
    M388
    H066
    P140
    P140
    M007
    M007
    P140
    P140
    M801
    M801
    M801
    M801
    O076
    O076

    P-ORAL DRUGS
    P-ORAL DRUGS

    M294
    P315
    P315

    P-INJECTABLES
    P-ORAL DRUGS
    ABORATORY
    P-ORAL DRUGS

    M093
    M093
    M093
    L156
    P008

    COMPLETE EXAMINATION
    O065
    MATERIALS: FRAMES
    O065
    MATERIALS: LENS, EACH-TRI-FOCAL
    O065
    MATERIALS: LENS, EACH-TRI-FOCAL
    O065

    P-ORAL DRUGS

    P433

    P-ORAL DRUGS

    S370
    P240

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES
    P-ORAL DRUGS

    M718
    M718
    P407
    M733
    M733
    M733
    M388

    $2,056.00
    $7,060.00
    $90.00
    $2,323.25
    $768.25
    $3,181.50
    $150.00
    $150.00
    $44.00
    $150.00
    $150.00
    $300.00
    $18.00
    $25.00
    $100.00
    $20.00
    $15.00
    $15.00
    $100.00
    $100.00
    $200.00
    $400.00
    $1,937.00
    $90.00
    $90.00
    $180.00
    $100.00
    $405.00
    $479.55
    $984.55
    $120.00
    $40.00
    $24.00
    $45.00
    $146.65
    $375.65
    $150.00
    $990.00
    $1,764.00
    $110.00
    $3,014.00
    $144.40
    $144.40
    $300.00
    $65.65
    $365.65
    $100.00
    $100.00
    $141.35
    $100.00
    $20.00
    $80.00
    $100.00

    P-INJECTABLES
    P-ORAL DRUGS

    M388
    $100.00
    P407
    $60.00
    M388
    $100.00
    ABSCESSES, BOILS & CARBUNCLES:
    M388
    INCISION FOR$600.00
    DRAINAGE W/O HOSPITAL
    ABORATORY
    L070
    $350.00
    $1,851.35
    M018
    $600.00
    ABORATORY
    M018
    $150.00
    $750.00
    M028
    $100.00
    P-ORAL DRUGS
    M028
    $15.00
    P-ORAL DRUGS
    P140
    $60.00
    $175.00
    S210
    $300.00
    P-INJECTABLES
    S210
    $400.00
    P-ORAL DRUGS
    P433
    $129.00
    P-ORAL DRUGS
    P145
    $220.00
    P-INJECTABLES
    S210
    $200.00
    P-ORAL DRUGS
    P145
    $875.00
    M156
    $100.00
    P-INJECTABLES
    M156
    $300.00
    P-ORAL DRUGS
    P433
    $191.90
    P-ORAL DRUGS
    P145
    $375.00
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D125
    $250.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D125CAVITY
    $75.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D125CAVITY $265.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D125CAVITY $320.00
    M156
    $100.00
    P-INJECTABLES
    M156
    $300.00
    P-ORAL DRUGS
    P433
    $193.50
    P-ORAL DRUGS
    P145
    $345.00
    P-ORAL DRUGS
    P145
    $140.00
    $5,149.40
    M061
    $100.00
    ABORATORY
    M061
    $100.00
    COMPLETE EXAMINATION
    O049
    $60.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O049
    $350.00
    MATERIALS: FRAMES
    O049
    $490.00
    M061
    $100.00
    P-ORAL DRUGS
    M061
    $40.00
    ABORATORY
    M061
    $20.00
    M061
    $100.00
    ABORATORY
    M061
    $215.00
    M061
    $100.00
    P-ORAL DRUGS
    M061
    $100.00
    M061
    $100.00
    P-INJECTABLES
    M061
    $100.00
    $1,975.00
    M083
    $100.00
    P-INJECTABLES
    M083
    $100.00
    $200.00
    M232
    $100.00

    ABORATORY
    P-ORAL DRUGS

    M232
    M232

    $30.00
    $20.00
    $150.00
    M553
    $140.00
    P-ORAL DRUGS
    P073
    $841.20
    $981.20
    S170
    $600.00
    S170
    $400.00
    ABORATORY
    L070
    $24.00
    P-ORAL DRUGS
    P140
    $500.00
    ABORATORY
    P140
    $194.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,479.20
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $419.80
    MATERIALS: FRAMES
    O001
    $2,065.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,227.80
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $356.80
    $7,267.10
    S354
    $100.00
    ABORATORY
    L070
    $250.00
    $350.00
    M159
    $720.00
    P-ORAL DRUGS
    P158
    $83.00
    M159
    $480.00
    P-ORAL DRUGS
    M159
    $60.00
    M159
    $160.00
    $1,503.00
    ABORATORY
    H023
    $652.00
    H006
    $400.00
    SLT-OFFICE
    S302
    $120.00
    SLT-OFFICE
    S302
    $340.00
    ABORATORY
    S302
    $540.00
    P-ORAL DRUGS
    P031
    $268.98
    $2,320.98
    PREVENTIVE: DENTAL PROPHYLAXIS
    D252
    $500.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D252
    X-RAY, SINGLE
    $75.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D252
    X-RAY, SINGLE
    $75.00
    VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D252CAVITY $350.00
    IT-HOSPITAL
    H003
    $600.00
    ABORATORY
    H003
    $400.00
    H003
    $250.00
    $2,250.00
    DIAGNOSTIC: INITIAL ORAL EXAM D263
    (EXCLUDE X-RAY)
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D263
    $350.00
    ORAL SURGERY: TREAT SIMPLE FRACTURE
    D263
    OF MANDIBLE,
    $77.00 OPEN REDUCTION
    ORAL SURGERY: TREAT SIMPLE FRACTURE
    D263
    OF MANDIBLE,
    $23.00 OPEN REDUCTION
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D263 SURFACE $700.00
    CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D263CAVITY $300.00
    $1,600.00
    M055
    $300.00
    L174
    $740.00
    ABORATORY
    L021
    $150.00
    ABORATORY
    L065
    $1,190.00
    COMPLETE EXAMINATION
    O001
    $110.00

    $2,490.00
    S096
    $90.00
    S096
    $210.00
    S201
    $300.00
    H008
    $154.00
    P-ORAL DRUGS
    P462
    $7.25
    P-ORAL DRUGS
    P462
    $507.11
    P-ORAL DRUGS
    P462
    $56.34
    P-ORAL DRUGS
    P435
    $199.50
    COMPLETE EXAMINATION
    O004
    $120.00
    COMPLETE EXAMINATION
    O004
    $80.00
    MATERIALS: FRAMES
    O004
    $1,380.00
    MATERIALS: FRAMES
    O004
    $515.00
    S160
    $240.00
    P-ORAL DRUGS
    P435
    $68.56
    S265
    $300.00
    ABORATORY
    S265
    $150.00
    DIAGNOSTIC: INITIAL ORAL EXAM D35
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D35
    $450.00
    S201
    $300.00
    P-ORAL DRUGS
    P435
    $498.85
    P-ORAL DRUGS
    P435
    $49.88
    P-ORAL DRUGS
    P435
    $62.05
    S160
    $400.00
    P-INJECTABLES
    S160
    $120.00
    S128
    $400.00
    ABORATORY
    S128
    $480.00
    ABORATORY
    H006
    $437.00
    H006
    $2,100.00
    $9,795.54
    S277
    $200.00
    ABORATORY
    L025
    $125.00
    P-ORAL DRUGS
    P478
    $105.00
    L174
    $340.00
    M857
    $200.00
    H025
    $60.00
    L018
    $240.00
    S277
    $200.00
    ABORATORY
    L025
    $210.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D266
    $400.00
    $2,080.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D259
    $350.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D259
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D259
    TIMES (EXCLUDE
    $80.00
    PROPHYLAXIS)
    S149
    $260.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D388VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D388VIEW
    $15.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D388
    $300.00
    S179
    $260.00
    ABORATORY
    S179
    $160.00
    S149
    $240.00
    $1,770.00
    M857
    $100.00

    ABORATORY

    M857

    $725.00
    $825.00
    ABSCESSES, BOILS & CARBUNCLES:
    S296
    INCISION FOR
    $2,400.00
    DRAINAGE W/O HOSPITAL
    S296
    $1,050.00
    M473
    $150.00
    $3,600.00
    S103
    $800.00
    L013
    $149.00
    P-ORAL DRUGS
    P430
    $288.00
    S103
    ($800.00)
    S103
    $800.00
    $1,237.00
    ENDODONTICS: EXTIRPATION OF PULP
    D376& FILL 3 ROOT
    $910.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D376& FILL 3 $1,590.00
    ROOT CANAL (EX RESTOR)
    $2,500.00
    M194
    $100.00
    P-ORAL DRUGS
    M194
    $70.00
    P-INJECTABLES
    M194
    $190.00
    M847
    $300.00
    P-ORAL DRUGS
    M847
    $168.00
    P-ORAL DRUGS
    M847
    $42.00
    P-INJECTABLES
    M847
    $40.00
    P-ORAL DRUGS
    M847
    $120.00
    M194
    $100.00
    P-INJECTABLES
    M194
    $25.00
    P-INJECTABLES
    M194
    $35.00
    P-ORAL DRUGS
    M194
    $60.00
    ABORATORY
    L061
    $865.00
    P-ORAL DRUGS
    P019
    $113.30
    MATERIALS: FRAMES
    O004
    $1,084.80
    MATERIALS: FRAMES
    O004
    $271.20
    MATERIALS: LENS, EACH-BI-FOCALO004
    $915.20
    MATERIALS: LENS, EACH-BI-FOCALO004
    $1,140.80
    COMPLETE EXAMINATION
    O004
    $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D90 CAVITY $475.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D90 CAVITY
    $25.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D90 CAVITY $2,000.00
    M194
    $100.00
    P-INJECTABLES
    M194
    $120.00
    P-INJECTABLES
    M194
    $30.00
    P-ORAL DRUGS
    M194
    $136.00
    P-ORAL DRUGS
    M194
    $34.00
    P-ORAL DRUGS
    P019
    $109.50
    P-ORAL DRUGS
    P014
    $26.40
    P-ORAL DRUGS
    P014
    $6.60
    P-ORAL DRUGS
    P019
    $448.00
    M694
    $100.00
    P-INJECTABLES
    M694
    $320.00
    P-INJECTABLES
    M694
    $80.00
    P-ORAL DRUGS
    M694
    $112.00
    P-ORAL DRUGS
    M694
    $28.00
    P-ORAL DRUGS
    P019
    $447.00
    $10,337.80

    PREVENTIVE: DENTAL PROPHYLAXIS


    D31
    M124
    P-ORAL DRUGS
    P435
    P-ORAL DRUGS
    P435
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    M437
    P-INJECTABLES
    M437
    P-INJECTABLES
    M437

    $325.00
    $250.00
    $32.42
    $168.44
    $310.00
    $310.00
    $250.00
    $25.00
    $50.00
    $1,720.86
    DIAGNOSTIC: INITIAL ORAL EXAM D341
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D341VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D341VIEW
    $170.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D341
    $700.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D341
    ROOT$500.00
    PLANING, SCALING, EACH
    IT-HOSPITAL
    P286
    $600.00
    ABORATORY
    P286
    $705.00
    P286
    $160.00
    M668
    $220.00
    P-ORAL DRUGS
    P435
    $284.45
    $3,509.45
    M300
    $320.00
    M300
    $500.00
    P-ORAL DRUGS
    P081
    $67.50
    P-ORAL DRUGS
    P155
    $225.55
    M300
    $1,000.00
    M053
    $280.00
    ABSCESSES, BOILS & CARBUNCLES:
    M053
    INCISION FOR$210.00
    DRAINAGE W/O HOSPITAL
    M053
    $60.00
    P-ORAL DRUGS
    P081
    $200.00
    ABDOMEN: GASTROSCOPY, TAPPING
    S214
    $1,920.00
    H005
    $1,500.00
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D125
    $280.00
    $6,643.05
    L001
    $1,672.00
    L075
    $3,800.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    $325.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D31 CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D31 CAVITY $460.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D31X-RAY, SINGLE
    $75.00
    VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM D181
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D181
    $450.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D181CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D181CAVITY $800.00
    M720
    $200.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    M720
    $1,700.00
    $9,822.00
    M119
    $60.00
    P-INJECTABLES
    M119
    $25.00
    P-INJECTABLES
    M119
    $55.00
    P-ORAL DRUGS
    P479
    $289.45
    COMPLETE EXAMINATION
    S200
    $300.00

    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:

    FRAMES
    O047
    LENS, EACH-BI-FOCALO047
    FRAMES
    O047
    LENS, EACH-BI-FOCALO047
    M872
    M872
    M872
    M872
    P479
    H008

    $2,065.50
    $1,778.50
    $625.50
    $1,539.00
    $150.00
    P-ORAL DRUGS
    $70.00
    P-INJECTABLES
    $50.00
    ABORATORY
    $105.00
    P-ORAL DRUGS
    $360.00
    $440.00
    $7,912.95
    M060
    $200.00
    P-ORAL DRUGS
    P031
    $65.49
    P-ORAL DRUGS
    P022
    $192.00
    P-ORAL DRUGS
    P022
    $192.50
    M375
    $160.00
    M060
    $200.00
    P-ORAL DRUGS
    P031
    $149.48
    P-ORAL DRUGS
    P122
    $184.00
    $1,343.47
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D97 CAVITY $360.00
    H029
    $100.00
    H029
    $100.00
    O053
    $100.00
    O053
    $50.00
    P-ORAL DRUGS
    O053
    $60.00
    M215
    $750.00
    L128
    $150.00
    ABORATORY
    L070
    $990.00
    P-ORAL DRUGS
    P231
    $8.50
    S286
    $300.00
    L128
    $1,780.00
    $4,748.50
    M847
    $180.00
    P-INJECTABLES
    M847
    $25.00
    P-INJECTABLES
    M847
    $75.00
    M166
    $140.00
    P-ORAL DRUGS
    M166
    $110.00
    P-ORAL DRUGS
    P487
    $38.61
    L153
    $360.00
    P-INJECTABLES
    L153
    $80.00
    P-INJECTABLES
    L153
    $20.00
    ABORATORY
    L153
    $550.00
    M166
    $160.00
    P-INJECTABLES
    M166
    $80.00
    P-INJECTABLES
    M166
    $20.00
    P-ORAL DRUGS
    P487
    $8.98
    P-ORAL DRUGS
    P487
    $2.24
    M166
    $140.00
    M166
    $112.00
    M166
    $28.00
    P-ORAL DRUGS
    M166
    $80.00
    P-ORAL DRUGS
    M166
    $20.00

    $2,229.83
    $1,000.00
    $1,800.00
    $2,800.00
    S279
    $500.00
    S279
    $232.00
    P-ORAL DRUGS
    S279
    $200.00
    P-ORAL DRUGS
    P435
    $59.06
    M437
    $300.00
    L96
    $400.00
    L96
    $700.00
    L96
    $250.00
    L96
    $500.00
    $3,141.06
    M152
    $300.00
    P-INJECTABLES
    H034
    $260.00
    H034
    $800.00
    M067
    $160.00
    P-INJECTABLES
    M067
    $160.00
    P-ORAL DRUGS
    P104
    $16.00
    P-ORAL DRUGS
    P454
    $84.00
    P-ORAL DRUGS
    P104
    $129.65
    M067
    $300.00
    P-ORAL DRUGS
    P435
    $147.97
    P-ORAL DRUGS
    P435
    $400.48
    ABORATORY
    L020
    $720.00
    P-INJECTABLES
    M067
    $25.00
    P-INJECTABLES
    M067
    $15.00
    M067
    $160.00
    $3,678.10
    S355
    $300.00
    ABORATORY
    S355
    $440.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,395.00
    $2,225.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D322
    $375.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D322
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D322
    TIMES (EXCLUDE
    $30.00
    PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D322
    $375.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D322
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    $950.00
    PROSTHETICS: PARTIAL UPPER/LOWER
    D260ACRYLIC BASE
    $700.00
    DENTURE W/O CLASP
    $700.00
    COMPLETE EXAMINATION
    O001
    $270.00
    MATERIALS: CONTACT, WHEN NOTO001
    MEDICALLY REQUIRED
    $1,925.00
    DIAGNOSTIC: INITIAL ORAL EXAM D150
    (EXCLUDE X-RAY)
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D150
    $350.00
    OTHER
    P011
    $15.00
    OTHER
    P022
    $8.00
    S400
    $400.00
    ABORATORY
    S400
    $300.00
    S400
    $350.00
    ABORATORY
    H005
    $100.00
    MATERIALS: FRAMES
    O037
    MATERIALS: LENS, EACH-TRI-FOCAL
    O037

    P-ORAL DRUGS

    P094
    S400
    H005

    $59.50
    $400.00
    ABORATORY
    $100.00
    $4,427.50
    H011
    $160.00
    H006
    $4,050.00
    ABORATORY
    H006
    $50.00
    SLT-OFFICE
    S386
    $300.00
    ABORATORY
    L065
    $2,090.00
    P-ORAL DRUGS
    P014
    $139.30
    S386
    $300.00
    P-ORAL DRUGS
    P014
    $88.90
    M225
    $250.00
    ABORATORY
    M225
    $130.00
    ABORATORY
    L001
    $960.00
    L046
    $1,100.00
    $9,618.20
    L081
    $200.00
    ABORATORY
    L081
    $60.00
    $260.00
    S382
    $300.00
    ABORATORY
    S382
    $180.00
    P-ORAL DRUGS
    P066
    $129.00
    P-ORAL DRUGS
    P066
    $69.00
    S421
    $300.00
    ABORATORY
    L041
    $200.00
    P-ORAL DRUGS
    P279
    $350.00
    P-ORAL DRUGS
    P497
    $157.50
    P-ORAL DRUGS
    P497
    $399.00
    MM06
    $281.75
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,596.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,896.00
    $5,958.25
    DIAGNOSTIC: INITIAL ORAL EXAM D181
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D181
    $450.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D181VIEW
    $350.00
    DIAGNOSTIC: INITIAL ORAL EXAM D181
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D181
    $450.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D181CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D181CAVITY $800.00
    S275
    $300.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D181 SURFACE
    $1,723.00
    CAVITY
    OTHER
    D181
    $77.00
    $4,450.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D432
    $350.00
    $350.00
    P-ORAL DRUGS
    P005
    $405.76
    M225
    $70.00
    M225
    $150.00
    ABORATORY
    L001
    $195.00
    M225
    $140.00
    M225
    $300.00

    ABORATORY
    L006
    $200.00
    P-ORAL DRUGS
    P011
    $324.50
    P-INJECTABLES
    M225
    $160.00
    DIAGNOSTIC: INITIAL ORAL EXAM D60
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $70.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $50.00
    VIEW
    ORAL SURGERY: ALVEOLECTOMY, SURG
    D60 PREP OF RIDGE
    $200.00
    FOR DENTURES/QUAD
    S375
    $200.00
    S375
    $800.00
    P-ORAL DRUGS
    P435
    $141.92
    M225
    $140.00
    M225
    $300.00
    L006
    $200.00
    ABORATORY
    M225
    $160.00
    P-ORAL DRUGS
    M225
    $324.50
    T040
    $200.00
    T040
    $975.00
    M225
    $440.00
    ABORATORY
    M225
    $260.00
    ABORATORY
    L157
    $200.00
    P-ORAL DRUGS
    P435
    $173.49
    ABORATORY
    L001
    $265.00
    ABORATORY
    L001
    $170.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D60 SURFACE $620.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D60 SURFACE $280.00
    CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $60.00
    VIEW
    CROWN & BRIDGE: ACRYLIC JACKET
    D60
    CROWN W METAL
    $880.00
    THIMBLE
    CROWN & BRIDGE: ACRYLIC JACKET
    D60
    CROWN W METAL
    $1,320.00
    THIMBLE
    M225
    $70.00
    M225
    $150.00
    ABORATORY
    M225
    $130.00
    P-ORAL DRUGS
    P005
    $405.76
    P-ORAL DRUGS
    P005
    $405.76
    $11,586.69
    M556
    $120.00
    P-ORAL DRUGS
    P435
    $495.60
    P-ORAL DRUGS
    P011
    $138.50
    P-ORAL DRUGS
    P073
    $805.20
    $1,559.30
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $400.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D102CAVITY $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D102CAVITY $600.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D102
    CROWN
    $2,400.00
    MATERIALS: FRAMES
    O001
    $540.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,216.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $200.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D102
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D102
    TIMES$130.00
    (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D102VIEW
    $400.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D102CAVITY $1,200.00
    ENDODONTICS: EXTIRPATION OF PULP
    D102& FILL 3 ROOT
    $910.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D102& FILL 3 $3,090.00
    ROOT CANAL (EX RESTOR)
    $11,356.00

    PREVENTIVE: DENTAL PROPHYLAXIS


    D07
    $475.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D07
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D07
    TIMES (EXCLUDE
    $30.00
    PROPHYLAXIS)
    $575.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D19
    $250.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D19 CAVITY $420.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D19 CAVITY $405.00
    M034
    $50.00
    L006
    $250.00
    P-ORAL DRUGS
    P014
    $15.00
    $1,390.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    $325.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    $325.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    $295.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    $325.00
    $1,270.00
    T060
    $2,490.00
    T060
    $2,270.00
    $4,760.00
    M034
    $50.00
    P-ORAL DRUGS
    P011
    $21.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D77
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D77
    $250.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D232CAVITY $280.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D232CAVITY $360.00
    $1,111.00
    L049
    $180.00
    COMPLETE EXAMINATION
    O001
    $110.00
    M030
    $160.00
    P-ORAL DRUGS
    P011
    $168.00
    ABORATORY
    L001
    $40.00
    IT-HOSPITAL
    H005
    $455.00
    M030
    $320.00
    P-ORAL DRUGS
    P091
    $112.20
    P-ORAL DRUGS
    P435
    $375.93
    M030
    $160.00
    M060
    $200.00
    IT-HOSPITAL
    H023
    $575.00
    ABORATORY
    H023
    $345.00
    ABORATORY
    L070
    $80.00
    $3,281.13
    SLT-OFFICE
    S137
    $450.00
    S137
    $400.00
    M473
    $140.00
    P-ORAL DRUGS
    P022
    $185.00
    ABORATORY
    L070
    $440.50
    H023
    $375.00
    H023
    $650.00
    SLT-OFFICE
    S137
    $450.00
    P-ORAL DRUGS
    P022
    $65.00
    P-ORAL DRUGS
    P022
    $50.00
    S137
    $400.00
    M473
    $120.00

    P-ORAL DRUGS

    P022
    M060
    P215
    M473
    P022
    L075
    L070
    M205
    P022
    S137
    S137
    M473
    S187

    $170.25
    $200.00
    P-ORAL DRUGS
    $102.75
    $120.00
    P-ORAL DRUGS
    $184.54
    $3,800.00
    ABORATORY
    $639.00
    $240.00
    P-ORAL DRUGS
    $74.90
    SLT-OFFICE
    $450.00
    P-ORAL DRUGS
    $49.00
    $240.00
    SLT-OFFICE
    $200.00
    $10,195.94
    PREVENTIVE: DENTAL PROPHYLAXIS
    D262
    $135.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D262
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D262
    TIMES (EXCLUDE
    $35.00
    PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D262CAVITY $200.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D262CAVITY $400.00
    S122
    $300.00
    S122
    $300.00
    S122
    $200.00
    M454
    $260.00
    L121
    $250.00
    ABORATORY
    L065
    $586.50
    $2,736.50
    S416
    $300.00
    $300.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D01
    TREATMENT
    $85.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D01
    TREATMENT
    $4,515.00 AFTER 1ST 6 MONTHS
    $4,600.00
    DIAGNOSTIC: INITIAL ORAL EXAM D239
    (EXCLUDE X-RAY)
    $90.00
    $90.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D387
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D387
    W ANESTHESIA
    $165.00
    & POST OPER
    M099
    $120.00
    $370.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D171
    $135.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D171
    TIMES (EXCLUDE
    $45.00
    PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D171VIEW
    $50.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D171CAVITY $390.00
    ENDODONTICS: EXTIRPATION OF PULP
    D171& FILL 1 ROOT
    $180.00
    CANAL (EX RESTOR)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D171
    $135.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D171
    TIMES (EXCLUDE
    $45.00
    PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D171
    $135.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D171
    TIMES (EXCLUDE
    $45.00
    PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D171
    $135.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D171
    TIMES (EXCLUDE
    $45.00
    PROPHYLAXIS)
    M178
    $400.00
    P-ORAL DRUGS
    P427
    $160.65
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D171CAVITY $300.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D171
    $280.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D171VIEW
    $200.00

    PREVENTIVE: DENTAL PROPHYLAXIS


    D171
    $135.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D171
    TIMES (EXCLUDE
    $45.00
    PROPHYLAXIS)
    $2,860.65
    S042
    $400.00
    L006
    $300.00
    $700.00
    M375
    $160.00
    P-ORAL DRUGS
    P422
    $581.80
    ABORATORY
    L021
    $520.00
    M375
    $160.00
    ABORATORY
    M375
    $160.00
    P-ORAL DRUGS
    P014
    $134.82
    $1,716.62
    M634
    $140.00
    P-ORAL DRUGS
    P022
    $35.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $528.00
    $703.00
    COMPLETE EXAMINATION
    O019
    $100.00
    $100.00
    PROSTHETICS: COMPLETE LOWER D291
    ACRYLIC BASE
    $1,400.00
    DENTURE
    PROSTHETICS: COMPLETE LOWER D291
    ACRYLIC BASE
    $1,100.00
    DENTURE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D291VIEW
    $133.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D291VIEW
    $167.00
    OTHER
    P011
    $181.30
    $2,981.30
    PREVENTIVE: DENTAL PROPHYLAXIS
    D232
    $250.00
    $250.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $100.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D411VIEW
    $100.00
    $450.00
    S293
    $500.00
    ABORATORY
    S293
    $100.00
    $600.00
    M861
    $200.00
    M861
    $200.00
    M861
    $600.00
    M230
    $300.00
    P-INJECTABLES
    M230
    $200.00
    P-ORAL DRUGS
    P426
    $364.10
    S257
    $400.00
    M861
    $200.00
    $2,464.10
    H003
    $100.00
    P-INJECTABLES
    H003
    $175.00
    M312
    $120.00
    P-INJECTABLES
    M312
    $60.00
    P-ORAL DRUGS
    P256
    $55.85
    M312
    $100.00
    P-ORAL DRUGS
    H003
    $51.50
    P-ORAL DRUGS
    P256
    $8.65

    P-ORAL DRUGS
    P256
    $74.30
    PREVENTIVE: DENTAL PROPHYLAXIS
    D224
    $350.00
    MM05
    $60.00
    MM05
    $60.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D224
    $400.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D224
    $230.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D224
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D102CAVITY $400.00
    M312
    $100.00
    P-ORAL DRUGS
    P094
    $109.50
    P-ORAL DRUGS
    P256
    $85.50
    ABORATORY
    H003
    $1,390.00
    M312
    $100.00
    P-ORAL DRUGS
    P094
    $183.50
    P-ORAL DRUGS
    P256
    $43.00
    P-ORAL DRUGS
    P256
    $59.55
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $496.00
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D39
    OR CEPHALOMETRIC
    $600.00
    X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D01
    OR CEPHALOMETRIC
    $300.00
    X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D102VIEW
    $100.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D102CAVITY $400.00
    ORTHODONTICS: INITIAL ORTHO APPLIANCE
    D01
    W 6$9,700.00
    MONTHS TREATMENT
    M312
    $100.00
    P-ORAL DRUGS
    P373
    $26.50
    P-ORAL DRUGS
    P256
    $77.35
    $16,186.20
    M807
    $400.00
    L149
    $150.00
    P-ORAL DRUGS
    P104
    $14.95
    $564.95
    COMPLETE EXAMINATION
    O001
    $100.00
    MATERIALS: FRAMES
    O001
    $1,395.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $660.00
    $2,155.00
    M760
    $100.00
    M760
    $100.00
    SLT-OFFICE
    S174
    $300.00
    P-ORAL DRUGS
    P467
    $457.00
    $957.00
    M815
    $160.00
    M815
    $140.00
    M815
    $100.00
    M815
    $35.00
    M815
    $215.00
    M815
    $160.00
    M815
    $1,200.00
    S275
    $60.01
    S275
    $239.99
    P-ORAL DRUGS
    P435
    $513.38
    M577
    $200.00
    M766
    $200.00
    $3,223.38
    M341
    $140.00

    P-INJECTABLES
    P-ORAL DRUGS

    M341
    P014
    M341
    M341
    M341
    P014
    H006
    H006
    H006
    M341
    H006
    H006
    H006
    H006
    M341
    M341
    P498

    $100.00
    $418.60
    $60.00
    $140.00
    P-INJECTABLES
    $100.00
    P-ORAL DRUGS
    $418.60
    IT-HOSPITAL
    $450.00
    ABORATORY
    $1,045.00
    $355.00
    $100.00
    IT-HOSPITAL
    $450.00
    $605.00
    ABORATORY
    $805.00
    $1,310.00
    $140.00
    P-INJECTABLES
    $100.00
    P-ORAL DRUGS
    $591.25
    $7,328.45
    ORMAL DELIVERY
    US01
    $28,440.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    H003
    $350.00
    $28,790.00
    S046
    $350.00
    ABORATORY
    S046
    $100.00
    $450.00
    M773
    $250.00
    ABORATORY
    M773
    $15.00
    P-ORAL DRUGS
    P436
    $82.74
    S323
    $350.00
    S323
    $350.00
    ABORATORY
    S323
    $160.00
    P-ORAL DRUGS
    P435
    $370.26
    $1,578.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D414
    TREATMENT
    $600.00 AFTER 1ST 6 MONTHS
    SLT-OFFICE
    S165
    $360.00
    SLT-OFFICE
    S375
    $200.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D414
    TREATMENT
    $600.00 AFTER 1ST 6 MONTHS
    EYE: OTHER CUTTING OPERATION S375
    $1,200.00
    $2,960.00
    ENDODONTICS: EXTIRPATION OF PULP
    D217& FILL 1 $2,490.00
    ROOT CANAL (EX RESTOR)
    $2,490.00
    ENATAL CARE
    H034
    $700.00
    $700.00
    DIAGNOSTIC: INITIAL ORAL EXAM D41
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D41X-RAY, SINGLE
    $35.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D41X-RAY, SINGLE
    $65.00
    VIEW
    ENDODONTICS: EXTIRPATION OF PULP
    D41 & FILL 1 $1,500.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D41 SURFACE $150.00
    CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM D41
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D41
    $500.00
    $2,450.00
    M202
    $100.00
    P-ORAL DRUGS
    M202
    $160.00
    OTHER
    P461
    $175.00

    DIAGNOSTIC: INITIAL ORAL EXAM D327


    (EXCLUDE X-RAY)
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D327
    $400.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D327VIEW
    $133.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D327VIEW
    $267.00
    ENDODONTICS: EXTIRPATION OF PULP
    D327& FILL 1 $1,500.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D327CAVITY $1,000.00
    $3,885.00
    M818
    $260.00
    M687
    $125.00
    P-ORAL DRUGS
    P435
    $79.84
    ORMAL DELIVERY
    S437
    $300.00
    M818
    $300.00
    M818
    $300.00
    M818
    $260.00
    $1,624.84
    M388
    $200.00
    P-INJECTABLES
    M388
    $200.00
    P-ORAL DRUGS
    P450
    $125.50
    P-ORAL DRUGS
    P140
    $311.15
    $836.65
    S450
    $300.00
    L149
    $900.00
    $1,200.00
    M833
    $240.00
    ABORATORY
    M833
    $60.00
    $300.00
    S083
    $400.00
    $400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D232
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D232
    $250.00
    $300.00
    M577
    $200.00
    SLT-OFFICE
    S404
    $300.00
    ABORATORY
    M577
    $240.00
    $740.00
    M454
    $200.00
    ABORATORY
    L065
    $235.00
    L149
    $150.00
    DIAGNOSTIC: INITIAL ORAL EXAM D169
    (EXCLUDE X-RAY)
    $160.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D169
    $440.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D169VIEW
    $105.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D169VIEW
    $115.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D169
    W ANESTHESIA
    $300.00
    & POST OPER
    $1,705.00
    S191
    $500.00
    P-ORAL DRUGS
    P154
    $1,744.50
    L041
    $400.00
    ABORATORY
    L041
    $2,400.00
    S437
    $300.00
    S437
    $250.00
    ABORATORY
    L061
    $250.00
    P-ORAL DRUGS
    P154
    $108.45
    S421
    $200.00

    $150.00
    $259.95
    $300.00
    $6,862.90
    S151
    $350.00
    S151
    $350.00
    ABORATORY
    S151
    $170.00
    ABORATORY
    L157
    $450.00
    IT-HOSPITAL
    H005
    $840.00
    $2,160.00
    ENDODONTICS: EXTIRPATION OF PULP
    D232& FILL 1 ROOT
    $495.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D232& FILL 1 ROOT
    $705.00
    CANAL (EX RESTOR)
    $1,200.00
    S112
    $300.00
    $300.00
    COMPLETE EXAMINATION
    O001
    $250.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $904.00
    M580
    $100.00
    P-INJECTABLES
    M580
    $400.00
    P-ORAL DRUGS
    M580
    $100.00
    M580
    $200.00
    $1,954.00
    DIAGNOSTIC: INITIAL ORAL EXAM D336
    (EXCLUDE X-RAY)
    $110.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D336VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D336VIEW
    $120.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D336CAVITY $940.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D336CAVITY $1,770.00
    $3,010.00
    M029
    $100.00
    P-ORAL DRUGS
    M029
    $20.00
    ABORATORY
    H008
    $268.00
    STONE OR TUMOR: REMOVAL OF FROM
    S296 KIDNEY $7,000.00
    OR BLADDER (OPEN SURGICAL)
    M750
    $2,500.00
    H023
    $3,000.00
    $12,888.00
    ORMAL DELIVERY
    H003
    $275.00
    M473
    $140.00
    IT-HOSPITAL
    H023
    $375.00
    M473
    $120.00
    P-ORAL DRUGS
    P373
    $214.50
    $1,124.50
    M297
    $120.00
    M297
    $120.00
    P-INJECTABLES
    M297
    $250.00
    ABORATORY
    L116
    $230.00
    L116
    $460.00
    P-ORAL DRUGS
    P404
    $163.50
    M297
    $120.00
    $1,463.50
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $400.00
    $400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D323
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D323
    $400.00

    P-ORAL DRUGS

    L041
    P060
    S052

    DIAGNOSTIC: BITEWING X-RAY, SINGLE


    D323VIEW
    $140.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D323VIEW
    $180.00
    DIAGNOSTIC: PULP VITALITY TEST D323
    $20.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D323 SURFACE $750.00
    CAVITY
    $1,590.00
    S184
    $260.00
    ABORATORY
    S184
    $100.00
    P-ORAL DRUGS
    P399
    $179.00
    $539.00
    ENATAL CARE
    M586
    $550.00
    ENATAL CARE
    P306
    $66.00
    DIAGNOSTIC: INITIAL ORAL EXAM D171
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D171
    X-RAY, SINGLE
    $70.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D171
    $180.00
    ENATAL CARE
    M586
    $550.00
    ENATAL CARE
    P306
    $90.50
    $1,606.50
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D23
    W ANESTHESIA
    $85.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D23
    W ANESTHESIA
    $315.00
    $400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D191
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D191
    $450.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D191
    TIMES$100.00
    (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D191VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D191VIEW
    $60.00
    M773
    $250.00
    ABORATORY
    M773
    $15.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D191
    $350.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D191
    TIMES$100.00
    (EXCLUDE
    ENATAL CARE
    S302
    $700.00
    $2,165.00
    M842
    $200.00
    M473
    $180.00
    $380.00
    S383
    $260.00
    P-ORAL DRUGS
    P049
    $51.65
    M331
    $140.00
    P-INJECTABLES
    M331
    $200.00
    P-ORAL DRUGS
    P014
    $47.25
    IT-HOSPITAL
    H034
    $525.00
    ABORATORY
    H034
    $145.00
    H034
    $500.00
    P-INJECTABLES
    H034
    $700.00
    P-ORAL DRUGS
    P456
    $42.00
    P-ORAL DRUGS
    P427
    $315.40
    $2,926.30
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D134CAVITY $360.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D134VIEW
    $60.00
    S386
    $300.00
    P-ORAL DRUGS
    P303
    $200.95
    P-ORAL DRUGS
    P014
    $180.00
    P-ORAL DRUGS
    P014
    $333.12
    $1,434.07

    & POST OPER


    & POST OPER

    PROPHYLAXIS)

    PROPHYLAXIS)

    M760
    $100.00
    M760
    $40.00
    P340
    $129.99
    M295
    $100.00
    SLT-OFFICE
    S187
    $200.00
    H030
    $250.00
    H030
    $2,984.95
    UTERUS: DILATION & CURRETTAGE,
    S187
    OR OTHER SURGERY
    $2,000.00ON EXT GENITALIA
    IT-HOSPITAL
    S187
    $200.00
    M864
    $100.00
    P-ORAL DRUGS
    M864
    $20.00
    M864
    $40.00
    P-ORAL DRUGS
    P158
    $72.00
    M864
    $80.00
    UN01
    $750.00
    $7,066.94
    L143
    $300.00
    S322
    $300.00
    IT-HOSPITAL
    H006
    $490.00
    ABORATORY
    H006
    $100.00
    ABORATORY
    H006
    $200.00
    $1,390.00
    ENATAL CARE
    S187
    $400.00
    ENATAL CARE
    P443
    $157.50
    ENATAL CARE
    S187
    $650.00
    $1,207.50
    M028
    $100.00
    ABORATORY
    M028
    $30.00
    P-ORAL DRUGS
    M028
    $75.00
    M028
    $100.00
    P-ORAL DRUGS
    M028
    $55.00
    $360.00
    M833
    $250.00
    ABORATORY
    M833
    $530.00
    $780.00
    ORAL SURGERY: SURGICAL REMOVAL
    D169
    OF TOOTH W
    $500.00
    SOFT TISSUE IMPACTION
    $500.00
    M789
    $200.00
    ABORATORY
    L081
    $255.00
    P-ORAL DRUGS
    P436
    $83.97
    $538.97
    M638
    $280.00
    ABORATORY
    M638
    $580.00
    P-INJECTABLES
    M638
    $100.00
    M638
    $140.00
    P-ORAL DRUGS
    P106
    $120.00
    $1,220.00
    DIAGNOSTIC: INITIAL ORAL EXAM D119
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D119
    $350.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D119VIEW
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D119VIEW
    $40.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D119CAVITY $600.00
    $1,120.00

    P-ORAL DRUGS
    P-ORAL DRUGS

    M683
    $260.00
    M683
    $270.00
    M683
    $30.00
    M683
    $250.00
    P-INJECTABLES
    M683
    $279.00
    P-INJECTABLES
    M683
    $31.00
    S259
    $600.00
    EYE: OPERATION ON EYE, EYE MUSCLE,
    S259 OR THROUGH
    $2,000.00
    SCLERA OR CORNEA
    S112
    $300.00
    S384
    $500.00
    M443
    $200.00
    ABSCESSES, BOILS & CARBUNCLES:
    M443
    INCISION FOR$450.00
    DRAINAGE W/O HOSPITAL
    $5,170.00
    M326
    $250.00
    $250.00
    H025
    $60.00
    $60.00
    M265
    $200.00
    M265
    $200.00
    P-ORAL DRUGS
    P369
    $47.45
    $447.45
    L018
    $60.00
    SLT-OFFICE
    S293
    $600.00
    ABORATORY
    S293
    $300.00
    ABSCESSES, BOILS & CARBUNCLES:
    S293
    INCISION FOR
    $5,000.00
    DRAINAGE W/O HOSPITAL
    $5,960.00
    M326
    $200.00
    P-ORAL DRUGS
    P478
    $360.70
    $560.70
    IT-HOSPITAL
    L091
    $400.00
    P-ORAL DRUGS
    P071
    $226.80
    P-ORAL DRUGS
    P071
    $168.50
    $795.30
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $2,120.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $442.00
    M310
    $150.00
    SLT-OFFICE
    S162
    $300.00
    P-ORAL DRUGS
    P246
    $159.70
    P-ORAL DRUGS
    P246
    $69.25
    $3,351.70
    S087
    $300.00
    P-ORAL DRUGS
    P031
    $309.80
    P-ORAL DRUGS
    P031
    $34.86
    P-ORAL DRUGS
    P031
    $1,549.00
    P-ORAL DRUGS
    P031
    $209.16
    S123
    $500.00
    SLT-OFFICE
    S365
    $460.00
    ABDOMEN: CUTTING ABDOMINAL CAVITY
    S365 EXCEPT
    $2,600.00
    AS OTHERWISE SPECIFIED
    $5,962.82
    M326
    $200.00
    $200.00
    S302
    $400.00

    P-INJECTABLES
    P-INJECTABLES

    S302
    $360.00
    ABORATORY
    S302
    $140.00
    DIAGNOSTIC: INITIAL ORAL EXAM D119
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D119
    $300.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D119VIEW
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D119VIEW
    $40.00
    $1,370.00
    M225
    $220.00
    ABORATORY
    M225
    $80.00
    $300.00
    T034
    $1,300.00
    T034
    $1,175.00
    P-ORAL DRUGS
    P005
    $283.07
    P-ORAL DRUGS
    P005
    $70.77
    P-ORAL DRUGS
    P372
    $517.80
    COMPLETE EXAMINATION
    O024
    $100.00
    MATERIALS: FRAMES
    O024
    $1,260.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O024
    $2,200.00
    ENDODONTICS: EXTIRPATION OF PULP
    D346& FILL 2 ROOT
    $840.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D346& FILL 2 $2,160.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D346 SURFACE $900.00
    CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $400.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $400.00
    $11,606.64
    M792
    $100.00
    P-INJECTABLES
    M792
    $25.00
    P-INJECTABLES
    M792
    $85.00
    P-ORAL DRUGS
    P178
    $186.55
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,615.50
    MATERIALS: LENS, EACH-BI-FOCALO076
    $1,020.50
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,165.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $810.50
    $5,188.55
    S141
    $400.00
    S141
    $350.00
    ABORATORY
    S141
    $715.00
    S141
    $180.00
    $1,645.00
    L128
    $700.00
    S296
    $300.00
    $1,000.00
    PROSTHETICS: PARTIAL UPPER/LOWER
    D425ACRYLIC BASE
    $800.00
    DENTURE W/O CLASP
    PROSTHETICS: PARTIAL UPPER/LOWER
    D425ACRYLIC $4,100.00
    BASE DENTURE W/O CLASP
    M326
    $250.00
    M326
    $250.00
    ABORATORY
    H005
    $1,280.00
    L143
    $3,500.00
    L143
    $1,000.00
    $11,180.00
    M104
    $360.00
    P-ORAL DRUGS
    P354
    $87.00

    P-ORAL DRUGS
    P-ORAL DRUGS

    P354
    P057

    $37.50
    $418.95
    $903.45
    S207
    $300.00
    P-INJECTABLES
    S207
    $2,100.00
    P-ORAL DRUGS
    P161
    $290.40
    P-ORAL DRUGS
    P161
    $175.00
    S207
    $300.00
    P-INJECTABLES
    S207
    $1,400.00
    S329
    $300.00
    H066
    $400.00
    $5,265.40
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D125
    X-RAY, SINGLE
    $80.00
    VIEW
    OTHER
    P122
    $290.45
    OTHER
    P435
    $13.28
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $100.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D411
    X-RAY, SINGLE
    $100.00
    VIEW
    COMPLETE EXAMINATION
    O001
    $110.00
    $1,023.73
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $716.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,593.00
    $2,399.00
    DIAGNOSTIC: INITIAL ORAL EXAM D131
    (EXCLUDE X-RAY)
    $120.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D131VIEW
    $120.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D131VIEW
    $210.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D131
    TIMES$500.00
    (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D131
    $400.00
    OTHER
    P057
    $50.00
    $1,400.00
    M354
    $140.00
    P-ORAL DRUGS
    P148
    $54.00
    P-ORAL DRUGS
    P148
    $294.00
    $488.00
    COMPLETE EXAMINATION
    O008
    $70.00
    MATERIALS: FRAMES
    O008
    $700.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O008
    $260.00
    $1,030.00
    M326
    $200.00
    P-ORAL DRUGS
    P014
    $120.00
    M326
    $250.00
    P-ORAL DRUGS
    P203
    $116.50
    $686.50
    COMPLETE EXAMINATION
    O001
    $110.00
    COMPLETE EXAMINATION
    O001
    $110.00
    M104
    $600.00
    P-ORAL DRUGS
    P435
    $31.33
    P-ORAL DRUGS
    P090
    $57.40
    $908.73
    COMPLETE EXAMINATION
    O076
    $90.00

    MATERIALS: FRAMES
    O076
    $1,615.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,695.00
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $120.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $200.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D113CAVITY $800.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D113CAVITY $450.00
    $5,050.50
    ORAL SURGERY: SURGICAL REMOVAL
    D324
    OF TOOTH W
    $400.00
    SOFT TISSUE IMPACTION
    OTHER
    P139
    $55.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D324CAVITY $900.00
    $1,355.00
    H034
    $100.00
    $100.00
    M341
    $140.00
    P-INJECTABLES
    M341
    $25.00
    P-INJECTABLES
    M341
    $75.00
    ABORATORY
    M341
    $100.00
    ABORATORY
    L116
    $80.00
    P-ORAL DRUGS
    P408
    $297.90
    DIAGNOSTIC: INITIAL ORAL EXAM D268
    (EXCLUDE X-RAY)
    $65.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D268
    $291.00
    $1,073.90
    L164
    $500.00
    ABORATORY
    L164
    $200.00
    L164
    $50.00
    P-ORAL DRUGS
    P094
    $93.75
    DIAGNOSTIC: COMPLETE SERIES OF
    S452
    BITEWING X-RAYS
    $150.00
    OTHER SERVICES: ADMINISTRATION
    S452
    OF GENERAL $350.00
    ANESTHESIA
    OTHER SERVICES: ADMINISTRATION
    S452
    OF GENERAL
    $2,150.00
    ANESTHESIA
    ORAL SURGERY: SURGICAL REMOVAL
    S452
    OF TOOTH$3,700.00
    W COMPLETE BONE IMPACTION
    OTHER
    P435
    $213.71
    $7,407.46
    M390
    $150.00
    P-ORAL DRUGS
    M390
    $30.00
    P-ORAL DRUGS
    M390
    $155.00
    $335.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,004.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $900.00
    $2,014.00
    M452
    $250.00
    P-ORAL DRUGS
    P122
    $604.95
    M452
    $200.00
    P-ORAL DRUGS
    P421
    $33.75
    $1,088.70
    PREVENTIVE: DENTAL PROPHYLAXIS
    D242
    $560.00
    MATERIALS: CONTACT, WHEN NOTO033
    MEDICALLY REQUIRED
    $300.00
    P-ORAL DRUGS
    P073
    $184.85
    M230
    $300.00
    P-INJECTABLES
    M230
    $50.00
    P-INJECTABLES
    M230
    $250.00
    P-ORAL DRUGS
    P014
    $94.60

    CROWN & BRIDGE: BRIDGE, 3 UNITS


    D77
    (UNIT=EACH)
    $4,000.00
    CROWN & BRIDGE: BRIDGE, 3 UNITS
    D77
    (UNIT=EACH)
    $2,000.00
    CROWN & BRIDGE: BRIDGE, 3 UNITS
    D77
    (UNIT=EACH)
    $1,200.00
    P-ORAL DRUGS
    P073
    $184.85
    PREVENTIVE: DENTAL PROPHYLAXIS
    D242
    $560.00
    DIAGNOSTIC: INITIAL ORAL EXAM D242
    (EXCLUDE X-RAY)
    $400.00
    COMPLETE EXAMINATION
    O033
    $230.00
    MATERIALS: FRAMES
    O033
    $760.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O033
    $352.75
    S217
    $500.00
    S217
    $338.00
    P-ORAL DRUGS
    P014
    $199.50
    P-ORAL DRUGS
    P005
    $190.40
    PREVENTIVE: DENTAL PROPHYLAXIS
    D07
    $375.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D07
    W ANESTHESIA
    $200.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D07
    W$1,150.00
    ANESTHESIA & POST OPER
    $14,380.70
    M630
    $80.00
    M630
    $100.00
    ABORATORY
    L001
    $260.00
    $440.00
    DIAGNOSTIC: INITIAL ORAL EXAM D346
    (EXCLUDE X-RAY)
    $150.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D346VIEW
    $160.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D346VIEW
    $240.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D346 SURFACE
    $1,400.00
    CAVITY
    ENDODONTICS: PULP CAPPING (EXCLUDE
    D346 RESTORATION)
    $500.00
    M298
    $240.00
    P-ORAL DRUGS
    D298
    $260.00
    P031
    $76.99
    P-ORAL DRUGS
    P031
    $80.43
    P-ORAL DRUGS
    P435
    $110.07
    L96
    $250.00
    ENDODONTICS: EXTIRPATION OF PULP
    D346& FILL 1 $3,000.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D346 SURFACE $900.00
    CAVITY
    M205
    $240.00
    P-ORAL DRUGS
    P031
    $122.49
    P-ORAL DRUGS
    P031
    $269.97
    $7,999.95
    M629
    $280.00
    ABORATORY
    L070
    $1,130.00
    $1,410.00
    M033
    $200.00
    P-ORAL DRUGS
    P088
    $383.30
    ABORATORY
    L070
    $300.00
    M033
    $100.00
    P-ORAL DRUGS
    P332
    $112.00
    P-ORAL DRUGS
    P332
    $30.00
    COMPLETE EXAMINATION
    O173
    $100.00
    MATERIALS: FRAMES
    O173
    $450.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O173
    $650.00
    $2,325.30
    S197
    $300.00
    P-ORAL DRUGS
    P487
    $64.50

    $364.50
    $100.00
    $967.50
    $1,440.00
    $2,507.50
    S293
    $500.00
    S293
    $500.00
    ABORATORY
    L070
    $140.00
    S390
    $600.00
    H066
    $550.00
    S390
    $300.00
    ABORATORY
    L070
    $140.00
    S293
    $500.00
    PROSTATE: TRANSURETHRAL RESECTION
    S293
    $31,000.00
    PROSTATE: TRANSURETHRAL RESECTION
    S293
    $3,000.00
    S293
    $8,500.00
    H005
    $2,800.00
    H005
    $24,396.55
    $72,926.55
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D90X-RAY, SINGLE
    $40.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D90X-RAY, SINGLE
    $60.00
    VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D90 CAVITY $500.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D90 CAVITY $600.00
    ORAL SURGERY: REDUCE DISLOC TEMPOROMANDIBULAR
    D90
    $20.00JOINT, CLOSED
    $1,220.00
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D125
    $300.00
    $380.00
    ENDODONTICS: EXTIRPATION OF PULP
    D86 & FILL 2 ROOT
    $400.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D86 & FILL 2 $1,200.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D86 SURFACE $100.00
    CAVITY
    OTHER
    D86
    $600.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D86
    CROWN
    $3,500.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D86
    $350.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D86
    CROWN
    $3,500.00
    $9,650.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D317 SURFACE $400.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D317 SURFACE
    $1,600.00
    CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    D22
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D22
    $150.00
    $2,270.00
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D143
    OR CEPHALOMETRIC
    $200.00
    X-RAY)
    $200.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D79X-RAY, SINGLE
    $20.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D79X-RAY, SINGLE
    $50.00
    VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D79
    W ANESTHESIA
    $50.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D79
    W ANESTHESIA
    $90.00
    & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM D129
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D129
    $360.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D129 SURFACE $470.00
    CAVITY
    $1,110.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D283
    $370.00
    DIAGNOSTIC: INITIAL ORAL EXAM D324
    (EXCLUDE X-RAY)
    $80.00
    COMPLETE EXAMINATION
    O007
    MATERIALS: FRAMES
    O007
    MATERIALS: LENS, EACH-SINGLE VISION
    O007

    DIAGNOSTIC: BITEWING X-RAY, SINGLE


    D324VIEW
    $60.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D324VIEW
    $180.00
    ENDODONTICS: EXTIRPATION OF PULP
    D283& FILL 1 $6,000.00
    ROOT CANAL (EX RESTOR)
    OTHER
    P011
    $170.50
    $6,860.50
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,268.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,323.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D291
    $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D291CAVITY
    $65.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D291CAVITY $335.00
    $3,381.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D218 SURFACE $625.00
    CAVITY
    $625.00
    M463
    $200.00
    $200.00
    M850
    $100.00
    P-ORAL DRUGS
    P049
    $516.00
    ORAL SURGERY: SURGICAL REMOVAL
    D371
    OF TOOTH W
    $100.00
    SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D371
    OF TOOTH W$50.00
    SOFT TISSUE IMPACTION
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D371VIEW
    $60.00
    OTHER
    P037
    $50.25
    $876.25
    M368
    $200.00
    P-ORAL DRUGS
    P349
    $420.35
    $620.35
    M666
    $160.00
    P-INJECTABLES
    M666
    $240.00
    L97
    $400.00
    M211
    $200.00
    ABORATORY
    M211
    $300.00
    SLT-OFFICE
    S459
    $600.00
    H011
    $3,800.00
    ABORATORY
    H011
    $435.00
    P-ORAL DRUGS
    H011
    $357.00
    S459
    $8,000.00
    S237
    $1,500.00
    IT-HOSPITAL
    M807
    $250.00
    H011
    $900.00
    H011
    $2,776.00
    $19,918.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D351
    W ANESTHESIA
    $40.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D351
    W ANESTHESIA
    $110.00
    & POST OPER
    ORAL SURGERY: SURGICAL REMOVAL
    D59OF TOOTH W
    $150.00
    SOFT TISSUE IMPACTION
    $300.00
    P-ORAL DRUGS
    P437
    $62.50
    P-ORAL DRUGS
    P115
    $31.20
    L97
    $250.00
    P348
    $69.95
    $413.65
    P-ORAL DRUGS
    P106
    $104.95
    L97
    $600.00
    P-ORAL DRUGS
    P106
    $83.00

    P-ORAL DRUGS

    P106

    $78.40
    $866.35
    ABORATORY
    L065
    $175.00
    ABORATORY
    L065
    $175.00
    ABORATORY
    L065
    $175.00
    $525.00
    M230
    $300.00
    P-INJECTABLES
    M230
    $200.00
    ABORATORY
    L065
    $240.00
    P-ORAL DRUGS
    P435
    $24.53
    P-ORAL DRUGS
    P509
    $71.30
    P-ORAL DRUGS
    P509
    $464.25
    P-ORAL DRUGS
    P353
    $57.50
    SLT-OFFICE
    M851
    $600.00
    L143
    $620.00
    ABORATORY
    L061
    $910.00
    $3,487.58
    M200
    $120.00
    L126
    $660.00
    P-ORAL DRUGS
    P131
    $111.00
    P-ORAL DRUGS
    P003
    $120.00
    M186
    $405.00
    P-ORAL DRUGS
    P003
    $45.00
    P-ORAL DRUGS
    P286
    $226.00
    ABORATORY
    L065
    $280.00
    ABORATORY
    L065
    $1,295.00
    $3,262.00
    S103
    $400.00
    OTHER SERVICES: EMERGENCY TREATMENT
    D402
    OF DENTAL
    $35.00
    PAIN
    OTHER SERVICES: EMERGENCY TREATMENT
    D402
    OF DENTAL
    $85.00
    PAIN
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D402VIEW
    $110.00
    M294
    $300.00
    P-INJECTABLES
    M294
    $200.00
    P-ORAL DRUGS
    M294
    $240.00
    ABORATORY
    M294
    $140.00
    $1,510.00
    M463
    $200.00
    P-ORAL DRUGS
    P014
    $36.50
    $236.50
    COMPLETE EXAMINATION
    O131
    $70.00
    MATERIALS: FRAMES
    O131
    $1,200.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O131
    $800.00
    $2,070.00
    H027
    $1,600.00
    H027
    $5,255.00
    SLT-HOSPITAL
    S242
    $2,500.00
    P-ORAL DRUGS
    P215
    $312.30
    $9,667.30
    S375
    $300.00
    $300.00
    M115
    $300.00
    P-INJECTABLES
    M115
    $570.00
    P-ORAL DRUGS
    M115
    $30.00

    $100.00
    $120.00
    $120.00
    $100.00
    P-INJECTABLES
    $70.00
    P-ORAL DRUGS
    $70.00
    ABORATORY
    $30.00
    $1,510.00
    DIAGNOSTIC: INITIAL ORAL EXAM D148
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D148
    X-RAY, SINGLE
    $240.00
    VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D148 SURFACE
    $2,350.00
    CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    D148
    $700.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D148
    TIMES$180.00
    (EXCLUDE PROPHYLAXIS)
    $3,570.00
    P-ORAL DRUGS
    P435
    $29.55
    P-ORAL DRUGS
    P435
    $116.69
    SLT-OFFICE
    S300
    $600.00
    P-ORAL DRUGS
    P076
    $149.55
    P-ORAL DRUGS
    P014
    $242.55
    ABORATORY
    L116
    $760.00
    P-ORAL DRUGS
    P179
    $101.99
    L075
    $3,800.00
    P-ORAL DRUGS
    P014
    $242.55
    SLT-OFFICE
    S300
    $300.00
    P-ORAL DRUGS
    P469
    $151.20
    T068
    $50.00
    T068
    $1,140.00
    $7,684.08
    M756
    $300.00
    P-INJECTABLES
    M756
    $400.00
    P-ORAL DRUGS
    P426
    $541.00
    $1,241.00
    M230
    $300.00
    M230
    $300.00
    $600.00
    P-ORAL DRUGS
    P037
    $58.00
    P-ORAL DRUGS
    P037
    $533.50
    $591.50
    P-ORAL DRUGS
    P182
    $125.00
    $125.00
    M267
    $200.00
    ABORATORY
    M267
    $60.00
    P-ORAL DRUGS
    M267
    $40.00
    $300.00
    M029
    $100.00
    P-ORAL DRUGS
    M029
    $40.00
    ABORATORY
    H008
    $375.00
    ABORATORY
    H008
    $196.00
    $711.00
    M505
    $140.00
    P-INJECTABLES
    M505
    $60.00
    ABORATORY
    L152
    $410.00
    P-ORAL DRUGS
    P115
    $59.90

    P-INJECTABLES
    P-ORAL DRUGS

    M327
    M327
    M115
    M115
    M115
    M115
    M115

    P-ORAL DRUGS

    P049

    $33.50
    $703.40
    M189
    $240.00
    P-ORAL DRUGS
    P076
    $37.50
    $277.50
    S197
    $200.00
    P-ORAL DRUGS
    P372
    $454.70
    P-ORAL DRUGS
    P372
    $227.35
    P-ORAL DRUGS
    P372
    $227.35
    $1,109.40
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $796.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $476.00
    M030
    $160.00
    P-ORAL DRUGS
    P031
    $341.35
    $1,873.35
    S220
    $260.00
    P-ORAL DRUGS
    P076
    $115.90
    $375.90
    L97
    $250.00
    $250.00
    S191
    $700.00
    ABORATORY
    L041
    $1,020.00
    L041
    $4,400.00
    P-ORAL DRUGS
    O176
    $125.58
    P-ORAL DRUGS
    P154
    $380.10
    $6,625.68
    M461
    $150.00
    M461
    $320.00
    P-INJECTABLES
    M461
    $460.00
    ABORATORY
    L070
    $2,400.00
    M461
    $300.00
    P-INJECTABLES
    M461
    $800.00
    M463
    $400.00
    P-INJECTABLES
    M463
    $100.00
    L143
    $500.00
    P-ORAL DRUGS
    P167
    $155.95
    MM06
    $46.00
    $5,631.95
    M176
    $160.00
    P-ORAL DRUGS
    P039
    $82.00
    L161
    $300.00
    M176
    $160.00
    P-ORAL DRUGS
    P014
    $56.00
    $758.00
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $15.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $65.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D113
    W ANESTHESIA
    $40.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D113
    W ANESTHESIA
    $560.00
    & POST OPER
    PROSTHETICS: PARTIAL UPPER/LOWER
    D113ACRYLIC $3,500.00
    BASE DENT 2 CLASP W REST
    M230
    $300.00
    M230
    $400.00

    P-ORAL DRUGS

    P509
    S162
    P014

    $328.60
    $480.00
    P-ORAL DRUGS
    $127.50
    $5,896.10
    L97
    $200.00
    COMPLETE EXAMINATION
    O065
    $150.00
    MATERIALS: FRAMES
    O065
    $800.00
    MATERIALS: LENS, EACH-BI-FOCALO065
    $1,920.00
    O065
    $150.00
    DIAGNOSTIC: INITIAL ORAL EXAM D173
    (EXCLUDE X-RAY)
    $140.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D173
    X-RAY, SINGLE
    $30.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D173
    X-RAY, SINGLE
    $130.00
    VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D173CAVITY $2,750.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D173CAVITY $900.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D173
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D173
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    $7,570.00
    S240
    $200.00
    L081
    $800.00
    P-ORAL DRUGS
    P349
    $53.00
    S103
    $700.00
    L046
    $650.00
    $2,403.00
    M660
    $200.00
    P-ORAL DRUGS
    P059
    $180.00
    M814
    $100.00
    P-ORAL DRUGS
    P167
    $16.45
    M814
    $100.00
    ABORATORY
    M814
    $720.00
    P-ORAL DRUGS
    P167
    $1,413.00
    $2,729.45
    M197
    $200.00
    P-ORAL DRUGS
    M197
    $335.00
    M197
    $440.00
    M197
    $100.00
    P-ORAL DRUGS
    P479
    $405.00
    M197
    $100.00
    ABORATORY
    M197
    $60.00
    P-ORAL DRUGS
    P019
    $477.00
    $2,117.00
    M299
    $120.00
    P-INJECTABLES
    M299
    $80.00
    P-ORAL DRUGS
    P394
    $613.00
    $813.00
    SLT-OFFICE
    S197
    $300.00
    ABORATORY
    S197
    $200.00
    EYE: REMOVAL OF CATARACT
    S197
    $4,700.00
    H023
    $1,800.00
    P-ORAL DRUGS
    P399
    $129.50
    SLT-OFFICE
    S197
    $200.00
    P-ORAL DRUGS
    P399
    $129.50
    $7,459.00
    SLT-OFFICE
    S367
    $260.00

    $260.00
    $300.00
    $800.00
    $200.00
    P-ORAL DRUGS
    $38.50
    $1,338.50
    P-ORAL DRUGS
    P014
    $72.55
    PREVENTIVE: DENTAL PROPHYLAXIS
    D219
    $400.00
    P-ORAL DRUGS
    P246
    $52.60
    $525.15
    P-ORAL DRUGS
    P115
    $61.95
    $61.95
    H025
    $300.00
    H025
    $260.00
    M183
    $150.00
    ABORATORY
    M183
    $690.00
    $1,400.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,975.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,080.00
    $3,145.50
    M331
    $420.00
    P-INJECTABLES
    M331
    $600.00
    P-ORAL DRUGS
    P139
    $128.00
    P-ORAL DRUGS
    P094
    $591.00
    ABORATORY
    L065
    $366.00
    M331
    $420.00
    P-INJECTABLES
    M331
    $600.00
    P-ORAL DRUGS
    P139
    $221.00
    SLT-OFFICE
    S077
    $300.00
    P-ORAL DRUGS
    S077
    $140.00
    $3,786.00
    P-ORAL DRUGS
    P458
    $246.95
    DIAGNOSTIC: INITIAL ORAL EXAM D374
    (EXCLUDE X-RAY)
    $125.00
    ORAL SURGERY: SURGICAL REMOVAL
    D374
    OF TOOTH W
    $100.00
    SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D374
    OF TOOTH W
    $400.00
    SOFT TISSUE IMPACTION
    OTHER
    P458
    $51.25
    P-ORAL DRUGS
    P014
    $41.55
    $964.75
    M087
    $180.00
    ABORATORY
    M087
    $160.00
    ABORATORY
    M087
    $20.00
    P-ORAL DRUGS
    P303
    $175.85
    S120
    $240.00
    P-ORAL DRUGS
    P286
    $114.25
    $890.10
    P-ORAL DRUGS
    P491
    $173.00
    $173.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D300
    $350.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D300
    BITEWING X-RAYS
    $66.50
    DIAGNOSTIC: COMPLETE SERIES OF
    D300
    BITEWING X-RAYS
    $333.50
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D300VIEW
    $400.00
    $1,150.00
    S253
    L149
    M211
    P286

    S323
    S301

    $600.00
    $200.00
    $800.00
    S281
    $400.00
    ABORATORY
    S281
    $400.00
    S285
    $450.00
    ABORATORY
    L079
    $15.00
    L079
    $400.00
    P-ORAL DRUGS
    P458
    $150.15
    $1,815.15
    H034
    $300.00
    P-ORAL DRUGS
    H034
    $712.70
    H034
    $300.00
    H034
    $300.00
    H034
    $400.00
    P-INJECTABLES
    H034
    $350.00
    P-ORAL DRUGS
    H034
    $650.00
    $3,012.70
    M386
    $460.00
    M386
    $25.00
    P-ORAL DRUGS
    P435
    $107.85
    $592.85
    P-ORAL DRUGS
    P428
    $131.20
    P-ORAL DRUGS
    P428
    $51.60
    $182.80
    ABORATORY
    H034
    $960.00
    $960.00
    M171
    $100.00
    $100.00
    M441
    $200.00
    P-INJECTABLES
    M441
    $300.00
    P-ORAL DRUGS
    P115
    $176.10
    M189
    $120.00
    P-ORAL DRUGS
    P115
    $112.00
    M327
    $300.00
    P-ORAL DRUGS
    M327
    $230.00
    P-ORAL DRUGS
    P115
    $158.40
    S347
    $300.00
    P-ORAL DRUGS
    P115
    $145.00
    M189
    $280.00
    P-ORAL DRUGS
    P115
    $49.00
    P-ORAL DRUGS
    P115
    $20.70
    M189
    $280.00
    P-ORAL DRUGS
    P115
    $35.80
    M189
    $140.00
    P-ORAL DRUGS
    P115
    $58.35
    $2,905.35
    PREVENTIVE: DENTAL PROPHYLAXIS
    D396
    $200.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D396
    TIMES (EXCLUDE
    $35.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D396
    TIMES (EXCLUDE
    $90.00
    PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D396CAVITY $375.00
    $700.00
    S384
    $400.00

    S384

    $400.00
    $800.00
    M793
    $400.00
    P-ORAL DRUGS
    M793
    $300.00
    P-INJECTABLES
    M793
    $350.00
    M793
    $625.00
    H034
    $550.00
    $2,225.00
    P-ORAL DRUGS
    P115
    $237.00
    P-ORAL DRUGS
    P037
    $90.35
    $327.35
    P-ORAL DRUGS
    P077
    $180.00
    $180.00
    IT-HOSPITAL
    H011
    $850.00
    H011
    $266.00
    P-ORAL DRUGS
    H011
    $15.00
    $1,131.00
    COMPLETE EXAMINATION
    O076
    $80.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $361.92
    MATERIALS: FRAMES
    O076
    $628.83
    $1,070.75
    SLT-OFFICE
    S118
    $200.00
    M200
    $60.00
    ABSCESSES, BOILS & CARBUNCLES:
    S118
    INCISION FOR
    $3,000.00
    DRAINAGE W/O HOSPITAL
    P-ORAL DRUGS
    P499
    $66.00
    $3,326.00
    M001
    $200.00
    L97
    $350.00
    $550.00
    L97
    $550.00
    M441
    $400.00
    H006
    $3,330.00
    S231
    $300.00
    $4,580.00
    P-ORAL DRUGS
    P014
    $105.30
    M317
    $240.00
    P-ORAL DRUGS
    M317
    $65.00
    P-ORAL DRUGS
    P014
    $129.10
    $539.40
    M189
    $140.00
    ABORATORY
    L136
    $600.00
    P-ORAL DRUGS
    P059
    $123.50
    $863.50
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $870.00
    MATERIALS: LENS, EACH-BI-FOCALO001
    $1,340.00
    S175
    $300.00
    S175
    $50.00
    $2,670.00
    M842
    $300.00
    P-ORAL DRUGS
    M842
    $150.00
    P-ORAL DRUGS
    P011
    $100.00
    H023
    $1,300.00

    OPERATIVE: AMALGAM FILL 1 SURFACE


    D102CAVITY $250.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D102CAVITY $1,050.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D102VIEW
    $300.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D102
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    $3,850.00
    S220
    $260.00
    S220
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $200.00
    P-ORAL DRUGS
    P235
    $381.90
    M049
    $120.00
    P-ORAL DRUGS
    P235
    $37.00
    $1,548.90
    ABORATORY
    L020
    $600.00
    M666
    $160.00
    P-INJECTABLES
    M666
    $200.00
    H006
    $700.00
    M666
    $160.00
    P-INJECTABLES
    M666
    $120.00
    ABORATORY
    M666
    $20.00
    ABORATORY
    L025
    $750.00
    $2,710.00
    M310
    $150.00
    ABORATORY
    M310
    $500.00
    M310
    $230.00
    $880.00
    S454
    $1,300.00
    ABORATORY
    L044
    $3,050.00
    S454
    $500.00
    L128
    $700.00
    $5,550.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $760.75
    MATERIALS: LENS, EACH-BI-FOCALO001
    $1,028.50
    $1,899.25
    S213
    $600.00
    ABORATORY
    L124
    $200.00
    $800.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D217
    X-RAY, SINGLE
    $30.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D217
    X-RAY, SINGLE
    $60.00
    VIEW
    OTHER
    D217
    $180.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D217CAVITY $640.00
    $910.00
    M100
    $160.00
    ABORATORY
    M100
    $160.00
    P-ORAL DRUGS
    M100
    $85.00
    P-ORAL DRUGS
    P014
    $114.90
    M100
    $80.00
    P-ORAL DRUGS
    P014
    $183.35
    M100
    $150.00
    P-ORAL DRUGS
    P104
    $597.00

    M213

    P-ORAL DRUGS

    S295
    P472

    P-ORAL DRUGS
    P-ORAL DRUGS

    H048
    P125
    L97
    P169
    S279
    P169
    H048
    M678
    P125
    P125

    P-ORAL DRUGS

    P450

    P-ORAL DRUGS

    P-ORAL DRUGS

    P-ORAL DRUGS

    S383
    ABORATORY
    O004
    COMPLETE EXAMINATION
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004

    P-ORAL DRUGS

    P-ORAL DRUGS
    P-ORAL DRUGS
    ABORATORY

    IT-HOSPITAL

    P-ORAL DRUGS
    ABORATORY

    P-ORAL DRUGS
    P-ORAL DRUGS

    M514
    P071
    M317
    M317
    P014
    L126
    L126
    H003
    H003
    H003
    H003
    S400
    P073
    P435
    L154
    L97
    P491
    P491

    COMPLETE EXAMINATION
    O001
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001

    ABORATORY

    L139

    P-ORAL DRUGS
    P-ORAL DRUGS

    P454
    P148

    $1,530.25
    $100.00
    $100.00
    $400.00
    $220.20
    $620.20
    $169.00
    $97.00
    $500.00
    $46.00
    $400.00
    $650.00
    $232.00
    $500.00
    $231.00
    $668.00
    $3,493.00
    $1,826.00
    $1,826.00
    $360.00
    $180.00
    $100.00
    $2,056.00
    $2,696.00
    $200.00
    $97.85
    $240.00
    $40.00
    $68.50
    $120.00
    $1,040.00
    $1,806.35
    $1,400.00
    $6,100.35
    $600.00
    $1,500.00
    $9,600.35
    $600.00
    $949.35
    $53.80
    $160.00
    $250.00
    $85.00
    $18.90
    $2,117.05
    $110.00
    $1,547.00
    $1,657.00
    $800.00
    $800.00
    $175.70
    $258.25
    $433.95

    $100.00
    $78.50
    $75.00
    $900.00
    $1,000.00
    $2,153.50
    M020
    $320.00
    P-INJECTABLES
    M020
    $90.00
    SLT-OFFICE
    S295
    $400.00
    L174
    $160.00
    P-ORAL DRUGS
    P039
    $106.00
    $1,076.00
    M164
    $100.00
    P-ORAL DRUGS
    P491
    $120.00
    $220.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,255.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,830.50
    SLT-OFFICE
    S391
    $280.00
    P-ORAL DRUGS
    S391
    $106.20
    M331
    $420.00
    P-INJECTABLES
    M331
    $600.00
    P-ORAL DRUGS
    P167
    $120.45
    S333
    $600.00
    S450
    $300.00
    UTERUS: DILATION & CURRETTAGE,
    S450
    OR OTHER SURGERY
    $3,000.00ON EXT GENITALIA
    M246
    $1,000.00
    H006
    $1,500.00
    P-ORAL DRUGS
    P167
    $209.10
    $11,311.75
    S220
    $280.00
    ABORATORY
    O156
    $150.00
    $430.00
    DIAGNOSTIC: INITIAL ORAL EXAM D59
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D59
    $480.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D59 VIEW
    $30.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D59 VIEW
    $160.00
    $790.00
    H011
    $1,400.00
    H011
    $8,499.00
    IT-HOSPITAL
    H011
    $2,000.00
    S312
    $12,000.00
    S237
    $2,500.00
    S340
    $500.00
    $26,899.00
    ENATAL CARE
    H034
    $160.00
    P-ORAL DRUGS
    P179
    $40.00
    $200.00
    P-ORAL DRUGS
    P476
    $176.25
    $176.25
    M441
    $200.00
    P-ORAL DRUGS
    P115
    $250.40
    $450.40

    P-ORAL DRUGS
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE

    M850
    P399
    O006
    O006
    VISION
    O006

    COMPLETE EXAMINATION
    O001
    MATERIALS: FRAMES
    O001
    MATERIALS: LENS, EACH-SINGLE VISION
    O001

    $110.00
    $1,695.00
    $1,520.00
    $3,325.00
    P-ORAL DRUGS
    P353
    $313.50
    $313.50
    COMPLETE EXAMINATION
    O136
    $60.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O136
    $1,150.17
    MATERIALS: FRAMES
    O136
    $760.83
    $1,971.00
    S136
    $250.00
    $250.00
    S440
    $280.00
    P-ORAL DRUGS
    P014
    $51.20
    $331.20
    M312
    $200.00
    H003
    $600.00
    $800.00
    UN01
    $3,000.00
    M230
    $600.00
    P-INJECTABLES
    M230
    $200.00
    P-ORAL DRUGS
    P167
    $175.95
    DIAGNOSTIC: INITIAL ORAL EXAM D107
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D107
    $300.00
    $4,475.95
    ABORATORY
    L014
    $285.00
    COMPLETE EXAMINATION
    O004
    $100.00
    $385.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D435
    $400.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D435
    BITEWING X-RAYS
    $66.50
    DIAGNOSTIC: COMPLETE SERIES OF
    D435
    BITEWING X-RAYS
    $233.50
    ORAL SURGERY: SURGICAL REMOVAL
    D435
    OF TOOTH W
    $500.00
    SOFT TISSUE IMPACTION
    OTHER
    P049
    $38.20
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D435
    W ANESTHESIA
    $500.00
    & POST OPER
    $1,738.20
    M139
    $100.00
    P-INJECTABLES
    M139
    $700.00
    $800.00
    M299
    $120.00
    P-INJECTABLES
    M299
    $240.00
    P-ORAL DRUGS
    P316
    $221.75
    $581.75
    M007
    $100.00
    P-INJECTABLES
    M007
    $20.00
    ABORATORY
    M007
    $80.00
    M786
    $80.00
    P-ORAL DRUGS
    M786
    $40.00
    M786
    $80.00
    P-ORAL DRUGS
    M786
    $40.00
    $440.00
    M100
    $160.00
    P-ORAL DRUGS
    M100
    $30.00
    P-ORAL DRUGS
    P247
    $31.20

    P-ORAL DRUGS

    P247
    M067
    M067
    M067

    $67.50
    $160.00
    P-INJECTABLES
    $40.00
    P-ORAL DRUGS
    $40.00
    $528.70
    S120
    $240.00
    P-ORAL DRUGS
    P394
    $200.00
    $440.00
    L97
    $400.00
    $400.00
    L97
    $250.00
    $250.00
    S068
    $300.00
    $300.00
    M792
    $100.00
    P-INJECTABLES
    M792
    $50.00
    M792
    $200.00
    P-ORAL DRUGS
    P140
    $262.00
    $612.00
    L091
    $300.00
    P-ORAL DRUGS
    L091
    $45.50
    P-ORAL DRUGS
    P071
    $42.85
    P-ORAL DRUGS
    P435
    $106.88
    P-ORAL DRUGS
    P014
    $167.30
    M331
    $280.00
    P-INJECTABLES
    M331
    $200.00
    L176
    $650.00
    $1,792.53
    COMPLETE EXAMINATION
    O008
    $80.00
    MATERIALS: FRAMES
    O008
    $900.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O008
    $1,300.00
    M029
    $100.00
    P-ORAL DRUGS
    M029
    $30.00
    ABORATORY
    M029
    $30.00
    M704
    $100.00
    P-ORAL DRUGS
    M704
    $110.00
    ABORATORY
    M704
    $30.00
    P-ORAL DRUGS
    P154
    $93.95
    $2,773.95
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    M494
    TREATMENT
    $1,000.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    M494
    TREATMENT
    $410.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    M494
    TREATMENT
    $490.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D45
    TREATMENT
    $2,000.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D45
    TREATMENT
    $2,000.00
    $5,900.00
    M371
    $140.00
    $140.00
    COMPLETE EXAMINATION
    O167
    $100.00
    MATERIALS: FRAMES
    O167
    $841.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O167
    $660.00
    $1,601.75
    DIAGNOSTIC: INITIAL ORAL EXAM D252
    (EXCLUDE X-RAY)
    $125.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D252VIEW
    $25.00

    AFTER
    AFTER
    AFTER
    AFTER
    AFTER

    1ST
    1ST
    1ST
    1ST
    1ST

    6
    6
    6
    6
    6

    MONTHS
    MONTHS
    MONTHS
    MONTHS
    MONTHS

    ENDODONTICS: EXTIRPATION OF PULP


    D252& FILL 2 $1,450.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D252CAVITY $1,250.00
    $2,850.00
    S162
    $300.00
    P-ORAL DRUGS
    P115
    $227.80
    S346
    $200.00
    $727.80
    M103
    $60.00
    P-ORAL DRUGS
    P478
    $38.00
    $98.00
    DIAGNOSTIC: INITIAL ORAL EXAM D86
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D86
    $350.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D86 VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D86 VIEW
    $15.00
    $450.00
    S309
    $600.00
    ABORATORY
    L074
    $1,645.00
    H006
    $700.00
    $2,945.00
    DIAGNOSTIC: INITIAL ORAL EXAM D86
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D86
    $250.00
    $300.00
    COMPLETE EXAMINATION
    O007
    $100.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O007
    $1,200.00
    $1,300.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $925.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $620.00
    $1,655.00
    O156
    $360.00
    $360.00
    COMPLETE EXAMINATION
    O054
    $80.00
    MATERIALS: FRAMES
    O054
    $400.00
    MATERIALS: LENS, EACH-BI-FOCALO054
    $400.00
    $880.00
    M001
    $160.00
    P-ORAL DRUGS
    P094
    $460.80
    P-ORAL DRUGS
    P094
    $115.20
    $736.00
    H006
    $900.00
    H006
    $2,600.00
    ABDOMEN: CUTTING ABDOMINAL CAVITY
    S089 EXCEPT
    $8,950.00
    AS OTHERWISE SPECIFIED
    M246
    $2,000.00
    ABORATORY
    S089
    $80.00
    $14,530.00
    COMPLETE EXAMINATION
    O004
    $100.00
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D312
    $210.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D312
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D312
    TIMES (EXCLUDE
    $90.00
    PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D312VIEW
    $150.00
    $550.00
    DIAGNOSTIC: INITIAL ORAL EXAM D276
    (EXCLUDE X-RAY)
    $60.00

    CROWN & BRIDGE: PORCELAIN JACKET


    D276CROWN W$910.00
    METAL THIMBLE
    CROWN & BRIDGE: PORCELAIN JACKET
    D276CROWN $2,090.00
    W METAL THIMBLE
    $3,060.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $50.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $100.00
    $650.00
    S217
    $400.00
    S217
    $400.00
    P-INJECTABLES
    S217
    $150.00
    S217
    $400.00
    S217
    $400.00
    T051
    $2,420.00
    $4,170.00
    M164
    $60.00
    $60.00
    M473
    $270.00
    ABORATORY
    L001
    $935.00
    P-ORAL DRUGS
    P094
    $268.70
    S400
    $300.00
    L081
    $800.00
    P-ORAL DRUGS
    P094
    $149.25
    SLT-OFFICE
    S356
    $300.00
    ABORATORY
    H005
    $200.00
    ABORATORY
    H025
    $60.00
    $3,282.95
    M374
    $200.00
    S428
    $350.00
    ABORATORY
    S428
    $240.00
    ABORATORY
    L154
    $400.00
    $1,190.00
    M225
    $230.00
    ABORATORY
    M225
    $190.00
    $420.00
    M452
    $450.00
    P-ORAL DRUGS
    P435
    $482.23
    $932.23
    S445
    $350.00
    ABORATORY
    S445
    $75.00
    P-ORAL DRUGS
    P435
    $186.47
    S084
    $300.00
    H006
    $350.00
    $1,261.47
    M304
    $185.00
    ABORATORY
    M304
    $515.00
    M304
    $100.00
    P-ORAL DRUGS
    P343
    $44.99
    P-ORAL DRUGS
    P435
    $228.64
    P-ORAL DRUGS
    P435
    $104.72
    $1,178.35

    $250.00
    $300.00
    $1,100.00
    $7,227.73
    SLT-HOSPITAL
    $2,500.00
    ABORATORY
    $520.00
    P-ORAL DRUGS
    $130.71
    ($250.00)
    $250.00
    $250.00
    P-ORAL DRUGS
    $314.49
    $400.00
    ABORATORY
    $250.00
    $13,242.93
    PREVENTIVE: DENTAL PROPHYLAXIS
    D299
    $500.00
    $500.00
    L034
    $300.00
    $300.00
    S401
    $300.00
    ABORATORY
    S401
    $150.00
    L046
    $300.00
    L046
    $300.00
    $1,050.00
    DIAGNOSTIC: INITIAL ORAL EXAM D41
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D41
    $500.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D41 VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D41 VIEW
    $65.00
    S302
    $360.00
    S302
    $300.00
    L97
    $400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D41
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D41
    $500.00
    $2,360.00
    M580
    $100.00
    P-INJECTABLES
    M580
    $25.00
    P-INJECTABLES
    M580
    $375.00
    P-ORAL DRUGS
    M580
    $100.00
    M580
    $400.00
    P-ORAL DRUGS
    P195
    $1,421.50
    ABORATORY
    H008
    $440.00
    H008
    $523.00
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D113
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D113
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $160.00
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D113
    $250.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D113
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $160.00
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D113
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D113
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $160.00

    IT-HOSPITAL

    M437
    H005
    H005
    H005
    S278
    H005
    P435
    M817
    M817
    M817
    P435
    S151
    S151

    DIAGNOSTIC: INITIAL ORAL EXAM D113


    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D113
    $350.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D113
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D113
    TIMES (EXCLUDE
    $30.00
    PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $240.00
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D113
    $350.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D113
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D113
    TIMES (EXCLUDE
    $30.00
    PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $160.00
    S242
    $500.00
    L041
    $350.00
    ABORATORY
    L041
    $370.00
    S242
    $2,500.00
    P-ORAL DRUGS
    P195
    $150.00
    S405
    $300.00
    $10,884.50
    PREVENTIVE: DENTAL PROPHYLAXIS
    D228
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D228
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D228
    TIMES (EXCLUDE
    $80.00
    PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D228CAVITY $1,050.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D228CAVITY $200.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D228CAVITY $700.00
    ORAL SURGERY: SURGICAL REMOVAL
    D228
    OF TOOTH W
    $300.00
    SOFT TISSUE IMPACTION
    PREVENTIVE: DENTAL PROPHYLAXIS
    D228
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D228
    TIMES$150.00
    (EXCLUDE PROPHYLAXIS)
    $3,150.00
    DIAGNOSTIC: INITIAL ORAL EXAM D259
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D259
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D259
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D259
    TIMES (EXCLUDE
    $80.00
    PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM D259
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D259
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D259
    TIMES$150.00
    (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: COMPLETE SERIES OF
    D259
    BITEWING X-RAYS
    $133.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D259
    BITEWING X-RAYS
    $217.00
    $1,350.00
    DIAGNOSTIC: INITIAL ORAL EXAM D66
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D66
    $450.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D66 CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D66 CAVITY $610.00
    $1,280.00
    M255
    $100.00
    P-INJECTABLES
    M255
    $20.00
    P-ORAL DRUGS
    M255
    $20.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D275
    $350.00
    M265
    $80.00
    P-ORAL DRUGS
    M265
    $120.00
    L041
    $600.00
    ABORATORY
    L041
    $545.00
    $1,835.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D164VIEW
    $70.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D164 SURFACE
    $2,000.00
    CAVITY

    DIAGNOSTIC: BITEWING X-RAY, SINGLE


    D164VIEW

    $30.00
    $2,100.00
    M238
    $100.00
    ABORATORY
    M238
    $305.00
    P-ORAL DRUGS
    P166
    $145.25
    COMPLETE EXAMINATION
    S172
    $200.00
    $750.25
    M580
    $100.00
    P-INJECTABLES
    M580
    $400.00
    P-ORAL DRUGS
    M580
    $300.00
    M580
    $100.00
    DIAGNOSTIC: INITIAL ORAL EXAM D89
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D89
    $150.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D89
    TIMES (EXCLUDE
    $70.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D89
    TIMES (EXCLUDE
    $55.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D89
    BITEWING X-RAYS
    $225.00
    $1,450.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D333
    W ANESTHESIA
    $85.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D333
    W ANESTHESIA
    $215.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D333
    $350.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D333
    TIMES (EXCLUDE
    $70.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D333
    TIMES (EXCLUDE
    $80.00
    M704
    $100.00
    $900.00
    S011
    $300.00
    P-ORAL DRUGS
    P014
    $1,491.40
    S011
    $300.00
    P-ORAL DRUGS
    P014
    $948.00
    ABORATORY
    L041
    $450.00
    $3,489.40
    M647
    $80.00
    P-INJECTABLES
    M647
    $60.00
    P-ORAL DRUGS
    P504
    $150.00
    M647
    $80.00
    P-INJECTABLES
    M647
    $25.00
    P-INJECTABLES
    M647
    $135.00
    $530.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $895.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,323.00
    $2,308.50
    M871
    $140.00
    P-ORAL DRUGS
    P340
    $100.10
    $240.10
    DIAGNOSTIC: INITIAL ORAL EXAM D02
    (EXCLUDE X-RAY)
    $250.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D02 VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D02 VIEW
    $90.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D02
    $750.00
    $1,160.00
    M686
    $80.00
    P-ORAL DRUGS
    P188
    $120.00
    P-ORAL DRUGS
    P188
    $45.00
    P-INJECTABLES
    M686
    $25.00

    PROPHYLAXIS)
    PROPHYLAXIS)

    & POST OPER


    & POST OPER
    PROPHYLAXIS)
    PROPHYLAXIS)

    P-INJECTABLES

    M686
    $95.00
    M686
    $80.00
    P-INJECTABLES
    M686
    $120.00
    P-ORAL DRUGS
    P294
    $30.00
    DIAGNOSTIC: INITIAL ORAL EXAM D35
    (EXCLUDE X-RAY)
    $120.00
    $715.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D198
    $400.00
    M726
    $100.00
    P-ORAL DRUGS
    P450
    $141.00
    P-ORAL DRUGS
    P450
    $4.50
    $645.50
    S160
    $200.00
    S160
    $120.00
    P-INJECTABLES
    S160
    $180.00
    S223
    $300.00
    P-ORAL DRUGS
    P154
    $94.55
    $894.55
    T077
    $1,950.00
    T077
    $750.00
    $2,700.00
    DIAGNOSTIC: INITIAL ORAL EXAM D41
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D41X-RAY, SINGLE
    $40.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D41X-RAY, SINGLE
    $60.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D41
    $500.00
    M018
    $200.00
    P-ORAL DRUGS
    P303
    $125.95
    P-ORAL DRUGS
    P303
    $61.15
    M018
    $200.00
    P-INJECTABLES
    M018
    $25.00
    P-INJECTABLES
    M018
    $35.00
    M018
    $200.00
    P-ORAL DRUGS
    P303
    $110.15
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D41 SURFACE $500.00
    CAVITY
    $2,157.25
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D255
    ROOT$520.00
    PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D255
    ROOT PLANING,
    $80.00 SCALING, EACH
    $600.00
    M747
    $120.00
    P-ORAL DRUGS
    M747
    $20.00
    M747
    $120.00
    P-ORAL DRUGS
    M747
    $223.00
    P-ORAL DRUGS
    P469
    $213.48
    P-ORAL DRUGS
    P469
    $9.12
    P-ORAL DRUGS
    M747
    $41.00
    $746.60
    CROWN & BRIDGE: ACRYLIC JACKET
    D51
    CROWN
    $1,400.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D51
    CROWN
    $2,200.00
    $3,600.00
    M449
    $100.00
    P-INJECTABLES
    M449
    $25.00
    P-INJECTABLES
    M449
    $95.00
    P-ORAL DRUGS
    M449
    $55.00
    M570
    $160.00

    P-ORAL DRUGS

    M570
    M449
    M449
    M449
    M449

    $100.00
    $100.00
    P-INJECTABLES
    $25.00
    P-INJECTABLES
    $35.00
    P-ORAL DRUGS
    $45.00
    $740.00
    ORMAL DELIVERY
    S323
    $6,000.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $50.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $100.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    S019
    $260.00
    S019
    $1,240.00
    $8,150.00
    ENATAL CARE
    S179
    $520.00
    ORMAL DELIVERY
    S179
    $5,000.00
    ORMAL DELIVERY
    S160
    $600.00
    ORMAL DELIVERY
    H027
    $5,245.00
    ORMAL DELIVERY
    P416
    $121.75
    $11,486.75
    DIAGNOSTIC: INITIAL ORAL EXAM D380
    (EXCLUDE X-RAY)
    $160.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D380VIEW
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D380VIEW
    $60.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D380
    $500.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D380
    TIMES (EXCLUDE
    $60.00
    PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D380CAVITY $440.00
    COMPLETE EXAMINATION
    O001
    $110.00
    $1,430.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $2,708.25
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $653.25
    $3,451.50
    M678
    $185.00
    P-ORAL DRUGS
    P435
    $157.24
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $400.00
    M304
    $200.00
    M304
    $140.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,516.00
    M304
    $180.00
    $2,778.24
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,525.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,147.50
    S302
    $460.00
    S302
    $400.00
    ABORATORY
    S302
    $140.00
    ABORATORY
    L070
    $820.00
    $4,603.25
    S384
    $400.00
    S384
    $400.00
    M327
    $140.00

    P-INJECTABLES
    P-INJECTABLES

    M327
    M327
    M327
    P014
    P014

    $25.00
    $35.00
    $140.00
    P-ORAL DRUGS
    $127.00
    P-ORAL DRUGS
    $12.75
    $1,279.75
    S416
    $450.00
    P-ORAL DRUGS
    S415
    $100.00
    S415
    $100.00
    P-ORAL DRUGS
    P468
    $72.50
    P-ORAL DRUGS
    P433
    $222.90
    $945.40
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,356.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,255.50
    $2,701.50
    S199
    $350.00
    P-ORAL DRUGS
    P416
    $123.90
    COMPLETE EXAMINATION
    O076
    $180.00
    MATERIALS: CONTACT, MEDICALLYO076
    REQUIRED
    $405.00
    S160
    $200.00
    P-ORAL DRUGS
    P416
    $30.95
    P-ORAL DRUGS
    P416
    $84.95
    M232
    $100.00
    P-ORAL DRUGS
    M232
    $60.00
    P-ORAL DRUGS
    M232
    $20.00
    M653
    $100.00
    P-ORAL DRUGS
    M653
    $60.00
    P-ORAL DRUGS
    M653
    $20.00
    $1,734.80
    PREVENTIVE: DENTAL PROPHYLAXIS
    D310
    $450.00
    $450.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D278VIEW
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D278VIEW
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D278
    $340.00
    DIAGNOSTIC: INITIAL ORAL EXAM D278
    (EXCLUDE X-RAY)
    $60.00
    $640.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D89 CAVITY $600.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D89 CAVITY $900.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D89
    TIMES$125.00
    (EXCLUDE PROPHYLAXIS)
    OTHER
    D89
    $50.00
    $1,675.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D64 CAVITY $300.00
    $300.00
    ENATAL CARE
    M104
    $180.00
    ENATAL CARE
    M104
    $40.00
    ENATAL CARE
    L070
    $140.00
    ENATAL CARE
    S302
    $400.00
    ENATAL CARE
    S302
    $1,600.00
    ENATAL CARE
    P106
    $126.40
    $2,486.40
    DIAGNOSTIC: INITIAL ORAL EXAM D89
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D89
    $150.00

    DIAGNOSTIC: COMPLETE SERIES OF


    D89
    BITEWING X-RAYS
    $225.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D89
    TIMES$125.00
    (EXCLUDE PROPHYLAXIS)
    $550.00
    OTHER SERVICES: EMERGENCY TREATMENT
    D208
    OF DENTAL
    $80.00
    PAIN
    DIAGNOSTIC: COMPLETE SERIES OF
    D208
    BITEWING X-RAYS
    $340.00
    ORAL SURGERY: SURGICAL REMOVAL
    D208
    OF TOOTH W
    $300.00
    SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D208
    OF TOOTH$1,500.00
    W COMPLETE BONE IMPACTION
    OTHER
    D208
    $201.86
    $2,421.86
    P-ORAL DRUGS
    P154
    $494.95
    S155
    $220.00
    P-ORAL DRUGS
    P427
    $83.20
    P-ORAL DRUGS
    P154
    $505.05
    P-ORAL DRUGS
    P154
    $437.95
    P-ORAL DRUGS
    P154
    $437.95
    P-ORAL DRUGS
    P154
    $437.95
    S155
    $240.00
    ABORATORY
    L070
    $530.00
    P-ORAL DRUGS
    P154
    $437.95
    $3,825.00
    IT-HOSPITAL
    S149
    $3,500.00
    H027
    $600.00
    H027
    $3,460.00
    ABORATORY
    H027
    $230.00
    IT-HOSPITAL
    S149
    $1,500.00
    H027
    $200.00
    H027
    $565.00
    ABORATORY
    H027
    $230.00
    $10,285.00
    DIAGNOSTIC: INITIAL ORAL EXAM D321
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D321
    $400.00
    $520.00
    H011
    $1,400.00
    H011
    $5,360.00
    H011
    $350.00
    ABDOMEN: APPENDECTOMY
    S312
    $12,000.00
    M549
    $1,500.00
    $20,610.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $875.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $940.00
    $1,925.00
    M153
    $200.00
    M153
    $200.00
    S160
    $200.00
    H027
    $400.00
    H027
    $2,030.00
    ABSCESSES, BOILS & CARBUNCLES:
    S393
    INCISION FOR
    $2,200.00
    DRAINAGE W/O HOSPITAL
    M602
    $800.00
    M602
    $50.00
    $6,080.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D64 CAVITY $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D64 CAVITY $120.00

    $420.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D348VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D348VIEW
    $10.00
    ENDODONTICS: EXTIRPATION OF PULP
    D348& FILL 1 $1,600.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D348 SURFACE $500.00
    CAVITY
    $2,160.00
    IT-HOSPITAL
    H023
    $375.00
    H023
    $241.00
    P-INJECTABLES
    H023
    $48.40
    P-ORAL DRUGS
    H023
    $75.00
    ABORATORY
    H023
    $1,847.00
    H023
    $380.00
    PROSTATE: TRANSURETHRAL RESECTION
    L081
    $24,000.00
    H44
    $60,490.00
    H44
    $59,000.00
    SLT-HOSPITAL
    L081
    $6,400.00
    $152,856.40
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D102CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D102CAVITY
    $60.00
    $400.00
    M505
    $140.00
    P-ORAL DRUGS
    P049
    $12.50
    P-ORAL DRUGS
    P049
    $28.50
    H025
    $240.00
    $421.00
    M067
    $160.00
    SLT-OFFICE
    S103
    $400.00
    ABORATORY
    L070
    $525.00
    $1,085.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $675.00
    MATERIALS: LENS, EACH-BI-FOCALO001
    $660.00
    $1,445.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D90
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D90
    W ANESTHESIA
    $415.00
    & POST OPER
    OTHER
    D90
    $104.00
    $604.00
    L075
    $3,800.00
    S427
    $350.00
    S427
    $350.00
    P-ORAL DRUGS
    P066
    $783.55
    $5,283.55
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D148VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D148VIEW
    $70.00
    ORAL SURGERY: SURGICAL REMOVAL
    D148
    OF TOOTH$1,800.00
    W PARTIAL BONE IMPACTION
    DIAGNOSTIC: INITIAL ORAL EXAM D380
    (EXCLUDE X-RAY)
    $120.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D380VIEW
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D380
    $500.00
    DIAGNOSTIC: INITIAL ORAL EXAM D380
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D380
    $400.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D380VIEW
    $150.00
    DIAGNOSTIC: INITIAL ORAL EXAM D380
    (EXCLUDE X-RAY)
    $120.00

    PREVENTIVE: DENTAL PROPHYLAXIS


    D380
    $400.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D380VIEW
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D426VIEW
    $70.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D426
    W ANESTHESIA
    $140.00
    & POST OPER
    ENDODONTICS: EXTIRPATION OF PULP
    D426& FILL 2 $2,000.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D426CAVITY $470.00
    $6,610.00
    SLT-OFFICE
    S103
    $800.00
    ABORATORY
    L070
    $115.00
    P-ORAL DRUGS
    H023
    $236.60
    P-ORAL DRUGS
    P005
    $418.61
    L113
    $2,000.00
    STONE OR TUMOR: REMOVAL OF FROM
    S103 KIDNEY$25,000.00
    OR BLADDER (OPEN SURGICAL)
    P-ORAL DRUGS
    P104
    $290.50
    SLT-OFFICE
    S103
    $400.00
    SLT-OFFICE
    S213
    $300.00
    P-ORAL DRUGS
    P066
    $163.00
    SLT-OFFICE
    S286
    $300.00
    S286
    $150.00
    H023
    $171.00
    ABORATORY
    L070
    $437.00
    P-ORAL DRUGS
    H023
    $114.50
    L145
    $4,000.00
    P-ORAL DRUGS
    P005
    $199.04
    P-ORAL DRUGS
    P066
    $163.00
    S458
    $500.00
    S103
    $800.00
    M411
    $130.00
    ABORATORY
    M411
    $10.00
    P-ORAL DRUGS
    P360
    $40.00
    P-ORAL DRUGS
    P066
    $326.00
    M001
    $200.00
    P-ORAL DRUGS
    P066
    $185.15
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $845.75
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $756.00
    M001
    $200.00
    P-ORAL DRUGS
    P068
    $20.60
    P-ORAL DRUGS
    P066
    $326.00
    $39,687.75
    S217
    $1,700.00
    S217
    $100.00
    S217
    $112.50
    S217
    $338.00
    H023
    $1,200.00
    $3,450.50
    COMPLETE EXAMINATION
    O001
    $270.00
    MATERIALS: FRAMES
    O001
    $1,695.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $995.00
    ENATAL CARE
    S323
    $1,880.00
    ENATAL CARE
    S311
    $800.00
    ENATAL CARE
    S323
    $2,555.00
    COMPLETE EXAMINATION
    O001
    $270.00

    MATERIALS: CONTACT, WHEN NOTO001


    MEDICALLY REQUIRED
    $369.15
    $8,834.15
    S220
    $220.00
    S220
    $120.00
    T051
    $350.00
    M374
    $200.00
    P-ORAL DRUGS
    P343
    $351.94
    T051
    $700.00
    T051
    $1,050.00
    T051
    $525.00
    T051
    $350.00
    T051
    $875.00
    M056
    $150.00
    P-ORAL DRUGS
    M056
    $55.00
    T051
    $350.00
    T051
    $700.00
    $5,996.94
    M248
    $100.00
    P-ORAL DRUGS
    P428
    $49.20
    $149.20
    PREVENTIVE: DENTAL PROPHYLAXIS
    D283
    $85.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D283
    $285.00
    DIAGNOSTIC: INITIAL ORAL EXAM D324
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D324VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D324VIEW
    $150.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D324VIEW
    $55.00
    ENDODONTICS: EXTIRPATION OF PULP
    D283& FILL 1 ROOT
    $580.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D283& FILL 1 $5,420.00
    ROOT CANAL (EX RESTOR)
    OTHER
    P011
    $170.50
    M001
    $150.00
    P-INJECTABLES
    M001
    $100.00
    P-ORAL DRUGS
    M001
    $30.00
    S112
    $300.00
    P-ORAL DRUGS
    P106
    $125.90
    S302
    $400.00
    P-ORAL DRUGS
    P106
    $350.00
    S302
    $360.00
    S302
    $300.00
    ABORATORY
    S302
    $140.00
    P-ORAL DRUGS
    P106
    $295.90
    $9,412.30
    M266
    $200.00
    P-ORAL DRUGS
    P506
    $257.35
    $457.35
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D103CAVITY $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D103CAVITY $180.00
    OPERATIVE: GOLD FOIL FILLING 2 SURFACE
    D103
    CAVITY
    $3,400.00
    $4,240.00
    M001
    $160.00
    P-ORAL DRUGS
    P458
    $266.75
    L117
    $3,800.00

    P-ORAL DRUGS

    P458
    M076
    P203
    M001
    M001
    P139
    P458
    M001
    P458

    $710.60
    $250.00
    P-ORAL DRUGS
    $160.26
    $400.00
    P-ORAL DRUGS
    $355.00
    P-ORAL DRUGS
    $158.00
    P-ORAL DRUGS
    $229.80
    $200.00
    P-ORAL DRUGS
    $326.50
    $7,016.91
    S400
    $300.00
    ABORATORY
    H005
    $100.00
    P-ORAL DRUGS
    P022
    $164.85
    P-ORAL DRUGS
    P011
    $67.50
    S400
    $200.00
    $832.35
    S384
    $400.00
    S384
    $400.00
    ABORATORY
    S384
    $200.00
    S007
    $440.00
    P-ORAL DRUGS
    P093
    $115.00
    $1,555.00
    S383
    $260.00
    P-ORAL DRUGS
    P435
    $151.07
    M326
    $200.00
    P-ORAL DRUGS
    P435
    $73.79
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D218 SURFACE $100.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D218 SURFACE $525.00
    CAVITY
    IT-HOSPITAL
    CD01
    $625.90
    ABORATORY
    CD01
    $1,126.62
    CD01
    $751.08
    CD01
    $625.90
    $4,439.36
    P-ORAL DRUGS
    P104
    $127.90
    M375
    $120.00
    P-ORAL DRUGS
    P104
    $242.90
    M375
    $160.00
    ABORATORY
    M375
    $160.00
    H006
    $400.00
    H006
    $145.00
    ABORATORY
    L065
    $730.00
    M067
    $160.00
    M067
    $160.00
    ABORATORY
    L065
    $200.00
    L121
    $700.00
    DIAGNOSTIC: INITIAL ORAL EXAM D115
    (EXCLUDE X-RAY)
    $90.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D115
    $400.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D115VIEW
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D115VIEW
    $160.00
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D184
    OR CEPHALOMETRIC
    $130.00
    X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D184
    OR CEPHALOMETRIC
    $170.00
    X-RAY)
    OTHER
    D184
    $140.00
    DIAGNOSTIC: CEPHALOMETRIC X-RAY
    D184
    $360.00

    DIAGNOSTIC: INITIAL ORAL EXAM D115


    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D115
    $350.00
    M375
    $160.00
    SLT-OFFICE
    S220
    $360.00
    L065
    $300.00
    P-ORAL DRUGS
    P104
    $106.45
    M089
    $180.00
    P-ORAL DRUGS
    P049
    $280.00
    ABORATORY
    L065
    $200.00
    $6,892.25
    M215
    $500.00
    P-INJECTABLES
    M215
    $100.00
    M215
    $450.00
    $1,050.00
    ENDODONTICS: EXTIRPATION OF PULP
    D86 & FILL 2 ROOT
    $375.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D86 & FILL 2 ROOT
    $900.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D86 & FILL 2 ROOT
    $325.00
    CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D86 SURFACE $100.00
    CAVITY
    OTHER
    D86
    $44.00
    OTHER
    D86
    $556.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D86
    CROWN
    $510.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D86
    CROWN
    $2,990.00
    M015
    $200.00
    P-ORAL DRUGS
    P435
    $781.41
    M015
    $200.00
    L149
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D86
    $85.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D86
    $265.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D86
    CROWN
    $510.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D86
    CROWN
    $2,990.00
    M015
    $200.00
    P-ORAL DRUGS
    P104
    $418.65
    $11,600.06
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D04 CAVITY $312.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D04 CAVITY
    $78.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $786.25
    MATERIALS: LENS, EACH-BI-FOCALO001
    $629.00
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D143
    OR$2,000.00
    CEPHALOMETRIC X-RAY)
    ORTHODONTICS: FIXED SPACE MAINTAINER,
    D143
    BAND
    $6,000.00
    TYPE
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $600.00 AFTER 1ST 6 MONTHS
    H005
    $2,250.00
    H005
    $2,653.04
    IT-HOSPITAL
    H005
    $700.00
    IT-HOSPITAL
    H005
    $2,100.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $1,200.00 AFTER 1ST 6 MONTHS
    $19,418.29
    PREVENTIVE: DENTAL PROPHYLAXIS
    D299
    $500.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D299
    $500.00
    $1,000.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D90X-RAY, SINGLE
    $15.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D90X-RAY, SINGLE
    $85.00
    VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D90 CAVITY
    $65.00

    OPERATIVE: AMALGAM FILL 1 SURFACE


    D90 CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D90 CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D90 CAVITY
    S152
    P-INJECTABLES
    S152

    $435.00
    $85.00
    $515.00
    $300.00
    $300.00
    $1,800.00
    M842
    $100.00
    P-ORAL DRUGS
    P081
    $280.65
    M842
    $300.00
    P-ORAL DRUGS
    P081
    $105.00
    M842
    $200.00
    P-ORAL DRUGS
    P081
    $195.65
    P-ORAL DRUGS
    P081
    $275.20
    M842
    $200.00
    P-ORAL DRUGS
    P081
    $178.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D78 CAVITY $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D78 CAVITY $2,201.00
    OTHER
    D78
    $99.00
    $4,334.50
    P-ORAL DRUGS
    P066
    $835.50
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D143
    OR CEPHALOMETRIC
    $50.00
    X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D143
    OR CEPHALOMETRIC
    $150.00
    X-RAY)
    P-ORAL DRUGS
    P066
    $914.64
    $1,950.14
    M386
    $200.00
    P-INJECTABLES
    M386
    $160.00
    $360.00
    M067
    $160.00
    ABORATORY
    L020
    $60.00
    P-ORAL DRUGS
    P059
    $515.99
    $735.99
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D79X-RAY, SINGLE
    $50.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D79X-RAY, SINGLE
    $20.00
    VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D79
    W ANESTHESIA
    $140.00
    & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM D129
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D129
    $85.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D129
    $275.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D129 SURFACE $100.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D129 SURFACE $370.00
    CAVITY
    $1,110.00
    M766
    $200.00
    ABORATORY
    M766
    $40.00
    P-ORAL DRUGS
    M766
    $253.00
    H005
    $650.00
    S383
    $360.00
    P-ORAL DRUGS
    P399
    $361.50
    EYE: OTHER CUTTING OPERATION S383
    $3,408.00
    EYE: OTHER CUTTING OPERATION S383
    $2,852.00
    P-ORAL DRUGS
    P399
    $129.50
    S383
    $260.00
    $8,514.00
    L046
    $550.00
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00

    PREVENTIVE: DENTAL PROPHYLAXIS


    D125
    PREVENTIVE: DENTAL PROPHYLAXIS
    D125
    ABORATORY
    L133
    L133
    L133

    $85.00
    $215.00
    $695.00
    $400.00
    $350.00
    $2,375.00
    H023
    $700.00
    S217
    $500.00
    S217
    $338.00
    P-ORAL DRUGS
    P457
    $161.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D60
    ROOT
    ($300.00)
    PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D60
    ROOT$300.00
    PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D60
    ROOT$300.00
    PLANING, SCALING, EACH
    $1,999.00
    DIAGNOSTIC: INITIAL ORAL EXAM D51
    (EXCLUDE X-RAY)
    $160.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D51X-RAY, SINGLE
    $100.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D51X-RAY, SINGLE
    $120.00
    VIEW
    ENDODONTICS: EXTIRPATION OF PULP
    D51 & FILL 3 $2,200.00
    ROOT CANAL (EX RESTOR)
    $2,580.00
    T034
    $725.00
    T034
    $225.00
    P-ORAL DRUGS
    P435
    $731.48
    P-ORAL DRUGS
    P435
    $91.20
    S309
    $600.00
    P-ORAL DRUGS
    P435
    $102.98
    P-ORAL DRUGS
    P093
    $171.57
    ABORATORY
    L065
    $630.00
    L065
    $672.58
    $3,949.81
    S076
    $250.00
    $250.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $396.00
    MATERIALS: FRAMES
    O004
    $716.00
    $1,212.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D148CAVITY $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D148CAVITY $1,000.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D148CAVITY $1,500.00
    $2,800.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $2,396.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,016.00
    DIAGNOSTIC: INITIAL ORAL EXAM D60
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D60
    $250.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D60 VIEW
    $150.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D60 VIEW
    $30.00
    ORAL SURGERY: SURGICAL REMOVAL
    D60OF TOOTH W
    $400.00
    SOFT TISSUE IMPACTION
    S165
    $300.00
    S301
    $200.00
    S301
    $200.00
    S301
    $200.00
    $5,292.00
    ESAR/EXTRA UT
    S401
    $8,000.00

    ESAR/EXTRA
    ESAR/EXTRA
    ESAR/EXTRA
    ESAR/EXTRA
    ESAR/EXTRA

    UT
    UT
    UT
    UT
    UT

    M328
    $4,000.00
    M707
    $2,100.00
    H023
    $3,100.00
    H023
    $9,266.38
    P435
    $161.38
    S275
    $900.00
    S275
    $300.00
    ORAL SURGERY: SURGICAL REMOVAL
    D323
    OF TOOTH W
    $650.00
    COMPLETE BONE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D323
    OF TOOTH$2,050.00
    W COMPLETE BONE IMPACTION
    OTHER
    P435
    $346.81
    $30,874.57
    M668
    $220.00
    P-ORAL DRUGS
    P014
    $384.50
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D148VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D148VIEW
    $70.00
    ENDODONTICS: EXTIRPATION OF PULP
    D148& FILL 2 $3,800.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D148CAVITY $700.00
    $5,224.50
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,516.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $776.00
    S151
    $350.00
    S151
    $300.00
    ABORATORY
    S151
    $170.00
    M185
    $360.00
    P-ORAL DRUGS
    P122
    $247.50
    M060
    $200.00
    $4,019.50
    S244
    $300.00
    S244
    $300.00
    S244
    $600.00
    S244
    $300.00
    S244
    $300.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D229
    $300.00
    $2,100.00
    ORMAL DELIVERY
    S400
    $7,450.00
    ORMAL DELIVERY
    L065
    $135.00
    ORMAL DELIVERY
    H005
    $170.00
    ORMAL DELIVERY
    S275
    $1,500.00
    S400
    $200.00
    S400
    $300.00
    $9,755.00
    M089
    $100.00
    M089
    $240.00
    ABORATORY
    L065
    $845.00
    M089
    $180.00
    P-ORAL DRUGS
    P437
    $262.30
    $1,627.30
    COMPLETE EXAMINATION
    O035
    $180.00
    MATERIALS: FRAMES
    O035
    $1,340.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O035
    $1,062.50
    $2,582.50
    P-ORAL DRUGS
    P435
    $762.91

    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS

    P435
    P435
    P435
    P435

    $1,283.45
    $762.91
    $762.91
    $4,842.92
    $8,415.10
    SLT-OFFICE
    S219
    $96.00
    SLT-OFFICE
    S219
    $100.00
    SLT-OFFICE
    S219
    $540.00
    SLT-OFFICE
    S278
    $160.00
    SLT-OFFICE
    S278
    $340.00
    URETHRA: CIRCUMCISION
    S278
    $1,200.00
    URETHRA: CIRCUMCISION
    S278
    $800.00
    P-ORAL DRUGS
    H005
    $89.95
    S219
    $400.00
    $3,725.95
    M171
    $240.00
    ABORATORY
    L136
    $640.00
    P-ORAL DRUGS
    P115
    $52.60
    P-ORAL DRUGS
    P115
    $146.30
    $1,078.90
    COMPLETE EXAMINATION
    O004
    $100.00
    $100.00
    ABORATORY
    L001
    $180.00
    $180.00
    COMPLETE EXAMINATION
    O076
    $180.00
    MATERIALS: FRAMES
    O076
    $1,478.55
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,600.20
    $3,258.75
    L006
    $360.00
    $360.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D412
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D412
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D412
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    DIAGNOSTIC: COMPLETE SERIES OF
    D412
    BITEWING X-RAYS
    $350.00
    M711
    $160.00
    P-ORAL DRUGS
    P057
    $260.00
    $1,220.00
    M001
    $200.00
    P-ORAL DRUGS
    P014
    $1,194.00
    P-ORAL DRUGS
    P066
    $1,956.00
    P-ORAL DRUGS
    P005
    $1,534.55
    PREVENTIVE: DENTAL PROPHYLAXIS
    D205
    $350.00
    $5,234.55
    COMPLETE EXAMINATION
    O174
    $50.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O174
    $927.00
    M387
    $200.00
    P-ORAL DRUGS
    P324
    $124.99
    M387
    $200.00
    P-ORAL DRUGS
    P324
    $96.76
    $1,598.75
    M060
    $200.00
    ABORATORY
    H005
    $260.00
    P-ORAL DRUGS
    P081
    $70.90

    $530.90
    $250.00
    P-ORAL DRUGS
    $86.33
    P-ORAL DRUGS
    $228.71
    $60.00
    $140.00
    P-ORAL DRUGS
    $209.24
    P-ORAL DRUGS
    $67.31
    $1,041.59
    S091
    $230.00
    S091
    $290.00
    S091
    $160.00
    S091
    $280.00
    DIAGNOSTIC: INITIAL ORAL EXAM D181
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D181
    $450.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D181VIEW
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D181VIEW
    $250.00
    S091
    $160.00
    P-ORAL DRUGS
    P003
    $501.20
    $2,521.20
    M304
    $200.00
    COMPLETE EXAMINATION
    O026
    $100.00
    O026
    $100.00
    $400.00
    S315
    $120.00
    ABORATORY
    S315
    $1,000.00
    S315
    $120.00
    P-ORAL DRUGS
    P349
    $128.10
    ORTHODONTICS: FIXED/CEMENTEDD38
    APPLIANCE FOR
    $130.00
    TOOTH GUIDANCE
    ORTHODONTICS: FIXED/CEMENTEDD38
    APPLIANCE FOR$20.00
    TOOTH GUIDANCE
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D38X-RAY, SINGLE
    $400.00
    VIEW
    $1,918.10
    M230
    $300.00
    P-ORAL DRUGS
    P014
    $486.00
    $786.00
    M666
    $240.00
    P-INJECTABLES
    M666
    $120.00
    P-ORAL DRUGS
    P131
    $93.00
    $453.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D90
    BITEWING X-RAYS
    $171.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D90
    BITEWING X-RAYS
    $129.00
    PROSTHETICS: ADD TOOTH TO PRTD90
    DENT REPL EXTR
    $1,500.00
    TOOTH W/O CLSP
    OTHER
    D90
    $159.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D90 CAVITY $500.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D90 SURFACE
    $1,200.00
    CAVITY
    DIAGNOSTIC: PULP VITALITY TEST D90
    $20.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D90 VIEW
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D90
    $450.00
    $4,179.00
    S069
    $300.00
    P-INJECTABLES
    S069
    $100.00
    P-ORAL DRUGS
    P306
    $212.00
    $612.00
    M068
    P203
    P203
    M068
    M068
    P085
    P085

    COMPLETE EXAMINATION
    O004
    MATERIALS: CONTACT, WHEN NOTO004
    MEDICALLY
    MATERIALS: CONTACT, WHEN NOTO004
    MEDICALLY
    MATERIALS: CONTACT, WHEN NOTO007
    MEDICALLY
    COMPLETE EXAMINATION
    O007
    MATERIALS: FRAMES
    O007
    MATERIALS: LENS, EACH-SINGLE VISION
    O007

    $350.00
    REQUIRED
    $432.00
    REQUIRED
    $432.00
    REQUIRED
    $800.00
    $210.00
    $1,075.50
    $1,260.00
    $4,559.50
    S281
    $400.00
    ABORATORY
    S281
    $400.00
    S384
    $500.00
    S323
    $350.00
    ABORATORY
    S323
    $160.00
    $1,810.00
    COMPLETE EXAMINATION
    O001
    $250.00
    MATERIALS: FRAMES
    O001
    $1,657.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $960.50
    DIAGNOSTIC: INITIAL ORAL EXAM D131
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D131
    $400.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D131
    X-RAY, SINGLE
    $150.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D131
    X-RAY, SINGLE
    $370.00
    VIEW
    $3,908.00
    P-ORAL DRUGS
    M019
    $276.90
    $276.90
    DIAGNOSTIC: INITIAL ORAL EXAM D432
    (EXCLUDE X-RAY)
    $150.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D432
    X-RAY, SINGLE
    $150.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D432
    X-RAY, SINGLE
    $250.00
    VIEW
    ENDODONTICS: EXTIRPATION OF PULP
    D432& FILL 2 $2,500.00
    ROOT CANAL (EX RESTOR)
    $3,050.00
    S384
    $400.00
    S384
    $400.00
    $800.00
    M766
    $200.00
    ABORATORY
    M766
    $25.00
    P-ORAL DRUGS
    P427
    $175.40
    COMPLETE EXAMINATION
    O001
    $270.00
    MATERIALS: FRAMES
    O001
    $1,895.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,130.00
    $3,695.40
    M029
    $100.00
    P-ORAL DRUGS
    P066
    $684.20
    ABORATORY
    H008
    $679.00
    H008
    $385.00
    $1,848.20
    PREVENTIVE: DENTAL PROPHYLAXIS
    D180
    $350.00
    COMPLETE EXAMINATION
    O001
    $110.00
    $460.00
    DIAGNOSTIC: INITIAL ORAL EXAM D208
    (EXCLUDE X-RAY)
    $160.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D208VIEW
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D208VIEW
    $60.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D208
    $600.00
    $920.00
    DIAGNOSTIC: INITIAL ORAL EXAM D82
    (EXCLUDE X-RAY)
    $80.00

    OPERATIVE: AMALGAM FILL 1 SURFACE


    D04 CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D04 CAVITY

    $300.00
    $400.00
    $780.00
    M134
    $150.00
    ABORATORY
    H022
    $80.00
    H022
    $200.00
    M545
    $150.00
    ABORATORY
    M545
    $240.00
    M867
    $150.00
    $970.00
    S244
    $600.00
    S244
    $600.00
    S244
    $300.00
    P-ORAL DRUGS
    P435
    $98.29
    $1,598.29
    DIAGNOSTIC: COMPLETE SERIES OF
    D01
    BITEWING X-RAYS
    $171.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D01
    BITEWING X-RAYS
    $179.00
    ORAL SURGERY: SURGICAL REMOVAL
    D221
    OF TOOTH$1,900.00
    W PARTIAL BONE IMPACTION
    $2,250.00
    M067
    $160.00
    P-INJECTABLES
    M067
    $60.00
    ABORATORY
    L020
    $210.00
    P-ORAL DRUGS
    P049
    $81.00
    $511.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D260CAVITY $125.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D260CAVITY $175.00
    $300.00
    S302
    $360.00
    ABORATORY
    S302
    $140.00
    P-ORAL DRUGS
    P094
    $168.00
    M045
    $150.00
    P-ORAL DRUGS
    P094
    $40.50
    $858.50
    H005
    $300.00
    H005
    $1,200.00
    $1,500.00
    M171
    $100.00
    P-ORAL DRUGS
    P435
    $151.64
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D324VIEW
    $80.00
    ORAL SURGERY: SURGICAL REMOVAL
    D324
    OF TOOTH W
    $260.00
    SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D324
    OF TOOTH W
    $440.00
    SOFT TISSUE IMPACTION
    S091
    $160.00
    ENDODONTICS: EXTIRPATION OF PULP
    D324& FILL 2 ROOT
    $840.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D324& FILL 2 $1,160.00
    ROOT CANAL (EX RESTOR)
    $3,191.64
    DIAGNOSTIC: INITIAL ORAL EXAM D324
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D324
    X-RAY, SINGLE
    $120.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D324
    X-RAY, SINGLE
    $120.00
    VIEW
    ORAL SURGERY: SURGICAL REMOVAL
    D324
    OF ERUPTED
    $400.00
    TOOTH
    PREVENTIVE: DENTAL PROPHYLAXIS
    D324
    $500.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D324CAVITY $1,000.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D324CAVITY $450.00
    $2,670.00

    S279
    S279

    $900.00
    $232.00
    $1,132.00
    M473
    $180.00
    L006
    $400.00
    P-ORAL DRUGS
    P373
    $162.50
    M229
    $160.00
    P-ORAL DRUGS
    P373
    $153.55
    P-ORAL DRUGS
    P373
    $28.35
    M229
    $160.00
    M473
    $150.00
    P-ORAL DRUGS
    P373
    $447.95
    M473
    $120.00
    P-ORAL DRUGS
    P342
    $470.40
    M607
    $450.00
    M607
    $375.00
    P-ORAL DRUGS
    P373
    $791.20
    H003
    $120.00
    P-INJECTABLES
    H003
    $115.00
    P-ORAL DRUGS
    H003
    $96.50
    H003
    $180.00
    P-ORAL DRUGS
    P373
    $98.00
    $4,658.45
    P-ORAL DRUGS
    P139
    $172.00
    M678
    $200.00
    $372.00
    ENDODONTICS: EXTIRPATION OF PULP
    D181& FILL 3 $1,000.00
    ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D181& FILL 3 $4,000.00
    ROOT CANAL (EX RESTOR)
    CROWN & BRIDGE: PORCELAIN JACKET
    D181CROWN $7,380.00
    W METAL THIMBLE
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D181 SURFACE
    $1,000.00
    CAVITY
    $13,380.00
    M789
    $90.00
    M789
    $110.00
    P-ORAL DRUGS
    P014
    $76.50
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,395.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,880.00
    $3,661.50
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D39
    TREATMENT
    $100.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D39
    TREATMENT
    $300.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D39
    TREATMENT
    $100.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D39
    TREATMENT
    $300.00 AFTER 1ST 6 MONTHS
    $800.00
    S327
    $600.00
    H008
    $3,080.00
    $3,680.00
    M326
    $200.00
    P-INJECTABLES
    M326
    $50.00
    ABSCESSES, BOILS & CARBUNCLES:
    M326
    INCISION FOR$400.00
    DRAINAGE W/O HOSPITAL
    M326
    $450.00
    P-ORAL DRUGS
    P427
    $2,194.50
    ABORATORY
    H023
    $3,800.00
    L046
    $2,375.00

    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    P427
    P022
    P427
    P005
    P005
    M326
    P427

    $1,216.90
    $174.65
    $1,346.15
    $10,549.05
    $9,966.72
    $250.00
    P-ORAL DRUGS
    $58.10
    $33,031.07
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $845.75
    $945.75
    M368
    $400.00
    ABORATORY
    M368
    $450.00
    P-ORAL DRUGS
    P394
    $2,325.00
    M033
    $200.00
    M008
    $200.00
    P-ORAL DRUGS
    M008
    $55.00
    SLT-OFFICE
    S281
    $400.00
    S281
    $400.00
    P-ORAL DRUGS
    P014
    $25.95
    P-ORAL DRUGS
    P332
    $150.00
    M463
    $200.00
    ABORATORY
    L070
    $190.00
    M368
    $200.00
    ABORATORY
    M368
    $250.00
    P-ORAL DRUGS
    P394
    $1,980.00
    $7,425.95
    P-ORAL DRUGS
    P435
    $715.97
    P-ORAL DRUGS
    P457
    $1,350.50
    $2,066.47
    DIAGNOSTIC: INITIAL ORAL EXAM D244
    (EXCLUDE X-RAY)
    $60.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D244VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D244VIEW
    $45.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D244 SURFACE $600.00
    CAVITY
    $740.00
    M212
    $1,050.00
    ABORATORY
    M212
    $380.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $476.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,116.00
    $3,122.00
    M430
    $100.00
    M430
    $100.00
    M430
    $200.00
    SLT-OFFICE
    S184
    $200.00
    ABORATORY
    S184
    $100.00
    L006
    $400.00
    P-ORAL DRUGS
    P399
    $266.20
    P-ORAL DRUGS
    P399
    $30.00
    ABORATORY
    L065
    $490.00
    P-ORAL DRUGS
    P399
    $28.50
    M430
    $100.00
    P-ORAL DRUGS
    P399
    $327.50

    $1,050.00
    $100.00
    $3,492.20
    MATERIALS: FRAMES
    O169
    $585.00
    MATERIALS: LENS, EACH-BI-FOCALO169
    $1,075.00
    $1,660.00
    M186
    $220.00
    P-ORAL DRUGS
    P353
    $46.80
    P-ORAL DRUGS
    P353
    $68.00
    SLT-OFFICE
    S159
    $800.00
    L075
    $3,800.00
    P-ORAL DRUGS
    P353
    $277.20
    M186
    $405.00
    P-ORAL DRUGS
    P399
    $96.50
    L149
    $230.00
    MM06
    $321.40
    SLT-OFFICE
    S159
    $400.00
    P-ORAL DRUGS
    P353
    $995.00
    T068
    $1,080.00
    SLT-OFFICE
    S159
    $800.00
    P-ORAL DRUGS
    P435
    $850.35
    T068
    $1,080.00
    $11,470.25
    M577
    $200.00
    ABORATORY
    M577
    $40.00
    $240.00
    SLT-OFFICE
    S126
    $300.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S126
    $1,200.00
    ABORATORY
    S126
    $500.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,525.75
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,496.00
    $5,131.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $2,335.50
    MATERIALS: FRAMES
    O076
    $876.00
    $3,211.50
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D257VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D257VIEW
    $65.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D257CAVITY $400.00
    $500.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D58 SURFACE $140.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D58 SURFACE $610.00
    CAVITY
    $750.00
    M215
    $250.00
    H023
    $505.00
    ABORATORY
    L070
    $1,080.00
    M215
    $250.00
    $2,085.00
    SLT-OFFICE
    S374
    $350.00
    $350.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $795.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,641.00

    ABORATORY

    M212
    M212

    $2,546.00
    PROSTHETICS: PARTIAL UPPER/LOWER
    D345ACRYLIC BASE
    $700.00
    DENTURE W/O CLASP
    PROSTHETICS: PARTIAL UPPER/LOWER
    D345ACRYLIC $1,800.00
    BASE DENTURE W/O CLASP
    $2,500.00
    M028
    $100.00
    $100.00
    M254
    $200.00
    P-ORAL DRUGS
    M254
    $200.00
    P-INJECTABLES
    M254
    $200.00
    $600.00
    M189
    $140.00
    P-ORAL DRUGS
    P115
    $11.50
    $151.50
    M033
    $100.00
    P-ORAL DRUGS
    P318
    $57.60
    $157.60
    M833
    $160.00
    P-ORAL DRUGS
    P106
    $49.00
    $209.00
    SLT-OFFICE
    S312
    $250.00
    S312
    $350.00
    ABORATORY
    S312
    $150.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D257
    X-RAY, SINGLE
    $35.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D257
    X-RAY, SINGLE
    $65.00
    VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D257 SURFACE
    $1,250.00
    CAVITY
    $2,100.00
    SLT-OFFICE
    S237
    $500.00
    P-ORAL DRUGS
    P014
    $541.65
    ABORATORY
    L061
    $70.00
    $1,111.65
    M229
    $40.00
    ABORATORY
    L001
    $320.00
    $360.00
    M327
    $140.00
    ABORATORY
    M327
    $80.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D79
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D79
    W ANESTHESIA
    $55.00
    & POST OPER
    $360.00
    SLT-OFFICE
    S240
    $200.00
    ABORATORY
    L074
    $545.00
    $745.00
    M701
    $600.00
    P-ORAL DRUGS
    P432
    $24.80
    ABSCESSES, BOILS & CARBUNCLES:
    P432
    INCISION FOR$400.00
    DRAINAGE W/O HOSPITAL
    M701
    $200.00
    COMPLETE EXAMINATION
    O076
    $80.00
    $1,304.80
    M014
    $140.00
    P-ORAL DRUGS
    P088
    $60.75
    L143
    $1,500.00
    M020
    $160.00
    L034
    $400.00
    M213
    $100.00

    ABSCESSES, BOILS & CARBUNCLES:


    M213
    INCISION FOR$400.00
    DRAINAGE W/O HOSPITAL
    $2,760.75
    M138
    $120.00
    P-INJECTABLES
    M138
    $25.00
    P-INJECTABLES
    M138
    $75.00
    $220.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,276.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $792.00
    $2,158.00
    DIAGNOSTIC: INITIAL ORAL EXAM D301
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D301VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D301VIEW
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D301
    $400.00
    ORAL SURGERY: SURGICAL REMOVAL
    D301
    OF ERUPTED
    $300.00
    TOOTH
    $870.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $535.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $340.50
    $966.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $945.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $723.19
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $677.06
    M463
    $200.00
    P-INJECTABLES
    M463
    $100.00
    P-ORAL DRUGS
    P337
    $180.00
    P-ORAL DRUGS
    P337
    $70.00
    SLT-OFFICE
    S187
    $200.00
    P-ORAL DRUGS
    P014
    $59.00
    P-ORAL DRUGS
    P014
    $133.50
    M463
    $100.00
    M463
    $300.00
    P-INJECTABLES
    M463
    $80.00
    P-ORAL DRUGS
    P337
    $60.00
    ABORATORY
    M463
    $80.00
    COMPLETE EXAMINATION
    O076
    $90.00
    $4,088.50
    M299
    $150.00
    P-INJECTABLES
    M299
    $25.00
    P-INJECTABLES
    M299
    $205.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: FRAMES
    O161
    $1,200.00
    MATERIALS: LENS, EACH-BI-FOCALO161
    $600.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: FRAMES
    O161
    $1,400.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O161
    $1,100.00
    $5,080.00
    M304
    $140.00
    P-ORAL DRUGS
    P014
    $239.45
    $379.45
    M230
    $300.00
    P-ORAL DRUGS
    P014
    $331.05

    $631.05
    $365.00
    P-ORAL DRUGS
    $2,028.80
    $24.00
    $306.00
    SLT-OFFICE
    $400.00
    $480.00
    P-ORAL DRUGS
    $52.40
    P-ORAL DRUGS
    $13.10
    $3,669.30
    SLT-OFFICE
    S069
    $250.00
    SLT-OFFICE
    S069
    $200.00
    P-ORAL DRUGS
    P267
    $70.00
    P-ORAL DRUGS
    P267
    $195.00
    SLT-OFFICE
    S069
    $250.00
    P-ORAL DRUGS
    P267
    $130.00
    $1,095.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D397CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D397CAVITY $300.00
    $400.00
    SLT-OFFICE
    S271
    $380.00
    P-ORAL DRUGS
    P039
    $105.00
    $485.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $476.00
    $576.00
    P-ORAL DRUGS
    P427
    $25.00
    P-ORAL DRUGS
    P005
    $524.24
    SLT-OFFICE
    S304
    $200.00
    P-ORAL DRUGS
    P427
    $1,176.00
    P-ORAL DRUGS
    P005
    $655.30
    P-ORAL DRUGS
    P465
    $46.00
    $2,626.54
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,036.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,036.00
    $2,172.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $476.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $396.00
    SLT-OFFICE
    S184
    $200.00
    ABORATORY
    S184
    $100.00
    P-ORAL DRUGS
    P337
    $234.00
    COMPLETE EXAMINATION
    O004
    $100.00
    $1,606.00
    SLT-OFFICE
    S384
    $300.00
    S384
    $400.00
    M299
    $150.00
    ABORATORY
    L070
    $300.00
    P-INJECTABLES
    M299
    $25.00
    P-INJECTABLES
    M299
    $215.00
    ABORATORY
    L070
    $740.00
    $2,130.00
    H006
    P005
    H006
    H006
    S128
    S128
    P091
    P091

    $250.00
    $140.00
    $390.00
    COMPLETE EXAMINATION
    O136
    $60.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O136
    $1,327.10
    $1,387.10
    M164
    $120.00
    M248
    $180.00
    P-ORAL DRUGS
    P016
    $52.80
    P-ORAL DRUGS
    P016
    $5.25
    $358.05
    ORAL SURGERY: SURGICAL REMOVAL
    D319
    OF ERUPTED
    $170.00
    TOOTH
    ORAL SURGERY: SURGICAL REMOVAL
    D319
    OF ERUPTED
    $530.00
    TOOTH
    M346
    $100.00
    P-INJECTABLES
    M346
    $25.00
    P-INJECTABLES
    M346
    $75.00
    P-ORAL DRUGS
    P435
    $96.52
    M346
    $100.00
    P-INJECTABLES
    M346
    $100.00
    P-ORAL DRUGS
    P306
    $190.25
    $1,386.77
    M299
    $120.00
    P-INJECTABLES
    M299
    $25.00
    P-INJECTABLES
    M299
    $55.00
    P-ORAL DRUGS
    P316
    $133.45
    M299
    $120.00
    P-INJECTABLES
    M299
    $336.00
    P-INJECTABLES
    M299
    $25.00
    P-INJECTABLES
    M299
    $59.00
    $873.45
    PREVENTIVE: DENTAL PROPHYLAXIS
    D176
    $350.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D176VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D176VIEW
    $30.00
    $450.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D381VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D381VIEW
    $35.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D381
    W ANESTHESIA
    $140.00
    & POST OPER
    M618
    $240.00
    L034
    $400.00
    P-ORAL DRUGS
    P472
    $51.25
    M618
    $140.00
    P-ORAL DRUGS
    P039
    $110.00
    $1,151.25
    M694
    $100.00
    P-INJECTABLES
    M694
    $200.00
    P-ORAL DRUGS
    M694
    $40.00
    P-ORAL DRUGS
    M694
    $340.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D38
    TREATMENT
    $85.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D38
    TREATMENT
    $115.00 AFTER 1ST 6 MONTHS
    M694
    $100.00
    P-INJECTABLES
    M694
    $25.00
    P-INJECTABLES
    M694
    $175.00
    P-ORAL DRUGS
    P366
    $220.00

    P-ORAL DRUGS

    M107
    P476

    $1,400.00
    $100.00
    ABORATORY
    $200.00
    $300.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $628.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $880.00
    $1,598.00
    S433
    $200.00
    S433
    $50.00
    SLT-OFFICE
    H005
    $240.00
    SLT-OFFICE
    H005
    $60.00
    S433
    $2,300.00
    S433
    $9,700.00
    S433
    $1,875.00
    S433
    $1,125.00
    S433
    $1,875.00
    S433
    $4,375.00
    P-ORAL DRUGS
    P031
    $13,221.99
    P-ORAL DRUGS
    P031
    $494.31
    $35,516.30
    M225
    $480.00
    ABORATORY
    M225
    $120.00
    ABORATORY
    L001
    $232.75
    SLT-OFFICE
    S214
    $350.00
    PROSTATE: TRANSURETHRAL RESECTION
    S214
    $3,400.00
    H005
    $2,400.00
    P-ORAL DRUGS
    P215
    $486.60
    P-ORAL DRUGS
    P066
    $700.00
    P-ORAL DRUGS
    P215
    $34.15
    P-ORAL DRUGS
    P215
    $32.50
    $8,236.00
    M374
    $350.00
    P-ORAL DRUGS
    P031
    $84.98
    P-ORAL DRUGS
    P436
    $290.90
    P-ORAL DRUGS
    P487
    $178.63
    M374
    $200.00
    COMPLETE EXAMINATION
    O001
    $110.00
    SLT-OFFICE
    S220
    $360.00
    SLT-OFFICE
    S127
    $300.00
    P-ORAL DRUGS
    P031
    $351.00
    S220
    $220.00
    SLT-OFFICE
    S220
    $240.00
    O156
    $300.00
    P-ORAL DRUGS
    P005
    $781.76
    P-ORAL DRUGS
    P005
    $390.88
    $4,158.15
    SLT-OFFICE
    S020
    $400.00
    P-ORAL DRUGS
    P031
    $98.99
    P-ORAL DRUGS
    P435
    $129.00
    P-ORAL DRUGS
    P031
    $337.50
    SLT-OFFICE
    S220
    $260.00
    DIAGNOSTIC: INITIAL ORAL EXAM D86
    (EXCLUDE X-RAY)
    $50.00
    S247
    L065

    OPERATIVE: AMALGAM FILL 3 OR MORE


    D86 SURFACE $170.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D86 SURFACE $280.00
    CAVITY
    P-ORAL DRUGS
    P031
    $337.50
    P-ORAL DRUGS
    P031
    $164.70
    P-ORAL DRUGS
    P031
    $98.99
    P-ORAL DRUGS
    P031
    $337.50
    P-ORAL DRUGS
    P005
    $132.07
    M304
    $200.00
    P-ORAL DRUGS
    P435
    $790.91
    P-ORAL DRUGS
    P435
    $764.27
    P-ORAL DRUGS
    P031
    $337.50
    P-ORAL DRUGS
    P031
    $59.70
    SLT-OFFICE
    S220
    $200.00
    O156
    $150.00
    M304
    $200.00
    M304
    $40.00
    $5,538.63
    P-ORAL DRUGS
    US01
    $988.55
    P-ORAL DRUGS
    US01
    $2,159.37
    P-ORAL DRUGS
    P372
    $7,195.20
    P-ORAL DRUGS
    US01
    $228.74
    P-ORAL DRUGS
    US01
    $512.00
    P-ORAL DRUGS
    US01
    $195.72
    P-ORAL DRUGS
    US01
    $639.88
    $11,919.46
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,435.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,593.00
    $3,118.00
    M204
    $200.00
    ABORATORY
    L070
    $700.00
    $900.00
    SLT-OFFICE
    S302
    $360.00
    ABORATORY
    S302
    $140.00
    SLT-OFFICE
    S302
    $200.00
    $700.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,547.00
    $1,657.00
    P-ORAL DRUGS
    P005
    $1,034.06
    P-ORAL DRUGS
    P435
    $147.63
    $1,181.69
    M498
    $700.00
    ABSCESSES, BOILS & CARBUNCLES:
    M498
    CUTTING OPERATION,
    $500.00 HOSPITALIZATION
    $1,200.00
    SLT-OFFICE
    S277
    $300.00
    P-ORAL DRUGS
    P014
    $297.00
    ABORATORY
    H006
    $1,040.00
    SLT-OFFICE
    S367
    $280.00
    M581
    $200.00
    ABORATORY
    M304
    $835.00
    SLT-OFFICE
    S367
    $360.00
    $3,312.00

    M310
    $150.00
    P484
    $903.80
    M020
    $180.00
    M019
    $300.00
    P-INJECTABLES
    M019
    $25.00
    P-INJECTABLES
    M019
    $175.00
    P-ORAL DRUGS
    P337
    $498.45
    L003
    $800.00
    P-ORAL DRUGS
    L003
    $100.00
    P-ORAL DRUGS
    L003
    $60.00
    M230
    $250.00
    ABORATORY
    M230
    $1,250.00
    M230
    $250.00
    M019
    $300.00
    L003
    $800.00
    P-INJECTABLES
    L003
    $25.00
    P-INJECTABLES
    L003
    $25.00
    M230
    $250.00
    ABORATORY
    M230
    $1,025.00
    M327
    $140.00
    P-INJECTABLES
    M327
    $25.00
    P-INJECTABLES
    M327
    $35.00
    ABORATORY
    L074
    $70.00
    P-ORAL DRUGS
    P484
    $194.60
    M019
    $500.00
    ABORATORY
    L065
    $300.00
    P-ORAL DRUGS
    P484
    $441.00
    P-ORAL DRUGS
    P472
    $105.80
    M230
    $400.00
    M230
    $450.00
    ABORATORY
    M230
    $150.00
    M019
    $100.00
    ABORATORY
    M019
    $600.00
    BIOPSY, SUPERFICIAL
    M019
    $500.00
    ABSCESSES, BOILS & CARBUNCLES:
    M019
    INCISION FOR$800.00
    DRAINAGE W/O HOSPITAL
    P-ORAL DRUGS
    P484
    $73.85
    P-ORAL DRUGS
    P484
    $50.50
    $12,303.00
    SLT-OFFICE
    S046
    $400.00
    ABORATORY
    S046
    $100.00
    P-ORAL DRUGS
    P435
    $395.83
    SLT-OFFICE
    S219
    $400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    S296
    $1,050.00
    ABORATORY
    S296
    $400.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S296
    $2,400.00
    P-ORAL DRUGS
    P435
    $1,421.00
    SLT-OFFICE
    S219
    $400.00
    IT-HOSPITAL
    S219
    $800.00
    ABORATORY
    S219
    $50.00

    P-ORAL DRUGS

    ABORATORY
    P-ORAL DRUGS
    P-ORAL DRUGS
    SLT-OFFICE
    ABORATORY
    P-ORAL DRUGS
    P-ORAL DRUGS

    H005
    P381
    P435
    S376
    S376
    P435
    P435

    $440.00
    $94.70
    $236.97
    $400.00
    $1,420.00
    $239.64
    $910.44
    $12,478.58
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $400.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D78 CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D78 CAVITY $800.00
    $1,300.00
    M683
    $250.00
    P-ORAL DRUGS
    M683
    $310.00
    SLT-OFFICE
    M695
    $350.00
    ABSCESSES, BOILS & CARBUNCLES:
    M695
    INCISION FOR$150.00
    DRAINAGE W/O HOSPITAL
    P-ORAL DRUGS
    P435
    $273.07
    P-ORAL DRUGS
    P339
    $150.50
    M626
    $200.00
    P-ORAL DRUGS
    P396
    $1,221.00
    P-ORAL DRUGS
    P396
    $251.30
    M626
    $200.00
    P-ORAL DRUGS
    P339
    $608.00
    M683
    $250.00
    P-ORAL DRUGS
    M683
    $310.00
    P-ORAL DRUGS
    P093
    $105.00
    H021
    $700.00
    H021
    $1,300.00
    P-INJECTABLES
    S237
    $4,000.00
    M626
    $200.00
    P-ORAL DRUGS
    P046
    $273.50
    M695
    $350.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    M695
    $1,000.00
    ABORATORY
    M695
    $400.00
    P-ORAL DRUGS
    M695
    $300.00
    M452
    $200.00
    ABORATORY
    M452
    $500.00
    P-ORAL DRUGS
    P421
    $750.00
    P-ORAL DRUGS
    P435
    $473.82
    P-ORAL DRUGS
    P396
    $1,137.00
    P-ORAL DRUGS
    P396
    $522.90
    $16,736.09
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D01
    OR CEPHALOMETRIC
    $225.00
    X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D01
    OR CEPHALOMETRIC
    $75.00
    X-RAY)
    ORTHODONTICS: INITIAL ORTHO APPLIANCE
    D01
    W 6$9,700.00
    MONTHS TREATMENT
    M577
    $200.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D01
    TREATMENT
    $1,650.00 AFTER 1ST 6 MONTHS
    H006
    $900.00
    H006
    $1,450.00
    EYE: REMOVAL OF CATARACT
    S109
    $6,650.00
    SLT-OFFICE
    S109
    $200.00
    P-ORAL DRUGS
    S200
    $210.00
    H006
    $1,200.00

    SLT-OFFICE
    SLT-OFFICE

    S046
    S046
    L158
    L158
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    M473
    P-ORAL DRUGS
    P435
    COMPLETE EXAMINATION
    O007
    MATERIALS: FRAMES
    O007
    MATERIALS: LENS, EACH-SINGLE VISION
    O007

    P-ORAL DRUGS
    P-ORAL DRUGS

    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    P-ORAL DRUGS
    P-ORAL DRUGS

    P-INJECTABLES
    P-INJECTABLES
    ABORATORY

    P-ORAL DRUGS
    P-ORAL DRUGS

    P066
    P014
    M448
    M448
    P014
    P014
    P014
    P014
    P066
    P014
    L139
    P014
    P066
    L139
    M297
    M297
    M297
    M297
    L116
    P422
    P066

    M393
    S107
    S107
    P005
    P487
    H023
    H023
    PROSTATE: TRANSURETHRAL RESECTION
    S266
    SLT-OFFICE
    S279
    L177
    M393
    SLT-OFFICE
    S383
    P-ORAL DRUGS
    P031
    H44
    COMPLETE EXAMINATION
    O033
    MATERIALS: FRAMES
    O033
    MATERIALS: LENS, EACH-BI-FOCALO033

    SLT-OFFICE
    ABORATORY
    P-ORAL DRUGS
    P-ORAL DRUGS

    SLT-OFFICE

    S173

    $100.00
    $300.00
    $120.00
    $30.00
    $275.00
    $275.00
    $60.00
    $371.33
    $100.00
    $855.00
    $985.50
    $25,931.83
    $881.55
    $556.00
    $200.00
    $400.00
    $139.50
    $163.00
    $340.15
    $197.25
    $719.72
    $518.00
    $200.00
    $1,035.00
    $1,341.84
    $200.00
    $120.00
    $25.00
    $225.00
    $20.00
    $220.00
    $164.00
    $84.06
    $7,750.07
    $470.00
    $300.00
    $100.00
    $803.20
    $308.61
    $2,470.68
    $29.32
    $4,000.00
    $500.00
    $3,400.00
    $250.00
    $760.00
    $361.47
    $4,850.00
    $100.00
    $701.25
    $2,065.50
    $21,470.03
    $260.00

    P-ORAL DRUGS

    P122
    O156
    P122

    $225.00
    $240.00
    P-ORAL DRUGS
    $225.00
    $950.00
    P-ORAL DRUGS
    P435
    $982.91
    P-ORAL DRUGS
    P435
    $407.47
    P-ORAL DRUGS
    P435
    $317.36
    M630
    $200.00
    P-ORAL DRUGS
    P435
    $39.90
    P-ORAL DRUGS
    P435
    $496.16
    P-ORAL DRUGS
    P435
    $407.47
    P-ORAL DRUGS
    P435
    $173.40
    P-ORAL DRUGS
    P435
    $129.80
    P-ORAL DRUGS
    P435
    $290.09
    P-ORAL DRUGS
    P435
    $383.53
    ABORATORY
    L070
    $1,660.00
    P-ORAL DRUGS
    P435
    $490.69
    P-ORAL DRUGS
    P435
    $210.00
    ABORATORY
    L070
    $200.00
    P-ORAL DRUGS
    P435
    $420.00
    UN01
    $539.90
    P-ORAL DRUGS
    P435
    $868.12
    P-ORAL DRUGS
    P435
    $112.50
    P-ORAL DRUGS
    P435
    $843.18
    P-ORAL DRUGS
    P435
    $66.69
    P-ORAL DRUGS
    P435
    $108.82
    P-ORAL DRUGS
    P435
    $395.83
    $9,743.82
    M630
    $180.00
    P-ORAL DRUGS
    P031
    $37.49
    H023
    $750.00
    H023
    $1,650.00
    PROSTATE: TRANSURETHRAL RESECTION
    S300
    $2,500.00
    P-ORAL DRUGS
    P435
    $105.42
    P-ORAL DRUGS
    P055
    $193.20
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D103CAVITY $380.00
    OTHER
    P031
    $13.00
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    IT-HOSPITAL
    H023
    $375.00
    P-ORAL DRUGS
    H023
    $127.03
    H023
    $2,690.00
    ABORATORY
    H023
    $960.00
    H023
    $241.00
    P-ORAL DRUGS
    P435
    $152.10
    SLT-OFFICE
    S213
    $300.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,325.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,310.00
    $13,859.24
    P-ORAL DRUGS
    P005
    $317.50
    P-ORAL DRUGS
    P486
    $39.00
    P-ORAL DRUGS
    P054
    $40.30

    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    P005
    P005
    P054
    P005
    P005
    P054
    P005
    P343

    H005
    S173
    EYE: OTHER CUTTING OPERATION S173
    SLT-OFFICE
    S173
    ABORATORY
    S173
    S173
    S173
    S245
    ABORATORY
    H011
    MATERIALS: FRAMES
    O076
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    COMPLETE EXAMINATION

    P-ORAL DRUGS

    P-ORAL DRUGS

    P-ORAL DRUGS

    P-ORAL DRUGS
    SLT-OFFICE
    P-ORAL DRUGS
    ABORATORY

    ABORATORY
    SLT-OFFICE

    O004
    S325
    P353
    M441
    P115
    M441
    P353
    H006
    P011
    S007
    P093
    L065
    M774
    L139
    L065
    S007
    L065

    ORAL SURGERY: SURGICAL REMOVAL


    D182
    OF
    ORAL SURGERY: SURGICAL REMOVAL
    D182
    OF
    OTHER
    D182
    OTHER
    D182
    ORAL SURGERY: SURGICAL REMOVAL
    D182
    OF

    P-ORAL DRUGS
    P-ORAL DRUGS

    P-ORAL DRUGS
    ABORATORY
    P-ORAL DRUGS

    M124
    P343
    P343
    P031
    L070
    P435
    M464

    $158.75
    $158.75
    $41.90
    $158.75
    $158.75
    $40.30
    $158.75
    $40.50
    $1,313.25
    $650.00
    $2,800.00
    $5,470.00
    $360.00
    $200.00
    $300.00
    $1,200.00
    $700.00
    $1,507.00
    $1,276.00
    $2,395.00
    $16,858.00
    $100.00
    $300.00
    $212.20
    $120.00
    $130.75
    $200.00
    $200.00
    $175.00
    $112.00
    $240.00
    $322.00
    $220.00
    $300.00
    $350.00
    $220.00
    $200.00
    $175.00
    $3,576.95
    TOOTH W
    $840.00
    COMPLETE BONE IMPACTION
    TOOTH$3,160.00
    W COMPLETE BONE IMPACTION
    $1,500.00
    $54.18
    ERUPTED
    $400.00
    TOOTH
    $5,954.18
    $500.00
    $49.35
    $587.74
    $1,137.09
    $473.48
    $1,240.00
    $870.10
    $300.00

    P-ORAL DRUGS

    P031
    M215
    P031
    S004
    P031
    P031
    M215
    P031
    P031
    L96
    P031
    P031

    $682.20
    $250.00
    P-ORAL DRUGS
    $1,155.68
    SLT-OFFICE
    $400.00
    P-ORAL DRUGS
    $809.40
    P-ORAL DRUGS
    $134.70
    $500.00
    P-ORAL DRUGS
    $119.80
    P-ORAL DRUGS
    $1,155.68
    ABORATORY
    $1,800.00
    P-ORAL DRUGS
    $859.20
    P-ORAL DRUGS
    $1,109.10
    $11,859.34
    DIAGNOSTIC: INITIAL ORAL EXAM D129
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D129VIEW
    $70.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D129 SURFACE
    $1,100.00
    CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D129
    ROOT$600.00
    PLANING, SCALING, EACH
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D129VIEW
    $60.00
    $1,910.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D103
    CROWN
    $2,025.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D103
    CROWN $11,575.00
    P-ORAL DRUGS
    P005
    $1,926.63
    P-ORAL DRUGS
    P005
    $85.00
    $15,611.63
    P-ORAL DRUGS
    P011
    $625.00
    P-ORAL DRUGS
    P011
    $267.12
    M607
    $250.00
    ABORATORY
    M607
    $120.00
    P-ORAL DRUGS
    P011
    $203.98
    P-ORAL DRUGS
    P011
    $97.09
    S182
    $90.00
    S182
    $210.00
    P-ORAL DRUGS
    P011
    $317.72
    PREVENTIVE: DENTAL PROPHYLAXIS
    D309
    $400.00
    ABORATORY
    H048
    $120.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D309VIEW
    $150.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D309VIEW
    $50.00
    DIAGNOSTIC: INITIAL ORAL EXAM D309
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D309
    $375.00
    P-ORAL DRUGS
    P011
    $1,156.00
    P-ORAL DRUGS
    P011
    $353.35
    $4,885.26
    SLT-OFFICE
    S244
    $300.00
    SLT-OFFICE
    S365
    $300.00
    M473
    $120.00
    P-ORAL DRUGS
    P343
    $262.50
    M473
    $150.00
    P-ORAL DRUGS
    P343
    $104.00
    P-ORAL DRUGS
    P435
    $277.31
    P-ORAL DRUGS
    P435
    $69.26
    M473
    $180.00
    SLT-OFFICE
    S300
    $600.00
    L075
    $6,000.00

    M473
    $120.00
    P-ORAL DRUGS
    P122
    $162.50
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D103VIEW
    $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D103CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D103CAVITY $240.00
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D103VIEW
    $140.00
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $240.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D103
    TIMES$160.00
    (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $240.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D103
    TIMES$160.00
    (EXCLUDE PROPHYLAXIS)
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D103
    W ANESTHESIA
    $350.00
    & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $240.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D103
    TIMES$160.00
    (EXCLUDE PROPHYLAXIS)
    ENDODONTICS: EXTIRPATION OF PULP
    D103& FILL 1 $2,100.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D103 SURFACE $480.00
    CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D103CAVITY $330.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D103CAVITY $660.00
    M473
    $120.00
    P-ORAL DRUGS
    P343
    $338.10
    M695
    $350.00
    PROSTATE: TRANSURETHRAL RESECTION
    M695
    $150.00
    SLT-OFFICE
    S300
    $300.00
    P-ORAL DRUGS
    S300
    $100.00
    $17,123.67
    M205
    $240.00
    ABORATORY
    M205
    $650.00
    P-ORAL DRUGS
    P031
    $1,331.26
    SLT-OFFICE
    S383
    $1,140.00
    P-ORAL DRUGS
    P031
    $144.98
    P-ORAL DRUGS
    P031
    $206.46
    EYE: OTHER CUTTING OPERATION S383
    $600.00
    P-ORAL DRUGS
    P507
    $396.00
    P-ORAL DRUGS
    EC01
    $502.26
    SLT-OFFICE
    S383
    $260.00
    $5,470.96
    MATERIALS: FRAMES
    O004
    $716.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,576.00
    $2,292.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D152
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D152
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D152
    TIMES$130.00
    (EXCLUDE PROPHYLAXIS)
    $500.00
    P-ORAL DRUGS
    P055
    $322.50
    M630
    $360.00
    P-ORAL DRUGS
    P055
    $361.30
    P-ORAL DRUGS
    P055
    $57.30

    M630
    P-ORAL DRUGS
    P055
    P-ORAL DRUGS
    P055
    COMPLETE EXAMINATION
    O015
    MATERIALS: LENS, EACH-TRI-FOCAL
    O015
    M630
    P-ORAL DRUGS
    P055
    P-ORAL DRUGS
    P055
    MATERIALS: FRAMES
    O015
    MATERIALS: LENS, EACH-BI-FOCALO015
    M630
    P-ORAL DRUGS
    P031
    COMPLETE EXAMINATION
    O015
    COMPLETE EXAMINATION
    O015
    MATERIALS: LENS, EACH-SINGLE VISION
    O015
    P-ORAL DRUGS
    P055
    P-ORAL DRUGS
    P055
    M089
    P-ORAL DRUGS
    P055
    M089
    D143
    P-ORAL DRUGS
    P055

    $180.00
    $18.30
    $20.00
    $130.00
    $530.00
    $180.00
    $185.90
    $302.00
    $540.00
    $605.00
    $180.00
    $254.85
    $130.00
    $130.00
    $415.00
    $169.50
    $339.00
    $180.00
    $189.70
    $180.00
    $600.00
    $169.95
    $6,730.30
    PREVENTIVE: DENTAL PROPHYLAXIS
    D59
    $340.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D59 SURFACE $170.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D59 SURFACE $280.00
    CAVITY
    $790.00
    COMPLETE EXAMINATION
    O001
    $110.00
    T034
    $16,200.00
    P-ORAL DRUGS
    P031
    $4,169.54
    M124
    $250.00
    M124
    $250.00
    COMPLETE EXAMINATION
    O001
    $110.00
    COMPLETE EXAMINATION
    O001
    $100.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $900.00
    MATERIALS: FRAMES
    O001
    $900.00
    ABORATORY
    O001
    $200.00
    L075
    $3,800.00
    IT-HOSPITAL
    H005
    $631.82
    COMPLETE EXAMINATION
    O001
    $100.00
    MATERIALS: FRAMES
    O001
    $895.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,280.00
    IT-HOSPITAL
    H005
    $380.00
    ABORATORY
    H005
    $1,141.30
    H005
    $240.00
    SLT-OFFICE
    H005
    $600.00
    H005
    $3,800.00
    DIAGNOSTIC: INITIAL ORAL EXAM D181
    (EXCLUDE X-RAY)
    $100.00
    SLT-OFFICE
    S041
    $700.00
    L006
    $1,050.00
    IT-HOSPITAL
    H005
    $280.00
    ABORATORY
    H005
    $44.68
    SLT-OFFICE
    S433
    $500.00

    M124
    $250.00
    P031
    $99.80
    T034
    $5,100.00
    UN01
    $750.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D181CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D181CAVITY $860.00
    M630
    $200.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S214
    $1,900.00
    S214
    $25.00
    H023
    $400.00
    H023
    $1,192.00
    M630
    $180.00
    M630
    $180.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D181
    W ANESTHESIA
    $800.00
    & POST OPER
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D181
    X-RAY, SINGLE
    $180.00
    VIEW
    MATERIALS: FRAMES
    O001
    $1,270.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,615.00
    P-ORAL DRUGS
    P031
    $1,465.28
    ABORATORY
    H005
    $280.00
    H005
    $200.00
    IT-HOSPITAL
    H005
    $500.00
    ABORATORY
    H005
    $400.00
    P-ORAL DRUGS
    P031
    $75.25
    P-ORAL DRUGS
    P031
    $1,014.23
    M089
    $280.00
    ABORATORY
    H047
    $400.00
    ABORATORY
    H005
    $208.00
    IT-HOSPITAL
    H005
    $500.00
    P-ORAL DRUGS
    P031
    $192.48
    SLT-OFFICE
    S219
    $400.00
    S219
    $400.00
    P-ORAL DRUGS
    P343
    $89.99
    SLT-OFFICE
    S107
    $300.00
    S107
    $100.00
    P-ORAL DRUGS
    P031
    $174.49
    T034
    $18,225.00
    $79,079.61
    SLT-OFFICE
    S383
    $360.00
    COMPLETE EXAMINATION
    O177
    $100.00
    MATERIALS: FRAMES
    O177
    $805.50
    MATERIALS: LENS, EACH-TRI-FOCAL
    O177
    $1,890.00
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D38
    OR CEPHALOMETRIC
    $140.00
    X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D38
    OR$1,260.00
    CEPHALOMETRIC X-RAY)
    M473
    $100.00
    SLT-OFFICE
    S363
    $300.00
    ABORATORY
    L070
    $130.00
    COMPLETE EXAMINATION
    O177
    $100.00
    MATERIALS: FRAMES
    O177
    $355.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O177
    $360.00
    M473
    $200.00
    P-ORAL DRUGS
    P435
    $295.26
    M473
    $130.00
    SLT-OFFICE
    S363
    $400.00

    P-ORAL DRUGS

    ABORATORY

    H006

    SLT-OFFICE

    S151
    S151
    ABORATORY
    S151
    M452
    P-ORAL DRUGS
    P435
    PREVENTIVE: DENTAL PROPHYLAXIS
    D427
    H023
    H023
    IT-HOSPITAL
    H023
    SLT-OFFICE
    S407

    SLT-OFFICE
    S006
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S433
    S433
    P-ORAL DRUGS
    P435
    COMPLETE EXAMINATION
    O004
    MATERIALS: FRAMES
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004

    SLT-OFFICE
    P-ORAL DRUGS

    S162
    P068

    COMPLETE EXAMINATION
    O001
    MATERIALS: FRAMES
    O001
    MATERIALS: LENS, EACH-BI-FOCALO001
    M101
    P-ORAL DRUGS
    P154
    P-ORAL DRUGS
    P154
    M101
    P-ORAL DRUGS
    P154
    P-ORAL DRUGS
    P154
    M463
    ABORATORY
    M463
    P-ORAL DRUGS
    P154
    P-ORAL DRUGS
    P154
    COMPLETE EXAMINATION
    O001
    MATERIALS: FRAMES
    O001
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    SLT-OFFICE
    S149
    S149
    SLT-OFFICE
    S149
    SLT-OFFICE
    S149
    P-INJECTABLES
    S149
    P-INJECTABLES
    S149
    COMPLETE EXAMINATION
    O001
    M233
    P-ORAL DRUGS
    M233

    P-ORAL DRUGS
    P-ORAL DRUGS

    M215
    P031
    P011

    $350.00
    $7,276.26
    $350.00
    $300.00
    $170.00
    $250.00
    $217.33
    $400.00
    $1,100.00
    $3,007.00
    $375.00
    $800.00
    $6,969.33
    $300.00
    $2,000.00
    $2,700.00
    $593.74
    $100.00
    $1,196.00
    $2,056.00
    $8,945.74
    $240.00
    $310.45
    $550.45
    $110.00
    $854.75
    $520.00
    $150.00
    $235.90
    $111.95
    $160.00
    $49.90
    $36.00
    $200.00
    $120.00
    $280.60
    $54.00
    $110.00
    $2,495.00
    $1,550.00
    $200.00
    $300.00
    $200.00
    $200.00
    $25.00
    $275.00
    $110.00
    $100.00
    $30.00
    $8,478.10
    $500.00
    $108.43
    $336.00

    $250.00
    $112.00
    $1,306.43
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,196.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,256.00
    M212
    $750.00
    M212
    $400.00
    $3,702.00
    M246
    $1,925.00
    PROSTATE: TRANSURETHRAL RESECTION
    S128
    $14,500.00
    H006
    $2,700.00
    H006
    $11,509.00
    SLT-HOSPITAL
    S277
    $4,000.00
    P-ORAL DRUGS
    P007
    $71.80
    IT-HOSPITAL
    H006
    $150.00
    P-ORAL DRUGS
    P007
    $309.50
    ABORATORY
    H006
    $360.00
    $35,525.30
    M577
    $200.00
    ABORATORY
    L065
    $462.50
    DIAGNOSTIC: INITIAL ORAL EXAM D283
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D283
    $400.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D283
    CROWN
    $860.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D283
    CROWN
    $1,640.00
    $3,662.50
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $400.00
    $400.00
    IT-HOSPITAL
    H029
    $700.00
    H029
    $200.00
    ABORATORY
    H029
    $355.00
    P-ORAL DRUGS
    H029
    $400.00
    H029
    $615.00
    DIAGNOSTIC: INITIAL ORAL EXAM D379
    (EXCLUDE X-RAY)
    $180.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D379VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D379VIEW
    $110.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D379
    $500.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $716.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $396.00
    IT-HOSPITAL
    S387
    $500.00
    H027
    $1,470.00
    COMPLETE EXAMINATION
    O001
    $250.00
    MATERIALS: CONTACT, WHEN NOTO001
    MEDICALLY REQUIRED
    $635.80
    ABORATORY
    L041
    $40.00
    P-ORAL DRUGS
    P416
    $574.80
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D182
    W$1,500.00
    ANESTHESIA & POST OPER
    OTHER SERVICES: ADMINISTRATION
    D182
    OF GENERAL
    $2,000.00
    ANESTHESIA
    OTHER
    D89
    $425.00
    DIAGNOSTIC: INITIAL ORAL EXAM D51
    (EXCLUDE X-RAY)
    $144.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D51X-RAY, SINGLE
    $70.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D51X-RAY, SINGLE
    $74.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D51
    $450.00

    P-ORAL DRUGS

    M215
    P011

    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4


    D51
    TIMES (EXCLUDE
    $54.00
    PROPHYLAXIS)
    ORAL SURGERY: SURGICAL REMOVAL
    D38OF ERUPTED
    $150.00
    TOOTH
    S160
    $200.00
    P-INJECTABLES
    S160
    $25.00
    P-INJECTABLES
    S160
    $635.00
    S160
    $200.00
    P-INJECTABLES
    S160
    $25.00
    P-INJECTABLES
    S160
    $375.00
    $14,139.60
    P-ORAL DRUGS
    P005
    $409.06
    COMPLETE EXAMINATION
    O001
    $110.00
    P-ORAL DRUGS
    P005
    $409.06
    P-ORAL DRUGS
    P005
    $409.06
    P-ORAL DRUGS
    P005
    $818.12
    P-ORAL DRUGS
    P005
    $409.60
    P-ORAL DRUGS
    P005
    $409.06
    $2,973.96
    P-ORAL DRUGS
    P435
    $731.69
    M393
    $220.00
    P-ORAL DRUGS
    P155
    $43.00
    P-ORAL DRUGS
    P155
    $51.10
    P-ORAL DRUGS
    P155
    $79.50
    P-ORAL DRUGS
    P435
    $731.69
    P-ORAL DRUGS
    P435
    $731.69
    P435
    $664.11
    M393
    $250.00
    $3,502.78
    S400
    $300.00
    P-ORAL DRUGS
    P343
    $376.45
    P-ORAL DRUGS
    P122
    $371.40
    M374
    $200.00
    ABORATORY
    L070
    $250.00
    P-ORAL DRUGS
    P435
    $103.82
    M695
    $350.00
    M695
    $150.00
    P-ORAL DRUGS
    M695
    $150.00
    $2,251.67
    IT-HOSPITAL
    H011
    $500.00
    $500.00
    SLT-OFFICE
    S137
    $450.00
    P-INJECTABLES
    S137
    $25.00
    P-INJECTABLES
    S137
    $375.00
    SLT-OFFICE
    S137
    $450.00
    P-INJECTABLES
    S137
    $400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D432
    (EXCLUDE X-RAY)
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D432
    $350.00
    MATERIALS: FRAMES
    O001
    $2,120.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $850.00
    ESAR/EXTRA UT
    H005
    $1,940.00
    ESAR/EXTRA UT
    H005
    $11,135.88
    ESAR/EXTRA UT
    S302
    $10,000.00
    ESAR/EXTRA UT
    M328
    $4,000.00
    M695
    $350.00

    ABSCESSES, BOILS & CARBUNCLES:


    M695
    INCISION FOR$350.00
    DRAINAGE W/O HOSPITAL
    SLT-OFFICE
    S076
    $350.00
    P-ORAL DRUGS
    P031
    $67.99
    P-ORAL DRUGS
    P031
    $124.99
    SLT-OFFICE
    S137
    $450.00
    P-INJECTABLES
    S137
    $400.00
    SLT-OFFICE
    S137
    $450.00
    P-INJECTABLES
    S137
    $25.00
    P-INJECTABLES
    S137
    $375.00
    SLT-OFFICE
    S076
    $250.00
    P-ORAL DRUGS
    P435
    $101.51
    SLT-OFFICE
    S137
    $450.00
    SLT-OFFICE
    S137
    $450.00
    SLT-OFFICE
    S076
    $500.00
    P-ORAL DRUGS
    P435
    $127.18
    $37,068.30
    P-ORAL DRUGS
    US01
    ($1,782.76)
    P-ORAL DRUGS
    US01
    $1,782.76
    US01
    ($802.44)
    US01
    $802.44
    P-ORAL DRUGS
    US01
    ($2,240.41)
    P-ORAL DRUGS
    US01
    $2,240.41
    $0.00
    ENATAL CARE
    H051
    $500.00
    ORMAL DELIVERY
    S446
    $5,000.00
    ORMAL DELIVERY
    S446
    $5,867.00
    $11,367.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S296
    $2,400.00
    S296
    $1,050.00
    H025
    $260.00
    SLT-OFFICE
    S323
    $350.00
    ABORATORY
    S323
    $160.00
    M049
    $120.00
    P-ORAL DRUGS
    P081
    $203.30
    PREVENTIVE: DENTAL PROPHYLAXIS
    D63
    $300.00
    COMPLETE EXAMINATION
    O015
    $130.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O015
    $2,860.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $25.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $25.00
    PROPHYLAXIS)
    $8,083.30
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $200.00
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $200.00
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $140.00
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $140.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D04 CAVITY $100.00
    SLT-OFFICE
    M443
    $450.00
    P-ORAL DRUGS
    P427
    $996.20
    P-INJECTABLES
    M060
    $180.00

    P-INJECTABLES

    M060

    $180.00
    $2,986.20
    S160
    $200.00
    P-ORAL DRUGS
    P154
    $184.40
    SLT-OFFICE
    S199
    $300.00
    P-INJECTABLES
    S199
    $25.00
    P-INJECTABLES
    S199
    $175.00
    SLT-OFFICE
    S124
    $300.00
    P-ORAL DRUGS
    P154
    $130.00
    P-ORAL DRUGS
    P154
    $32.50
    SLT-OFFICE
    S115
    $300.00
    P-ORAL DRUGS
    P154
    $23.50
    P-ORAL DRUGS
    P154
    $261.98
    SLT-OFFICE
    S199
    $300.00
    P-ORAL DRUGS
    P154
    $38.08
    P-ORAL DRUGS
    P154
    $50.40
    P-ORAL DRUGS
    P154
    $9.52
    L041
    $350.00
    S124
    $200.00
    P-ORAL DRUGS
    P154
    $162.50
    L041
    $400.00
    ABSCESSES, BOILS & CARBUNCLES:
    S124
    INCISION FOR
    $1,360.00
    DRAINAGE W/O HOSPITAL
    ABSCESSES, BOILS & CARBUNCLES:
    S124
    INCISION FOR$340.00
    DRAINAGE W/O HOSPITAL
    SLT-OFFICE
    S160
    $200.00
    P-ORAL DRUGS
    P014
    $59.50
    M304
    $140.00
    P-ORAL DRUGS
    P337
    $120.00
    P-ORAL DRUGS
    P337
    $91.75
    $5,754.13
    ABORATORY
    H005
    $420.00
    $420.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: FRAMES
    O004
    $1,516.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,896.00
    $3,612.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D173CAVITY $800.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D173CAVITY $600.00
    ORAL SURGERY: SURGICAL REMOVAL
    D173
    OF TOOTH W
    $300.00
    SOFT TISSUE IMPACTION
    $1,700.00
    ENATAL CARE
    S302
    $860.00
    ENATAL CARE
    P014
    $76.50
    $936.50
    SLT-OFFICE
    S127
    $400.00
    ABORATORY
    S127
    $1,200.00
    S127
    $3,000.00
    S127
    $2,000.00
    $6,600.00
    M053
    $290.00
    P-ORAL DRUGS
    P081
    $216.50
    P-ORAL DRUGS
    P081
    $31.90
    IT-HOSPITAL
    H023
    $375.00
    H023
    $383.76
    P-ORAL DRUGS
    H023
    $14.95

    H023
    SLT-OFFICE
    S279
    FRACTURE: HAND, FOOT OR STERNUM
    S279
    P-ORAL DRUGS
    P435
    M045
    ABORATORY
    L001
    SLT-OFFICE
    S279
    S279
    S279

    $210.00
    $500.00
    $700.00
    $49.99
    $150.00
    $505.00
    $400.00
    $182.00
    $100.00
    $4,109.10
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,356.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,656.00
    $3,112.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D04 CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D04 CAVITY $285.00
    M060
    $200.00
    P-INJECTABLES
    M060
    $25.00
    P-INJECTABLES
    M060
    $315.00
    M060
    $200.00
    P-INJECTABLES
    M060
    $25.00
    P-INJECTABLES
    M060
    $315.00
    M060
    $200.00
    $1,705.00
    M577
    $200.00
    SLT-OFFICE
    S217
    $500.00
    L177
    $3,400.00
    P-ORAL DRUGS
    P031
    $199.15
    L96
    $500.00
    H023
    $950.00
    H023
    $17,759.72
    P-ORAL DRUGS
    P427
    $48.90
    P-ORAL DRUGS
    H023
    $171.15
    S217
    $100.00
    S217
    $12,000.00
    S217
    $4,500.00
    S217
    $4,000.00
    DIAGNOSTIC: INITIAL ORAL EXAM D86
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D86
    $300.00
    H023
    $4,318.85
    SLT-OFFICE
    S217
    $800.00
    P-ORAL DRUGS
    H023
    $100.60
    P-ORAL DRUGS
    P435
    $366.21
    T074
    $1,730.00
    M060
    $200.00
    ABORATORY
    L070
    $80.00
    P348
    $14.78
    P-ORAL DRUGS
    P435
    $93.03
    P-ORAL DRUGS
    H023
    $94.50
    $52,476.89
    MATERIALS: CONTACT, MEDICALLYO004
    REQUIRED
    $688.00
    $688.00
    ENATAL CARE
    S151
    $1,050.00

    ENATAL CARE
    ENATAL CARE

    H005
    L068

    $600.00
    $1,130.00
    $2,780.00
    COMPLETE EXAMINATION
    O076
    $180.00
    MATERIALS: FRAMES
    O076
    $1,525.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,170.00
    $2,875.50
    COMPLETE EXAMINATION
    O065
    $150.00
    MATERIALS: FRAMES
    O065
    $810.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O065
    $180.00
    $1,140.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D38
    TREATMENT
    $900.00 AFTER 1ST 6 MONTHS
    $900.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $25.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $25.00
    PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM D382
    (EXCLUDE X-RAY)
    $200.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D382
    X-RAY, SINGLE
    $260.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D382
    $500.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D382
    TIMES$305.00
    (EXCLUDE PROPHYLAXIS)
    $1,515.00
    SLT-OFFICE
    S275
    $300.00
    P-INJECTABLES
    S275
    $25.00
    P-INJECTABLES
    S275
    $925.00
    COMPLETE EXAMINATION
    US01
    $787.50
    SLT-OFFICE
    US01
    $1,575.00
    ABORATORY
    US01
    $630.00
    US01
    $13,860.00
    US01
    $17,640.00
    P-ORAL DRUGS
    P372
    $2,585.00
    P-ORAL DRUGS
    P372
    $26,200.00
    $64,527.50
    SLT-OFFICE
    S244
    $300.00
    P-ORAL DRUGS
    P011
    $476.00
    ABSCESSES, BOILS & CARBUNCLES:
    S296
    INCISION FOR
    $1,500.00
    DRAINAGE W/O HOSPITAL
    ABORATORY
    S296
    $450.00
    S296
    $800.00
    $3,526.00
    M124
    $600.00
    P-ORAL DRUGS
    P011
    $28.50
    $628.50
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,871.25
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,365.00
    S296
    $1,050.00
    ABORATORY
    S296
    $400.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S296
    $3,900.00
    M124
    $500.00
    M124
    $200.00
    ABORATORY
    L070
    $1,110.00
    $10,506.25
    P-ORAL DRUGS
    P077
    $310.00
    M164
    $100.00

    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS

    P077
    P077
    P077
    P077
    M164
    P077
    P077
    H026
    M164
    P077

    $98.00
    $310.00
    $310.00
    $310.00
    $100.00
    P-ORAL DRUGS
    $5.00
    P-ORAL DRUGS
    $20.00
    $83.00
    $120.00
    P-ORAL DRUGS
    $310.00
    $2,076.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D34 CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D34 CAVITY $250.00
    $350.00
    M204
    $200.00
    M204
    $200.00
    P-ORAL DRUGS
    M204
    $60.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $776.00
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: FRAMES
    O004
    $1,516.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,016.00
    SLT-OFFICE
    S120
    $300.00
    P-ORAL DRUGS
    P014
    $27.95
    SLT-OFFICE
    S120
    $240.00
    P-ORAL DRUGS
    P093
    $66.74
    ABORATORY
    H011
    $220.00
    P-ORAL DRUGS
    P093
    $55.10
    SLT-OFFICE
    S184
    $200.00
    ABORATORY
    S184
    $100.00
    $5,377.79
    SLT-OFFICE
    S381
    $400.00
    P-ORAL DRUGS
    P090
    $72.60
    $472.60
    SLT-OFFICE
    S400
    $300.00
    ABORATORY
    S400
    $550.00
    ABORATORY
    H005
    $1,280.00
    L143
    $500.00
    $2,630.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D07
    $475.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D07
    TIMES (EXCLUDE
    $80.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D07
    TIMES (EXCLUDE
    $20.00
    PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $200.00
    $775.00
    M178
    $200.00
    S247
    $100.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,516.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $680.00
    $2,596.00
    ABORATORY
    S026
    $160.00
    P-ORAL DRUGS
    P382
    $300.00
    DIAGNOSTIC: INITIAL ORAL EXAM D86
    (EXCLUDE X-RAY)
    $50.00

    PREVENTIVE: DENTAL PROPHYLAXIS


    D86
    PREVENTIVE: DENTAL PROPHYLAXIS
    D86
    M452
    M452
    P-ORAL DRUGS
    M452

    $240.00
    $60.00
    $240.00
    $60.00
    $290.00
    $1,400.00
    SLT-OFFICE
    Missing
    $300.00
    $300.00
    SLT-OFFICE
    S144
    $300.00
    S144
    $200.00
    M231
    $100.00
    SLT-OFFICE
    S417
    $300.00
    H066
    $800.00
    ABORATORY
    H066
    $500.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    H066
    $2,500.00
    $4,700.00
    H047
    $1,300.00
    P-ORAL DRUGS
    P343
    $123.20
    H005
    $200.00
    M089
    $380.00
    ABORATORY
    L070
    $295.00
    $2,298.20
    M216
    $100.00
    P-ORAL DRUGS
    M216
    $100.00
    $200.00
    M207
    $200.00
    P-ORAL DRUGS
    P167
    $1,223.40
    M207
    $200.00
    P-ORAL DRUGS
    P167
    $1,703.90
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D92
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D92
    W ANESTHESIA
    $415.00
    & POST OPER
    OTHER
    P484
    $60.00
    M207
    $100.00
    P-ORAL DRUGS
    P167
    $675.75
    M207
    $200.00
    P-ORAL DRUGS
    P167
    $562.25
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,295.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $650.00
    M207
    $300.00
    P-ORAL DRUGS
    P167
    $1,916.00
    M207
    $100.00
    P-ORAL DRUGS
    P484
    $67.50
    P-ORAL DRUGS
    P167
    $59.75
    M207
    $400.00
    P-ORAL DRUGS
    P167
    $2,518.30
    $12,841.85
    DIAGNOSTIC: INITIAL ORAL EXAM D07
    (EXCLUDE X-RAY)
    $150.00
    DIAGNOSTIC: DIAGNOSTIC MODELD07
    $350.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D07 VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D07 VIEW $1,265.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D07
    $325.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D07
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)

    ORAL SURGERY: SURGICAL REMOVAL


    D07OF TOOTH$1,350.00
    W SOFT TISSUE IMPACTION
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D07
    W$1,350.00
    ANESTHESIA & POST OPER
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D07 SURFACE $875.00
    CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D07X-RAY, SINGLE
    $100.00
    VIEW
    M346
    $100.00
    P-INJECTABLES
    M346
    $100.00
    P-ORAL DRUGS
    P478
    $7.00
    P-ORAL DRUGS
    P478
    $46.20
    $6,153.20
    M230
    $300.00
    M230
    $300.00
    P-ORAL DRUGS
    P167
    $205.25
    M584
    $150.00
    P-ORAL DRUGS
    M584
    $52.00
    MATERIALS: LENS, EACH-BI-FOCALO004
    $1,140.00
    M584
    $150.00
    DIAGNOSTIC: INITIAL ORAL EXAM D114
    (EXCLUDE X-RAY)
    $120.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D114VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D114VIEW
    $10.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D114
    $340.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D114CAVITY $540.00
    S374
    $200.00
    ABORATORY
    O001
    $200.00
    P-ORAL DRUGS
    P014
    $121.25
    $3,898.50
    SLT-OFFICE
    S069
    $650.00
    P-ORAL DRUGS
    P014
    $20.00
    P-ORAL DRUGS
    P014
    $37.15
    M089
    $180.00
    ABORATORY
    M089
    $200.00
    M089
    $100.00
    M089
    $180.00
    ABORATORY
    M089
    $20.00
    $1,387.15
    PREVENTIVE: DENTAL PROPHYLAXIS
    D22
    $200.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D22 CAVITY $480.00
    M657
    $100.00
    P-ORAL DRUGS
    P014
    $148.40
    L006
    $350.00
    L006
    $350.00
    ABORATORY
    L140
    $1,728.00
    ABORATORY
    L140
    $216.00
    P-ORAL DRUGS
    P005
    $312.88
    S296
    $800.00
    ABORATORY
    S296
    $450.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S296
    $1,500.00
    $6,635.28
    PREVENTIVE: DENTAL PROPHYLAXIS
    D232
    $250.00
    $250.00
    DIAGNOSTIC: INITIAL ORAL EXAM D129
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D129
    $320.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D129VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D129VIEW
    $60.00

    OPERATIVE: AMALGAM FILL 1 SURFACE


    D129CAVITY

    $370.00
    $890.00
    M189
    $140.00
    M019
    $300.00
    P-ORAL DRUGS
    P435
    $42.00
    P-ORAL DRUGS
    P085
    $188.25
    ABORATORY
    M304
    $745.00
    M189
    $140.00
    ABORATORY
    M304
    $865.00
    P-ORAL DRUGS
    P435
    $529.75
    P-ORAL DRUGS
    P435
    $529.75
    $3,479.75
    M087
    $160.00
    ABORATORY
    M087
    $20.00
    M087
    $160.00
    P-ORAL DRUGS
    P081
    $81.00
    P-ORAL DRUGS
    P081
    $33.75
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D437
    X-RAY, SINGLE
    $35.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D437
    X-RAY, SINGLE
    $15.00
    VIEW
    ORAL SURGERY: SURGICAL REMOVAL
    D437
    OF TOOTH W
    $500.00
    SOFT TISSUE IMPACTION
    OTHER
    P081
    $144.00
    $1,148.75
    M374
    $200.00
    L006
    $400.00
    P-ORAL DRUGS
    P085
    $109.10
    $709.10
    M325
    $100.00
    P-INJECTABLES
    M325
    $40.00
    S115
    $200.00
    M294
    $100.00
    COMPLETE EXAMINATION
    O076
    $80.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,200.00
    M294
    $100.00
    M775
    $300.00
    M775
    $140.00
    S113
    $900.00
    ABORATORY
    H027
    $390.00
    $3,550.00
    M863
    $100.00
    $100.00
    M310
    $150.00
    ABORATORY
    M310
    $320.00
    L97
    $400.00
    M310
    $150.00
    M310
    $475.00
    M310
    $125.00
    $1,620.00
    SLT-OFFICE
    S136
    $250.00
    $250.00
    M633
    $100.00
    P-ORAL DRUGS
    P343
    $204.89
    $304.89
    SLT-OFFICE
    S136
    $200.00

    P-ORAL DRUGS
    SLT-OFFICE

    P007
    S136

    SLT-OFFICE
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS

    S091
    P014
    P447
    P465

    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    ABORATORY
    ABORATORY

    M298
    P106
    P106
    P011
    P066
    M298
    M298

    ENATAL CARE

    S450

    P-ORAL DRUGS

    ABORATORY

    M211
    P093
    M006
    L065
    S159
    S159

    M378
    ABORATORY
    M378
    ABORATORY
    H005
    PREVENTIVE: DENTAL PROPHYLAXIS
    D141
    M378
    ABORATORY
    H005
    P-ORAL DRUGS
    P435
    P-ORAL DRUGS
    P005
    M378
    ABORATORY
    M378
    PREVENTIVE: DENTAL PROPHYLAXIS
    D141

    SLT-OFFICE
    ABORATORY
    P-ORAL DRUGS

    IT-HOSPITAL
    SLT-HOSPITAL
    SLT-OFFICE
    ABORATORY
    P-ORAL DRUGS
    P-ORAL DRUGS

    H023
    S220
    O156
    P005
    H006
    H006
    S277
    S277
    S220
    S220
    P005
    P001
    M454

    $49.95
    $200.00
    $449.95
    $160.00
    $45.85
    $107.45
    $399.00
    $712.30
    $240.00
    $96.45
    $119.00
    $555.00
    $93.00
    $40.00
    $920.00
    $2,063.45
    $6,000.00
    $6,000.00
    $200.00
    $100.70
    $300.00
    $440.00
    $1,040.70
    $400.00
    $200.00
    $600.00
    $400.00
    $125.00
    $674.50
    $300.00
    $350.00
    $280.00
    $356.99
    $1,418.70
    $350.00
    $50.00
    $360.00
    $4,665.19
    $3,819.85
    $3,819.85
    $220.00
    $150.00
    $451.02
    $900.00
    $5,385.00
    $150.00
    $2,000.00
    $220.00
    $150.00
    $451.02
    $286.60
    $10,363.64
    $800.00

    IT-HOSPITAL
    NURSING CARE

    P-ORAL DRUGS
    P-ORAL DRUGS
    COMPLETE EXAMINATION
    P-ORAL DRUGS

    SLT-OFFICE
    P-ORAL DRUGS

    ABORATORY

    H006
    H006
    H006
    H006
    M229
    P055
    P055
    O001
    O001
    H025
    H025
    S383
    P055
    M229
    L001
    M326

    M030
    P-ORAL DRUGS
    P031
    P-ORAL DRUGS
    P031
    COMPLETE EXAMINATION
    O001
    MATERIALS: FRAMES
    O001
    MATERIALS: LENS, EACH-BI-FOCALO001
    SLT-OFFICE
    S375
    P-ORAL DRUGS
    P066
    SLT-OFFICE
    S046
    ABORATORY
    S046
    M186
    P-ORAL DRUGS
    P487
    P-ORAL DRUGS
    P487
    ABORATORY
    H026
    H026

    SLT-OFFICE
    P-INJECTABLES
    P-ORAL DRUGS
    P-ORAL DRUGS
    SLT-OFFICE
    P-ORAL DRUGS
    P-ORAL DRUGS

    SLT-OFFICE
    SLT-OFFICE
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    SLT-OFFICE

    L075
    S216
    S216
    P343
    P005
    S235
    P435
    P005
    M300
    S069
    S069
    P507
    P343
    P507
    S235
    M771
    M771
    T051

    $2,200.00
    $350.00
    $300.00
    $3,900.50
    $7,550.50
    $140.00
    $3,553.00
    $2,655.25
    $110.00
    $173.04
    $260.00
    $300.00
    $260.00
    $6,501.65
    $140.00
    $303.80
    $250.00
    $14,646.74
    $160.00
    $99.60
    $137.99
    $110.00
    $930.75
    $1,207.00
    $200.00
    $278.64
    $350.00
    $50.00
    $85.00
    $133.32
    $10.10
    $379.95
    $80.00
    $4,212.35
    $1,900.00
    $1,200.00
    $600.00
    $167.30
    $5,363.94
    $300.00
    $494.68
    $818.12
    $320.00
    $300.00
    $1,200.00
    $637.10
    $224.24
    $27.00
    $300.00
    $13,852.38
    $300.00
    $400.00
    $750.00

    T051
    $393.00
    P435
    $156.11
    P435
    $17.35
    P427
    $48.60
    P427
    $5.40
    P005
    $617.70
    P435
    $678.92
    M657
    $200.00
    P-ORAL DRUGS
    P435
    $178.12
    P-ORAL DRUGS
    P435
    $19.79
    P-ORAL DRUGS
    P435
    $678.92
    L075
    $3,400.00
    P-ORAL DRUGS
    P435
    $92.91
    P-ORAL DRUGS
    P435
    $10.32
    H005
    $800.00
    H005
    $1,400.00
    H005
    $12,862.72
    P-ORAL DRUGS
    P427
    $1,047.60
    P-ORAL DRUGS
    P427
    $116.40
    SPINE/SPINAL CORD: REMOVAL NUCLEUS
    S159 PULPOSUS
    $20,000.00
    INTERVERTEBRAL DISK
    M673
    $5,000.00
    P-ORAL DRUGS
    P435
    $1,883.58
    P-ORAL DRUGS
    P427
    $153.85
    M657
    $200.00
    P-ORAL DRUGS
    P005
    $312.88
    L140
    $1,640.00
    SLT-OFFICE
    S159
    $800.00
    P-ORAL DRUGS
    P427
    $276.50
    P-ORAL DRUGS
    P427
    $63.00
    P-ORAL DRUGS
    P427
    $189.00
    M657
    $200.00
    P-ORAL DRUGS
    P427
    $235.90
    $55,128.57
    M299
    $150.00
    L034
    $400.00
    ABORATORY
    M299
    $60.00
    ABORATORY
    L061
    $145.00
    P-INJECTABLES
    M299
    $25.00
    P-INJECTABLES
    M299
    $265.00
    ABORATORY
    L061
    $180.00
    P-ORAL DRUGS
    P337
    $54.00
    ABORATORY
    L061
    $300.00
    ABORATORY
    L061
    $205.00
    P-ORAL DRUGS
    P337
    $90.00
    $1,874.00
    M187
    $200.00
    L97
    $250.00
    SLT-OFFICE
    S007
    $440.00
    P-ORAL DRUGS
    P231
    $94.50
    H023
    $750.00
    H023
    $3,000.00
    H023
    $2,190.00
    P-INJECTABLES
    H023
    $25.00

    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    P-INJECTABLES

    H023
    M001
    M001
    P476
    P399

    $25.00
    $160.00
    P-INJECTABLES
    $50.00
    P-ORAL DRUGS
    $33.60
    P-ORAL DRUGS
    $138.50
    $7,356.60
    COMPLETE EXAMINATION
    O002
    $70.00
    MATERIALS: LENS, EACH-BI-FOCALO002
    $495.00
    $565.00
    M156
    $100.00
    P-INJECTABLES
    M156
    $200.00
    P-ORAL DRUGS
    P145
    $275.00
    $575.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D31
    $325.00
    $325.00
    L143
    $500.00
    $500.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D41 CAVITY $1,000.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D41
    $500.00
    S458
    $300.00
    S458
    $300.00
    $2,100.00
    COMPLETE EXAMINATION
    O163
    $70.00
    MATERIALS: FRAMES
    O163
    $1,245.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O163
    $1,200.00
    $2,515.00
    SLT-OFFICE
    S136
    $200.00
    P-INJECTABLES
    S136
    $300.00
    P-ORAL DRUGS
    P014
    $65.00
    M858
    $200.00
    P-ORAL DRUGS
    P014
    $406.25
    MATERIALS: FRAMES
    O006
    $500.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O006
    $900.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O006
    $1,095.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O006
    $700.00
    $4,476.25
    SCARRIAGE
    M230
    $300.00
    SCARRIAGE
    M858
    $300.00
    SCARRIAGE
    L054
    $300.00
    $900.00
    M104
    $360.00
    ABORATORY
    L070
    $230.00
    P-ORAL DRUGS
    P466
    $151.50
    $741.50
    S123
    $400.00
    $400.00
    M167
    $140.00
    P-INJECTABLES
    M167
    $25.00
    P-INJECTABLES
    M167
    $35.00
    ABORATORY
    M327
    $80.00
    M327
    $140.00
    P-ORAL DRUGS
    M327
    $60.00

    P-INJECTABLES
    P-ORAL DRUGS

    M327
    P426

    SLT-OFFICE
    P-ORAL DRUGS
    SLT-OFFICE
    P-ORAL DRUGS
    SLT-OFFICE

    S375
    P235
    S375
    P001
    S375
    M053
    M053
    M053
    M053

    ABORATORY

    P-ORAL DRUGS
    SLT-OFFICE
    P-ORAL DRUGS
    P-ORAL DRUGS

    ABORATORY

    M345
    P014
    S184
    P014
    P014
    M345
    M304
    M345

    M188
    COMPLETE EXAMINATION
    O001
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    MATERIALS: FRAMES
    O001
    M188
    L082
    ABORATORY
    L082

    P-ORAL DRUGS
    P-ORAL DRUGS

    ABORATORY
    SLT-OFFICE

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE
    MATERIALS: FRAMES
    SLT-OFFICE
    IT-HOSPITAL

    SLT-OFFICE

    ABORATORY
    COMPLETE EXAMINATION

    ABORATORY
    COMPLETE EXAMINATION

    S096
    S096
    P140
    P140
    L013
    L013
    S439
    S367
    VISION
    O161
    O161
    S367
    H006
    H006
    S306
    H025
    O004
    M184
    M184
    L001
    O004

    $60.00
    $188.00
    $728.00
    $200.00
    $2,457.00
    $200.00
    $100.93
    $200.00
    $75.00
    $65.00
    $20.00
    $140.00
    $3,457.93
    $200.00
    $421.00
    $300.00
    $83.60
    $10.80
    $200.00
    $585.00
    $200.00
    $2,000.40
    $100.00
    $250.00
    $1,020.00
    $1,440.75
    $100.00
    $240.00
    $625.00
    $3,775.75
    $300.00
    $300.00
    $1.40
    $119.00
    $4,990.00
    $475.00
    $300.00
    $6,485.40
    $340.00
    $800.00
    $600.00
    $260.00
    $450.00
    $150.00
    $400.00
    $3,000.00
    $150.00
    $200.00
    $60.00
    $140.00
    $260.00
    $810.00
    $100.00

    MATERIALS: LENS, EACH-TRI-FOCAL


    O004
    S090
    P-ORAL DRUGS
    P034

    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS

    M215
    P014
    P014
    P022
    M215

    M053
    P435
    P435
    M053
    P-ORAL DRUGS
    P435
    P-ORAL DRUGS
    P435
    M053
    P-ORAL DRUGS
    P435
    P-ORAL DRUGS
    P435
    M053
    P-ORAL DRUGS
    P435
    COMPLETE EXAMINATION
    O007
    MATERIALS: FRAMES
    O007
    MATERIALS: LENS, EACH-SINGLE VISION
    O007
    O007
    M053
    P-ORAL DRUGS
    P435
    M053
    SLT-OFFICE
    S046
    P-ORAL DRUGS
    P435
    M053
    P-ORAL DRUGS
    P435
    P-ORAL DRUGS
    P435
    M053
    P-ORAL DRUGS
    P435
    P-ORAL DRUGS
    P435

    P-ORAL DRUGS
    P-ORAL DRUGS

    COMPLETE EXAMINATION
    O004
    MATERIALS: FRAMES
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004

    ABORATORY

    P-ORAL DRUGS
    P-ORAL DRUGS

    M630
    M630
    M089
    M089
    M630
    M630
    P435
    P435
    M630
    M630
    L034
    M630

    $2,056.00
    $180.00
    $77.00
    $2,413.00
    $250.00
    $369.00
    $118.50
    $175.00
    $250.00
    $1,162.50
    $140.00
    $108.41
    $303.55
    $140.00
    $24.12
    $365.98
    $140.00
    $32.37
    $239.97
    $140.00
    $141.05
    $100.00
    $675.00
    $1,440.00
    $100.00
    $140.00
    $646.62
    $140.00
    $400.00
    $255.31
    $140.00
    $153.45
    $58.19
    $140.00
    $108.23
    $56.51
    $6,328.76
    $100.00
    $1,196.00
    $1,280.00
    $2,576.00
    $75.00
    $105.00
    $180.00
    $180.00
    $75.00
    $105.00
    $126.64
    $31.66
    $75.00
    $105.00
    $500.00
    $75.00

    $105.00
    $105.45
    $26.36
    $150.00
    $250.00
    $364.44
    $91.11
    $410.00
    $600.00
    $180.00
    SLT-OFFICE
    $400.00
    ABORATORY
    $200.00
    $180.00
    P-ORAL DRUGS
    $98.29
    $4,793.95
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D58 VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D58 VIEW
    $25.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D58
    W ANESTHESIA
    $450.00
    & POST OPER
    $510.00
    ENATAL CARE
    M077
    $600.00
    $600.00
    D219
    $200.00
    $200.00
    M687
    $250.00
    P-ORAL DRUGS
    P437
    $55.50
    P-ORAL DRUGS
    P437
    $420.75
    $726.25
    M786
    $120.00
    M786
    $120.00
    SLT-OFFICE
    S086
    $300.00
    S086
    $450.00
    ABORATORY
    L070
    $400.00
    S086
    $1,200.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S086
    $1,200.00
    $3,790.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $2,396.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $680.00
    $3,176.00
    M388
    $150.00
    P-INJECTABLES
    M388
    $25.00
    P-INJECTABLES
    M388
    $125.00
    $300.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D309VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D309VIEW
    $15.00
    DIAGNOSTIC: INITIAL ORAL EXAM D309
    (EXCLUDE X-RAY)
    $50.00
    ENDODONTICS: PULP CAPPING (EXCLUDE
    D309 RESTORATION)
    $400.00
    DIAGNOSTIC: PULP VITALITY TEST D309
    $20.00
    M786
    $100.00
    ABORATORY
    M786
    $20.00
    H008
    $450.00
    H008
    $1,581.80
    S032
    $5,300.00

    P-ORAL DRUGS
    P-ORAL DRUGS
    SLT-OFFICE
    SLT-OFFICE
    P-ORAL DRUGS
    P-ORAL DRUGS
    ABORATORY

    M630
    P435
    P435
    S281
    S281
    S281
    S281
    S281
    L049
    M630
    S281
    S281
    M630
    P435

    P-ORAL DRUGS
    P-ORAL DRUGS

    P140
    P492
    S032

    $125.75
    $115.50
    $1,000.00
    $9,213.05
    M159
    $900.00
    P-ORAL DRUGS
    P283
    $255.95
    M159
    $160.00
    $1,315.95
    S209
    $200.00
    SLT-OFFICE
    S256
    $350.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D260
    $300.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D260
    ROOT$100.00
    PLANING, SCALING, EACH
    DIAGNOSTIC: COMPLETE SERIES OF
    D260
    BITEWING X-RAYS
    $400.00
    SLT-OFFICE
    S256
    $350.00
    P-ORAL DRUGS
    P011
    $126.00
    P-ORAL DRUGS
    P011
    $16.00
    ABORATORY
    S256
    $180.00
    $2,022.00
    M386
    $125.00
    P-INJECTABLES
    M386
    $25.00
    P-INJECTABLES
    M386
    $75.00
    $225.00
    DIAGNOSTIC: INITIAL ORAL EXAM D41
    (EXCLUDE X-RAY)
    $100.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D41 CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D41 CAVITY $360.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D41 CAVITY $500.00
    $1,100.00
    S391
    $280.00
    P-ORAL DRUGS
    P014
    $61.95
    SLT-OFFICE
    S391
    $280.00
    P-ORAL DRUGS
    P014
    $127.95
    M304
    $140.00
    M304
    $400.00
    P-INJECTABLES
    M304
    $25.00
    P-INJECTABLES
    M304
    $75.00
    M608
    $200.00
    SLT-OFFICE
    S007
    $400.00
    $1,989.90
    SLT-OFFICE
    S281
    $800.00
    ABORATORY
    S281
    $400.00
    L006
    $400.00
    ABORATORY
    L070
    $650.00
    $2,250.00
    MATERIALS: FRAMES
    O154
    $475.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O154
    $360.00
    DIAGNOSTIC: INITIAL ORAL EXAM D413
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D413VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D413VIEW
    $285.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D413
    $350.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D413
    $200.00
    M046
    $60.00
    P-ORAL DRUGS
    P049
    $51.00
    P-ORAL DRUGS
    P049
    $30.50

    SLT-OFFICE
    S005
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D129CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D129CAVITY

    $300.00
    $140.00
    $330.00
    $2,696.50
    M030
    $160.00
    ABORATORY
    L001
    $325.00
    COMPLETE EXAMINATION
    O033
    $100.00
    MATERIALS: LENS, EACH-BI-FOCALO033
    $567.00
    $1,152.00
    P-ORAL DRUGS
    P115
    $3,285.00
    M156
    $100.00
    P-ORAL DRUGS
    P115
    $2,235.00
    M156
    $100.00
    M156
    $100.00
    P-ORAL DRUGS
    P115
    $3,285.00
    P-ORAL DRUGS
    P115
    $2,235.00
    SLT-OFFICE
    S174
    $300.00
    P-ORAL DRUGS
    P435
    $471.39
    P-ORAL DRUGS
    P435
    $18.00
    S210
    $100.00
    P-ORAL DRUGS
    P115
    $2,133.00
    S210
    $100.00
    P-ORAL DRUGS
    P115
    $3,285.00
    M156
    $100.00
    P-ORAL DRUGS
    P115
    $2,202.00
    M156
    $100.00
    P-ORAL DRUGS
    P115
    $3,285.00
    P-ORAL DRUGS
    P115
    $2,202.00
    M156
    $100.00
    M156
    $100.00
    P-ORAL DRUGS
    P115
    $3,285.00
    $29,121.39
    H023
    $2,437.50
    H023
    $62.50
    H44
    $6,050.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D31 VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D31 VIEW
    $40.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D31
    ROOT$150.00
    PLANING, SCALING, EACH
    OTHER
    P014
    $153.30
    $8,928.30
    M630
    $180.00
    P-ORAL DRUGS
    P435
    $263.55
    DIAGNOSTIC: INITIAL ORAL EXAM D51
    (EXCLUDE X-RAY)
    $180.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D51 VIEW
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D51
    $600.00
    $1,293.55
    PREVENTIVE: DENTAL PROPHYLAXIS
    D291
    $400.00
    ORAL SURGERY: SURGICAL REMOVAL
    D291
    OF TOOTH W
    $210.00
    SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D291
    OF TOOTH W
    $190.00
    SOFT TISSUE IMPACTION
    $800.00
    COMPLETE EXAMINATION
    O033
    $134.00
    COMPLETE EXAMINATION
    O033
    $96.00
    MATERIALS: CONTACT, MEDICALLYO033
    REQUIRED
    $190.00

    ENATAL
    ENATAL
    ENATAL
    ENATAL

    CARE
    CARE
    CARE
    CARE

    S151
    H005
    P022
    P427

    $3,150.00
    $969.00
    $132.00
    $66.00
    $4,737.00
    SLT-OFFICE
    S089
    $450.00
    P-ORAL DRUGS
    P435
    $14.70
    P-ORAL DRUGS
    P014
    $52.50
    $517.20
    CROWN & BRIDGE: RECEMENTING D78
    BRIDGE
    $42.00
    CROWN & BRIDGE: RECEMENTING D78
    BRIDGE
    $1,058.00
    $1,100.00
    S458
    $300.00
    $300.00
    ENATAL CARE
    S242
    $850.00
    ENATAL CARE
    P430
    $168.20
    ENATAL CARE
    P467
    $79.00
    ENATAL CARE
    M694
    $700.00
    P-INJECTABLES
    M694
    $25.00
    P-INJECTABLES
    M694
    $75.00
    $1,897.20
    ENDODONTICS: EXTIRPATION OF PULP
    D253& FILL 3 ROOT
    $900.00
    CANAL (EX RESTOR)
    OTHER
    P106
    $247.50
    $1,147.50
    H025
    $240.00
    M124
    $750.00
    P-ORAL DRUGS
    P001
    $1,076.70
    ABORATORY
    L070
    $1,855.00
    SLT-OFFICE
    S151
    $400.00
    S151
    $300.00
    ABORATORY
    S151
    $170.00
    SLT-OFFICE
    S286
    $350.00
    S286
    $100.00
    P-ORAL DRUGS
    L128
    $700.00
    P-ORAL DRUGS
    P031
    $876.98
    M124
    $250.00
    P-ORAL DRUGS
    P435
    $151.53
    $7,220.21
    P-ORAL DRUGS
    P034
    $106.80
    P-ORAL DRUGS
    P034
    $92.70
    IT-HOSPITAL
    H011
    $750.00
    ABORATORY
    H011
    $215.00
    P-ORAL DRUGS
    P286
    $500.00
    H011
    $257.00
    COMPLETE EXAMINATION
    O065
    $150.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O065
    $3,300.00
    M183
    $150.00
    ABORATORY
    M183
    $140.00
    M186
    $220.00
    P-ORAL DRUGS
    P397
    $130.00
    $6,011.50
    M189
    $120.00
    ABORATORY
    L065
    $630.00

    $750.00
    $400.00
    P-ORAL DRUGS
    $200.00
    $300.00
    P-ORAL DRUGS
    $49.00
    P-ORAL DRUGS
    $16.00
    $200.00
    P-ORAL DRUGS
    $1,734.24
    $200.00
    P-ORAL DRUGS
    $190.65
    P-ORAL DRUGS
    $3,791.97
    $7,081.86
    M346
    $320.00
    P-ORAL DRUGS
    P499
    $150.00
    $470.00
    L075
    $3,610.00
    T073
    $900.00
    $4,510.00
    DIAGNOSTIC: INITIAL ORAL EXAM D60
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D60
    $300.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D60 VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D60 VIEW
    $70.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D60 CAVITY $300.00
    CROWN & BRIDGE: REPLACE BROKEN
    D60FACING WITH
    $300.00
    STEELE'S/OTHER FACING
    P-ORAL DRUGS
    P014
    $273.00
    P-ORAL DRUGS
    P003
    $199.80
    P-ORAL DRUGS
    P003
    $299.80
    P-ORAL DRUGS
    P014
    $210.00
    SLT-OFFICE
    S384
    $100.00
    SLT-OFFICE
    S384
    $300.00
    M341
    $100.00
    M341
    $40.00
    P-INJECTABLES
    M341
    $80.00
    P-INJECTABLES
    M341
    $20.00
    S384
    $400.00
    $3,092.60
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $675.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $561.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: LENS, EACH-BI-FOCALO001
    $400.00
    MATERIALS: LENS, EACH-BI-FOCALO001
    $1,062.00
    SLT-OFFICE
    S281
    $400.00
    S281
    $200.00
    P-ORAL DRUGS
    P014
    $106.00
    L149
    $150.00
    ABORATORY
    L147
    $250.00
    $4,024.75
    M120
    $140.00
    P-ORAL DRUGS
    M120
    $80.00
    P-ORAL DRUGS
    M120
    $93.00
    $313.00
    SLT-OFFICE
    S367
    $260.00
    M463
    M463
    M463
    P115
    P011
    M015
    P005
    M015
    P115
    P005

    $260.00
    $7,540.00
    $350.00
    $350.00
    $8,240.00
    L139
    $650.00
    $650.00
    M814
    $70.00
    M814
    $30.00
    P-INJECTABLES
    M814
    $40.00
    P-ORAL DRUGS
    P337
    $65.00
    M814
    $100.00
    ABSCESSES, BOILS & CARBUNCLES:
    M814
    INCISION FOR$500.00
    DRAINAGE W/O HOSPITAL
    P-ORAL DRUGS
    P195
    $84.00
    P-ORAL DRUGS
    P272
    $73.58
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D113VIEW
    $110.00
    ORAL SURGERY: SURGICAL REMOVAL
    D113
    OF TOOTH W
    $850.00
    SOFT TISSUE IMPACTION
    SLT-OFFICE
    S071
    $84.00
    SLT-OFFICE
    S071
    $566.00
    P-ORAL DRUGS
    P014
    $184.15
    P-ORAL DRUGS
    P014
    $44.48
    P-ORAL DRUGS
    P014
    $9.17
    $2,960.38
    M189
    $140.00
    P-ORAL DRUGS
    P077
    $140.00
    P-ORAL DRUGS
    P115
    $51.60
    P-ORAL DRUGS
    P115
    $74.90
    M067
    $160.00
    P-INJECTABLES
    M067
    $25.00
    P-INJECTABLES
    M067
    $55.00
    P-ORAL DRUGS
    P049
    $87.50
    P-ORAL DRUGS
    P435
    $221.46
    ABSCESSES, BOILS & CARBUNCLES:
    M067
    INCISION FOR$760.00
    DRAINAGE W/O HOSPITAL
    $1,715.46
    M164
    $120.00
    P-ORAL DRUGS
    P077
    $46.00
    $166.00
    P-ORAL DRUGS
    P106
    $597.00
    P-ORAL DRUGS
    P106
    $285.00
    SLT-OFFICE
    M851
    $500.00
    P-ORAL DRUGS
    P014
    $40.95
    P-ORAL DRUGS
    P106
    $1,791.00
    ABORATORY
    L025
    $575.00
    COMPLETE EXAMINATION
    O004
    $100.00
    SLT-OFFICE
    S165
    $360.00
    EYE: OPERATION ON EYE, EYE MUSCLE,
    S165 OR THROUGH
    $4,000.00
    SCLERA OR CORNEA
    P-ORAL DRUGS
    P106
    $298.50
    H006
    $4,500.00
    SLT-OFFICE
    S165
    $300.00
    P-ORAL DRUGS
    P014
    $119.25
    P-ORAL DRUGS
    P106
    $60.00

    ABORATORY
    SLT-OFFICE
    SLT-OFFICE

    H006
    S374
    S374

    P-ORAL DRUGS

    P106

    $597.00
    $14,123.70
    S266
    $400.00
    P-INJECTABLES
    S266
    $200.00
    P-ORAL DRUGS
    P055
    $651.95
    P-ORAL DRUGS
    P022
    $60.00
    ABORATORY
    S323
    $450.00
    P-ORAL DRUGS
    P055
    $228.00
    H023
    $241.00
    H023
    $4,380.00
    P-ORAL DRUGS
    P435
    $82.57
    ABORATORY
    H023
    $2,170.00
    IT-HOSPITAL
    M550
    $800.00
    M452
    $250.00
    P-ORAL DRUGS
    P421
    $88.20
    ABORATORY
    M452
    $540.00
    M452
    $250.00
    ABORATORY
    M452
    $810.00
    M452
    $250.00
    P-ORAL DRUGS
    P421
    $166.60
    M550
    $300.00
    P-ORAL DRUGS
    P435
    $1,507.68
    P-ORAL DRUGS
    P055
    $420.60
    ABORATORY
    P055
    $270.00
    P-ORAL DRUGS
    P435
    $27.24
    P-ORAL DRUGS
    P435
    $59.28
    ABORATORY
    S323
    $1,060.00
    ABORATORY
    L079
    $630.00
    $16,293.12
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D60
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D60
    W ANESTHESIA
    $65.00
    & POST OPER
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $60.00
    VIEW
    OTHER
    P469
    $102.50
    SLT-OFFICE
    S245
    $400.00
    ABORATORY
    H011
    $360.00
    L121
    $700.00
    M297
    $120.00
    ABORATORY
    M297
    $20.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D60 VIEW
    $60.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D60
    W ANESTHESIA
    $200.00
    & POST OPER
    M297
    $610.00
    P-ORAL DRUGS
    L116
    $119.50
    P-ORAL DRUGS
    L116
    $52.00
    ABORATORY
    L021
    $1,445.00
    L174
    $800.00
    ABORATORY
    H011
    $400.00
    S245
    $300.00
    ABORATORY
    H011
    $580.00
    S316
    $400.00
    S239
    $200.00
    $7,079.00
    L97
    $800.00
    $800.00

    SLT-OFFICE

    P-INJECTABLES
    P-ORAL DRUGS
    P-ORAL DRUGS

    ABORATORY

    P-INJECTABLES
    P-INJECTABLES

    ABORATORY

    P-ORAL DRUGS

    S300
    M139
    M139
    M139
    M139
    M139
    M139
    M139
    M139
    M139
    M851
    H034
    H034
    H005
    M851
    M851
    P014

    S111
    S111
    ABORATORY
    H011
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D414
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D414

    COMPLETE EXAMINATION
    O001
    MATERIALS: FRAMES
    O001
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    P-ORAL DRUGS
    P034
    P-ORAL DRUGS
    P034
    SLT-OFFICE
    S214
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S214
    H005
    H005

    L065
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    IT-HOSPITAL
    H023
    P-ORAL DRUGS
    H023
    PREVENTIVE: DENTAL PROPHYLAXIS
    D141
    PREVENTIVE: DENTAL PROPHYLAXIS
    D141
    COMPLETE EXAMINATION
    O004

    SLT-OFFICE

    ABORATORY

    P-ORAL DRUGS

    P-ORAL DRUGS

    P-ORAL DRUGS

    S084
    H006
    H006
    M189
    P059
    M002
    M002
    M002
    M002

    $300.00
    $300.00
    $100.00
    $700.00
    $200.00
    $40.00
    $100.00
    $1,000.00
    $100.00
    $25.00
    $675.00
    $500.00
    $610.00
    $1,180.00
    $2,500.00
    $200.00
    $300.00
    $158.85
    $8,388.85
    $300.00
    $200.00
    $300.00
    TREATMENT
    $60.00
    TREATMENT
    $440.00
    $1,300.00
    $110.00
    $745.00
    $1,730.00
    $254.80
    $277.50
    $350.00
    $1,500.00
    $400.00
    $1,592.00
    $6,959.30
    $1,225.00
    TREATMENT
    $3,700.00
    TREATMENT
    $400.00
    $375.00
    $50.00
    $300.00
    $300.00
    $100.00
    $6,450.00
    $300.00
    $3,000.00
    $440.00
    $140.00
    $720.00
    $130.00
    $50.00
    $130.00
    $135.00

    AFTER 1ST 6 MONTHS


    AFTER 1ST 6 MONTHS

    AFTER 1ST 6 MONTHS


    AFTER 1ST 6 MONTHS

    $140.00
    $720.00
    $140.00
    P-ORAL DRUGS
    $95.00
    P-ORAL DRUGS
    $20.00
    ABORATORY
    $190.00
    $6,350.00
    P-ORAL DRUGS
    P011
    $45.50
    $45.50
    M393
    $220.00
    P-ORAL DRUGS
    P343
    $175.15
    M393
    $220.00
    P-ORAL DRUGS
    P343
    $268.00
    P-ORAL DRUGS
    P005
    $412.04
    P-ORAL DRUGS
    P005
    $518.58
    M393
    $60.00
    P-ORAL DRUGS
    P005
    $518.58
    P-ORAL DRUGS
    P005
    $412.04
    L081
    $400.00
    P-ORAL DRUGS
    L081
    $345.72
    M393
    $370.00
    ABORATORY
    M393
    $950.00
    P-ORAL DRUGS
    P005
    $691.44
    P-ORAL DRUGS
    P005
    $412.00
    $5,973.55
    S091
    $160.00
    P-ORAL DRUGS
    P049
    $90.10
    S091
    $160.00
    $410.10
    PERIODONTICS: GINGIVECTOMY, SURGICAL,
    D205
    PER$4,000.00
    QUADRANT W POST OPER
    PREVENTIVE: DENTAL PROPHYLAXIS
    D205
    $450.00
    DIAGNOSTIC: INITIAL ORAL EXAM D205
    (EXCLUDE X-RAY)
    $300.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D205VIEW
    $135.00
    $4,885.00
    DIAGNOSTIC: INITIAL ORAL EXAM D60
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $105.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $75.00
    VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D60 CAVITY $300.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D60 SURFACE $300.00
    CAVITY
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D60
    W ANESTHESIA
    $200.00
    & POST OPER
    $1,030.00
    M254
    $200.00
    P-INJECTABLES
    M254
    $250.00
    P-ORAL DRUGS
    M254
    $300.00
    $750.00
    M152
    $150.00
    P-INJECTABLES
    M152
    $25.00
    P-INJECTABLES
    M152
    $95.00
    L067
    $80.00
    M152
    $150.00
    L067
    $120.00
    COMPLETE EXAMINATION
    O002
    $50.00
    MATERIALS: FRAMES
    O002
    $707.50

    P-ORAL DRUGS

    M189
    P059
    M189
    P059
    P059
    L025

    MATERIALS: LENS, EACH-SINGLE VISION


    O002
    M152
    P-INJECTABLES
    M152
    P-INJECTABLES
    M152
    L121
    ABORATORY
    L074

    $862.50
    $150.00
    $25.00
    $95.00
    $250.00
    $70.00
    $2,830.00
    SLT-OFFICE
    S138
    $250.00
    P-INJECTABLES
    S138
    $25.00
    P-INJECTABLES
    S138
    $25.00
    M345
    $200.00
    P-INJECTABLES
    M345
    $25.00
    P-INJECTABLES
    M345
    $175.00
    ABORATORY
    L147
    $100.00
    P-ORAL DRUGS
    P484
    $71.50
    M345
    $200.00
    ABORATORY
    L147
    $450.00
    P-INJECTABLES
    M345
    $25.00
    P-INJECTABLES
    M345
    $275.00
    $1,821.50
    SLT-OFFICE
    S386
    $500.00
    S004
    $600.00
    P-ORAL DRUGS
    P005
    $698.48
    H006
    $3,330.00
    DIAGNOSTIC: INITIAL ORAL EXAM D48
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D48 VIEW
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D48 VIEW
    $14.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D48 VIEW
    $25.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D48 VIEW
    $25.00
    SLT-OFFICE
    S346
    $300.00
    H003
    $1,750.00
    H003
    $11,369.30
    S346
    $5,200.00
    PROSTATE: TRANSURETHRAL RESECTION
    S346
    $10,200.00
    H003
    $7,000.00
    H003
    $687.95
    P-ORAL DRUGS
    P247
    $42.75
    P-ORAL DRUGS
    P005
    $367.82
    S346
    $400.00
    ABORATORY
    H023
    $1,600.00
    SLT-OFFICE
    S346
    $200.00
    P-ORAL DRUGS
    P247
    $135.00
    P-ORAL DRUGS
    P005
    $349.24
    P-ORAL DRUGS
    P104
    $185.00
    M304
    $100.00
    M304
    $100.00
    P-ORAL DRUGS
    P247
    $507.64
    P-ORAL DRUGS
    P247
    $126.91
    P-ORAL DRUGS
    P247
    $92.56
    P-ORAL DRUGS
    P247
    $23.14
    SLT-OFFICE
    S346
    $200.00
    $46,279.79
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D148CAVITY $600.00

    OPERATIVE: AMALGAM FILL 2 SURFACE


    D148CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D148CAVITY $400.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D148CAVITY $100.00
    ENDODONTICS: EXTIRPATION OF PULP
    D148& FILL 1 ROOT
    $156.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D148& FILL 1 $3,344.00
    ROOT CANAL (EX RESTOR)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D148VIEW
    $120.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D148
    W ANESTHESIA
    $300.00
    & POST OPER
    SLT-OFFICE
    S228
    $300.00
    O178
    $1,500.00
    P-ORAL DRUGS
    P140
    $140.00
    $7,060.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D420
    W ANESTHESIA
    $250.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D420
    W ANESTHESIA
    $250.00
    & POST OPER
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D420VIEW
    $80.00
    IT-HOSPITAL
    H011
    $350.00
    IT-HOSPITAL
    H011
    $250.00
    H011
    $5.60
    H011
    $1.40
    $1,187.00
    COMPLETE EXAMINATION
    O002
    $50.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O002
    $950.00
    $1,000.00
    SLT-OFFICE
    S250
    $300.00
    SLT-OFFICE
    S446
    $300.00
    $600.00
    S160
    $200.00
    $200.00
    M189
    $120.00
    M189
    $140.00
    P-ORAL DRUGS
    P059
    $120.00
    P-ORAL DRUGS
    P059
    $25.00
    P-ORAL DRUGS
    P059
    $252.00
    P-ORAL DRUGS
    P059
    $152.00
    $809.00
    M265
    $80.00
    P-ORAL DRUGS
    M265
    $120.00
    $200.00
    SLT-OFFICE
    S069
    $450.00
    P-ORAL DRUGS
    P167
    $244.00
    M020
    $160.00
    P-ORAL DRUGS
    P039
    $330.00
    SLT-OFFICE
    S069
    $450.00
    M136
    $160.00
    P-ORAL DRUGS
    P039
    $199.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $925.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,010.00
    $4,038.00
    M851
    $500.00
    ABORATORY
    L126
    $550.00
    $1,050.00
    M138
    $100.00
    P-INJECTABLES
    M138
    $25.00

    P-INJECTABLES
    M138
    $75.00
    DIAGNOSTIC: INITIAL ORAL EXAM D173
    (EXCLUDE X-RAY)
    $140.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D173VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D173VIEW
    $90.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D173CAVITY $450.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D173
    ROOT$450.00
    PLANING, SCALING, EACH
    PREVENTIVE: DENTAL PROPHYLAXIS
    D173
    $400.00
    $1,800.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D38
    TREATMENT
    $85.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D38
    TREATMENT
    $215.00 AFTER 1ST 6 MONTHS
    S242
    $250.00
    P-ORAL DRUGS
    P497
    $83.00
    P-ORAL DRUGS
    P497
    $23.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,674.00
    $2,440.00
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D113
    $450.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D113CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D113CAVITY $310.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D113
    X-RAY, SINGLE
    $80.00
    VIEW
    $1,060.00
    P-ORAL DRUGS
    P483
    $115.00
    P-ORAL DRUGS
    P483
    $45.80
    P-ORAL DRUGS
    P483
    $134.65
    $295.45
    PREVENTIVE: DENTAL PROPHYLAXIS
    D412
    $300.00
    $300.00
    ENDODONTICS: EXTIRPATION OF PULP
    D426& FILL 1 ROOT
    $350.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D426& FILL 1 $1,600.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D426CAVITY $470.00
    $2,420.00
    COMPLETE EXAMINATION
    O065
    $150.00
    MATERIALS: FRAMES
    O065
    $1,080.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O065
    $540.00
    M067
    $320.00
    P-ORAL DRUGS
    P077
    $1,386.00
    $3,476.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D397
    $400.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D397 SURFACE $170.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D397 SURFACE $330.00
    CAVITY
    P-ORAL DRUGS
    P034
    $5.00
    P-ORAL DRUGS
    P034
    $176.25
    P-ORAL DRUGS
    P034
    $106.15
    P-ORAL DRUGS
    P034
    $269.80
    $1,457.20
    DIAGNOSTIC: INITIAL ORAL EXAM D114
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D114
    $340.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D114VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D114VIEW
    $10.00
    $540.00
    IT-HOSPITAL
    H005
    $455.00
    P-ORAL DRUGS
    H005
    $254.84

    H005
    $200.00
    P-ORAL DRUGS
    P122
    $123.80
    SLT-OFFICE
    S001
    $400.00
    ABORATORY
    S001
    $100.00
    UTERUS: OTHER OPR ON UTERUS, S001
    TUBES, OVARIES
    $750.00
    BY ABDOMINAL APPROACH
    IT-HOSPITAL
    H005
    $455.00
    $2,738.64
    IT-HOSPITAL
    H023
    $375.00
    ABORATORY
    H023
    $532.00
    P-ORAL DRUGS
    H023
    $178.80
    SLT-OFFICE
    S450
    $300.00
    H006
    $300.00
    H006
    $1,000.00
    UTERUS: DILATION & CURRETTAGE,
    S450
    OR OTHER SURGERY
    $3,700.00ON EXT GENITALIA
    M246
    $1,000.00
    $7,385.80
    M657
    $200.00
    P-ORAL DRUGS
    P090
    $1,232.00
    P-ORAL DRUGS
    P090
    $2,420.80
    $3,852.80
    COMPLETE EXAMINATION
    O001
    $50.00
    COMPLETE EXAMINATION
    O001
    $220.00
    MATERIALS: FRAMES
    O001
    $750.00
    MATERIALS: FRAMES
    O001
    $645.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $450.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,320.00
    $3,435.00
    SLT-OFFICE
    S266
    $400.00
    ABORATORY
    H021
    $613.80
    P-ORAL DRUGS
    P353
    $2,208.00
    $3,221.80
    S314
    $300.00
    P-ORAL DRUGS
    P073
    $454.70
    COMPLETE EXAMINATION
    O004
    $100.00
    O004
    $180.00
    $1,034.70
    SLT-OFFICE
    S019
    $780.00
    S019
    $360.00
    P-ORAL DRUGS
    S019
    $240.00
    SLT-OFFICE
    S019
    $780.00
    P-INJECTABLES
    S019
    $25.00
    P-INJECTABLES
    S019
    $135.00
    SLT-OFFICE
    S019
    $260.00
    $2,580.00
    M666
    $160.00
    P-INJECTABLES
    M666
    $50.00
    P-INJECTABLES
    M666
    $30.00
    $240.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,885.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,695.00
    $3,670.50
    ABORATORY
    L025
    $200.00

    $200.00
    $300.00
    ABORATORY
    $125.00
    ABORATORY
    $375.00
    $300.00
    ABORATORY
    $390.00
    P-ORAL DRUGS
    $143.81
    $1,633.81
    M215
    $250.00
    L96
    $500.00
    ABORATORY
    L070
    $980.00
    ABORATORY
    L96
    $700.00
    M215
    $250.00
    M215
    $250.00
    P-ORAL DRUGS
    P014
    $118.50
    $3,048.50
    L091
    $350.00
    $350.00
    M026
    $440.00
    ABORATORY
    L001
    $210.00
    ABORATORY
    L001
    $185.00
    $835.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O002
    $1,657.50
    MATERIALS: FRAMES
    O002
    $2,120.75
    $3,778.25
    L075
    $3,800.00
    COMPLETE EXAMINATION
    O177
    $100.00
    MATERIALS: FRAMES
    O177
    $1,890.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O177
    $1,935.00
    O177
    $150.00
    $7,875.00
    DIAGNOSTIC: INITIAL ORAL EXAM D276
    (EXCLUDE X-RAY)
    $60.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D276VIEW
    $128.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D276VIEW
    $32.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D276
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D276
    $160.00
    H047
    $75.00
    H047
    $325.00
    COMPLETE EXAMINATION
    O007
    $100.00
    MATERIALS: FRAMES
    O007
    $700.00
    MATERIALS: FRAMES
    O007
    $627.50
    MATERIALS: LENS, EACH-TRI-FOCAL
    O007
    $810.00
    M814
    $100.00
    P-ORAL DRUGS
    P457
    $32.00
    P-ORAL DRUGS
    P457
    $8.00
    $3,297.50
    COMPLETE EXAMINATION
    O004
    $200.00
    MATERIALS: FRAMES
    O004
    $1,356.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,656.00
    $3,212.00
    SLT-OFFICE
    S277
    $300.00
    ABORATORY
    H006
    $506.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D129CAVITY $300.00
    M068
    M068
    L081
    M068
    M068
    P203

    SLT-OFFICE
    ABORATORY

    S277
    H006

    $300.00
    $625.00
    $2,031.00
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $320.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $120.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D103
    X-RAY, SINGLE
    $35.00
    VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    M225
    $220.00
    ABORATORY
    M225
    $280.00
    P-ORAL DRUGS
    P055
    $70.00
    M225
    $220.00
    ABORATORY
    M225
    $50.00
    P-ORAL DRUGS
    P055
    $15.25
    P-ORAL DRUGS
    P055
    $189.70
    M225
    $220.00
    ABORATORY
    M225
    $130.00
    P-INJECTABLES
    M225
    $100.00
    P-ORAL DRUGS
    P055
    $79.75
    P-ORAL DRUGS
    P011
    $101.00
    ABORATORY
    L001
    $1,990.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D103
    CROWN W METAL
    $1,720.00
    THIMBLE
    CROWN & BRIDGE: ACRYLIC JACKET
    D103
    CROWN W METAL
    $5,080.00
    THIMBLE
    OTHER SERVICES: ADMINISTRATION
    M613
    OF GENERAL
    $2,400.00
    ANESTHESIA
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D103
    X-RAY, SINGLE
    $140.00
    VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D103
    X-RAY, SINGLE
    $140.00
    VIEW
    M225
    $440.00
    P-INJECTABLES
    M225
    $170.00
    M225
    $170.00
    P-ORAL DRUGS
    M225
    $40.00
    ABORATORY
    M225
    $70.00
    $15,890.70
    M188
    $140.00
    P-INJECTABLES
    M188
    $25.00
    P-ORAL DRUGS
    M188
    $75.00
    SLT-OFFICE
    S194
    $300.00
    L013
    $127.00
    P-ORAL DRUGS
    P167
    $156.45
    $823.45
    COMPLETE EXAMINATION
    O168
    $90.00
    MATERIALS: FRAMES
    O168
    $1,195.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O168
    $1,520.00
    COMPLETE EXAMINATION
    O168
    $90.00
    MATERIALS: FRAMES
    O168
    $1,345.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O168
    $1,520.00
    $5,760.00
    IT-HOSPITAL
    H011
    $550.00
    H011
    $365.00
    ABORATORY
    H011
    $485.00

    P-ORAL DRUGS

    H011

    $250.00
    $1,650.00
    SLT-OFFICE
    S226
    $1,600.00
    P-ORAL DRUGS
    P435
    $2,960.02
    P-ORAL DRUGS
    P435
    $174.42
    P-ORAL DRUGS
    P231
    $1,822.50
    P-ORAL DRUGS
    P011
    $204.00
    P-ORAL DRUGS
    P372
    $805.20
    SLT-OFFICE
    S226
    $1,600.00
    P-ORAL DRUGS
    P173
    $1,704.75
    P-ORAL DRUGS
    P073
    $2,862.50
    P-ORAL DRUGS
    H023
    $1,656.20
    P-ORAL DRUGS
    P011
    $405.00
    $15,794.59
    S295
    $300.00
    P-ORAL DRUGS
    P467
    $201.60
    P-ORAL DRUGS
    P467
    $7.00
    MATERIALS: FRAMES
    O151
    $895.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O151
    $400.00
    SLT-OFFICE
    S295
    $300.00
    S295
    $400.00
    SLT-OFFICE
    S295
    $300.00
    US01
    $2,890.80
    P-ORAL DRUGS
    P467
    $35.00
    $5,729.40
    P-ORAL DRUGS
    P487
    $696.86
    $696.86
    COMPLETE EXAMINATION
    O065
    $250.00
    MATERIALS: CONTACT, WHEN NOTO065
    MEDICALLY REQUIRED
    $340.00
    P-ORAL DRUGS
    P169
    $240.50
    $830.50
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    M067
    $600.00
    M067
    $160.00
    $760.00
    P-ORAL DRUGS
    P011
    $176.00
    P-ORAL DRUGS
    P011
    $185.00
    $361.00
    IT-HOSPITAL
    H011
    $510.00
    H011
    $30.00
    H011
    $160.00
    P-ORAL DRUGS
    H011
    $395.00
    SLT-OFFICE
    S386
    $300.00
    P-ORAL DRUGS
    P498
    $42.00
    SLT-OFFICE
    S237
    $500.00
    SLT-OFFICE
    S250
    $300.00
    M183
    $700.00
    H011
    $700.00
    H011
    $2,960.00
    VARICOSE VEINS: INJECTION TREATMENT
    S250 ON ONE
    $10,000.00
    LEG
    S237
    $900.00
    $17,497.00
    M167
    $140.00
    P-INJECTABLES
    M167
    $25.00

    P-INJECTABLES

    M167

    $35.00
    $200.00
    IT-HOSPITAL
    H005
    $274.32
    IT-HOSPITAL
    H005
    $180.68
    H005
    $35.64
    H005
    $23.47
    P-ORAL DRUGS
    H005
    $297.81
    $811.92
    SLT-OFFICE
    S114
    $2,000.00
    P-INJECTABLES
    S114
    $25.00
    P-INJECTABLES
    S114
    $25.00
    S114
    $200.00
    P-ORAL DRUGS
    P427
    $252.70
    SLT-OFFICE
    S137
    $800.00
    SLT-OFFICE
    S137
    $450.00
    P-INJECTABLES
    S137
    $25.00
    P-INJECTABLES
    S137
    $1,200.00
    SLT-OFFICE
    S137
    $800.00
    SLT-OFFICE
    S137
    $450.00
    P-INJECTABLES
    S137
    $25.00
    P-INJECTABLES
    S137
    $1,200.00
    SLT-OFFICE
    S137
    $450.00
    $7,902.70
    ABORATORY
    L025
    $220.00
    $220.00
    P-ORAL DRUGS
    P435
    $181.53
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,440.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,395.00
    $3,107.28
    M791
    $200.00
    M791
    $200.00
    ABORATORY
    M791
    $300.00
    M791
    $200.00
    P-ORAL DRUGS
    M791
    $110.00
    $1,010.00
    P-ORAL DRUGS
    P353
    $195.00
    P-ORAL DRUGS
    P353
    $59.60
    P-ORAL DRUGS
    P353
    $1,306.00
    P-ORAL DRUGS
    P353
    $130.00
    P-ORAL DRUGS
    P353
    $268.00
    $1,958.60
    SLT-OFFICE
    S144
    $600.00
    P-ORAL DRUGS
    P430
    $206.50
    P-ORAL DRUGS
    P140
    $1,685.95
    $2,492.45
    SLT-OFFICE
    S030
    $240.00
    $240.00
    DIAGNOSTIC: INITIAL ORAL EXAM D171
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D171
    $350.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D171VIEW
    $100.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D171
    X-RAY, SINGLE
    $60.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D171
    X-RAY, SINGLE
    $240.00
    VIEW

    $850.00
    DIAGNOSTIC: INITIAL ORAL EXAM D152
    (EXCLUDE X-RAY)
    $200.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D152
    X-RAY, SINGLE
    $300.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D152
    $500.00
    $1,000.00
    P-ORAL DRUGS
    P090
    $269.90
    SLT-OFFICE
    S118
    $700.00
    P-ORAL DRUGS
    P090
    $45.80
    P-ORAL DRUGS
    P090
    $15.50
    P-ORAL DRUGS
    P090
    $214.65
    ABORATORY
    H005
    $200.00
    SLT-OFFICE
    S266
    $400.00
    P-ORAL DRUGS
    P090
    $307.50
    SLT-OFFICE
    S314
    $300.00
    P-ORAL DRUGS
    P090
    $93.35
    P-ORAL DRUGS
    P005
    $219.95
    $2,766.65
    ABORATORY
    L140
    $180.00
    ABORATORY
    L140
    $400.00
    ABORATORY
    L140
    $60.00
    ABORATORY
    L070
    $216.00
    ABORATORY
    L070
    $689.00
    $1,545.00
    M505
    $180.00
    P-ORAL DRUGS
    P049
    $4,221.00
    L081
    $900.00
    ABORATORY
    L152
    $810.00
    P-ORAL DRUGS
    L112
    $8,847.60
    M505
    $180.00
    P-INJECTABLES
    M505
    $25.00
    P-INJECTABLES
    M505
    $175.00
    ABORATORY
    L152
    $385.00
    M505
    $180.00
    P-ORAL DRUGS
    P049
    $74.00
    P-ORAL DRUGS
    P049
    $92.25
    $16,069.85
    S165
    $360.00
    P-ORAL DRUGS
    P246
    $128.90
    L018
    $300.00
    SLT-OFFICE
    S076
    $350.00
    P-ORAL DRUGS
    P422
    $206.15
    P-ORAL DRUGS
    P422
    $241.80
    M076
    $225.00
    M076
    $225.00
    P-INJECTABLES
    M076
    $240.00
    P-INJECTABLES
    M076
    $50.00
    P-INJECTABLES
    M076
    $10.00
    P-ORAL DRUGS
    P388
    $75.00
    P-ORAL DRUGS
    P422
    $80.60
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,819.00
    SLT-OFFICE
    S076
    $250.00
    P-ORAL DRUGS
    P422
    $214.90

    S165
    S165
    M076
    M076
    S044
    S044
    P246
    P076
    P076
    S286
    S286
    S286
    L065
    M076
    M076
    P487
    P487
    S044
    S044
    P014
    P014
    P014

    $75.00
    $225.00
    $75.00
    $175.00
    SLT-OFFICE
    $300.00
    SLT-OFFICE
    $300.00
    P-ORAL DRUGS
    $76.00
    P-ORAL DRUGS
    $84.96
    P-ORAL DRUGS
    $21.24
    SLT-OFFICE
    $150.00
    SLT-OFFICE
    $150.00
    $150.00
    ABORATORY
    $153.00
    $225.00
    $525.00
    P-ORAL DRUGS
    $36.07
    P-ORAL DRUGS
    $9.02
    $175.00
    $125.00
    P-ORAL DRUGS
    $101.32
    P-ORAL DRUGS
    $7.83
    P-ORAL DRUGS
    $17.50
    $8,043.29
    SLT-OFFICE
    S220
    $240.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $1,200.00 AFTER 1ST 6 MONTHS
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $120.00
    COMPLETE EXAMINATION
    O011
    $80.00
    MATERIALS: FRAMES
    O011
    $780.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O011
    $2,000.00
    $4,500.00
    M215
    $500.00
    $500.00
    IT-HOSPITAL
    P286
    $750.00
    P-ORAL DRUGS
    P286
    $165.00
    P-ORAL DRUGS
    P068
    $63.90
    L97
    $800.00
    M692
    $500.00
    ABORATORY
    L065
    $610.00
    SLT-OFFICE
    S159
    $400.00
    L075
    $3,610.00
    SLT-OFFICE
    S159
    $400.00
    COMPLETE EXAMINATION
    O004
    $200.00
    O004
    $180.00
    SLT-OFFICE
    S044
    $400.00
    SLT-OFFICE
    S375
    $300.00
    P-ORAL DRUGS
    P011
    $146.00
    SLT-OFFICE
    S083
    $400.00
    S083
    $200.00
    $9,124.90
    P-ORAL DRUGS
    P031
    $62.00
    COMPLETE EXAMINATION
    O015
    $450.00
    MATERIALS: FRAMES
    O015
    $2,090.00

    MATERIALS: LENS, EACH-SINGLE VISION


    O015
    IT-HOSPITAL
    US01
    PREVENTIVE: DENTAL PROPHYLAXIS
    D141
    SLT-OFFICE
    S244
    S244
    PREVENTIVE: DENTAL PROPHYLAXIS
    D141

    $3,390.00
    $7,745.32
    $300.00
    $300.00
    $200.00
    $260.00
    $14,797.32
    M225
    $660.00
    ABORATORY
    M225
    $390.00
    P-ORAL DRUGS
    P022
    $354.05
    P-ORAL DRUGS
    P022
    $112.35
    P-ORAL DRUGS
    P487
    $195.48
    P-ORAL DRUGS
    P094
    $83.15
    COMPLETE EXAMINATION
    O156
    $300.00
    MATERIALS: FRAMES
    O001
    $1,695.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,760.00
    P-ORAL DRUGS
    P011
    $292.50
    SLT-OFFICE
    S111
    $300.00
    P-ORAL DRUGS
    P286
    $159.79
    $6,302.32
    M562
    $150.00
    P-INJECTABLES
    M562
    $100.00
    P-ORAL DRUGS
    M562
    $140.00
    $390.00
    COMPLETE EXAMINATION
    O065
    $150.00
    O065
    $68.00
    $218.00
    M304
    $185.00
    P-ORAL DRUGS
    P104
    $150.60
    $335.60
    M411
    $130.00
    P-ORAL DRUGS
    P465
    $15.00
    P-ORAL DRUGS
    P465
    $101.80
    M411
    $130.00
    P-ORAL DRUGS
    P465
    $65.00
    $441.80
    M700
    $100.00
    M249
    $120.00
    P-ORAL DRUGS
    P014
    $228.20
    $448.20
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $300.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $400.00
    OTHER
    P022
    $39.50
    ABORATORY
    L033
    $605.00
    $1,344.50
    MATERIALS: FRAMES
    O004
    $2,716.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,656.00
    $4,372.00
    P-ORAL DRUGS
    P380
    $622.50
    P-ORAL DRUGS
    P380
    $90.00
    $712.50
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL
    D238
    OR$1,100.00
    CEPHALOMETRIC X-RAY)
    $1,100.00

    SLT-OFFICE

    S426
    L065
    L065
    S419
    S419

    $600.00
    $900.00
    ABORATORY
    $880.00
    $250.00
    P-INJECTABLES
    $25.00
    $2,655.00
    P-ORAL DRUGS
    P005
    $617.10
    M657
    $200.00
    P-ORAL DRUGS
    P215
    $313.60
    SLT-OFFICE
    S055
    $200.00
    P-ORAL DRUGS
    P155
    $90.00
    ABSCESSES, BOILS & CARBUNCLES:
    S055
    INCISION FOR
    $1,700.00
    DRAINAGE W/O HOSPITAL
    H023
    $2,000.00
    H023
    $1,800.00
    $6,920.70
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,125.00
    MATERIALS: FRAMES
    O001
    $970.00
    $2,205.00
    DIAGNOSTIC: INITIAL ORAL EXAM D380
    (EXCLUDE X-RAY)
    $160.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D380
    X-RAY, SINGLE
    $160.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D380
    $500.00
    S329
    $60.00
    S329
    $240.00
    $1,120.00
    M138
    $100.00
    P-INJECTABLES
    M138
    $25.00
    P-INJECTABLES
    M138
    $55.00
    $180.00
    T034
    $2,475.00
    T034
    $800.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $400.00
    OTHER
    P435
    $30.21
    ENATAL CARE
    S083
    $2,100.00
    ORMAL DELIVERY
    H023
    $4,353.56
    ORMAL DELIVERY
    S083
    $7,762.50
    ORMAL DELIVERY
    M707
    $1,200.00
    SLT-OFFICE
    S361
    $250.00
    $19,371.27
    DIAGNOSTIC: INITIAL ORAL EXAM D180
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D180VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D180VIEW
    $165.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D180
    $350.00
    DIAGNOSTIC: INITIAL ORAL EXAM D180
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D180VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D180VIEW
    $130.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D180
    $400.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D180CAVITY $2,280.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D180CAVITY $460.00
    DIAGNOSTIC: INITIAL ORAL EXAM D180
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D180VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D180VIEW
    $130.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D180
    $400.00

    SLT-OFFICE

    S231
    T060
    UN01
    UN01
    S141

    $200.00
    $1,040.00
    $300.00
    $580.00
    ABORATORY
    $4,165.00
    $11,075.00
    COMPLETE EXAMINATION
    O076
    $180.00
    MATERIALS: FRAMES
    O076
    $472.50
    $652.50
    T064
    $1,040.00
    SLT-OFFICE
    S217
    $400.00
    T064
    $1,370.00
    T064
    $2,590.00
    $5,400.00
    M353
    $300.00
    P-ORAL DRUGS
    M353
    $70.00
    P-ORAL DRUGS
    P049
    $182.85
    $552.85
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D04
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D04
    W ANESTHESIA
    $115.00
    & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $200.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D04 CAVITY $200.00
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $100.00
    $880.00
    SLT-OFFICE
    S083
    $700.00
    S083
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D421
    $400.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D421CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D421CAVITY $400.00
    ABORATORY
    L025
    $285.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    M421CAVITY $450.00
    $2,535.00
    M851
    $300.00
    ABORATORY
    L065
    $700.00
    P-ORAL DRUGS
    P427
    $35.25
    P-ORAL DRUGS
    P427
    $188.40
    $1,223.65
    ENATAL CARE
    S290
    $2,540.00
    M463
    $250.00
    ABORATORY
    M463
    $150.00
    $2,940.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $895.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,720.00
    $2,725.00
    L97
    $200.00
    $200.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $895.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,350.00
    $2,355.00

    $300.00
    $40.00
    $235.00
    $575.00
    M144
    $200.00
    P-ORAL DRUGS
    P467
    $313.85
    M598
    $200.00
    P-ORAL DRUGS
    M598
    $110.00
    M144
    $200.00
    ABORATORY
    L041
    $390.00
    P-ORAL DRUGS
    P369
    $146.15
    SCARRIAGE
    S223
    $600.00
    SCARRIAGE
    S223
    $2,500.00
    SCARRIAGE
    M602
    $600.00
    SCARRIAGE
    L041
    $2,000.00
    $7,260.00
    DIAGNOSTIC: INITIAL ORAL EXAM D114
    (EXCLUDE X-RAY)
    $120.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D114VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D114VIEW
    $10.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D114
    $340.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D114 SURFACE
    $1,080.00
    CAVITY
    MATERIALS: FRAMES
    US01
    $1,615.44
    MATERIALS: LENS, EACH-SINGLE VISION
    US01
    $1,097.10
    US01
    $3,185.72
    P-ORAL DRUGS
    US01
    $1,025.02
    $8,543.28
    M814
    $100.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $930.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,080.00
    $2,200.75
    P-ORAL DRUGS
    P076
    $98.25
    P-ORAL DRUGS
    P076
    $36.25
    $134.50
    ABORATORY
    L147
    $210.00
    M230
    $300.00
    P-INJECTABLES
    M230
    $25.00
    P-INJECTABLES
    M230
    $175.00
    $710.00
    P-ORAL DRUGS
    P435
    $141.71
    P-ORAL DRUGS
    P435
    ($141.71)
    P-ORAL DRUGS
    P435
    $141.71
    $141.71
    UN01
    $600.00
    M451
    $300.00
    $900.00
    L049
    $180.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D78 CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D78 CAVITY $800.00
    COMPLETE EXAMINATION
    Missing
    $300.00
    SLT-OFFICE
    S300
    $300.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D64 VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D64 VIEW
    $15.00

    P-ORAL DRUGS
    P-ORAL DRUGS

    M230
    P475
    P475

    OPERATIVE: AMALGAM FILL 2 SURFACE


    D64 CAVITY

    $350.00
    $2,080.00
    M229
    $160.00
    ABORATORY
    L001
    $510.00
    SLT-OFFICE
    S041
    $800.00
    L006
    $520.00
    $1,990.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    EC01
    ROOT$288.00
    PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    EC01
    ROOT$264.00
    PLANING, SCALING, EACH
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    EC01 VIEW
    $120.00
    EC01
    $360.00
    ABORATORY
    EC01
    $868.80
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    EC01
    ROOT$552.00
    PLANING, SCALING, EACH
    $2,452.80
    EC01
    $120.00
    ABORATORY
    EC01
    $345.60
    P-ORAL DRUGS
    EC01
    $299.52
    EC01
    $168.00
    ABORATORY
    EC01
    $180.00
    P-ORAL DRUGS
    EC01
    $168.00
    P-ORAL DRUGS
    EC01
    $293.76
    EC01
    $144.00
    EC01
    $240.00
    ABORATORY
    EC01
    $86.40
    P-ORAL DRUGS
    EC01
    $24.00
    P-ORAL DRUGS
    EC01
    $167.04
    EC01
    $120.00
    P-ORAL DRUGS
    EC01
    $117.50
    $2,473.82
    EC01
    $2,548.80
    $2,548.80
    EC01
    $168.00
    $168.00
    ORAL SURGERY: SURGICAL REMOVAL
    EC01
    OF TOOTH W
    $360.00
    SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    EC01
    OF TOOTH W$96.00
    SOFT TISSUE IMPACTION
    OPERATIVE: AMALGAM FILL 1 SURFACE
    EC01 CAVITY $360.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    EC01 CAVITY $1,392.00
    EC01
    $240.00
    ABORATORY
    EC01
    $903.60
    P-ORAL DRUGS
    EC01
    $68.40
    $3,420.00
    EC01
    $288.00
    $288.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    EC01 SURFACE $288.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    EC01 SURFACE $192.00
    CAVITY
    $480.00
    ENATAL CARE
    EC01
    $2,606.40
    $2,606.40
    SLT-OFFICE
    S192
    $800.00
    P-ORAL DRUGS
    P106
    $439.80
    P-ORAL DRUGS
    P248
    $378.00
    ABORATORY
    L061
    $540.00
    $2,157.80

    DIAGNOSTIC: INITIAL ORAL EXAM D04


    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $185.00
    SLT-OFFICE
    S312
    $250.00
    P-ORAL DRUGS
    P011
    $125.00
    DIAGNOSTIC: INITIAL ORAL EXAM D04
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D04
    $200.00
    $960.00
    SLT-OFFICE
    S453
    $250.00
    MATERIALS: FRAMES
    O147
    $800.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: LENS, EACH-BI-FOCALO004
    $2,056.00
    $3,206.00
    ORAL SURGERY: SURGICAL REMOVAL
    D283
    OF TOOTH W
    $150.00
    SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D283
    OF TOOTH W
    $350.00
    SOFT TISSUE IMPACTION
    $500.00
    COMPLETE EXAMINATION
    O163
    $70.00
    MATERIALS: FRAMES
    O163
    $1,000.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O163
    $800.00
    $1,870.00
    H011
    $400.00
    H011
    $1,000.00
    H011
    $5,890.00
    UTERUS: COMPLETE REMOVAL W/OS446
    REMOVAL OF
    $10,000.00
    TUBES OR OVARIES
    S237
    $1,500.00
    P-ORAL DRUGS
    H011
    $55.00
    M304
    $140.00
    P-ORAL DRUGS
    P337
    $120.00
    S111
    $40.00
    S111
    $60.00
    COMPLETE EXAMINATION
    O001
    $100.00
    MATERIALS: FRAMES
    O001
    $1,130.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $895.00
    $21,330.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D22
    $300.00
    ENDODONTICS: EXTIRPATION OF PULP
    D22 & FILL 3 ROOT
    $650.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D22 & FILL 3 ROOT
    $350.00
    CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D22 SURFACE $680.00
    CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D22 VIEW
    $80.00
    ENDODONTICS: PULP CAPPING (EXCLUDE
    D22
    RESTORATION)
    $320.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D22 CAVITY $380.00
    $2,760.00
    SLT-OFFICE
    S103
    $400.00
    ABORATORY
    L070
    $200.00
    $600.00
    OTHER SERVICES: EMERGENCY TREATMENT
    D391
    OF DENTAL
    $100.00
    PAIN
    OTHER
    P469
    $125.00
    OTHER
    P071
    $117.50
    ENDODONTICS: EXTIRPATION OF PULP
    D391& FILL 1 ROOT
    $800.00
    CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D391 SURFACE $120.00
    CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM D438
    (EXCLUDE X-RAY)
    $200.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D438
    X-RAY, SINGLE
    $380.00
    VIEW
    ENDODONTICS: APICOECTOMY
    D438
    $2,500.00
    OTHER
    P465
    $243.40

    OPERATIVE: AMALGAM FILL 2 SURFACE


    D391CAVITY $1,140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D391
    $260.00
    $5,985.90
    DIAGNOSTIC: INITIAL ORAL EXAM D129
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D129VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D129VIEW
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D129
    $320.00
    DIAGNOSTIC: INITIAL ORAL EXAM D129
    (EXCLUDE X-RAY)
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D129
    $280.00
    P-ORAL DRUGS
    P055
    $537.90
    P-ORAL DRUGS
    P372
    $566.10
    $1,994.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D283CAVITY
    $75.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D283CAVITY $525.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D283CAVITY $600.00
    $1,200.00
    M008
    $220.00
    P-ORAL DRUGS
    M008
    $10.00
    P-ORAL DRUGS
    M008
    $30.00
    P-INJECTABLES
    M008
    $20.00
    SLT-OFFICE
    S403
    $300.00
    S403
    $600.00
    DIAGNOSTIC: INITIAL ORAL EXAM D327
    (EXCLUDE X-RAY)
    $150.00
    DIAGNOSTIC: COMPLETE INTRAORAL
    D327
    SERIES OF PERIAPICAL
    $95.00 X-RAYS
    DIAGNOSTIC: COMPLETE INTRAORAL
    D327
    SERIES OF PERIAPICAL
    $305.00 X-RAYS
    PREVENTIVE: DENTAL PROPHYLAXIS
    D327
    $300.00
    L034
    $360.00
    L034
    $800.00
    ABORATORY
    L061
    $1,180.00
    P-ORAL DRUGS
    L061
    $388.50
    P-ORAL DRUGS
    P005
    $40.27
    P-ORAL DRUGS
    P014
    $142.50
    H006
    $540.00
    ABORATORY
    H006
    $45.00
    M463
    $200.00
    $5,726.27
    SLT-OFFICE
    S426
    $600.00
    ABORATORY
    L065
    $440.00
    H006
    $315.00
    ABORATORY
    H006
    $675.00
    S426
    $900.00
    ORAL SURGERY: SURGICAL REMOVAL
    D182
    OF TOOTH W
    $600.00
    COMPLETE BONE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D182
    OF TOOTH$3,400.00
    W COMPLETE BONE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D182
    OF TOOTH$3,000.00
    W COMPLETE BONE IMPACTION
    OTHER SERVICES: ADMINISTRATION
    D182
    OF GENERAL
    $1,500.00
    ANESTHESIA
    OTHER
    P011
    $170.50
    P-ORAL DRUGS
    P011
    $2,200.00
    P-ORAL DRUGS
    P005
    $1,231.66
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D283CAVITY $272.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D283CAVITY $100.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D283CAVITY $128.00
    DIAGNOSTIC: INITIAL ORAL EXAM D283
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D283VIEW
    $80.00

    OPERATIVE: AMALGAM FILL 1 SURFACE


    D283CAVITY $304.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D283CAVITY
    $96.00
    M310
    $150.00
    M310
    $275.00
    P-ORAL DRUGS
    M310
    $290.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D283CAVITY $1,280.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D283CAVITY $620.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D283CAVITY $320.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D283CAVITY $180.00
    ABORATORY
    L065
    $395.00
    P-ORAL DRUGS
    P011
    $340.00
    P-ORAL DRUGS
    P066
    $393.00
    P-ORAL DRUGS
    P005
    $1,269.38
    SLT-OFFICE
    S426
    $300.00
    $21,924.54
    P-ORAL DRUGS
    P458
    $1,270.10
    P-ORAL DRUGS
    P458
    $10.00
    $1,280.10
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D104CAVITY $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D104CAVITY $600.00
    $800.00
    DIAGNOSTIC: INITIAL ORAL EXAM D23
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D23
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D23 VIEW
    $290.00
    M505
    $360.00
    ABORATORY
    L152
    $655.00
    P-INJECTABLES
    M505
    $25.00
    P-INJECTABLES
    M505
    $75.00
    P-ORAL DRUGS
    P478
    $315.00
    M505
    $360.00
    P-INJECTABLES
    M505
    $200.00
    ABORATORY
    L152
    $660.00
    P-ORAL DRUGS
    P478
    $305.20
    P-ORAL DRUGS
    P478
    $120.00
    P-ORAL DRUGS
    P478
    $225.00
    COMPLETE EXAMINATION
    S109
    $200.00
    MATERIALS: FRAMES
    O134
    $900.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O134
    $660.00
    M505
    $180.00
    P-INJECTABLES
    M505
    $25.00
    P-INJECTABLES
    M505
    $75.00
    P-ORAL DRUGS
    P478
    $147.00
    $5,927.20
    L97
    $200.00
    SLT-OFFICE
    S300
    $300.00
    $500.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D393
    W ANESTHESIA
    $60.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D393
    W ANESTHESIA
    $120.00
    & POST OPER
    $180.00
    M647
    $80.00
    P-INJECTABLES
    M647
    $25.00
    P-INJECTABLES
    M647
    $235.00
    M647
    $240.00

    P-INJECTABLES
    P-ORAL DRUGS
    ABORATORY
    ABORATORY
    ABORATORY

    M647
    P504
    L070
    L070
    L070

    $220.00
    $1,326.40
    $390.00
    $200.00
    $200.00
    $2,916.40
    P-ORAL DRUGS
    P478
    $27.80
    COMPLETE EXAMINATION
    O007
    $100.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O007
    $1,160.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O007
    $290.00
    $1,577.80
    P-ORAL DRUGS
    P465
    $304.80
    P-ORAL DRUGS
    P465
    $50.75
    L97
    $300.00
    $655.55
    SLT-OFFICE
    S214
    $300.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S214
    $2,000.00
    P-ORAL DRUGS
    P148
    $202.25
    $2,502.25
    S004
    $400.00
    M225
    $220.00
    ABORATORY
    M225
    $180.00
    ABORATORY
    M225
    $80.00
    ABORATORY
    L001
    $958.50
    M225
    $220.00
    ABORATORY
    M225
    $80.00
    M030
    $160.00
    P-ORAL DRUGS
    P507
    $520.80
    P-ORAL DRUGS
    P507
    $45.64
    P-ORAL DRUGS
    P031
    $50.27
    P-ORAL DRUGS
    P055
    $179.30
    M225
    $50.00
    P-ORAL DRUGS
    P031
    $107.10
    L006
    $200.00
    M225
    $220.00
    $3,671.61
    SLT-OFFICE
    S136
    $400.00
    P-ORAL DRUGS
    P435
    $227.27
    SLT-OFFICE
    S136
    $600.00
    P-ORAL DRUGS
    P435
    $15.00
    $1,242.27
    SLT-OFFICE
    S296
    $300.00
    ABORATORY
    S296
    $400.00
    S296
    $800.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S296
    $1,500.00
    $3,000.00
    SLT-OFFICE
    S120
    $300.00
    P-ORAL DRUGS
    P014
    $36.40
    H006
    $450.00
    H006
    $315.00
    H006
    $3,600.00
    S191
    $3,600.00
    UTERUS: COMPLETE REMOVAL W/OS191
    REMOVAL OF
    $1,900.00
    TUBES OR OVARIES

    M246
    M246
    H006
    P353
    P353

    $900.00
    $600.00
    ABORATORY
    $121.50
    P-ORAL DRUGS
    $174.40
    P-ORAL DRUGS
    $43.60
    $12,040.90
    H006
    $1,400.00
    ABORATORY
    H006
    $915.00
    $2,315.00
    P-ORAL DRUGS
    P167
    $393.05
    P-ORAL DRUGS
    P349
    $643.30
    P-ORAL DRUGS
    P167
    $393.05
    M751
    $240.00
    ABORATORY
    M751
    $495.00
    P-ORAL DRUGS
    P014
    $160.00
    P-ORAL DRUGS
    P472
    $274.60
    P-ORAL DRUGS
    P215
    $1,163.35
    M751
    $120.00
    P-ORAL DRUGS
    P472
    $462.00
    $4,344.35
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $985.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,080.00
    $2,155.00
    H006
    $125.00
    ABORATORY
    H006
    $60.00
    ABORATORY
    H006
    $120.00
    P-ORAL DRUGS
    P005
    $2,126.07
    ABORATORY
    P404
    $330.00
    $2,761.07
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $925.50
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,030.50
    $2,046.00
    M140
    $150.00
    M140
    $150.00
    P-ORAL DRUGS
    P360
    $152.25
    P-ORAL DRUGS
    P360
    $42.00
    M140
    $150.00
    P-ORAL DRUGS
    P360
    $367.00
    P-ORAL DRUGS
    P360
    $35.00
    $1,046.25
    M001
    $200.00
    P-ORAL DRUGS
    P068
    $162.00
    P-ORAL DRUGS
    P068
    $118.05
    SLT-OFFICE
    S551
    $500.00
    ABORATORY
    L021
    $450.00
    P-ORAL DRUGS
    P476
    $339.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D253
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D253VIEW
    $25.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D253VIEW
    $25.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D253CAVITY $800.00
    H011
    $500.00

    H011
    $1,000.00
    ABSCESSES, BOILS & CARBUNCLES:
    S250
    INCISION FOR
    $2,000.00
    DRAINAGE W/O HOSPITAL
    P-ORAL DRUGS
    P091
    $92.00
    $6,311.05
    SLT-OFFICE
    S120
    $240.00
    P-ORAL DRUGS
    P093
    $43.70
    $283.70
    DIAGNOSTIC: INITIAL ORAL EXAM D41
    (EXCLUDE X-RAY)
    $100.00
    ORAL SURGERY: SURGICAL REMOVAL
    D41OF TOOTH W
    $300.00
    COMPLETE BONE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL
    D41OF TOOTH W
    $200.00
    COMPLETE BONE IMPACTION
    OTHER
    P353
    $84.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D41 CAVITY $500.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D41
    ROOT$200.00
    PLANING, SCALING, EACH
    $1,384.00
    COMPLETE EXAMINATION
    O001
    $110.00
    M067
    $160.00
    P-INJECTABLES
    M067
    $80.00
    P-ORAL DRUGS
    P303
    $72.00
    P-ORAL DRUGS
    P303
    $23.95
    $445.95
    PREVENTIVE: DENTAL PROPHYLAXIS
    D192
    $620.00
    DIAGNOSTIC: INITIAL ORAL EXAM D192
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D192VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D192VIEW
    $300.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D192 SURFACE $120.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D192 SURFACE $680.00
    CAVITY
    $1,820.00
    DIAGNOSTIC: INITIAL ORAL EXAM D303
    (EXCLUDE X-RAY)
    $250.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D303
    $500.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D303VIEW
    $150.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D303VIEW
    $300.00
    DIAGNOSTIC: INITIAL ORAL EXAM D303
    (EXCLUDE X-RAY)
    $150.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D303
    ROOT$120.00
    PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D303
    ROOT$880.00
    PLANING, SCALING, EACH
    OTHER
    D303
    $100.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D303 SURFACE $500.00
    CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D303VIEW
    $300.00
    $3,250.00
    P-ORAL DRUGS
    P154
    $310.65
    P-ORAL DRUGS
    P154
    $30.00
    P-ORAL DRUGS
    P443
    $69.50
    P-ORAL DRUGS
    P154
    $106.45
    P-ORAL DRUGS
    P154
    $15.95
    P-ORAL DRUGS
    P154
    $16.10
    P-ORAL DRUGS
    P154
    $12.40
    COMPLETE EXAMINATION
    O076
    $180.00
    MATERIALS: CONTACT, MEDICALLYO076
    REQUIRED
    $405.00
    L97
    $300.00
    P-ORAL DRUGS
    P154
    $54.00
    $1,500.05
    DIAGNOSTIC: INITIAL ORAL EXAM D297
    (EXCLUDE X-RAY)
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D297VIEW
    $75.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D297VIEW
    $125.00

    PREVENTIVE: DENTAL PROPHYLAXIS


    D297
    $400.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D297
    W ANESTHESIA
    $180.00
    & POST OPER
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D297CAVITY $180.00
    $1,030.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D63
    ROOT$170.00
    PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D63
    ROOT$230.00
    PLANING, SCALING, EACH
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D63
    W ANESTHESIA
    $200.00
    & POST OPER
    PREVENTIVE: DENTAL PROPHYLAXIS
    D07
    $325.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D07
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM D07
    (EXCLUDE X-RAY)
    $150.00
    $1,145.00
    P-ORAL DRUGS
    P131
    $360.00
    $360.00
    S323
    $350.00
    S323
    $300.00
    $650.00
    M139
    $100.00
    P-INJECTABLES
    M139
    $30.00
    P-ORAL DRUGS
    M139
    $190.00
    P-ORAL DRUGS
    M139
    $80.00
    $400.00
    ENATAL CARE
    S445
    $2,520.00
    ENATAL CARE
    H006
    $225.00
    ENATAL CARE
    S445
    $880.00
    $3,625.00
    P-ORAL DRUGS
    P353
    $125.00
    P-ORAL DRUGS
    P353
    $555.00
    MATERIALS: CONTACT, MEDICALLYO004
    REQUIRED $1,056.00
    M353
    $150.00
    M353
    $150.00
    P-ORAL DRUGS
    P034
    $19.95
    P-ORAL DRUGS
    P435
    $97.20
    P-ORAL DRUGS
    P435
    $193.54
    $2,346.69
    SLT-OFFICE
    S162
    $300.00
    P-ORAL DRUGS
    P068
    $192.45
    P-ORAL DRUGS
    P435
    $109.50
    $601.95
    L018
    $120.00
    ABORATORY
    L018
    $180.00
    $300.00
    COMPLETE EXAMINATION
    O033
    $230.00
    MATERIALS: CONTACT, MEDICALLYO033
    REQUIRED
    $150.00
    $380.00
    L97
    ($250.00)
    L97
    $250.00
    L97
    $250.00
    SLT-OFFICE
    S300
    $300.00
    $550.00
    COMPLETE EXAMINATION
    O058
    $80.00
    MATERIALS: FRAMES
    O058
    $1,700.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O058
    $650.00
    ORAL SURGERY: SURGICAL REMOVAL
    D51OF TOOTH W
    $300.00
    COMPLETE BONE IMPACTION

    ORAL SURGERY: SURGICAL REMOVAL


    D51OF TOOTH W
    $200.00
    COMPLETE BONE IMPACTION
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D51
    W ANESTHESIA
    $400.00
    & POST OPER
    P-ORAL DRUGS
    P353
    $235.00
    $3,565.00
    COMPLETE EXAMINATION
    S197
    $300.00
    $300.00
    PROSTHETICS: PRT UPR DENT W CHRM
    D102COBLT ALLOY
    $1,000.00
    PALATAL BAR 2 CL RST
    PROSTHETICS: PRT UPR DENT W CHRM
    D102COBLT ALLOY
    $3,000.00
    PALATAL BAR 2 CL RST
    $4,000.00
    M297
    $250.00
    L116
    $200.00
    P-ORAL DRUGS
    P179
    $185.00
    M114
    $40.00
    P-ORAL DRUGS
    P419
    $121.80
    $796.80
    M020
    $160.00
    P-ORAL DRUGS
    P014
    $239.85
    PREVENTIVE: DENTAL PROPHYLAXIS
    D188
    $360.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D188
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D188
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    M020
    $160.00
    P-ORAL DRUGS
    P484
    $54.00
    P-ORAL DRUGS
    P484
    $16.00
    P-ORAL DRUGS
    P167
    $46.90
    M020
    $350.00
    P-INJECTABLES
    M020
    $25.00
    P-INJECTABLES
    M020
    $95.00
    L034
    $800.00
    $2,406.75
    P-ORAL DRUGS
    P191
    $164.99
    P-ORAL DRUGS
    P191
    $136.50
    S355
    $300.00
    ABORATORY
    L041
    $260.00
    P-ORAL DRUGS
    P445
    $152.90
    $1,014.39
    M461
    $150.00
    P-INJECTABLES
    M461
    $25.00
    P-INJECTABLES
    M461
    $265.00
    M014
    $140.00
    P-INJECTABLES
    M014
    $25.00
    M014
    $40.00
    ABORATORY
    M014
    $70.00
    $715.00
    M317
    $120.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $575.00
    MATERIALS: LENS, EACH-BI-FOCALO001
    $1,010.00
    L091
    $400.00
    P-ORAL DRUGS
    L091
    $149.50
    P-ORAL DRUGS
    L091
    $22.50
    L091
    $900.00
    P-INJECTABLES
    L091
    $700.00
    L091
    $500.00

    ABORATORY

    P-ORAL DRUGS

    P-ORAL DRUGS
    SLT-OFFICE
    ABORATORY
    P-ORAL DRUGS

    ABORATORY

    P-INJECTABLES
    P-ORAL DRUGS

    L091
    L091
    M317
    P498
    M317
    M317
    S385
    L065
    P005
    M127
    L091
    M799
    M310
    M310
    M310

    COMPLETE EXAMINATION
    O011
    MATERIALS: FRAMES
    O011
    MATERIALS: LENS, EACH-SINGLE VISION
    O011
    COMPLETE EXAMINATION
    O011
    MATERIALS: FRAMES
    O011
    MATERIALS: LENS, EACH-TRI-FOCAL
    O011

    P-INJECTABLES
    P-INJECTABLES

    P-INJECTABLES
    P-INJECTABLES

    M346
    M346
    M346
    M346
    M346
    M346

    SLT-OFFICE
    S198
    P-ORAL DRUGS
    P031
    PROSTATE: TRANSURETHRAL RESECTION
    S198
    P-ORAL DRUGS
    P073
    SLT-OFFICE
    S103
    S103
    P-ORAL DRUGS
    P031
    P-ORAL DRUGS
    P031
    SINUS OPERATION: TRACHEOTOMYP031
    P-ORAL DRUGS
    P073
    P-ORAL DRUGS
    P005

    SLT-OFFICE
    SLT-OFFICE

    P-ORAL DRUGS

    M310
    M310
    S080
    S080
    L075
    M310
    H023
    H023
    H023

    $145.00
    $375.00
    $240.00
    $231.30
    $240.00
    $130.00
    $400.00
    $175.00
    $1,488.44
    $7,911.74
    $300.00
    $1,075.00
    $300.00
    $1,675.00
    $150.00
    $225.00
    $420.00
    $795.00
    $80.00
    $690.00
    $700.00
    $80.00
    $780.00
    $1,500.00
    $3,830.00
    $100.00
    $25.00
    $75.00
    $100.00
    $25.00
    $75.00
    $400.00
    $400.00
    $1,545.09
    $800.00
    $2,698.20
    $800.00
    $3,500.00
    $434.70
    $89.10
    $1,500.00
    $1,798.80
    $899.40
    $14,465.29
    $80.00
    $170.00
    $80.00
    $220.00
    $3,800.00
    $100.00
    $440.00
    $310.00
    $7,629.00

    $12,829.00
    $100.00
    P-INJECTABLES
    $25.00
    P-INJECTABLES
    $75.00
    P-ORAL DRUGS
    $260.40
    $80.00
    P-INJECTABLES
    $60.00
    P-ORAL DRUGS
    $220.00
    $80.00
    P-INJECTABLES
    $25.00
    P-INJECTABLES
    $35.00
    P-ORAL DRUGS
    $210.00
    P-ORAL DRUGS
    $60.00
    $100.00
    P-INJECTABLES
    $500.00
    P-ORAL DRUGS
    $400.00
    $300.00
    $160.00
    P-INJECTABLES
    $50.00
    P-INJECTABLES
    $270.00
    $3,010.40
    SLT-OFFICE
    S191
    $600.00
    ABORATORY
    S191
    $400.00
    ABORATORY
    H006
    $180.00
    H006
    $500.00
    P-ORAL DRUGS
    P435
    $753.41
    $2,433.41
    M045
    $150.00
    ABORATORY
    L001
    $355.00
    $505.00
    DIAGNOSTIC: INITIAL ORAL EXAM D81
    (EXCLUDE X-RAY)
    $120.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D81 VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D81 VIEW
    $45.00
    CROWN & BRIDGE: RECEMENTING D81
    BRIDGE
    $180.00
    ENDODONTICS: EXTIRPATION OF PULP
    D81 & FILL 3 $1,620.00
    ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D81 CAVITY $320.00
    CROWN & BRIDGE: STAINLESS STEEL
    D81CROWN
    $480.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D81 CAVITY $720.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D81
    $560.00
    $4,080.00
    SLT-OFFICE
    S083
    $400.00
    ABORATORY
    S083
    $150.00
    M224
    $300.00
    P-ORAL DRUGS
    P022
    $161.85
    P-ORAL DRUGS
    P022
    $31.75
    $1,043.60
    M167
    $60.00
    M167
    $80.00
    P-INJECTABLES
    M167
    $120.00
    M167
    $60.00
    M167
    $80.00
    P-INJECTABLES
    M167
    $96.00
    P-INJECTABLES
    M167
    $24.00
    M402
    M402
    M402
    P430
    M647
    M647
    P504
    M647
    M647
    M647
    M647
    P504
    M580
    M580
    M580
    L041
    M647
    M647
    M647

    M586
    M586
    P-ORAL DRUGS
    P306
    P-ORAL DRUGS
    P437
    COMPLETE EXAMINATION
    O065
    COMPLETE EXAMINATION
    O065
    MATERIALS: CONTACT, MEDICALLYO065
    REQUIRED
    O065

    IT-HOSPITAL
    P-ORAL DRUGS

    H023
    H023
    H023
    ABORATORY
    H023
    H023
    P-ORAL DRUGS
    P031
    M630
    P-ORAL DRUGS
    P031
    M089
    P-ORAL DRUGS
    P435
    SLT-OFFICE
    S112
    P-ORAL DRUGS
    P014
    COMPLETE EXAMINATION
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    MATERIALS: FRAMES
    O004
    O004
    SLT-OFFICE
    S195
    S195

    P-ORAL DRUGS
    P-ORAL DRUGS
    ABORATORY
    P-ORAL DRUGS
    P-ORAL DRUGS

    M662
    M662
    M662
    H005
    P122
    P122

    ABORATORY

    M229
    L001

    ABORATORY

    M105
    L124

    M028
    MATERIALS: FRAMES
    O076
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    M028
    P-ORAL DRUGS
    M028
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    MATERIALS: FRAMES
    O076
    MATERIALS: FRAMES
    O004
    MATERIALS: FRAMES
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004

    $60.00
    $140.00
    $69.80
    $62.40
    $50.00
    $300.00
    $800.00
    $150.00
    $2,152.20
    $375.00
    $127.28
    $200.00
    $730.00
    $180.00
    $213.29
    $200.00
    $335.98
    $180.00
    $303.48
    $300.00
    $35.50
    $100.00
    $476.00
    $556.00
    $180.00
    $500.00
    $1,800.00
    $6,792.53
    $100.00
    $45.00
    $55.00
    $630.00
    $84.15
    $9.35
    $923.50
    $200.00
    $505.00
    $705.00
    $170.00
    $440.00
    $610.00
    $235.00
    $1,325.75
    $1,925.75
    $100.00
    $15.00
    $3,601.50
    $840.00
    $846.75
    $1,686.75
    $425.00
    $771.00
    $200.00

    MATERIALS: LENS, EACH-SINGLE VISION


    O004

    $916.00
    $2,312.00
    ABORATORY
    L133
    $3,900.00
    $3,900.00
    COMPLETE EXAMINATION
    O108
    $90.00
    MATERIALS: FRAMES
    O108
    $1,390.00
    MATERIALS: LENS, EACH-BI-FOCALO108
    $1,970.00
    $3,450.00
    COMPLETE EXAMINATION
    O015
    $130.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O015
    $2,690.00
    DIAGNOSTIC: INITIAL ORAL EXAM D263
    (EXCLUDE X-RAY)
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D263
    $350.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D263VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D263VIEW
    $230.00
    $3,620.00
    M758
    $220.00
    M248
    $100.00
    P-ORAL DRUGS
    P458
    $87.50
    $407.50
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $930.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $825.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $642.24
    MATERIALS: FRAMES
    O076
    $1,293.63
    $3,871.62
    M019
    $200.00
    P-INJECTABLES
    M019
    $260.00
    P-ORAL DRUGS
    P154
    $284.50
    $744.50
    S302
    $360.00
    ABORATORY
    S302
    $140.00
    S019
    $260.00
    P-INJECTABLES
    S019
    $25.00
    P-INJECTABLES
    S019
    $335.00
    S019
    $260.00
    P-INJECTABLES
    S019
    $25.00
    P-INJECTABLES
    S019
    $255.00
    SLT-OFFICE
    S114
    $400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D411
    $100.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D411
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    SLT-OFFICE
    S019
    $260.00
    P-INJECTABLES
    S019
    $25.00
    P-INJECTABLES
    S019
    $335.00
    $3,030.00
    ENATAL CARE
    S428
    $1,050.00
    ENATAL CARE
    H006
    $165.00
    $1,215.00
    SLT-OFFICE
    S314
    $300.00
    $300.00
    DIAGNOSTIC: INITIAL ORAL EXAM D421
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D421
    $400.00

    DIAGNOSTIC: INTRAORAL PERIAPICAL


    D421
    X-RAY, SINGLE
    $70.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D421
    X-RAY, SINGLE
    $30.00
    VIEW
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D421
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    H025
    $240.00
    ABORATORY
    H025
    $60.00
    $950.00
    M456
    $140.00
    P-INJECTABLES
    M456
    $25.00
    P-INJECTABLES
    M456
    $35.00
    H008
    $182.00
    M456
    $140.00
    ABORATORY
    M456
    $160.00
    $682.00
    P-ORAL DRUGS
    P055
    $151.35
    SLT-OFFICE
    S418
    $400.00
    $551.35
    P-ORAL DRUGS
    P005
    $578.85
    P-ORAL DRUGS
    P005
    $578.85
    M215
    $250.00
    P-ORAL DRUGS
    P256
    $165.30
    ABORATORY
    L070
    $2,250.00
    ABORATORY
    L96
    $1,800.00
    $5,623.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D141
    $400.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D141CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D141CAVITY $360.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D141
    $400.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D141CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D141CAVITY $360.00
    ABDOMEN: CUTTING ABDOMINAL CAVITY
    S296 EXCEPT
    $2,400.00
    AS OTHERWISE SPECIFIED
    S296
    $1,250.00
    ABORATORY
    S296
    $400.00
    $5,850.00
    M577
    $200.00
    P-ORAL DRUGS
    P435
    $490.69
    M124
    $250.00
    M124
    $50.00
    P-ORAL DRUGS
    P435
    $85.07
    $1,075.76
    M152
    $300.00
    P-ORAL DRUGS
    P008
    $46.15
    P-ORAL DRUGS
    P034
    $189.00
    P-ORAL DRUGS
    P008
    $357.00
    $892.15
    DIAGNOSTIC: INITIAL ORAL EXAM D60
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D60
    $200.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D60
    W ANESTHESIA
    $200.00
    & POST OPER
    SLT-OFFICE
    S112
    $300.00
    M735
    $250.00
    ABORATORY
    M735
    $350.00
    $1,350.00
    COMPLETE EXAMINATION
    O033
    $100.00
    MATERIALS: FRAMES
    O033
    $845.75

    MATERIALS: LENS, EACH-SINGLE VISION


    O033

    $348.50
    $1,294.25
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D113CAVITY $950.00
    $950.00
    M580
    $100.00
    M580
    $200.00
    P-INJECTABLES
    M580
    $400.00
    M580
    $200.00
    P-ORAL DRUGS
    M580
    $200.00
    $1,100.00
    ENATAL CARE
    S089
    $850.00
    $850.00
    M029
    $100.00
    P-ORAL DRUGS
    M029
    $20.00
    P-INJECTABLES
    M029
    $20.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D137CAVITY $850.00
    SLT-OFFICE
    M019
    $300.00
    P-ORAL DRUGS
    P318
    $162.85
    P-ORAL DRUGS
    P318
    $179.40
    P-ORAL DRUGS
    P073
    $654.03
    $2,286.28
    P-ORAL DRUGS
    P005
    $312.88
    P-ORAL DRUGS
    P005
    $312.88
    P-ORAL DRUGS
    P245
    $378.35
    M456
    $140.00
    P-ORAL DRUGS
    P057
    $100.00
    P-ORAL DRUGS
    P057
    $54.00
    P-INJECTABLES
    M456
    $120.00
    ABORATORY
    M456
    $200.00
    ABORATORY
    M456
    $1,400.00
    ENATAL CARE
    S122
    $600.00
    P-ORAL DRUGS
    P245
    $359.10
    $3,977.21
    DIAGNOSTIC: INITIAL ORAL EXAM D436
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D436
    $375.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D436
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D436
    TIMES (EXCLUDE
    $55.00
    PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D436VIEW
    $180.00
    $750.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,196.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,016.00
    $2,312.00
    SLT-OFFICE
    S384
    $400.00
    S384
    $400.00
    $800.00
    M304
    $125.00
    S011
    $300.00
    $425.00
    S198
    $700.00
    L046
    $140.00
    ABORATORY
    L001
    $215.00
    $1,055.00

    COMPLETE EXAMINATION
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004

    $100.00
    $1,576.00
    $1,676.00
    M156
    $100.00
    P-INJECTABLES
    M156
    $25.00
    P-INJECTABLES
    M156
    $125.00
    P-ORAL DRUGS
    P145
    $345.00
    M255
    $100.00
    P-INJECTABLES
    M255
    $40.00
    P-ORAL DRUGS
    M255
    $60.00
    M469
    $80.00
    P-ORAL DRUGS
    M469
    $80.00
    M469
    $60.00
    COMPLETE EXAMINATION
    O151
    $75.00
    MATERIALS: FRAMES
    O151
    $895.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O151
    $1,295.00
    $3,280.00
    M390
    $150.00
    P-ORAL DRUGS
    M390
    $150.00
    P-ORAL DRUGS
    M390
    $95.00
    M390
    $150.00
    M390
    $150.00
    P-ORAL DRUGS
    M390
    $360.00
    M390
    $150.00
    M390
    $400.00
    P-INJECTABLES
    M390
    $100.00
    P-ORAL DRUGS
    M390
    $120.00
    P-ORAL DRUGS
    M390
    $105.00
    $1,930.00
    COMPLETE EXAMINATION
    O156
    $100.00
    COMPLETE EXAMINATION
    O156
    $100.00
    MATERIALS: FRAMES
    O156
    $1,124.25
    MATERIALS: LENS, EACH-BI-FOCALO156
    $993.75
    M353
    $300.00
    H026
    $97.00
    ABORATORY
    L021
    $500.00
    $3,215.00
    M835
    $300.00
    M835
    $202.50
    M835
    $197.50
    M835
    $125.00
    P-INJECTABLES
    M835
    $200.00
    ABORATORY
    M835
    $1,345.00
    M835
    $300.00
    M866
    $125.00
    P-INJECTABLES
    M866
    $200.00
    M866
    $400.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D371CAVITY $280.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D371CAVITY $370.00
    M331
    $280.00
    P-INJECTABLES
    M331
    $400.00
    P-ORAL DRUGS
    P076
    $298.70
    M464
    $400.00

    M464

    $600.00
    $6,023.70
    P-ORAL DRUGS
    P076
    $127.95
    PREVENTIVE: DENTAL PROPHYLAXIS
    D134
    $400.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D134
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D134
    TIMES (EXCLUDE
    $30.00
    PROPHYLAXIS)
    P-ORAL DRUGS
    P066
    $430.74
    $1,058.69
    M297
    $610.00
    P-INJECTABLES
    M297
    $250.00
    P-ORAL DRUGS
    P075
    $275.90
    P-ORAL DRUGS
    P075
    $56.00
    ABORATORY
    M297
    $60.00
    M297
    $200.00
    L116
    $180.00
    P-ORAL DRUGS
    P014
    $39.20
    P-ORAL DRUGS
    P014
    $62.79
    P-ORAL DRUGS
    P076
    $31.95
    P-ORAL DRUGS
    P076
    $41.30
    $1,807.14
    COMPLETE EXAMINATION
    O011
    $80.00
    MATERIALS: FRAMES
    O011
    $290.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O011
    $600.00
    M390
    $200.00
    ABORATORY
    M390
    $510.00
    $1,680.00
    M103
    $140.00
    ABORATORY
    M103
    $20.00
    M103
    $140.00
    M103
    $140.00
    ABORATORY
    M103
    $20.00
    ABORATORY
    L021
    $320.00
    M103
    $140.00
    P-ORAL DRUGS
    P014
    $54.60
    ABORATORY
    L021
    $400.00
    ABORATORY
    M103
    $20.00
    M331
    $280.00
    P-INJECTABLES
    M331
    $50.00
    P-INJECTABLES
    M331
    $350.00
    $2,074.60
    M667
    $200.00
    P-ORAL DRUGS
    P168
    $57.30
    $257.30
    COMPLETE EXAMINATION
    O011
    $80.00
    MATERIALS: FRAMES
    O011
    $1,610.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O011
    $1,900.00
    $3,590.00
    M006
    $160.00
    H034
    $510.00
    P-ORAL DRUGS
    P076
    $86.10
    $756.10
    COMPLETE EXAMINATION
    O175
    $50.00
    MATERIALS: FRAMES
    O175
    $1,350.00

    MATERIALS: LENS, EACH-BI-FOCALO175

    $1,800.00
    $3,200.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $85.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $715.00 AFTER 1ST 6 MONTHS
    S001
    $400.00
    ABORATORY
    S001
    $200.00
    S001
    $200.00
    ABORATORY
    L021
    $160.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D143
    TREATMENT
    $1,600.00 AFTER 1ST 6 MONTHS
    M393
    $250.00
    P-ORAL DRUGS
    P155
    $257.90
    P-ORAL DRUGS
    P155
    $122.00
    $3,989.90
    S384
    $400.00
    S384
    $800.00
    S384
    $800.00
    P-ORAL DRUGS
    P011
    $240.00
    P-ORAL DRUGS
    P435
    $578.66
    $2,818.66
    S281
    $400.00
    ABORATORY
    S281
    $200.00
    ABORATORY
    L049
    $600.00
    M317
    $120.00
    P-ORAL DRUGS
    M317
    $70.00
    P-ORAL DRUGS
    M317
    $5.00
    M317
    $120.00
    P-ORAL DRUGS
    M317
    $70.00
    M317
    $120.00
    P-ORAL DRUGS
    M317
    $70.00
    S343
    $300.00
    L170
    $180.00
    M341
    $140.00
    P-ORAL DRUGS
    M341
    $60.00
    S029
    $160.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D171
    $280.00
    $2,895.00
    H034
    $100.00
    ABORATORY
    H034
    $1,710.00
    $1,810.00
    COMPLETE EXAMINATION
    O131
    $70.00
    MATERIALS: FRAMES
    O131
    $1,300.00
    MATERIALS: LENS, EACH-BI-FOCALO131
    $800.00
    $2,170.00
    COMPLETE EXAMINATION
    O065
    $150.00
    MATERIALS: FRAMES
    O065
    $675.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O065
    $1,242.00
    $2,067.00
    DIAGNOSTIC: INITIAL ORAL EXAM D59
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D59
    $430.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D59 VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D59 VIEW
    $45.00
    $580.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D345
    $700.00

    $700.00
    $300.00
    P-INJECTABLES
    $25.00
    P-INJECTABLES
    $95.00
    ABORATORY
    $250.00
    $670.00
    M087
    $180.00
    P-ORAL DRUGS
    P353
    $179.10
    P-ORAL DRUGS
    P353
    $19.90
    SUTURING SURFACE WOUNDS: ONE
    M087
    OR MORE W 5$300.00
    OR FEWER STITCHES
    ABORATORY
    M087
    $140.00
    $819.00
    M514
    $200.00
    ABORATORY
    L021
    $460.00
    S130
    $100.00
    ABORATORY
    L169
    $150.00
    P-ORAL DRUGS
    P179
    $115.00
    P-ORAL DRUGS
    P179
    $36.00
    S130
    $100.00
    ABORATORY
    S130
    $40.00
    M390
    $175.00
    P-ORAL DRUGS
    M390
    $35.00
    P-ORAL DRUGS
    M390
    $285.00
    $1,696.00
    M390
    $150.00
    P-ORAL DRUGS
    M390
    $340.00
    $490.00
    M799
    $300.00
    P-INJECTABLES
    M799
    $200.00
    M230
    $300.00
    P-INJECTABLES
    M230
    $300.00
    L032
    $250.00
    P-ORAL DRUGS
    P337
    $160.00
    M230
    $300.00
    M230
    $300.00
    P-ORAL DRUGS
    P014
    $34.10
    P-ORAL DRUGS
    P014
    $216.75
    M077
    $480.00
    P-ORAL DRUGS
    M077
    $300.00
    M230
    $900.00
    P-INJECTABLES
    M230
    $400.00
    P-ORAL DRUGS
    P014
    $105.00
    P-ORAL DRUGS
    P337
    $649.50
    P-ORAL DRUGS
    P337
    $396.00
    P-ORAL DRUGS
    P337
    $242.00
    $5,833.35
    ORAL SURGERY: SURGICAL REMOVAL
    D113
    OF TOOTH$4,400.00
    W SOFT TISSUE IMPACTION
    COMPLETE EXAMINATION
    O162
    $75.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O162
    $1,475.00
    MATERIALS: FRAMES
    O162
    $895.00
    $6,845.00
    M300
    $160.00
    P-ORAL DRUGS
    P094
    $103.60
    M152
    M152
    M152
    L021

    $263.60
    DIAGNOSTIC: INITIAL ORAL EXAM D190
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D190VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D190VIEW
    $5.00
    PROSTHETICS: PARTIAL UPPER/LOWER
    D190ACRYLIC $2,000.00
    BASE DENTURE W/O CLASP
    $2,090.00
    S120
    $300.00
    S136
    $200.00
    P-INJECTABLES
    S136
    $25.00
    P-INJECTABLES
    S136
    $35.00
    S136
    $200.00
    S136
    $160.00
    S120
    $540.00
    S120
    $300.00
    P-ORAL DRUGS
    P104
    $122.95
    P-ORAL DRUGS
    P104
    $29.89
    $1,912.84
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,300.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,520.00
    $2,930.00
    M067
    $420.00
    ABORATORY
    L020
    $360.00
    ABORATORY
    L065
    $290.00
    L149
    $150.00
    $1,220.00
    M189
    $120.00
    COMPLETE EXAMINATION
    O063
    $150.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O065
    $1,150.00
    ABORATORY
    L025
    $160.00
    M189
    $280.00
    ABORATORY
    L025
    $235.00
    L126
    $300.00
    S347
    $300.00
    M189
    $140.00
    P-ORAL DRUGS
    P059
    $96.00
    IT-HOSPITAL
    H011
    $550.00
    H011
    $250.00
    P-ORAL DRUGS
    H011
    $184.00
    M189
    $140.00
    P-ORAL DRUGS
    P059
    $25.00
    S250
    $300.00
    SLT-OFFICE
    S245
    $400.00
    ABORATORY
    P286
    $690.00
    SLT-OFFICE
    S245
    $300.00
    P-ORAL DRUGS
    P115
    $96.95
    SLT-OFFICE
    S245
    $300.00
    ABORATORY
    L065
    $250.00
    ABORATORY
    L065
    $375.00
    M189
    $140.00
    L149
    $150.00
    M189
    $120.00
    $7,201.95

    M575

    $100.00
    $100.00
    M138
    $100.00
    P-INJECTABLES
    M138
    $25.00
    P-INJECTABLES
    M138
    $55.00
    $180.00
    L121
    $650.00
    $650.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D41 SURFACE $712.50
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D41 SURFACE $287.50
    CAVITY
    M103
    $50.00
    M103
    $90.00
    ABORATORY
    L021
    $200.00
    P-ORAL DRUGS
    H011
    $21.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D41 SURFACE $400.00
    CAVITY
    P-ORAL DRUGS
    P093
    $91.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D41 SURFACE $170.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D41 SURFACE $330.00
    CAVITY
    $2,352.00
    SLT-OFFICE
    S383
    $260.00
    $260.00
    S086
    $350.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S086
    $1,200.00
    S086
    $1,200.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S086
    $1,800.00
    S086
    $1,200.00
    ABORATORY
    S086
    $1,600.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D228
    $350.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D228
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D228
    TIMES (EXCLUDE
    $80.00
    PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D228CAVITY $450.00
    OTHER
    P443
    $157.50
    $8,457.50
    M104
    $160.00
    ABORATORY
    L070
    $680.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,462.00
    S432
    $260.00
    P-ORAL DRUGS
    P453
    $346.75
    P-ORAL DRUGS
    P453
    $407.50
    $3,426.25
    M386
    $365.00
    P-ORAL DRUGS
    M386
    $31.00
    P-ORAL DRUGS
    M386
    $26.00
    M386
    $30.00
    M647
    $160.00
    P-INJECTABLES
    M647
    $50.00
    P-INJECTABLES
    M647
    $270.00
    SLT-OFFICE
    S103
    $700.00
    L013
    $699.00
    $2,331.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,276.00

    MATERIALS: LENS, EACH-TRI-FOCAL


    O004
    M647
    P-INJECTABLES
    M647
    P-INJECTABLES
    M647

    $1,516.00
    $80.00
    $25.00
    $235.00
    $3,232.00
    DIAGNOSTIC: INITIAL ORAL EXAM D189
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D189
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D189
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL STANNOUS D189
    FLUORIDE, ONE $80.00
    (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D189VIEW
    $350.00
    DIAGNOSTIC: INITIAL ORAL EXAM D189
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D189
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D189
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D189
    TIMES (EXCLUDE
    $50.00
    PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D189VIEW
    $350.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D189
    ROOT$800.00
    PLANING, SCALING, EACH
    S071
    $496.00
    S071
    $124.00
    P-ORAL DRUGS
    P450
    $257.56
    P-ORAL DRUGS
    P450
    $64.39
    $3,411.95
    PROSTHETICS: PARTIAL UPPER/LOWER
    DT04ACRYLIC BASE
    $700.00
    DENTURE W/O CLASP
    PROSTHETICS: PARTIAL UPPER/LOWER
    DT04ACRYLIC $2,300.00
    BASE DENTURE W/O CLASP
    $3,000.00
    M786
    $100.00
    SLT-OFFICE
    M683
    $300.00
    P-ORAL DRUGS
    M683
    $260.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D38
    TREATMENT
    $1,400.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D38
    TREATMENT
    $200.00 AFTER 1ST 6 MONTHS
    PREVENTIVE: DENTAL PROPHYLAXIS
    D278
    $300.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D278VIEW
    $240.00
    M733
    $60.00
    M733
    $120.00
    M733
    $60.00
    ABORATORY
    M733
    $370.00
    P-ORAL DRUGS
    M733
    $130.00
    $3,540.00
    M019
    $300.00
    P-ORAL DRUGS
    P416
    $205.50
    P-ORAL DRUGS
    P416
    $222.80
    $728.30
    ABORATORY
    L046
    $500.00
    $500.00
    M124
    $250.00
    P-ORAL DRUGS
    P372
    $1,000.00
    P-ORAL DRUGS
    P005
    $937.76
    ABORATORY
    M124
    $50.00
    M437
    $250.00
    ABORATORY
    M437
    $250.00
    SLT-OFFICE
    S286
    $300.00
    ABORATORY
    L070
    $1,053.00
    P-ORAL DRUGS
    P435
    $49.95
    P-ORAL DRUGS
    P005
    $884.40

    P-ORAL DRUGS
    P-ORAL DRUGS

    P005
    P372

    $937.76
    $1,000.00
    $6,962.87
    M185
    $300.00
    P-ORAL DRUGS
    P005
    $405.76
    ABORATORY
    L001
    $313.50
    P-ORAL DRUGS
    P055
    $154.00
    L133
    $400.00
    ABORATORY
    L133
    $1,265.00
    ABORATORY
    H026
    $1,275.00
    P-ORAL DRUGS
    P005
    $405.76
    P-ORAL DRUGS
    P005
    $405.76
    P005
    $840.17
    $5,764.95
    M374
    $200.00
    $200.00
    H003
    $100.00
    $100.00
    M026
    $220.00
    P-ORAL DRUGS
    P031
    $406.26
    P-ORAL DRUGS
    P031
    $61.26
    P-ORAL DRUGS
    P031
    $262.29
    M026
    $440.00
    P-ORAL DRUGS
    P085
    $280.00
    P-ORAL DRUGS
    P031
    $33.75
    $1,703.56
    M317
    $120.00
    P-ORAL DRUGS
    M317
    $80.00
    P-ORAL DRUGS
    M317
    $5.00
    $205.00
    M297
    $120.00
    M297
    $120.00
    ABORATORY
    L116
    $760.00
    $1,000.00
    M202
    $200.00
    P-ORAL DRUGS
    P408
    $1,305.00
    $1,505.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D102
    CROWN
    $860.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D102
    CROWN
    $3,140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $400.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D102VIEW
    $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D102CAVITY $400.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D102 SURFACE $500.00
    CAVITY
    $5,500.00
    M026
    $220.00
    P-ORAL DRUGS
    P094
    $315.00
    P-ORAL DRUGS
    P094
    $288.75
    P-ORAL DRUGS
    P073
    $635.00
    P-ORAL DRUGS
    P066
    $672.00
    P-ORAL DRUGS
    P094
    $94.50
    M026
    $440.00
    P-ORAL DRUGS
    P094
    $1,251.80
    ABORATORY
    L001
    $38.00

    P-ORAL DRUGS

    P073

    $635.00
    $4,590.05
    H003
    $100.00
    P-ORAL DRUGS
    H003
    $185.85
    ABORATORY
    H003
    $445.00
    H003
    $60.00
    H003
    $140.00
    IT-HOSPITAL
    H003
    $75.00
    H003
    $125.00
    H003
    $300.00
    H003
    $650.00
    P-ORAL DRUGS
    P085
    $108.95
    SLT-OFFICE
    S006
    $200.00
    H005
    $700.00
    M099
    $120.00
    $3,209.80
    M344
    $150.00
    P-ORAL DRUGS
    P437
    $35.95
    M344
    $150.00
    P-ORAL DRUGS
    P437
    $290.00
    M344
    $150.00
    SLT-OFFICE
    S133
    $300.00
    L041
    $750.00
    H066
    $700.00
    P-ORAL DRUGS
    P437
    $598.75
    COMPLETE EXAMINATION
    S370
    $300.00
    MATERIALS: FRAMES
    O004
    $1,916.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $476.00
    M344
    $150.00
    P-ORAL DRUGS
    P032
    $47.60
    $6,014.30
    S375
    $200.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D102CAVITY $500.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D102CAVITY $500.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D102VIEW
    $100.00
    MATERIALS: FRAMES
    O025
    $1,275.00
    MATERIALS: LENS, EACH-BI-FOCALO025
    $950.00
    $3,525.00
    M229
    $360.00
    ABORATORY
    L001
    $288.00
    P-ORAL DRUGS
    P066
    $372.00
    P-ORAL DRUGS
    P031
    $273.00
    $1,293.00
    S302
    $100.00
    S302
    $260.00
    ABORATORY
    S302
    $440.00
    P-ORAL DRUGS
    P031
    $123.99
    S162
    $400.00
    S162
    $200.00
    P-ORAL DRUGS
    P011
    $149.00
    P-ORAL DRUGS
    P031
    $182.97
    P-ORAL DRUGS
    P031
    $4.06
    M509
    $100.00

    M509
    S162
    DRUGS
    P031
    M509
    DRUGS
    P031
    M229
    DRUGS
    P011
    COMPLETE EXAMINATION
    O004
    MATERIALS: FRAMES
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    M509
    M509
    DRUGS
    P011
    DRUGS
    P031
    DRUGS
    P031
    M509
    M509
    DRUGS
    P031
    DRUGS
    P031
    DRUGS
    P031

    $80.00
    $240.00
    P-ORAL
    $88.49
    $150.00
    P-ORAL
    $277.50
    $200.00
    P-ORAL
    $86.45
    $100.00
    $1,356.00
    $1,516.00
    $100.00
    $80.00
    P-ORAL
    $44.65
    P-ORAL
    $239.00
    P-ORAL
    $77.99
    $100.00
    $90.00
    P-ORAL
    $415.58
    P-ORAL
    $63.82
    P-ORAL
    $28.99
    $7,294.49
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,196.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $2,056.00
    $3,352.00
    M229
    $200.00
    P-ORAL DRUGS
    P106
    $1,620.00
    ABORATORY
    L001
    $610.00
    P-ORAL DRUGS
    P106
    $459.90
    ABORATORY
    L001
    $190.00
    $3,079.90
    M300
    $160.00
    PROSTHETICS: COMPLETE UPPER ACRYLIC
    D22
    BASE$1,400.00
    DENTURE
    $1,560.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D224CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D224CAVITY $250.00
    $390.00
    SLT-OFFICE
    S049
    $400.00
    P-ORAL DRUGS
    O061
    $110.00
    EYE: REMOVAL OF CATARACT
    S049
    $2,750.00
    S049
    $500.00
    S049
    $5,510.00
    COMPLETE EXAMINATION
    O019
    $120.00
    MATERIALS: FRAMES
    O019
    $1,160.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O019
    $1,711.50
    S049
    $400.00
    P-ORAL DRUGS
    O061
    $110.00
    SLT-OFFICE
    S049
    $400.00
    P-ORAL DRUGS
    O061
    $110.00
    S324
    $250.00
    ABORATORY
    S324
    $150.00
    $13,682.00
    M608
    $200.00

    P-INJECTABLES
    P-INJECTABLES

    M608
    M608
    M608

    $50.00
    $190.00
    $40.00
    $480.00
    DIAGNOSTIC: INITIAL ORAL EXAM D171
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D171VIEW
    $175.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D171VIEW
    $75.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D171
    BITEWING X-RAYS
    $300.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D171 SURFACE $750.00
    CAVITY
    ABORATORY
    M100
    $880.00
    SLT-OFFICE
    S220
    $280.00
    P-ORAL DRUGS
    S220
    $200.00
    $2,760.00
    COMPLETE EXAMINATION
    S200
    $250.00
    $250.00
    M375
    $160.00
    L081
    $400.00
    ABORATORY
    L065
    $310.00
    $870.00
    COMPLETE EXAMINATION
    O054
    $80.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O054
    $1,095.00
    $1,175.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $796.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $800.00
    $1,696.00
    H006
    $4,500.00
    H006
    $25,418.70
    PROSTATE: TRANSURETHRAL RESECTION
    S424
    $5,000.00
    IT-HOSPITAL
    M788
    $2,400.00
    IT-HOSPITAL
    S402
    $500.00
    IT-HOSPITAL
    S084
    $800.00
    P-ORAL DRUGS
    P316
    $128.50
    SLT-OFFICE
    S257
    $200.00
    $38,947.20
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O004
    $800.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: LENS, EACH-BI-FOCALO004
    $740.00
    $1,740.00
    O001
    $200.00
    S383
    $260.00
    P-ORAL DRUGS
    P215
    $300.00
    COMPLETE EXAMINATION
    O001
    $110.00
    P-ORAL DRUGS
    P215
    $300.00
    P-ORAL DRUGS
    P215
    $300.00
    P-ORAL DRUGS
    P215
    $300.00
    P-ORAL DRUGS
    P215
    $300.00
    S383
    $260.00
    P-ORAL DRUGS
    P215
    $365.40
    $2,695.40
    M229
    $200.00
    P-ORAL DRUGS
    P014
    $145.30

    ABORATORY

    P-ORAL DRUGS

    L046
    L001
    H005
    M229
    P085

    COMPLETE EXAMINATION
    O108
    COMPLETE EXAMINATION
    O108
    MATERIALS: FRAMES
    O108
    MATERIALS: LENS, EACH-TRI-FOCAL
    O108
    M124

    SLT-OFFICE
    ABORATORY
    P-ORAL DRUGS
    P-ORAL DRUGS

    ABORATORY

    P-ORAL DRUGS
    ABORATORY

    ABORATORY
    P-ORAL DRUGS
    P-ORAL DRUGS

    P-ORAL DRUGS

    P-INJECTABLES
    P-INJECTABLES
    P-ORAL DRUGS
    P-ORAL DRUGS
    ABORATORY

    P-INJECTABLES
    P-INJECTABLES
    P-ORAL DRUGS
    ABORATORY

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES
    ABORATORY
    P-ORAL DRUGS

    M616
    S107
    S107
    P115
    P435
    S004
    L075
    H034
    L165
    M354
    M354
    P148
    L165
    S130
    S130
    L169
    P071
    P071
    P071
    P182
    M666
    M666
    M666
    M666
    P131
    M666
    M666
    M666
    M666
    P490
    M666
    M666
    M666
    P490
    M666
    M666
    M666
    M666

    $200.00
    $675.00
    $2,500.00
    $200.00
    $45.75
    $3,966.05
    $90.00
    $90.00
    $1,195.00
    $920.00
    $250.00
    $2,545.00
    $120.00
    $600.00
    $150.00
    $414.00
    $352.50
    $600.00
    $3,800.00
    $180.00
    $590.00
    $120.00
    $160.00
    $89.95
    $560.00
    $300.00
    $60.00
    $775.00
    $4.00
    $305.00
    $5.22
    $9,185.67
    $130.00
    $130.00
    $80.00
    $50.00
    $50.00
    $40.00
    $266.75
    $60.00
    $160.00
    $50.00
    $20.00
    $190.18
    $70.00
    $160.00
    $60.00
    $297.36
    $80.00
    $50.00
    $100.00
    $50.00
    $1,834.29

    M480
    M073
    S441
    S441
    M325
    M325
    P150
    P150
    P150
    L046

    $250.00
    $200.00
    $400.00
    $1,500.00
    $75.00
    $65.00
    P-ORAL DRUGS
    $193.60
    P-ORAL DRUGS
    $48.40
    P-ORAL DRUGS
    $3.20
    $540.00
    $3,275.20
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D97 VIEW
    $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D97 CAVITY $1,100.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D97 CAVITY $440.00
    OTHER
    D97
    $150.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D97 SURFACE $660.00
    CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D97 CAVITY $660.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D97 SURFACE $660.00
    CAVITY
    $3,970.00
    M251
    $300.00
    P-INJECTABLES
    M251
    $50.00
    P-INJECTABLES
    M251
    $150.00
    P-ORAL DRUGS
    M251
    $160.00
    $660.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D77
    $250.00
    $250.00
    M190
    $100.00
    P-INJECTABLES
    M190
    $25.00
    P-INJECTABLES
    M190
    $55.00
    M213
    $200.00
    P-INJECTABLES
    M213
    $40.00
    $420.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D102
    $200.00
    $200.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D77 SURFACE $170.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D77 SURFACE $230.00
    CAVITY
    ORAL SURGERY: SURGICAL REMOVAL
    D19OF ERUPTED
    $1,000.00
    TOOTH
    $1,400.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D82
    $400.00
    M087
    $260.00
    ABORATORY
    M087
    $140.00
    P-ORAL DRUGS
    P332
    $324.00
    $1,124.00
    ENATAL CARE
    H034
    $200.00
    $200.00
    M176
    $160.00
    P-ORAL DRUGS
    P014
    $76.65
    $236.65
    M189
    $140.00
    P-ORAL DRUGS
    P435
    $51.41
    $191.41
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $760.75

    MATERIALS: LENS, EACH-SINGLE VISION


    O001
    PREVENTIVE: DENTAL PROPHYLAXIS
    D232

    $1,504.50
    $250.00
    $2,625.25
    SLT-OFFICE
    S309
    $300.00
    H006
    $700.00
    $1,000.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,916.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $776.00
    $2,792.00
    S091
    $160.00
    P-ORAL DRUGS
    P306
    $165.00
    COMPLETE EXAMINATION
    O019
    $120.00
    $445.00
    L079
    $200.00
    P-ORAL DRUGS
    P436
    $219.47
    $419.47
    COMPLETE EXAMINATION
    O004
    $250.00
    MATERIALS: CONTACT, MEDICALLYO004
    REQUIRED
    $686.40
    $936.40
    MATERIALS: CONTACT, MEDICALLYO004
    REQUIRED $1,200.00
    $1,200.00
    IT-HOSPITAL
    M821
    $380.00
    ABORATORY
    H005
    $208.00
    P-INJECTABLES
    H005
    $25.00
    P-INJECTABLES
    H005
    $235.63
    P-ORAL DRUGS
    P435
    $266.53
    $1,115.16
    ABORATORY
    L041
    $350.00
    $350.00
    S091
    $160.00
    S091
    $160.00
    P-ORAL DRUGS
    P427
    $27.30
    OTHER SERVICES: EMERGENCY TREATMENT
    D41
    OF DENTAL
    $70.00
    PAIN
    OTHER SERVICES: EMERGENCY TREATMENT
    D41
    OF DENTAL
    $30.00
    PAIN
    $447.30
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D368CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D368CAVITY $150.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D308
    W ANESTHESIA
    $250.00
    & POST OPER
    $500.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D300CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D300CAVITY $400.00
    $500.00
    S077
    $300.00
    P-ORAL DRUGS
    P427
    $66.70
    $366.70
    S146
    $300.00
    ABORATORY
    S146
    $300.00
    ABORATORY
    H005
    $200.00
    $800.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,126.25
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $858.50

    $2,094.75
    S219
    $400.00
    M026
    $80.00
    M026
    $140.00
    P-ORAL DRUGS
    P343
    $201.50
    P-ORAL DRUGS
    P343
    $75.70
    P-ORAL DRUGS
    P343
    $97.35
    P-ORAL DRUGS
    P343
    $33.99
    P-ORAL DRUGS
    P343
    $144.50
    OTHER SERVICES: SPECIAL CONSULTATION
    D299
    (ADVISE
    $85.00
    OTHER DENTISTS/PHYS)
    OTHER SERVICES: SPECIAL CONSULTATION
    D299
    (ADVISE
    $15.00
    OTHER DENTISTS/PHYS)
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D299
    X-RAY, SINGLE
    $300.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D299
    $500.00
    OTHER SERVICES: SPECIAL CONSULTATION
    D299
    (ADVISE
    $85.00
    OTHER DENTISTS/PHYS)
    OTHER SERVICES: SPECIAL CONSULTATION
    D299
    (ADVISE
    $15.00
    OTHER DENTISTS/PHYS)
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D299
    X-RAY, SINGLE
    $300.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D299
    $500.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,600.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D299 SURFACE $800.00
    CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D299CAVITY $700.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D299CAVITY $800.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D299CAVITY $700.00
    COMPLETE EXAMINATION
    O001
    $38.00
    COMPLETE EXAMINATION
    O001
    $72.00
    M026
    $80.00
    M026
    $140.00
    P-ORAL DRUGS
    P343
    $831.60
    P-ORAL DRUGS
    P343
    $10.05
    M026
    $220.00
    P-ORAL DRUGS
    P215
    $217.60
    P-ORAL DRUGS
    P005
    $1,854.18
    ABORATORY
    L070
    $290.00
    ABORATORY
    L070
    $180.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D299CAVITY $1,500.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D299CAVITY $2,100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D299CAVITY $800.00
    $16,016.47
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D64 SURFACE $170.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D64 SURFACE $230.00
    CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D64 CAVITY $400.00
    $800.00
    S107
    $400.00
    ABORATORY
    S107
    $150.00
    $550.00
    ORTHODONTICS: INITIAL ORTHO APPLIANCE
    D07
    W 6$1,400.00
    MONTHS TREATMENT
    ORTHODONTICS: INITIAL ORTHO APPLIANCE
    D07
    W 6$3,600.00
    MONTHS TREATMENT
    $5,000.00
    SLT-OFFICE
    H047
    $400.00
    H047
    $1,550.00
    P-ORAL DRUGS
    P056
    $2,746.20
    P-ORAL DRUGS
    P056
    $469.00
    IT-HOSPITAL
    H005
    $380.00

    H005
    M166
    P-ORAL DRUGS
    M166
    P-INJECTABLES
    M166
    P-ORAL DRUGS
    P056
    SLT-OFFICE
    S144
    D144
    ABORATORY
    L013
    COMPLETE EXAMINATION
    O004
    MATERIALS: FRAMES
    O004
    MATERIALS: LENS, EACH-TRI-FOCAL
    O004

    $4,601.21
    $140.00
    $60.00
    $80.00
    $153.30
    $300.00
    $200.00
    $352.00
    $100.00
    $1,916.00
    $1,516.00
    $14,963.71
    COMPLETE EXAMINATION
    O007
    $130.00
    MATERIALS: FRAMES
    O007
    $900.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O007
    $1,285.00
    $2,315.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D205
    ROOT$170.00
    PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D205
    ROOT$280.00
    PLANING, SCALING, EACH
    $450.00
    ORMAL DELIVERY
    H051
    $10,500.00
    $10,500.00
    S174
    $300.00
    $300.00
    DIAGNOSTIC: INITIAL ORAL EXAM D216
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D216VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D216VIEW
    $45.00
    ORAL SURGERY: SURGICAL REMOVAL
    D216
    OF TOOTH$1,200.00
    W SOFT TISSUE IMPACTION
    $1,380.00
    M332
    $100.00
    P-ORAL DRUGS
    P049
    $500.50
    P-ORAL DRUGS
    P049
    $105.00
    M332
    $100.00
    P-ORAL DRUGS
    P049
    $2,065.50
    COMPLETE EXAMINATION
    S069
    $360.00
    $3,231.00
    M316
    $100.00
    P-ORAL DRUGS
    P451
    $50.40
    $150.40
    DIAGNOSTIC: INITIAL ORAL EXAM D60
    (EXCLUDE X-RAY)
    $50.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D60 SURFACE $170.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D60 SURFACE $130.00
    CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET
    D60
    CROWN
    $2,500.00
    $2,850.00
    M501
    $400.00
    P-ORAL DRUGS
    P073
    $820.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,196.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,520.00
    M215
    $250.00
    P-ORAL DRUGS
    P094
    $238.50
    M215
    $250.00
    ABORATORY
    L070
    $1,440.00
    S302
    $400.00

    P-ORAL DRUGS
    ABORATORY

    P215
    S302

    $73.70
    $140.00
    $6,838.20
    COMPLETE EXAMINATION
    O065
    $250.00
    MATERIALS: CONTACT, WHEN NOTO065
    MEDICALLY REQUIRED
    $600.00
    $850.00
    M267
    $200.00
    P-ORAL DRUGS
    M267
    $120.00
    O156
    $760.00
    O156
    $800.00
    P-ORAL DRUGS
    P085
    $275.00
    O001
    $50.00
    $2,205.00
    M185
    $180.00
    P-ORAL DRUGS
    P122
    $353.00
    S174
    $150.00
    S174
    $150.00
    P-ORAL DRUGS
    L041
    $575.00
    P-ORAL DRUGS
    L041
    $8.40
    P-ORAL DRUGS
    L041
    $75.00
    L041
    $120.00
    $1,611.40
    COMPLETE EXAMINATION
    O011
    $80.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O011
    $1,200.00
    MATERIALS: FRAMES
    O011
    $780.00
    $2,060.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D281
    X-RAY, SINGLE
    $200.00
    VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D257CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D257CAVITY $310.00
    $650.00
    M152
    $300.00
    P-INJECTABLES
    M152
    $25.00
    P-INJECTABLES
    M152
    $95.00
    $420.00
    M164
    $140.00
    S127
    $200.00
    ABSCESSES, BOILS & CARBUNCLES:
    S127
    INCISION FOR$400.00
    DRAINAGE W/O HOSPITAL
    $740.00
    DIAGNOSTIC: INITIAL ORAL EXAM D150
    (EXCLUDE X-RAY)
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D150
    $200.00
    $350.00
    P-ORAL DRUGS
    P011
    $477.00
    P-ORAL DRUGS
    P011
    $370.00
    $847.00
    P-ORAL DRUGS
    P005
    $126.44
    M229
    $160.00
    P-ORAL DRUGS
    P343
    $102.70
    COMPLETE EXAMINATION
    O033
    $100.00
    MATERIALS: FRAMES
    O033
    $1,035.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O033
    $427.50
    COMPLETE EXAMINATION
    O033
    $100.00
    MATERIALS: FRAMES
    O033
    $895.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O033
    $427.50

    P-ORAL
    P-ORAL
    P-ORAL
    P-ORAL

    DRUGS
    DRUGS
    DRUGS
    DRUGS

    P343
    P005
    P155
    P005

    $79.80
    $126.44
    $160.00
    $316.10
    $4,056.98
    H003
    $300.00
    H003
    $300.00
    M774
    $200.00
    P-ORAL DRUGS
    P353
    $180.00
    P-ORAL DRUGS
    P353
    $45.00
    L075
    $3,420.00
    PROSTATE: TRANSURETHRAL RESECTION
    S107
    $300.00
    SLT-OFFICE
    S107
    $200.00
    P-ORAL DRUGS
    P085
    $103.60
    P-ORAL DRUGS
    P085
    $25.90
    $5,074.50
    M205
    $240.00
    P-ORAL DRUGS
    P343
    $219.10
    P-ORAL DRUGS
    P343
    $25.00
    $484.10
    DIAGNOSTIC: INITIAL ORAL EXAM D205
    (EXCLUDE X-RAY)
    $600.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D205
    BITEWING X-RAYS
    $480.00
    DIAGNOSTIC: COMPLETE INTRAORAL
    D143
    SERIES OF PERIAPICAL
    $250.00 X-RAYS
    $1,330.00
    MATERIALS: FRAMES
    O004
    $1,000.50
    O004
    $1,395.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $499.50
    O004
    $696.50
    $3,592.00
    ENATAL CARE
    S128
    $800.00
    ENATAL CARE
    S128
    $800.00
    $1,600.00
    M089
    $360.00
    L006
    $500.00
    $860.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D66 CAVITY $750.00
    $750.00
    M647
    $80.00
    P-INJECTABLES
    M647
    $25.00
    P-INJECTABLES
    M647
    $95.00
    P-ORAL DRUGS
    P504
    $190.00
    H016
    $60.00
    P-ORAL DRUGS
    P166
    $60.00
    M647
    $80.00
    P-INJECTABLES
    M647
    $25.00
    P-INJECTABLES
    M647
    $95.00
    M647
    $80.00
    P-INJECTABLES
    M647
    $25.00
    P-INJECTABLES
    M647
    $95.00
    ABORATORY
    L041
    $70.00
    $980.00
    S124
    $200.00
    P-ORAL DRUGS
    P158
    $150.00

    PROSTATE: TRANSURETHRAL RESECTION


    S124
    $2,200.00
    ORAL SURGERY: SURGICAL REMOVAL
    D194
    OF TOOTH W
    $210.00
    SOFT TISSUE IMPACTION
    S242
    $250.00
    P-ORAL DRUGS
    P158
    $75.00
    DIAGNOSTIC: INITIAL ORAL EXAM D413
    (EXCLUDE X-RAY)
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D413VIEW
    $200.00
    $3,355.00
    M801
    $500.00
    P-INJECTABLES
    M801
    $100.00
    P-ORAL DRUGS
    P208
    $407.00
    P-ORAL DRUGS
    P208
    $183.90
    PREVENTIVE: DENTAL PROPHYLAXIS
    D313
    $320.00
    $1,510.90
    S353
    $200.00
    ABORATORY
    H066
    $360.00
    P-ORAL DRUGS
    P045
    $230.00
    S327
    $250.00
    ABORATORY
    S327
    $200.00
    H066
    $550.00
    P-ORAL DRUGS
    P467
    $126.00
    S327
    $200.00
    L134
    $715.00
    H066
    $800.00
    H066
    $2,960.00
    URETHRA: INTRA-URETHRAL CUTTING
    S327
    OPERATION
    $1,500.00
    M357
    $1,200.00
    P-ORAL DRUGS
    P467
    $175.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,276.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,080.00
    S353
    $200.00
    SLT-OFFICE
    S327
    $200.00
    ABORATORY
    L070
    $110.00
    H066
    $2,500.00
    DIAGNOSTIC: INITIAL ORAL EXAM D200
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D200
    X-RAY, SINGLE
    $35.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D200
    X-RAY, SINGLE
    $25.00
    VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D200
    W ANESTHESIA
    $800.00
    & POST OPER
    ABORATORY
    S296
    $450.00
    PROSTATE: TRANSURETHRAL RESECTION
    S296
    $2,400.00
    S296
    $1,000.00
    SLT-OFFICE
    S385
    $600.00
    P-ORAL DRUGS
    P467
    $225.00
    S237
    $500.00
    P-ORAL DRUGS
    P467
    $21.00
    L013
    $6,300.00
    ABORATORY
    L013
    $87.00
    $27,465.00
    M580
    $100.00
    P-INJECTABLES
    M580
    $500.00
    P-ORAL DRUGS
    M580
    $100.00
    M580
    $100.00
    $800.00

    M694
    M694
    M694
    M694

    $100.00
    $500.00
    P-INJECTABLES
    $400.00
    P-ORAL DRUGS
    $100.00
    $1,100.00
    M732
    $200.00
    P-INJECTABLES
    M732
    $50.00
    P-INJECTABLES
    M732
    $250.00
    M732
    $200.00
    P-ORAL DRUGS
    M732
    $20.00
    M732
    $200.00
    $920.00
    M732
    $200.00
    ABORATORY
    M732
    $20.00
    M732
    $100.00
    M732
    $200.00
    ABORATORY
    M732
    $2,430.00
    M732
    $100.00
    P-INJECTABLES
    M732
    $25.00
    P-INJECTABLES
    M732
    $75.00
    ABORATORY
    M732
    $20.00
    DIAGNOSTIC: INITIAL ORAL EXAM D313
    (EXCLUDE X-RAY)
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D313VIEW
    $130.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D313
    $300.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D313
    $150.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D313
    TIMES (EXCLUDE
    $70.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D313
    TIMES (EXCLUDE
    $80.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D313
    $100.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D313
    TIMES (EXCLUDE
    $70.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D313
    TIMES (EXCLUDE
    $80.00
    S115
    $300.00
    P-ORAL DRUGS
    P309
    $481.88
    P-ORAL DRUGS
    P309
    $120.47
    M732
    $100.00
    P-ORAL DRUGS
    P309
    $31.99
    P-ORAL DRUGS
    P427
    $161.75
    P-ORAL DRUGS
    P427
    $35.95
    M732
    $100.00
    ABORATORY
    M732
    $170.00
    P-ORAL DRUGS
    P427
    $107.16
    P-ORAL DRUGS
    P427
    $26.79
    $5,855.99
    S179
    $36.00
    S179
    $204.00
    P-ORAL DRUGS
    P279
    $58.50
    P-ORAL DRUGS
    P279
    $6.50
    P-ORAL DRUGS
    P279
    $115.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,756.00
    MATERIALS: FRAMES
    O004
    $439.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $164.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,412.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D260
    CROWN
    $860.00

    PROPHYLAXIS)
    PROPHYLAXIS)
    PROPHYLAXIS)
    PROPHYLAXIS)

    CROWN & BRIDGE: ACRYLIC JACKET


    D260
    CROWN
    $2,140.00
    S427
    $350.00
    ABORATORY
    L070
    $400.00
    P005
    $261.00
    P-ORAL DRUGS
    P005
    $1,094.90
    PREVENTIVE: DENTAL PROPHYLAXIS
    D260
    $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D260CAVITY $580.00
    P-ORAL DRUGS
    P005
    $4,620.10
    $14,897.00
    M123
    $150.00
    P-INJECTABLES
    M123
    $80.00
    ABORATORY
    M123
    $60.00
    M123
    $150.00
    COMPLETE EXAMINATION
    O151
    $75.00
    MATERIALS: FRAMES
    O151
    $1,195.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O151
    $1,650.00
    DIAGNOSTIC: INITIAL ORAL EXAM D228
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D228
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D228
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D228
    TIMES (EXCLUDE
    $80.00
    PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D228CAVITY $2,250.00
    $6,110.00
    S353
    $400.00
    S103
    $300.00
    H008
    $330.00
    S277
    $600.00
    H006
    $825.00
    ABORATORY
    H006
    $1,200.00
    S359
    $700.00
    H006
    $300.00
    H006
    $750.00
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    S359
    $2,000.00
    H023
    $1,900.00
    H023
    $40,600.00
    S353
    $7,500.00
    S353
    $25,000.00
    $82,405.00
    S456
    $650.00
    H066
    $400.00
    ABORATORY
    L069
    $830.00
    SLT-OFFICE
    S417
    $600.00
    SLT-OFFICE
    S322
    $300.00
    L143
    $10,000.00
    ABORATORY
    L069
    $380.00
    UN01
    $200.00
    M029
    $100.00
    $13,460.00
    M274
    $120.00
    P-ORAL DRUGS
    P154
    $235.00
    H029
    $1,200.00
    H029
    $3,494.00
    IT-HOSPITAL
    S113
    $850.00
    PROSTATE: TRANSURETHRAL RESECTION
    S086
    $1,800.00

    S086
    S086
    S086
    L061
    S086

    $600.00
    $1,200.00
    ABORATORY
    $400.00
    ABORATORY
    $290.00
    $450.00
    $10,639.00
    M449
    $100.00
    P-INJECTABLES
    M449
    $25.00
    P-INJECTABLES
    M449
    $75.00
    P-ORAL DRUGS
    M449
    $100.00
    M449
    $100.00
    M449
    $40.00
    P-ORAL DRUGS
    M449
    $65.00
    M795
    $150.00
    M795
    $60.00
    P-ORAL DRUGS
    M795
    $120.00
    M759
    $100.00
    M759
    $100.00
    P-ORAL DRUGS
    P457
    $163.00
    M759
    $100.00
    M759
    $100.00
    $1,398.00
    DIAGNOSTIC: INITIAL ORAL EXAM D148
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D148
    $700.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D148 SURFACE $170.00
    CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D148 SURFACE $730.00
    CAVITY
    P-ORAL DRUGS
    P015
    $297.00
    P-ORAL DRUGS
    P430
    $857.00
    P-ORAL DRUGS
    P349
    $103.60
    $2,957.60
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,014.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,520.00
    $2,644.00
    COMPLETE EXAMINATION
    O027
    $40.00
    MATERIALS: FRAMES
    O027
    $750.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O027
    $1,450.00
    $2,240.00
    COMPLETE EXAMINATION
    O174
    $50.00
    MATERIALS: FRAMES
    O174
    $400.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O174
    $877.00
    COMPLETE EXAMINATION
    O174
    $50.00
    MATERIALS: FRAMES
    O174
    $1,228.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O174
    $1,250.00
    $3,855.00
    M204
    $400.00
    ABORATORY
    H066
    $700.00
    H066
    $350.00
    P-ORAL DRUGS
    P318
    $74.10
    M204
    $200.00
    P-ORAL DRUGS
    P318
    $75.30
    ABORATORY
    H008
    $360.00
    $2,159.40

    $170.00
    $50.00
    $110.00
    $94.50
    $424.50
    M167
    $280.00
    P-INJECTABLES
    M167
    $25.00
    P-INJECTABLES
    M167
    $25.00
    $330.00
    COMPLETE EXAMINATION
    S391
    $280.00
    MATERIALS: FRAMES
    O076
    $1,525.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $2,225.50
    $4,031.00
    S160
    $200.00
    P-ORAL DRUGS
    P154
    $70.95
    $270.95
    M598
    $200.00
    P-ORAL DRUGS
    M598
    $90.00
    P-INJECTABLES
    M598
    $40.00
    M598
    $480.00
    $810.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D27 CAVITY $1,010.00
    $1,010.00
    COMPLETE EXAMINATION
    O008
    $80.00
    MATERIALS: FRAMES
    O008
    $700.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O008
    $1,400.00
    $2,180.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D408VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D408VIEW
    $55.00
    ORAL SURGERY: SURGICAL REMOVAL
    D408
    OF TOOTH W
    $260.00
    SOFT TISSUE IMPACTION
    $350.00
    M461
    $150.00
    P-INJECTABLES
    M461
    $600.00
    M694
    $160.00
    P-INJECTABLES
    M694
    $500.00
    M461
    $150.00
    P-INJECTABLES
    M461
    $520.00
    $2,080.00
    M813
    $100.00
    P-ORAL DRUGS
    P495
    $66.70
    P-ORAL DRUGS
    P495
    $202.30
    $369.00
    MATERIALS: FRAMES
    O076
    $1,095.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,100.00
    $2,195.00
    M325
    $140.00
    P-ORAL DRUGS
    P150
    $135.20
    P-ORAL DRUGS
    P150
    $56.70
    DIAGNOSTIC: INITIAL ORAL EXAM D305
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INITIAL ORAL EXAM D305
    (EXCLUDE X-RAY)
    $140.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D305VIEW
    $60.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D305CAVITY $900.00
    $1,481.90

    P-INJECTABLES
    P-INJECTABLES
    P-ORAL DRUGS

    M237
    M237
    M237
    P453

    DIAGNOSTIC: INTRAORAL PERIAPICAL


    D255
    X-RAY, SINGLE
    $105.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D255
    X-RAY, SINGLE
    $135.00
    VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D255CAVITY $300.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D255
    CROWN
    $2,500.00
    $3,040.00
    M159
    $140.00
    P-ORAL DRUGS
    M159
    $40.00
    P-ORAL DRUGS
    P479
    $34.00
    S318
    $300.00
    S318
    $250.00
    L041
    $600.00
    ABORATORY
    L041
    $600.00
    ENATAL CARE
    L041
    $250.00
    $2,214.00
    S423
    $200.00
    $200.00
    H027
    $250.00
    L041
    $350.00
    $600.00
    ENATAL CARE
    S382
    $2,400.00
    ENATAL CARE
    L041
    $370.00
    ENATAL CARE
    L041
    $300.00
    ENATAL CARE
    L041
    $30.00
    $3,100.00
    M352
    $250.00
    P-ORAL DRUGS
    M352
    $175.00
    ABORATORY
    L074
    $240.00
    M352
    $150.00
    P-ORAL DRUGS
    M352
    $50.00
    M352
    $100.00
    M352
    $60.00
    P-ORAL DRUGS
    P435
    $57.38
    P-ORAL DRUGS
    P435
    $6.38
    M377
    $80.00
    SLT-OFFICE
    S083
    $400.00
    S083
    $200.00
    UTERUS: DILATION & CURRETTAGE,
    S083
    OR OTHER SURGERY
    $1,800.00ON EXT GENITALIA
    M377
    $120.00
    P-ORAL DRUGS
    P435
    $415.38
    ABORATORY
    L074
    $290.00
    $4,394.14
    S419
    $300.00
    P-ORAL DRUGS
    P366
    $31.00
    P-ORAL DRUGS
    P366
    $219.75
    S419
    $200.00
    P-ORAL DRUGS
    P366
    $153.50
    DIAGNOSTIC: INITIAL ORAL EXAM D389
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: PULP VITALITY TEST D389
    $20.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D389VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D389VIEW
    $14.00
    $1,058.25
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $2,480.37

    MATERIALS: LENS, EACH-SINGLE VISION


    O076

    $880.37
    $3,450.74
    COMPLETE EXAMINATION
    O108
    $90.00
    MATERIALS: FRAMES
    O108
    $895.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O108
    $390.00
    $1,375.00
    M575
    $110.00
    M575
    $300.00
    DIAGNOSTIC: INITIAL ORAL EXAM D114
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D114
    $340.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D114CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D114CAVITY $320.00
    $1,330.00
    H066
    $700.00
    $700.00
    DIAGNOSTIC: INITIAL ORAL EXAM D188
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D188VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D188VIEW
    $45.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D188CAVITY $800.00
    ENDODONTICS: EXTIRPATION OF PULP
    D188& FILL 2 ROOT
    $900.00
    CANAL (EX RESTOR)
    $1,860.00
    DIAGNOSTIC: INITIAL ORAL EXAM D219
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D219
    $300.00
    ENDODONTICS: PULP CAPPING (EXCLUDE
    D219 RESTORATION)
    $280.00
    ENDODONTICS: PULP CAPPING (EXCLUDE
    D219 RESTORATION)
    $520.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D219
    X-RAY, SINGLE
    $230.00
    VIEW
    MATERIALS: FRAMES
    O171
    $675.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O171
    $800.00
    $2,875.00
    M633
    $300.00
    P-ORAL DRUGS
    P081
    $15.00
    P-ORAL DRUGS
    P081
    $572.30
    M053
    $280.00
    M053
    $240.00
    M053
    $140.00
    P-ORAL DRUGS
    P081
    $53.20
    P-ORAL DRUGS
    P081
    $45.00
    M053
    $280.00
    SUTURING SURFACE WOUNDS: ONE
    M053
    OR MORE W 5$300.00
    OR FEWER STITCHES
    P-ORAL DRUGS
    P081
    $70.20
    $2,295.70
    COMPLETE EXAMINATION
    S200
    $470.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $400.00
    COMPLETE EXAMINATION
    S432
    $570.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $500.00
    O145
    $500.00
    $2,440.00
    IT-HOSPITAL
    H006
    $450.00
    P-INJECTABLES
    H006
    $25.00
    P-ORAL DRUGS
    H006
    $140.00
    H006
    $145.00
    $760.00
    M304
    $400.00

    ABORATORY
    P-ORAL DRUGS

    M304
    P031
    M304
    P031
    P031

    $915.00
    $17.50
    $450.00
    P-ORAL DRUGS
    $114.90
    P-ORAL DRUGS
    $23.25
    $1,920.65
    M089
    $180.00
    S008
    $200.00
    P-ORAL DRUGS
    P094
    $399.95
    $779.95
    IT-HOSPITAL
    L128
    $250.00
    P-ORAL DRUGS
    P427
    $1,147.90
    M692
    $1,200.00
    ABORATORY
    L065
    $70.00
    H023
    $1,100.00
    H023
    $2,617.48
    H023
    $2,472.50
    M868
    $2,500.00
    M868
    $800.00
    P-ORAL DRUGS
    P427
    $1,147.90
    SLT-OFFICE
    S286
    $250.00
    S286
    $700.00
    ABORATORY
    H023
    $1,900.00
    $16,155.78
    M225
    $400.00
    M225
    $200.00
    ABSCESSES, BOILS & CARBUNCLES:
    M225
    INCISION FOR$500.00
    DRAINAGE W/O HOSPITAL
    ABORATORY
    L064
    $400.00
    S063
    $300.00
    ABORATORY
    S063
    $350.00
    $2,150.00
    ENDODONTICS: EXTIRPATION OF PULP
    D224& FILL 1 ROOT
    $495.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D224& FILL 1 ROOT
    $5.00
    CANAL (EX RESTOR)
    $500.00
    M111
    $400.00
    ABORATORY
    M111
    $30.00
    P-ORAL DRUGS
    M111
    $80.00
    P-ORAL DRUGS
    M111
    $120.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D39
    TREATMENT
    $170.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D39
    TREATMENT
    $830.00 AFTER 1ST 6 MONTHS
    M541
    $200.00
    P-ORAL DRUGS
    P155
    $180.00
    $2,010.00
    S231
    $80.00
    S231
    $220.00
    T034
    $480.00
    T034
    $1,720.00
    M045
    $80.00
    M045
    $70.00
    P-ORAL DRUGS
    P022
    $9.75
    P-ORAL DRUGS
    P022
    $23.70
    M304
    $80.00
    M304
    $70.00

    M045
    M045
    M304
    P014
    S279
    S279
    S279

    $80.00
    $70.00
    ABORATORY
    $160.00
    P-ORAL DRUGS
    $132.65
    SLT-OFFICE
    $150.00
    SLT-OFFICE
    $350.00
    $132.00
    $3,908.10
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D83 VIEW
    $200.00
    M067
    $400.00
    M657
    $150.00
    L032
    $216.00
    H023
    $1,900.00
    M019
    $300.00
    M067
    $200.00
    $3,366.00
    S076
    $600.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,416.00
    $2,116.00
    M706
    $100.00
    P-ORAL DRUGS
    P451
    $452.00
    P-ORAL DRUGS
    P451
    $102.00
    P-ORAL DRUGS
    P451
    $36.00
    SLT-OFFICE
    S216
    $100.00
    SLT-OFFICE
    S216
    $300.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,211.25
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,211.24
    $3,622.49
    H003
    $200.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,196.00
    MATERIALS: LENS, EACH-BI-FOCALO004
    $876.00
    H003
    $200.00
    S006
    $200.00
    $2,772.00
    M053
    $140.00
    ABORATORY
    M053
    $20.00
    M053
    $140.00
    $300.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D346
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D346
    $300.00
    S300
    $50.00
    S300
    $250.00
    $700.00
    M030
    $160.00
    P-ORAL DRUGS
    P256
    $261.80
    P-ORAL DRUGS
    P256
    $66.35
    $488.15
    M225
    $440.00
    ABORATORY
    M225
    $260.00
    P-ORAL DRUGS
    P507
    $2.50

    P-ORAL DRUGS
    P-ORAL DRUGS

    P507
    P215

    $31.70
    $165.50
    $899.70
    S103
    $400.00
    ABORATORY
    L070
    $200.00
    DIAGNOSTIC: INITIAL ORAL EXAM D198
    (EXCLUDE X-RAY)
    $200.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D198
    X-RAY, SINGLE
    $420.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D198
    X-RAY, SINGLE
    $180.00
    VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D198 SURFACE $700.00
    CAVITY
    PERIODONTICS: GINGIVECTOMY, SURGICAL,
    D198
    PER$2,400.00
    QUADRANT W POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM D198
    (EXCLUDE X-RAY)
    $100.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D198
    $400.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D198
    X-RAY, SINGLE
    $420.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D198
    X-RAY, SINGLE
    $180.00
    VIEW
    ENDODONTICS: EXTIRPATION OF PULP
    D198& FILL 1 $3,000.00
    ROOT CANAL (EX RESTOR)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D198VIEW
    $50.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D198
    ROOT
    $2,400.00
    PLANING, SCALING, EACH
    $11,050.00
    P-ORAL DRUGS
    P390
    $142.50
    P-ORAL DRUGS
    P390
    $199.50
    P-ORAL DRUGS
    P360
    $199.00
    P-ORAL DRUGS
    P360
    $199.00
    $740.00
    ENDODONTICS: EXTIRPATION OF PULP
    D77 & FILL 3 ROOT
    $910.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D77 & FILL 3 ROOT
    $690.00
    CANAL (EX RESTOR)
    $1,600.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D232CAVITY $280.00
    $280.00
    M089
    $200.00
    $200.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,214.49
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,475.51
    M156
    $100.00
    P-INJECTABLES
    M156
    $200.00
    P-ORAL DRUGS
    P145
    $60.00
    P-ORAL DRUGS
    P145
    $175.00
    $3,315.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D39
    TREATMENT
    $400.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D39
    TREATMENT
    $400.00 AFTER 1ST 6 MONTHS
    $800.00
    S292
    $400.00
    P-ORAL DRUGS
    P430
    $170.50
    S427
    $50.00
    P-INJECTABLES
    S427
    $25.00
    P-INJECTABLES
    S427
    $675.00
    P-ORAL DRUGS
    P005
    $631.96
    $1,952.46
    US01
    $96.00
    US01
    $95.10
    $191.10
    M229
    $160.00
    ABORATORY
    M229
    $280.00

    $440.00
    $500.00
    $700.00
    $1,200.00
    L113
    $3,000.00
    H003
    $400.00
    SLT-OFFICE
    S383
    $1,000.00
    H006
    $1,200.00
    H027
    $4,500.00
    EYE: REMOVAL OF CATARACT
    S374
    $4,700.00
    ABORATORY
    S374
    $200.00
    S374
    $1,000.00
    $16,000.00
    M215
    $250.00
    ABORATORY
    L070
    $1,270.00
    $1,520.00
    MATERIALS: CONTACT, WHEN NOTO004
    MEDICALLY REQUIRED
    $1,145.60
    MATERIALS: CONTACT, WHEN NOTO004
    MEDICALLY REQUIRED
    $286.40
    $1,432.00
    IT-HOSPITAL
    H003
    $350.00
    ABORATORY
    H003
    $525.00
    $875.00
    IT-HOSPITAL
    H006
    $400.00
    ABORATORY
    H006
    $275.00
    $675.00
    ABSCESSES, BOILS & CARBUNCLES:
    S296
    INCISION FOR
    $1,500.00
    DRAINAGE W/O HOSPITAL
    ABORATORY
    S296
    $400.00
    L113
    $2,000.00
    S296
    $800.00
    IT-HOSPITAL
    H006
    $250.00
    H006
    $2,028.00
    ABORATORY
    H006
    $705.00
    H006
    $355.00
    H006
    $600.00
    H023
    $950.00
    H023
    $5,854.82
    H44
    $4,850.00
    CHEST: OTHER CUTTING INTO THORACTIC
    S266
    CAVITY
    $4,000.00
    SLT-OFFICE
    S266
    $800.00
    SLT-HOSPITAL
    H006
    $400.00
    $25,492.82
    M577
    $200.00
    P-ORAL DRUGS
    P011
    $150.00
    P-ORAL DRUGS
    P011
    $22.50
    M577
    $200.00
    ABORATORY
    M577
    $40.00
    ABORATORY
    L070
    $510.00
    $1,122.50
    M449
    $100.00
    M449
    $60.00
    P-INJECTABLES
    M449
    $25.00
    P-INJECTABLES
    M449
    $135.00
    P-ORAL DRUGS
    M449
    $90.00
    MATERIALS: FRAMES
    O161
    MATERIALS: LENS, EACH-TRI-FOCAL
    O161

    $410.00
    $100.00
    $150.00
    $250.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D79 SURFACE $200.00
    CAVITY
    $200.00
    S126
    $600.00
    L97
    $180.00
    P-ORAL DRUGS
    P014
    $19.25
    S126
    $300.00
    H023
    $2,000.00
    ABORATORY
    H011
    $100.00
    ABORATORY
    L070
    $115.00
    $3,314.25
    SLT-OFFICE
    S375
    $300.00
    COMPLETE EXAMINATION
    O065
    $150.00
    MATERIALS: FRAMES
    O065
    $1,395.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O065
    $1,399.50
    M189
    $120.00
    P-ORAL DRUGS
    P059
    $91.20
    P-ORAL DRUGS
    P059
    $102.80
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D78
    W ANESTHESIA
    $525.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D78
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D78
    W ANESTHESIA
    $140.00
    & POST OPER
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $245.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D78
    $155.00
    OTHER
    P091
    $110.25
    OTHER
    P091
    $47.25
    $4,866.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D180CAVITY $350.00
    ABORATORY
    H022
    $360.00
    $710.00
    ENATAL CARE
    S290
    $1,200.00
    $1,200.00
    S136
    $200.00
    P-ORAL DRUGS
    P007
    $84.19
    P-ORAL DRUGS
    P007
    $9.99
    $294.18
    S122
    $1,000.00
    S122
    $2,000.00
    $3,000.00
    M156
    $300.00
    S427
    $350.00
    ABORATORY
    L061
    $170.00
    P-ORAL DRUGS
    P430
    $768.00
    P-ORAL DRUGS
    P462
    $1,387.50
    S427
    $200.00
    P-ORAL DRUGS
    P430
    $768.00
    P-ORAL DRUGS
    P462
    $1,387.50
    P-ORAL DRUGS
    P462
    $1,387.50
    P-ORAL DRUGS
    P430
    $768.00
    P-ORAL DRUGS
    P430
    $768.00
    P-ORAL DRUGS
    P462
    $1,387.50
    M549
    L128

    $200.00
    $900.00
    $200.00
    $200.00
    ABORATORY
    $500.00
    P-ORAL DRUGS
    $1,387.50
    P-ORAL DRUGS
    $768.00
    P-ORAL DRUGS
    $768.00
    P-ORAL DRUGS
    $1,387.50
    $15,953.00
    ENDODONTICS: EXTIRPATION OF PULP
    D77 & FILL 1 ROOT
    $533.00
    CANAL (EX RESTOR)
    $533.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $2,796.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,816.00
    M584
    $120.00
    S004
    $200.00
    ABORATORY
    S004
    $400.00
    SLT-OFFICE
    S159
    $800.00
    SLT-OFFICE
    S357
    $300.00
    ABORATORY
    L065
    $400.00
    ABORATORY
    H005
    $2,220.00
    L075
    $3,420.00
    M386
    $1,920.00
    $14,492.00
    M041
    $200.00
    P-INJECTABLES
    M041
    $50.00
    P-ORAL DRUGS
    P167
    $2.10
    P-ORAL DRUGS
    P167
    $111.95
    $364.05
    M002
    $150.00
    P-ORAL DRUGS
    M002
    $210.00
    P-ORAL DRUGS
    M002
    $20.00
    $380.00
    H006
    $700.00
    ABORATORY
    H006
    $695.00
    DIAGNOSTIC: INITIAL ORAL EXAM D371
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D371
    $200.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D371
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D371
    W ANESTHESIA
    $65.00
    & POST OPER
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D371VIEW
    $120.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D371CAVITY $200.00
    COMPLETE EXAMINATION
    O006
    $75.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O006
    $650.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D371CAVITY $150.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D371CAVITY $400.00
    SLT-OFFICE
    S309
    $300.00
    ABORATORY
    L020
    $890.00
    $4,580.00
    M374
    $350.00
    M374
    $50.00
    L006
    $100.00
    L006
    $20.00

    P-INJECTABLES
    P-ORAL DRUGS

    M580
    M580
    M580
    M580
    M580
    P462
    P430
    P430
    P462

    L070
    L070

    $890.00
    $120.00
    $1,530.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D66 VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D66 VIEW
    $130.00
    OTHER
    P139
    $180.00
    OTHER
    P014
    $108.15
    $488.15
    PREVENTIVE: DENTAL PROPHYLAXIS
    D397
    $135.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D397
    TIMES (EXCLUDE
    $65.00
    PROPHYLAXIS)
    S121
    $300.00
    $500.00
    M187
    $200.00
    P-ORAL DRUGS
    M187
    $50.00
    M187
    $30.00
    P014
    $93.90
    P-ORAL DRUGS
    P349
    $83.90
    $457.80
    M067
    $160.00
    P-ORAL DRUGS
    P049
    $733.50
    M067
    $160.00
    P-ORAL DRUGS
    P049
    $580.55
    M067
    $160.00
    P-ORAL DRUGS
    P049
    $1,290.00
    P-ORAL DRUGS
    P049
    $247.95
    $3,332.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D151
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D151
    W ANESTHESIA
    $165.00
    & POST OPER
    $250.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $760.75
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $2,082.00
    $2,952.75
    M019
    $400.00
    BIOPSY, SUPERFICIAL
    M019
    $400.00
    M019
    $200.00
    ABORATORY
    M019
    $500.00
    P-ORAL DRUGS
    P492
    $170.50
    P-ORAL DRUGS
    P492
    $70.95
    M194
    $100.00
    P-INJECTABLES
    M194
    $25.00
    P-INJECTABLES
    M194
    $115.00
    P-ORAL DRUGS
    M194
    $60.00
    P-ORAL DRUGS
    P154
    $191.50
    P-ORAL DRUGS
    M194
    $80.00
    P-ORAL DRUGS
    P154
    $59.70
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D196
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D196
    W ANESTHESIA
    $115.00
    & POST OPER
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D196
    ROOT$660.00
    PLANING, SCALING, EACH
    DIAGNOSTIC: INITIAL ORAL EXAM D259
    (EXCLUDE X-RAY)
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D259
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D259
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D259
    TIMES (EXCLUDE
    $80.00
    PROPHYLAXIS)

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES
    P-INJECTABLES
    P-ORAL DRUGS

    P-ORAL DRUGS
    P-ORAL DRUGS
    P-INJECTABLES

    P-ORAL DRUGS
    P-INJECTABLES

    P-INJECTABLES
    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES
    P-ORAL DRUGS

    P-ORAL DRUGS

    COMPLETE EXAMINATION

    P-ORAL DRUGS

    ABORATORY
    ABORATORY

    P-INJECTABLES
    P-ORAL DRUGS

    P-INJECTABLES

    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    S346
    P240
    L013
    O065
    M304
    P215
    M873
    M873
    M395
    L020
    M395
    M580
    M580
    M580
    M580
    M580
    M580
    M580

    $3,732.65
    $100.00
    $20.00
    $20.00
    $100.00
    $20.00
    $40.00
    $100.00
    $25.00
    $15.00
    $20.00
    $100.00
    $20.00
    $20.00
    $20.00
    $100.00
    $20.00
    $20.00
    $100.00
    $25.00
    $15.00
    $20.00
    $100.00
    $20.00
    $40.00
    $100.00
    $20.00
    $20.00
    $100.00
    $20.00
    $60.00
    $200.00
    $466.00
    $3,400.00
    $5,466.00
    $150.00
    $150.00
    $185.00
    $135.00
    $200.00
    $10.00
    $530.00
    $200.00
    $240.00
    $20.00
    $460.00
    $100.00
    $400.00
    $100.00
    $200.00
    $200.00
    $700.00
    $200.00

    P-ORAL DRUGS

    P-INJECTABLES
    ABORATORY
    P-ORAL DRUGS

    P-INJECTABLES

    P-ORAL DRUGS

    P-INJECTABLES
    ABORATORY
    P-ORAL DRUGS

    ABORATORY
    P-ORAL DRUGS
    ABORATORY

    P-INJECTABLES
    ABORATORY

    P-INJECTABLES
    ABORATORY

    P-ORAL DRUGS

    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M769
    M769

    COMPLETE EXAMINATION
    O170
    MATERIALS: FRAMES
    O170
    MATERIALS: LENS, EACH-SINGLE VISION
    O170
    COMPLETE EXAMINATION
    O001
    MATERIALS: FRAMES
    O001
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001

    ABORATORY
    P-ORAL DRUGS

    P-ORAL DRUGS

    COMPLETE EXAMINATION
    SLT-OFFICE
    ABORATORY

    L140
    P049
    M657
    P049

    O001
    S375
    O156
    S375
    P-ORAL DRUGS
    P472
    S375
    P-ORAL DRUGS
    P487
    P-ORAL DRUGS
    P472
    O156
    EYE: OTHER CUTTING OPERATION S375

    $500.00
    $200.00
    $900.00
    $300.00
    $300.00
    $200.00
    $100.00
    $200.00
    $100.00
    $4,700.00
    $180.00
    $80.00
    $60.00
    $150.00
    $450.00
    $420.00
    $160.00
    $1,730.00
    $150.00
    $80.00
    $210.00
    $150.00
    $80.00
    $60.00
    $150.00
    $4,110.00
    $150.00
    $70.00
    $220.00
    $90.00
    $557.87
    $1,752.88
    $2,400.75
    $110.00
    $1,284.00
    $1,320.00
    $2,714.00
    $1,640.00
    $4,638.50
    $300.00
    $6,024.45
    $12,602.95
    $110.00
    $500.00
    $500.00
    $5,000.00
    $97.85
    $200.00
    $216.94
    $201.00
    $500.00
    $5,000.00
    $12,325.79

    S319
    L034
    ABORATORY
    L074
    P-ORAL DRUGS
    P332
    P-ORAL DRUGS
    P332
    H011
    H011
    M151
    UTERUS: COMPLETE REMOVAL W/OS319
    REMOVAL

    $620.00
    $400.00
    $70.00
    $90.00
    $60.00
    $1,800.00
    $7,560.00
    $1,500.00
    OF
    $8,000.00
    TUBES OR OVARIES
    $20,100.00
    S199
    $300.00
    $300.00
    COMPLETE EXAMINATION
    O004
    $100.00
    $100.00
    M463
    $200.00
    M463
    $600.00
    ABSCESSES, BOILS & CARBUNCLES:
    M463
    INCISION FOR$800.00
    DRAINAGE W/O HOSPITAL
    M327
    $280.00
    L034
    $400.00
    P-ORAL DRUGS
    P014
    $76.95
    P-ORAL DRUGS
    P014
    $2.25
    P-ORAL DRUGS
    P475
    $75.00
    $2,434.20
    PREVENTIVE: DENTAL PROPHYLAXIS
    D310
    $450.00
    $450.00
    M312
    $100.00
    P-ORAL DRUGS
    H003
    $159.08
    H003
    $120.00
    P-ORAL DRUGS
    P360
    $105.65
    IT-HOSPITAL
    H003
    $200.00
    SLT-OFFICE
    S375
    $200.00
    P-ORAL DRUGS
    P360
    $442.25
    M140
    $150.00
    P-ORAL DRUGS
    P360
    $198.00
    ABORATORY
    L126
    $300.00
    ABORATORY
    L126
    $310.00
    P-ORAL DRUGS
    P360
    $236.35
    M857
    $100.00
    ABORATORY
    H003
    $175.00
    SLT-OFFICE
    S375
    $200.00
    P-ORAL DRUGS
    P104
    $443.25
    $3,439.58
    S433
    $300.00
    $300.00
    M211
    $200.00
    ABORATORY
    M211
    $300.00
    L149
    $150.00
    P-ORAL DRUGS
    P014
    $79.00
    $729.00
    M297
    $240.00
    P-INJECTABLES
    M297
    $580.00
    ABORATORY
    L116
    $1,020.00
    P-ORAL DRUGS
    P404
    $465.40

    $300.00
    $70.00
    $2,675.40
    M657
    $200.00
    P-ORAL DRUGS
    P005
    $709.35
    $909.35
    M215
    $500.00
    ABORATORY
    M215
    $50.00
    H023
    $600.00
    P-ORAL DRUGS
    P031
    $81.06
    M215
    $250.00
    P-INJECTABLES
    M215
    $25.00
    P-INJECTABLES
    M215
    $75.00
    IT-HOSPITAL
    H023
    $375.00
    P-INJECTABLES
    H023
    $75.00
    P-ORAL DRUGS
    H023
    $52.28
    P-ORAL DRUGS
    P031
    $6.30
    $2,089.64
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D426
    X-RAY, SINGLE
    $70.00
    VIEW
    ORAL SURGERY: SURGICAL REMOVAL
    D426
    OF ERUPTED
    $140.00
    TOOTH
    $210.00
    S103
    $800.00
    L013
    $550.00
    $1,350.00
    DIAGNOSTIC: INITIAL ORAL EXAM D113
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D113
    X-RAY, SINGLE
    $105.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D113
    X-RAY, SINGLE
    $135.00
    VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D113CAVITY $500.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D113CAVITY $400.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D113CAVITY $1,050.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D113 SURFACE $600.00
    CAVITY
    ORAL SURGERY: SURGICAL REMOVAL
    D113
    OF ERUPTED
    $1,365.00
    TOOTH
    OTHER
    P014
    $38.85
    S091
    $160.00
    P-INJECTABLES
    S091
    $230.00
    S091
    $160.00
    P-INJECTABLES
    S091
    $370.00
    ESAR/EXTRA UT
    S122
    $80.00
    ESAR/EXTRA UT
    S122
    $220.00
    ESAR/EXTRA UT
    S122
    $160.00
    ESAR/EXTRA UT
    S122
    $40.00
    ESAR/EXTRA UT
    H011
    $560.00
    ESAR/EXTRA UT
    H011
    $1,840.00
    ESAR/EXTRA UT
    H011
    $2,180.00
    ESAR/EXTRA UT
    H011
    $480.00
    ESAR/EXTRA UT
    H011
    $842.72
    ESAR/EXTRA UT
    H011
    $210.68
    ESAR/EXTRA UT
    H011
    $1,432.28
    ESAR/EXTRA UT
    H011
    $279.32
    ESAR/EXTRA UT
    H011
    $7,225.00
    ESAR/EXTRA UT
    H011
    $2,775.00
    ESAR/EXTRA UT
    H011
    $2,000.00
    ESAR/EXTRA UT
    H011
    $500.00

    P-ORAL DRUGS

    L116
    P404

    S091
    S091
    S091
    S091
    S091
    COMPLETE EXAMINATION
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    S091
    P-INJECTABLES
    S091

    P-INJECTABLES
    P-INJECTABLES

    P-ORAL DRUGS
    P-ORAL DRUGS

    P066
    P066

    P-ORAL DRUGS
    ABORATORY

    M068
    M068
    P436
    H005

    P-ORAL DRUGS
    ABORATORY
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS
    P-ORAL DRUGS

    M248
    P005
    M304
    P066
    P005
    P005
    P005
    P001
    P487
    P001
    P094

    COMPLETE EXAMINATION
    O004
    MATERIALS: FRAMES
    O004
    MATERIALS: LENS, EACH-TRI-FOCAL
    O004
    M248
    COMPLETE EXAMINATION
    O030
    MATERIALS: FRAMES
    O030
    MATERIALS: LENS, EACH-TRI-FOCAL
    O030

    COMPLETE EXAMINATION

    S375
    S375

    M183
    M183
    M183
    M183
    ABORATORY
    M183
    ABORATORY
    M183
    M706
    M706
    L174
    MATERIALS: FRAMES
    O168
    MATERIALS: LENS, EACH-BI-FOCALO168

    P-INJECTABLES
    P-INJECTABLES

    $160.00
    $25.00
    $205.00
    $160.00
    $370.00
    $100.00
    $776.00
    $160.00
    $230.00
    $28,204.85
    $849.15
    $849.15
    $1,698.30
    $600.00
    $250.00
    $361.99
    $350.00
    $1,561.99
    $140.00
    $413.37
    $490.00
    $312.00
    $811.52
    $811.52
    $347.31
    $903.80
    $36.00
    $1,342.14
    $150.00
    $5,757.66
    $100.00
    $1,356.00
    $1,356.00
    $2,812.00
    $140.00
    $100.00
    $2,605.50
    $1,552.50
    $4,398.00
    $5,000.00
    $200.00
    $5,200.00
    $200.00
    $25.00
    $25.00
    $300.00
    $70.00
    $400.00
    $100.00
    $100.00
    $160.00
    $1,040.00
    $1,050.00

    $3,470.00
    $140.00
    $1,020.35
    $35.00
    $280.00
    $1,265.39
    $300.00
    $760.70
    $300.00
    $50.00
    $110.00
    $300.00
    $120.00
    $160.00
    $140.00
    $60.00
    $113.75
    $162.50
    $140.00
    $55.00
    $283.40
    $99.60
    $750.00
    $300.00
    $280.00
    $552.07
    $363.85
    $140.00
    $560.36
    $140.00
    $312.88
    $66.50
    $141.70
    $860.00
    $5,540.00
    $450.00
    $180.00
    $871.00
    $240.00
    $450.00
    $55.00
    $18,149.05
    PREVENTIVE: DENTAL PROPHYLAXIS
    D388
    $200.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D86
    W ANESTHESIA
    $85.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D86
    W ANESTHESIA
    $365.00
    & POST OPER
    PROSTHETICS: PART LOWER ACRYLIC
    D86DENT W LINGUAL
    $450.00
    BAR 2 CLASP W REST
    $1,100.00
    COMPLETE EXAMINATION
    O136
    $60.00
    MATERIALS: FRAMES
    O136
    $1,777.50
    MATERIALS: LENS, EACH-TRI-FOCAL
    O136
    $1,057.50
    DIAGNOSTIC: INITIAL ORAL EXAM D319
    (EXCLUDE X-RAY)
    $60.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D319
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D319
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)

    M456
    P-ORAL DRUGS
    P178
    P-ORAL DRUGS
    P057
    M456
    P-ORAL DRUGS
    P178
    M780
    P-ORAL DRUGS
    P019
    M123
    P-INJECTABLES
    M123
    P-INJECTABLES
    M123
    M123
    ABORATORY
    M123
    ABORATORY
    L070
    M456
    P-INJECTABLES
    M456
    P-ORAL DRUGS
    P057
    P-ORAL DRUGS
    P057
    M456
    P-ORAL DRUGS
    P178
    P-ORAL DRUGS
    P178
    P-ORAL DRUGS
    P178
    S086
    S086
    M456
    P-ORAL DRUGS
    P178
    P-ORAL DRUGS
    P178
    M456
    P-ORAL DRUGS
    P178
    M456
    P-ORAL DRUGS
    P005
    P-ORAL DRUGS
    P178
    P-ORAL DRUGS
    P178
    CROWN & BRIDGE: ACRYLIC JACKET
    D25
    CROWN
    CROWN & BRIDGE: ACRYLIC JACKET
    D25
    CROWN
    M123
    ABORATORY
    M123
    P-ORAL DRUGS
    P178
    P-INJECTABLES
    M123
    M123
    P-ORAL DRUGS
    P178

    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4


    D319
    TIMES (EXCLUDE
    $30.00
    PROPHYLAXIS)
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D319
    ROOT
    $1,600.00
    PLANING, SCALING, EACH
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D319VIEW
    $120.00
    $5,075.00
    MATERIALS: FRAMES
    O076
    $805.50
    MATERIALS: LENS, EACH-BI-FOCALO076
    $425.50
    M779
    $140.00
    P-INJECTABLES
    M779
    $25.00
    P-INJECTABLES
    M779
    $275.00
    P-ORAL DRUGS
    M779
    $60.00
    P-ORAL DRUGS
    P394
    $177.50
    DIAGNOSTIC: INITIAL ORAL EXAM D60
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $70.00
    VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $50.00
    VIEW
    ENDODONTICS: EXTIRPATION OF PULP
    D60 & FILL 1 ROOT
    $800.00
    CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D60 SURFACE $300.00
    CAVITY
    CROWN & BRIDGE: PORCELAIN JACKET
    D60 CROWN $2,700.00
    $5,878.50
    DIAGNOSTIC: INITIAL ORAL EXAM D275
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D275VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D275VIEW
    $15.00
    ORAL SURGERY: SURGICAL REMOVAL
    D275
    OF TOOTH W
    $300.00
    SOFT TISSUE IMPACTION
    OTHER
    P489
    $148.90
    $548.90
    COMPLETE EXAMINATION
    O076
    $75.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O076
    $1,200.00
    MATERIALS: FRAMES
    O169
    $1,095.00
    $2,370.00
    M353
    $150.00
    $150.00
    COMPLETE EXAMINATION
    O007
    $100.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O007
    $1,350.00
    $1,450.00
    COMPLETE EXAMINATION
    O026
    $200.00
    MATERIALS: LENS, EACH-BI-FOCALO037
    $400.00
    MATERIALS: FRAMES
    O037
    $440.00
    S245
    $300.00
    ABORATORY
    H026
    $585.00
    P-ORAL DRUGS
    P014
    $174.00
    P-ORAL DRUGS
    P014
    $180.00
    $2,279.00
    M773
    $300.00
    P-ORAL DRUGS
    P011
    $28.50
    $328.50
    COMPLETE EXAMINATION
    O004
    $100.00
    $100.00
    M045
    $150.00
    P-ORAL DRUGS
    P342
    $30.00
    $180.00
    DIAGNOSTIC: INITIAL ORAL EXAM D60
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D60X-RAY, SINGLE
    $360.00
    VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D60 CAVITY $200.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D60
    $400.00

    ENDODONTICS: EXTIRPATION OF PULP


    D60 & FILL 1 ROOT
    $800.00
    CANAL (EX RESTOR)
    PERIODONTICS: GINGIVECTOMY, SURGICAL,
    D60
    PER QUADRANT
    $100.00
    W POST OPER
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D60 SURFACE $175.00
    CAVITY
    OTHER
    D60
    $175.00
    CROWN & BRIDGE: ACRYLIC JACKET
    D60
    CROWN
    $2,500.00
    H026
    $250.00
    ABORATORY
    H025
    $60.00
    H025
    $240.00
    H025
    $260.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D60 CAVITY $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D60 CAVITY $330.00
    $6,100.00
    M378
    $350.00
    S356
    $300.00
    S356
    $2,400.00
    S323
    $100.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D119CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D119CAVITY $360.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D119
    $400.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D119VIEW
    $120.00
    ORTHODONTICS: INITIAL ORTHO APPLIANCE
    D38
    W 6 MONTHS
    $900.00 TREATMENT
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D119 SURFACE $500.00
    CAVITY
    ABORATORY
    L96
    $700.00
    $6,270.00
    S298
    $260.00
    S298
    $360.00
    P-ORAL DRUGS
    P505
    $81.90
    $701.90
    T068
    $1,080.00
    M375
    $200.00
    ABORATORY
    M375
    $460.00
    M375
    $160.00
    ABORATORY
    M375
    $500.00
    L97
    $400.00
    $2,800.00
    M262
    $200.00
    P-INJECTABLES
    M262
    $25.00
    P-INJECTABLES
    M262
    $75.00
    M262
    $200.00
    P-INJECTABLES
    M262
    $25.00
    P-INJECTABLES
    M262
    $75.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D137
    $380.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D137CAVITY $300.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D137CAVITY $780.00
    M262
    $200.00
    $2,260.00
    S277
    $400.00
    ABORATORY
    H006
    $120.00
    S277
    $400.00
    ABORATORY
    H006
    $1,170.00
    $2,090.00
    S220
    $220.00
    O156
    $500.00

    COMPLETE EXAMINATION
    O156
    $100.00
    COMPLETE EXAMINATION
    O156
    $200.00
    MATERIALS: FRAMES
    O156
    $1,075.50
    MATERIALS: LENS, EACH-TRI-FOCAL
    O156
    $389.60
    MATERIALS: LENS, EACH-TRI-FOCAL
    O156
    $483.40
    M076
    $250.00
    P-INJECTABLES
    M076
    $75.00
    P-ORAL DRUGS
    P011
    $75.00
    SLT-OFFICE
    S286
    $300.00
    M076
    $250.00
    ABSCESSES, BOILS & CARBUNCLES:
    M076
    INCISION FOR$750.00
    DRAINAGE W/O HOSPITAL
    M076
    $200.00
    M076
    $50.00
    $4,918.50
    MATERIALS: FRAMES
    Missing
    $350.00
    $350.00
    M230
    $240.00
    M230
    $60.00
    P-ORAL DRUGS
    M230
    $300.00
    P-ORAL DRUGS
    P475
    $65.00
    P-ORAL DRUGS
    P475
    $125.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D90
    $300.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D90
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D90
    TIMES$130.00
    (EXCLUDE PROPHYLAXIS)
    M230
    $240.00
    M230
    $60.00
    P-INJECTABLES
    M230
    $160.00
    P-INJECTABLES
    M230
    $25.00
    P-INJECTABLES
    M230
    $15.00
    P-ORAL DRUGS
    P475
    $11.00
    P-ORAL DRUGS
    P475
    $94.00
    M230
    $240.00
    M230
    $60.00
    M230
    $300.00
    P-ORAL DRUGS
    P475
    $30.00
    P-ORAL DRUGS
    P475
    $156.00
    P-ORAL DRUGS
    P475
    $39.00
    S356
    $300.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D90
    $350.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D90
    $350.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D90 CAVITY $1,200.00
    ABORATORY
    H005
    $2,400.00
    M230
    $300.00
    M230
    $300.00
    P-ORAL DRUGS
    P337
    $720.80
    $8,640.80
    M326
    $200.00
    ABORATORY
    M326
    $50.00
    P-ORAL DRUGS
    P011
    $84.00
    $334.00
    M657
    $100.00
    $100.00
    M164
    $100.00

    P-ORAL DRUGS
    P-ORAL DRUGS

    P169
    P169

    $25.00
    $30.00
    $155.00
    PROSTHETICS: ADD TOOTH TO PRTD228
    DENT REPL EXTR
    $500.00
    TOOTH W/O CLSP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D228
    W ANESTHESIA
    $350.00
    & POST OPER
    $850.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D103CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D103CAVITY $250.00
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    $850.00
    M754
    $200.00
    ABORATORY
    P167
    $1,400.00
    P-ORAL DRUGS
    P167
    $150.00
    $1,750.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D208VIEW
    $35.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D208VIEW
    $25.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D208 SURFACE $550.00
    CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D297VIEW
    $70.00
    ORAL SURGERY: SURGICAL REMOVAL
    D297
    OF TOOTH W
    $250.00
    SOFT TISSUE IMPACTION
    S060
    $260.00
    ABORATORY
    S060
    $20.00
    P-ORAL DRUGS
    P045
    $45.00
    P-ORAL DRUGS
    P045
    $260.00
    $1,515.00
    M317
    $120.00
    P-ORAL DRUGS
    M317
    $100.00
    H034
    $400.00
    P-ORAL DRUGS
    P168
    $199.50
    $819.50
    COMPLETE EXAMINATION
    O006
    $75.00
    MATERIALS: FRAMES
    O006
    $1,075.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O006
    $350.00
    $1,500.00
    S301
    $200.00
    SLT-OFFICE
    S114
    $400.00
    $600.00
    M304
    $185.00
    L97
    $600.00
    M211
    $300.00
    M211
    $400.00
    $1,485.00
    S274
    $140.00
    SCARRIAGE
    M700
    $140.00
    SCARRIAGE
    L035
    $195.00
    ENATAL CARE
    S274
    $420.00
    ENATAL CARE
    M700
    $300.00
    $1,195.00
    COMPLETE EXAMINATION
    O001
    $110.00
    P104
    $71.60
    $181.60
    PREVENTIVE: DENTAL PROPHYLAXIS
    D228
    $250.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D228
    TIMES (EXCLUDE
    $70.00
    PROPHYLAXIS)

    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4


    D228
    TIMES (EXCLUDE
    $80.00
    PROPHYLAXIS)
    OTHER
    P057
    $65.00
    $465.00
    M412
    $200.00
    P-ORAL DRUGS
    P237
    $42.99
    $242.99
    M078
    $100.00
    ABORATORY
    L006
    $400.00
    $500.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,116.00
    $1,216.00
    M375
    $160.00
    L079
    $400.00
    $560.00
    ENATAL CARE
    S371
    $300.00
    ENATAL CARE
    S371
    $3,000.00
    ENATAL CARE
    M729
    $600.00
    ENATAL CARE
    H010
    $1,800.00
    $5,700.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D160
    ROOT$170.00
    PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D160
    ROOT$230.00
    PLANING, SCALING, EACH
    DIAGNOSTIC: INITIAL ORAL EXAM D160
    (EXCLUDE X-RAY)
    $100.00
    M626
    $300.00
    ABORATORY
    M626
    $20.00
    M829
    $350.00
    $1,170.00
    M067
    $160.00
    P-ORAL DRUGS
    P049
    $869.40
    MM06
    $285.00
    M067
    $460.00
    P-INJECTABLES
    M067
    $40.00
    M067
    $300.00
    P-ORAL DRUGS
    P049
    $571.40
    ABORATORY
    L020
    $740.00
    M067
    $240.00
    P-ORAL DRUGS
    M067
    $40.00
    P-ORAL DRUGS
    P049
    $124.95
    M067
    $240.00
    M183
    $400.00
    $4,470.75
    COMPLETE EXAMINATION
    O004
    $250.00
    MATERIALS: FRAMES
    O004
    $1,516.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $2,056.00
    $3,822.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,165.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $2,265.50
    $3,521.00
    M152
    $150.00
    P-INJECTABLES
    M152
    $25.00
    P-INJECTABLES
    M152
    $105.00
    S242
    $250.00

    P-ORAL DRUGS

    P008

    $204.60
    $734.60
    M138
    $100.00
    P-INJECTABLES
    M138
    $25.00
    P-INJECTABLES
    M138
    $55.00
    M371
    $100.00
    P-INJECTABLES
    M371
    $25.00
    P-INJECTABLES
    M371
    $75.00
    M371
    $100.00
    P-INJECTABLES
    M371
    $25.00
    P-INJECTABLES
    M371
    $15.00
    $520.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $556.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $260.00
    M346
    $200.00
    P-INJECTABLES
    M346
    $240.00
    L126
    $150.00
    H006
    $1,200.00
    ABORATORY
    H006
    $50.00
    SLT-OFFICE
    S239
    $400.00
    L149
    $150.00
    P-ORAL DRUGS
    P049
    $119.00
    S239
    $5,000.00
    P-ORAL DRUGS
    P115
    $35.00
    P-ORAL DRUGS
    P115
    $64.50
    S245
    $400.00
    P-ORAL DRUGS
    P014
    $212.00
    P-ORAL DRUGS
    P014
    $109.20
    $9,245.70
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $870.75
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,134.25
    M229
    $160.00
    P-ORAL DRUGS
    P022
    $220.50
    $2,495.50
    M411
    $130.00
    ABORATORY
    M411
    $30.00
    P-ORAL DRUGS
    P115
    $43.50
    $203.50
    M353
    $150.00
    P-ORAL DRUGS
    P115
    $48.75
    P-ORAL DRUGS
    P155
    $77.00
    $275.75
    OTHER SERVICES: EMERGENCY TREATMENT
    D59
    OF DENTAL
    $60.00
    PAIN
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D59X-RAY, SINGLE
    $80.00
    VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D59 SURFACE $590.00
    CAVITY
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D59
    W ANESTHESIA
    $150.00
    & POST OPER
    $880.00
    DIAGNOSTIC: INITIAL ORAL EXAM D111
    (EXCLUDE X-RAY)
    $180.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D111
    $395.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D111
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D111CAVITY $960.00

    DIAGNOSTIC: BITEWING X-RAY, SINGLE


    D111VIEW
    $360.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D111CAVITY $1,040.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D111 SURFACE $700.00
    CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM D111
    (EXCLUDE X-RAY)
    $180.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D111
    X-RAY, SINGLE
    $60.00
    VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D111CAVITY $649.00
    $4,624.00
    P-ORAL DRUGS
    P215
    $225.00
    ABORATORY
    O015
    $150.00
    MATERIALS: FRAMES
    O015
    $1,216.00
    O015
    $604.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O015
    $1,184.00
    O015
    $1,516.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D218CAVITY $360.00
    P-ORAL DRUGS
    S280
    $195.00
    DIAGNOSTIC: INITIAL ORAL EXAM D103
    (EXCLUDE X-RAY)
    $140.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D103
    $320.00
    COMPLETE EXAMINATION
    O033
    $230.00
    P-ORAL DRUGS
    P215
    $360.00
    OPERATIVE: AMALGAM FILL 3 OR MORE
    D103 SURFACE $400.00
    CAVITY
    P-ORAL DRUGS
    P215
    $306.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D218
    $120.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D218
    TIMES$120.00
    (EXCLUDE PROPHYLAXIS)
    M437
    $200.00
    ABORATORY
    M437
    $50.00
    ABORATORY
    L070
    $108.00
    P-ORAL DRUGS
    P215
    $215.20
    PREVENTIVE: DENTAL PROPHYLAXIS
    D218
    $200.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D218
    TIMES$120.00
    (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D218
    $100.00
    P-ORAL DRUGS
    P215
    $306.00
    S313
    $300.00
    P-INJECTABLES
    S313
    $25.00
    P-INJECTABLES
    S313
    $375.00
    S313
    $350.00
    P-ORAL DRUGS
    P215
    $111.60
    $9,906.80
    S256
    $350.00
    S256
    $180.00
    $530.00
    M189
    $140.00
    P-ORAL DRUGS
    P115
    $49.00
    $189.00
    M095
    $160.00
    P-ORAL DRUGS
    P231
    $70.00
    ABORATORY
    L001
    $420.00
    $650.00
    S052
    $300.00
    $300.00
    M766
    $200.00
    M766
    $200.00
    $400.00
    DIAGNOSTIC: INITIAL ORAL EXAM D119
    (EXCLUDE X-RAY)
    $50.00

    DIAGNOSTIC: BITEWING X-RAY, SINGLE


    D119VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D119VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D119
    M060
    P-ORAL DRUGS
    P011

    $70.00
    $50.00
    $400.00
    $200.00
    $67.00
    $837.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D64 VIEW
    $50.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D64 CAVITY $180.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D64 CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D64 CAVITY
    $30.00
    $400.00
    P456
    $300.00
    ABORATORY
    P456
    $300.00
    P-ORAL DRUGS
    P014
    $170.05
    $770.05
    S319
    $970.00
    P-ORAL DRUGS
    S319
    $260.00
    L034
    $400.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $1,276.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $1,395.00
    M115
    $100.00
    P-INJECTABLES
    M155
    $30.00
    P-ORAL DRUGS
    M115
    $70.00
    L046
    $300.00
    $4,891.00
    M774
    $300.00
    ABORATORY
    L070
    $607.00
    P-ORAL DRUGS
    P005
    $1,217.28
    $2,124.28
    MATERIALS: FRAMES
    O002
    $1,295.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O002
    $500.00
    $1,795.00
    M316
    $100.00
    P-ORAL DRUGS
    P014
    $19.45
    P-ORAL DRUGS
    P014
    $63.30
    M103
    $140.00
    P-ORAL DRUGS
    P076
    $111.95
    P-ORAL DRUGS
    P408
    $6.00
    $440.70
    S165
    $300.00
    P-ORAL DRUGS
    P351
    $663.70
    $963.70
    M662
    $100.00
    P-INJECTABLES
    M662
    $25.00
    P-INJECTABLES
    M662
    $35.00
    MATERIALS: FRAMES
    O169
    $675.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O169
    $1,975.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D59
    BITEWING X-RAYS
    $133.00
    DIAGNOSTIC: COMPLETE SERIES OF
    D257
    BITEWING X-RAYS
    $147.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D257CAVITY $400.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D257
    $500.00
    $3,990.00

    OPERATIVE: AMALGAM FILL 1 SURFACE


    D59 CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D59 CAVITY
    COMPLETE EXAMINATION
    O004
    MATERIALS: FRAMES
    O004
    MATERIALS: LENS, EACH-SINGLE VISION
    O004

    ABORATORY

    M099
    L070

    P-ORAL DRUGS

    H034
    P456

    P-INJECTABLES
    P-INJECTABLES
    ABORATORY
    ABORATORY

    P-INJECTABLES
    P-INJECTABLES
    ABORATORY

    P-ORAL DRUGS

    P-INJECTABLES
    P-INJECTABLES

    P-INJECTABLES
    P-INJECTABLES

    P-INJECTABLES
    P-INJECTABLES

    P-ORAL DRUGS
    P-ORAL DRUGS

    P-ORAL DRUGS

    COMPLETE EXAMINATION

    P-INJECTABLES
    P-ORAL DRUGS
    SLT-OFFICE
    ABORATORY

    M014
    M014
    M014
    M014
    L065
    M014
    M014
    M014
    M014
    M014
    L034
    P332
    M014
    M014
    M014
    M014
    M014
    M014
    S114
    S114
    S114
    L117
    S187
    M325
    P477
    P457
    S187
    P477
    S187
    S187
    O001
    M194
    M194
    M194
    S079
    L013

    $200.00
    $780.00
    $980.00
    $100.00
    $1,516.00
    $2,056.00
    $3,672.00
    $120.00
    $250.00
    $370.00
    $300.00
    $78.99
    $378.99
    $140.00
    $25.00
    $95.00
    $120.00
    $180.00
    $140.00
    $25.00
    $55.00
    $120.00
    $140.00
    $400.00
    $57.50
    $140.00
    $25.00
    $55.00
    $140.00
    $25.00
    $95.00
    $1,977.50
    $1,600.00
    $50.00
    $50.00
    $3,800.00
    $5,500.00
    $200.00
    $140.00
    $32.95
    $114.00
    $250.00
    $48.50
    $200.00
    $1,600.00
    $2,585.45
    $110.00
    $110.00
    $200.00
    $300.00
    $150.00
    $300.00
    $175.00

    P-ORAL DRUGS
    P-ORAL DRUGS

    P479
    P136
    M580
    M580
    M580

    $127.80
    $29.40
    $100.00
    P-ORAL DRUGS
    $100.00
    P-INJECTABLES
    $500.00
    $1,982.20
    M581
    $150.00
    ABORATORY
    L124
    $740.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D27
    $680.00
    M115
    $200.00
    ABORATORY
    M115
    $30.00
    P-INJECTABLES
    M115
    $50.00
    P-ORAL DRUGS
    M115
    $40.00
    ABORATORY
    L172
    $520.00
    P-INJECTABLES
    M115
    $20.00
    $2,430.00
    S367
    $920.00
    ABORATORY
    S367
    $500.00
    M657
    $200.00
    L034
    $650.00
    P-ORAL DRUGS
    P014
    $139.65
    P-ORAL DRUGS
    P014
    $31.50
    $2,441.15
    M213
    $100.00
    P-INJECTABLES
    M213
    $20.00
    M213
    $100.00
    P-INJECTABLES
    M213
    $20.00
    M213
    $200.00
    P-ORAL DRUGS
    M213
    $20.00
    M213
    $200.00
    P-ORAL DRUGS
    M213
    $20.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D248VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D248VIEW
    $90.00
    ORAL SURGERY: SURGICAL REMOVAL
    D248
    OF TOOTH W
    $300.00
    SOFT TISSUE IMPACTION
    $1,140.00
    ABDOMEN: OPERATION ON GALL BLADDER
    S232
    $5,400.00
    ABDOMEN: OPERATION ON GALL BLADDER
    S232
    $2,600.00
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,196.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $396.00
    $9,692.00
    S232
    $300.00
    M304
    $200.00
    ABORATORY
    M304
    $525.00
    $1,025.00
    DIAGNOSTIC: INITIAL ORAL EXAM D35
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D35
    $450.00
    DIAGNOSTIC: INITIAL ORAL EXAM D35
    (EXCLUDE X-RAY)
    $120.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D35
    $450.00
    $1,140.00
    DIAGNOSTIC: INITIAL ORAL EXAM D125
    (EXCLUDE X-RAY)
    $80.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D125VIEW
    $70.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D125VIEW
    $140.00

    OPERATIVE: AMALGAM FILL 3 OR MORE


    D125 SURFACE $400.00
    CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    D125
    $280.00
    $970.00
    H047
    $700.00
    IT-HOSPITAL
    H006
    $450.00
    H006
    $400.00
    $1,550.00
    ENATAL CARE
    S311
    $800.00
    ENATAL CARE
    S311
    $600.00
    $1,400.00
    ENATAL CARE
    M841
    $1,500.00
    S244
    $300.00
    S244
    $400.00
    $2,200.00
    M056
    $150.00
    P-ORAL DRUGS
    M056
    $50.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D342
    $300.00
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D342
    TREATMENT
    $1,000.00 AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D342
    TREATMENT
    $3,500.00 AFTER 1ST 6 MONTHS
    $5,000.00
    S112
    $300.00
    S244
    $300.00
    S244
    $300.00
    M473
    $140.00
    P-ORAL DRUGS
    P031
    $27.45
    $1,067.45
    S019
    $260.00
    S019
    $520.00
    P-ORAL DRUGS
    P055
    $83.10
    S019
    $260.00
    $1,123.10
    M056
    $150.00
    P-ORAL DRUGS
    M056
    $20.00
    IT-HOSPITAL
    H005
    $455.00
    H005
    $170.40
    H005
    $200.00
    P-ORAL DRUGS
    P122
    $87.99
    $1,083.39
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D102CAVITY $100.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D102CAVITY $150.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D102CAVITY
    $50.00
    $300.00
    COMPLETE EXAMINATION
    O076
    $90.00
    MATERIALS: FRAMES
    O076
    $625.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O076
    $2,155.50
    M759
    $100.00
    $2,971.00
    S247
    $200.00
    P-ORAL DRUGS
    P031
    $34.86
    P-ORAL DRUGS
    P005
    $976.49
    PREVENTIVE: DENTAL PROPHYLAXIS
    D150
    $350.00
    S302
    $400.00
    ABORATORY
    S302
    $200.00

    P-ORAL DRUGS
    ABORATORY

    P-ORAL DRUGS
    P-ORAL DRUGS

    P-ORAL DRUGS

    P-ORAL DRUGS
    P-ORAL DRUGS

    P-ORAL DRUGS

    IT-HOSPITAL

    P-ORAL DRUGS
    P-ORAL DRUGS

    ABORATORY

    IT-HOSPITAL

    ABORATORY
    P-ORAL DRUGS

    P-ORAL DRUGS

    ABORATORY
    P-ORAL DRUGS
    IT-HOSPITAL

    P-ORAL DRUGS

    P-ORAL DRUGS

    P-ORAL DRUGS
    P-INJECTABLES

    P-INJECTABLES
    P-ORAL DRUGS
    ORAL

    P031
    L070
    S247
    P005
    P343

    $246.48
    $540.00
    $200.00
    $1,952.98
    $128.20
    $5,229.01
    P005
    $476.25
    M817
    $250.00
    M437
    $500.00
    L96
    $700.00
    P005
    $317.50
    P005
    $635.00
    $2,878.75
    M026
    $220.00
    S042
    $1,600.00
    L006
    $300.00
    P031
    $424.30
    $2,544.30
    H011
    $550.00
    H011
    $258.00
    H011
    $15.00
    P003
    $83.00
    M706
    $100.00
    M706
    $305.00
    L091
    $510.00
    H011
    $550.00
    H011
    $24.00
    H011
    $725.00
    P049
    $132.55
    $3,252.55
    S194
    $300.00
    S194
    $300.00
    H008
    $150.00
    P315
    $326.00
    L013
    $3,600.00
    L070
    $650.00
    P005
    $2,681.97
    S194
    $1,000.00
    L070
    $200.00
    L070
    $180.00
    M035
    $200.00
    P315
    $75.00
    S194
    $300.00
    P309
    $239.40
    M035
    $200.00
    $10,402.37
    M166
    $140.00
    M166
    $180.00
    M166
    $60.00
    M166
    $140.00
    M166
    $100.00
    M166
    $80.00
    SURGERY: SIMPLE TOOTH EXTRACTION
    D257
    W ANESTHESIA
    $130.00
    & POST OPER

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION


    D257
    W ANESTHESIA
    $270.00
    & POST OPER
    $1,100.00
    M035
    $200.00
    M035
    $200.00
    ABORATORY
    L070
    $780.00
    DIAGNOSTIC: INITIAL ORAL EXAM D120
    (EXCLUDE X-RAY)
    $70.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D120
    $300.00
    S242
    $250.00
    S242
    $350.00
    S242
    $150.00
    L041
    $350.00
    $2,650.00
    M580
    $100.00
    P-INJECTABLES
    M580
    $400.00
    P-ORAL DRUGS
    M580
    $100.00
    $600.00
    S160
    $200.00
    M035
    $90.00
    M035
    $110.00
    $400.00
    S279
    $500.00
    ABSCESSES, BOILS & CARBUNCLES:
    S279
    INCISION FOR
    $3,000.00
    DRAINAGE W/O HOSPITAL
    P-ORAL DRUGS
    P435
    $89.59
    S001
    $700.00
    S001
    $200.00
    $4,489.59
    O156
    $200.00
    EYE: OTHER CUTTING OPERATION O156
    $1,200.00
    $1,400.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D75
    $395.00
    ENDODONTICS: EXTIRPATION OF PULP
    D75 & FILL 1 ROOT
    $700.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D75 & FILL 1 $2,250.00
    ROOT CANAL (EX RESTOR)
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    D01
    TREATMENT
    $300.00 AFTER 1ST 6 MONTHS
    S019
    $260.00
    $3,905.00
    M087
    $160.00
    P-ORAL DRUGS
    P373
    $231.00
    $391.00
    M304
    $200.00
    ABORATORY
    M304
    $40.00
    ABORATORY
    H005
    $560.00
    $800.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D303
    $300.00
    ABSCESSES, BOILS & CARBUNCLES:
    M254
    INCISION FOR
    $1,000.00
    DRAINAGE W/O HOSPITAL
    P-INJECTABLES
    M254
    $400.00
    P-ORAL DRUGS
    M254
    $400.00
    $2,100.00
    ORMAL DELIVERY
    EC01
    $2,484.00
    ORMAL DELIVERY
    EC01
    $782.40
    ORMAL DELIVERY
    EC01
    $144.00
    $3,410.40
    PREVENTIVE: DENTAL PROPHYLAXIS
    D79
    $300.00
    $300.00

    DIAGNOSTIC: INITIAL ORAL EXAM D217


    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D217VIEW
    $45.00
    ORAL SURGERY: SURGICAL REMOVAL
    D217
    OF ERUPTED
    $260.00
    TOOTH
    ORAL SURGERY: SURGICAL REMOVAL
    D217
    OF ERUPTED
    $390.00
    TOOTH
    OTHER
    P179
    $69.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D217CAVITY $560.00
    $1,374.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $1,504.50
    $1,614.50
    PREVENTIVE: DENTAL PROPHYLAXIS
    D192
    $600.00
    $600.00
    M347
    $600.00
    P-ORAL DRUGS
    P081
    $1,422.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D192
    $500.00
    M534
    $200.00
    ABORATORY
    M534
    $2,035.00
    M534
    $500.00
    ABORATORY
    M534
    $1,855.00
    L075
    $6,000.00
    H023
    $3,380.00
    S385
    $400.00
    ABORATORY
    H005
    $200.00
    $17,092.00
    COMPLETE EXAMINATION
    O001
    $110.00
    MATERIALS: FRAMES
    O001
    $1,395.00
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,740.00
    $3,245.00
    M034
    $50.00
    ABORATORY
    L006
    $155.00
    L003
    $800.00
    $1,005.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D397
    $500.00
    $500.00
    M851
    $500.00
    ABORATORY
    L172
    $1,020.00
    P-ORAL DRUGS
    P167
    $438.00
    $1,958.00
    IT-HOSPITAL
    H006
    $250.00
    H006
    $185.00
    ABORATORY
    H006
    $385.00
    $820.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D07
    $575.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D07
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    M454
    $280.00
    ABORATORY
    M454
    $684.25
    P-ORAL DRUGS
    P049
    $156.00
    ORTHODONTICS: INITIAL ORTHO APPLIANCE
    D07
    W 6$7,500.00
    MONTHS TREATMENT
    $9,295.25
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D286
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D286
    TIMES (EXCLUDE
    $25.00
    PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    D286
    $375.00
    OTHER
    P090
    $148.50

    $648.50
    M443
    $200.00
    P-ORAL DRUGS
    P073
    $1,308.06
    ABORATORY
    L070
    $460.00
    DIAGNOSTIC: INITIAL ORAL EXAM D119
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: INTRAORAL PERIAPICAL
    D119
    X-RAY, SINGLE
    $120.00
    VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    D119
    $250.00
    $2,388.06
    M375
    $280.00
    P-ORAL DRUGS
    M375
    $122.55
    ABORATORY
    L065
    $435.00
    L123
    $420.00
    S184
    $300.00
    M375
    $160.00
    P-INJECTABLES
    M375
    $60.00
    L117
    $3,800.00
    M375
    $120.00
    T032
    $1,100.00
    T032
    $1,360.00
    M375
    $160.00
    $8,317.55
    M833
    $240.00
    $240.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D60 VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D60 VIEW
    $10.00
    ORAL SURGERY: SURGICAL REMOVAL
    D60OF TOOTH W
    $300.00
    SOFT TISSUE IMPACTION
    OTHER
    P435
    $66.33
    $426.33
    DIAGNOSTIC: INITIAL ORAL EXAM D150
    (EXCLUDE X-RAY)
    $150.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D150
    $350.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D150CAVITY $200.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D150CAVITY $400.00
    $1,100.00
    S107
    $400.00
    S367
    $360.00
    S107
    $200.00
    $960.00
    COMPLETE EXAMINATION
    S367
    $360.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D305
    $400.00
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4
    D305
    TIMES$100.00
    (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM D255
    (EXCLUDE X-RAY)
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D255VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D255VIEW
    $40.00
    ORAL SURGERY: SURGICAL REMOVAL
    D255
    OF TOOTH W
    $260.00
    SOFT TISSUE IMPACTION
    $1,260.00
    M343
    $300.00
    ABORATORY
    M343
    $40.00
    ABORATORY
    L065
    $240.00
    L065
    $345.00
    $925.00
    ENDODONTICS: EXTIRPATION OF PULP
    D255& FILL 1 ROOT
    $900.00
    CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP
    D255& FILL 1 ROOT
    $950.00
    CANAL (EX RESTOR)
    $1,850.00

    $280.00
    $184.90
    $644.55
    $1,109.45
    COMPLETE EXAMINATION
    O076
    $90.00
    $90.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D427
    $400.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D427CAVITY $600.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D427CAVITY $500.00
    $1,500.00
    COMPLETE EXAMINATION
    O001
    $250.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O001
    $2,056.00
    MATERIALS: FRAMES
    O001
    $476.00
    $2,782.00
    DIAGNOSTIC: INITIAL ORAL EXAM D192
    (EXCLUDE X-RAY)
    $100.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D192VIEW
    $50.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D192VIEW
    $250.00
    PREVENTIVE: DENTAL PROPHYLAXIS
    D192
    $600.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D192CAVITY $600.00
    M473
    $240.00
    P-ORAL DRUGS
    P343
    $85.75
    ABORATORY
    L070
    $795.00
    L046
    $690.00
    P-ORAL DRUGS
    P343
    $104.00
    M473
    $150.00
    $3,664.75
    COMPLETE EXAMINATION
    O004
    $100.00
    MATERIALS: FRAMES
    O004
    $1,756.00
    MATERIALS: LENS, EACH-SINGLE VISION
    O004
    $1,016.00
    $2,872.00
    OPERATIVE: AMALGAM FILL 1 SURFACE
    D276CAVITY $1,550.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D276VIEW
    $80.00
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D276
    ROOT$200.00
    PLANING, SCALING, EACH
    $1,830.00
    P-ORAL DRUGS
    S149
    $200.00
    P-ORAL DRUGS
    S149
    $300.00
    S149
    $200.00
    P-INJECTABLES
    S149
    $100.00
    S149
    $200.00
    S393
    $200.00
    S393
    $1,000.00
    M602
    $800.00
    H027
    $400.00
    H027
    $2,300.00
    S550
    $200.00
    S550
    $200.00
    $6,100.00
    COMPLETE EXAMINATION
    O076
    $180.00
    MATERIALS: CONTACT, WHEN NOTO076
    MEDICALLY REQUIRED
    $1,200.00
    M166
    $140.00
    P-INJECTABLES
    M166
    $170.00
    ABORATORY
    M166
    $160.00
    M166
    $140.00

    P-ORAL DRUGS
    P-ORAL DRUGS

    M325
    P477
    P014

    P-INJECTABLES
    ABORATORY

    M166
    M166

    $100.00
    $600.00
    $2,690.00
    M233
    $100.00
    P-ORAL DRUGS
    M233
    $100.00
    P-INJECTABLES
    M233
    $100.00
    M233
    $100.00
    SLT-OFFICE
    S144
    $500.00
    ABORATORY
    L013
    $550.00
    ABORATORY
    L070
    $1,550.00
    SLT-OFFICE
    S115
    $300.00
    P-ORAL DRUGS
    P309
    $346.50
    PREVENTIVE: DENTAL PROPHYLAXIS
    D244
    $750.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D244VIEW
    $200.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D244VIEW
    $120.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D244CAVITY $550.00
    M233
    $100.00
    P-ORAL DRUGS
    M233
    $120.00
    S109
    $300.00
    EYE: OPERATION ON EYE, EYE MUSCLE,
    S109 OR THROUGH
    $3,400.00
    SCLERA OR CORNEA
    SLT-OFFICE
    S109
    $270.00
    MATERIALS: FRAMES
    O001
    $1,041.25
    MATERIALS: LENS, EACH-TRI-FOCAL
    O001
    $1,819.00
    $12,316.75
    M233
    $150.00
    L013
    $165.00
    L013
    $375.00
    M233
    $100.00
    $790.00
    DIAGNOSTIC: BITEWING X-RAY, SINGLE
    D253VIEW
    $50.00
    ORAL SURGERY: SURGICAL REMOVAL
    D253
    OF TOOTH W
    $500.00
    SOFT TISSUE IMPACTION
    $550.00
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D173
    W ANESTHESIA
    $260.00
    & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION
    D173
    W ANESTHESIA
    $140.00
    & POST OPER
    PERIODONTICS: SUBGINGIVAL CURETTAGE,
    D173
    ROOT$450.00
    PLANING, SCALING, EACH
    PREVENTIVE: DENTAL PROPHYLAXIS
    D173
    $350.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D173CAVITY $450.00
    $1,650.00
    S361
    $250.00
    $250.00
    ORAL SURGERY: ALVEOLECTOMY, SURG
    D90 PREP OF RIDGE
    $650.00
    FOR DENTURES/QUAD
    ORAL SURGERY: ALVEOLECTOMY, SURG
    D90 PREP OF RIDGE
    $350.00
    FOR DENTURES/QUAD
    $1,000.00
    ENATAL CARE
    M275
    $300.00
    ENATAL CARE
    M275
    $200.00
    ENATAL CARE
    M626
    $200.00
    ENATAL CARE
    M829
    $300.00
    $1,000.00
    DIAGNOSTIC: INITIAL ORAL EXAM D411
    (EXCLUDE X-RAY)
    $200.00
    COMPLETE EXAMINATION
    O033
    $100.00
    MATERIALS: FRAMES
    O033
    $1,192.50
    MATERIALS: LENS, EACH-SINGLE VISION
    O033
    $688.50
    $2,181.00

    H006

    $3,000.00
    $3,000.00
    UN01
    $150.00
    P-ORAL DRUGS
    UN01
    $345.00
    UN01
    $470.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D06 CAVITY $140.00
    OPERATIVE: AMALGAM FILL 2 SURFACE
    D06 CAVITY
    $80.00
    $1,185.00
    M026
    $220.00
    $220.00
    S266
    $400.00
    $400.00
    S049
    $900.00
    O156
    $500.00
    $1,400.00
    ###

    Beneficiary ID
    Grand Total
    748 Total
    143 Total
    54 Total
    1466 Total
    143
    935 Total
    148 Total
    536 Total
    81 Total
    972 Total
    748
    748
    1016 Total
    965 Total
    1100 Total
    1466
    756 Total
    51 Total
    1391 Total
    951 Total
    943 Total
    898 Total
    54
    841 Total
    536
    788 Total
    148
    1057 Total
    452 Total
    452
    1583 Total
    1459 Total
    143
    644 Total
    972
    914 Total
    34 Total
    1534 Total
    1391
    1466
    756
    536
    748
    80 Total
    81
    54
    1225 Total
    916 Total
    1218 Total
    148
    743 Total

    Amount
    ###
    $152,856.40
    $133,100.00
    $125,291.11
    $82,405.00
    $80,503.10
    $79,079.61
    $77,592.62
    $72,926.55
    $67,656.00
    $64,527.50
    $60,490.00
    $59,000.00
    $55,128.57
    $52,476.89
    $46,279.79
    $40,600.00
    $39,687.75
    $39,084.00
    $38,947.20
    $37,068.30
    $35,525.30
    $35,516.30
    $33,550.00
    $33,031.07
    $31,000.00
    $30,874.57
    $30,000.00
    $29,121.39
    $28,790.00
    $28,440.00
    $28,204.85
    $27,465.00
    $27,312.12
    $26,899.00
    $26,200.00
    $25,931.83
    $25,581.37
    $25,492.82
    $25,418.70
    $25,000.00
    $25,000.00
    $24,396.55
    $24,000.00
    $23,448.90
    $22,450.00
    $22,050.00
    $21,924.54
    $21,470.03
    $21,330.00
    $20,629.30
    $20,610.00

    317 Total
    1570 Total
    1016
    549 Total
    771 Total
    1183 Total
    3 Total
    935
    1591 Total
    54
    965
    972
    54
    1148 Total
    148
    929 Total
    1704 Total
    921 Total
    913 Total
    59 Total
    1083 Total
    935
    446 Total
    1505 Total
    1162 Total
    1425 Total
    1529 Total
    1545 Total
    1138 Total
    1142 Total
    927 Total
    1429 Total
    1464 Total
    216 Total
    1167 Total
    1013 Total
    682 Total
    943
    1547 Total
    81
    1275 Total
    529 Total
    51
    946 Total
    1082 Total
    972
    919 Total
    1015 Total
    1384 Total
    1467 Total
    837 Total
    695 Total
    898

    $20,143.46
    $20,100.00
    $20,000.00
    $19,918.00
    $19,418.29
    $19,371.27
    $18,710.99
    $18,225.00
    $18,149.05
    $18,000.00
    $17,759.72
    $17,640.00
    $17,527.00
    $17,497.00
    $17,423.24
    $17,123.67
    $17,092.00
    $16,858.00
    $16,736.09
    $16,701.20
    $16,293.12
    $16,200.00
    $16,186.20
    $16,155.78
    $16,069.85
    $16,016.47
    $16,000.00
    $15,953.00
    $15,890.70
    $15,794.59
    $15,611.63
    $14,963.71
    $14,897.00
    $14,810.00
    $14,797.32
    $14,646.74
    $14,530.00
    $14,500.00
    $14,492.00
    $14,480.00
    $14,465.29
    $14,380.70
    $14,307.00
    $14,139.60
    $14,123.70
    $13,860.00
    $13,859.24
    $13,852.38
    $13,682.00
    $13,460.00
    $13,380.00
    $13,242.93
    $13,221.99

    62 Total
    474 Total
    1016
    988 Total
    1276 Total
    108 Total
    1568 Total
    143
    911 Total
    1569 Total
    1730 Total
    910 Total
    81
    1238 Total
    965
    743
    644
    317
    902 Total
    925 Total
    507 Total
    770 Total
    421 Total
    927
    943
    724 Total
    849 Total
    1100
    953 Total
    423 Total
    641 Total
    187 Total
    511 Total
    951
    1184 Total
    1518 Total
    50 Total
    54
    54
    700 Total
    162 Total
    216
    1468 Total
    44 Total
    841
    975 Total
    1432 Total
    1432
    1688 Total
    1011 Total
    400 Total
    741 Total
    1100

    $13,132.25
    $12,888.00
    $12,862.72
    $12,841.85
    $12,829.00
    $12,626.45
    $12,602.95
    $12,484.78
    $12,478.58
    $12,325.79
    $12,316.75
    $12,303.00
    $12,068.00
    $12,040.90
    $12,000.00
    $12,000.00
    $12,000.00
    $12,000.00
    $11,919.46
    $11,859.34
    $11,606.64
    $11,600.06
    $11,586.69
    $11,575.00
    $11,509.00
    $11,486.75
    $11,470.25
    $11,369.30
    $11,367.00
    $11,356.00
    $11,311.75
    $11,244.00
    $11,180.00
    $11,135.88
    $11,075.00
    $11,050.00
    $11,048.00
    $10,983.36
    $10,983.36
    $10,884.50
    $10,727.30
    $10,700.00
    $10,639.00
    $10,635.00
    $10,549.05
    $10,506.25
    $10,500.00
    $10,500.00
    $10,402.37
    $10,363.64
    $10,337.80
    $10,285.00
    $10,200.00

    430 Total
    1467
    1218
    1148
    951
    841
    1644 Total
    404 Total
    393 Total
    792 Total
    918 Total
    914
    898
    446
    122 Total
    1671 Total
    559 Total
    539 Total
    416 Total
    633 Total
    761 Total
    1710 Total
    788
    1638 Total
    1048 Total
    1396 Total
    1166 Total
    682
    938 Total
    1058 Total
    59
    1162
    758 Total
    1611 Total
    1197 Total
    779 Total
    536
    51
    644
    940 Total
    1356 Total
    795 Total
    1087 Total
    1713 Total
    1077 Total
    899 Total
    723 Total
    954 Total
    1163 Total
    1570
    788
    549
    143

    $10,195.94
    $10,000.00
    $10,000.00
    $10,000.00
    $10,000.00
    $9,966.72
    $9,906.80
    $9,822.00
    $9,795.54
    $9,755.00
    $9,743.82
    $9,700.00
    $9,700.00
    $9,700.00
    $9,697.00
    $9,692.00
    $9,667.30
    $9,650.00
    $9,618.20
    $9,600.35
    $9,412.30
    $9,295.25
    $9,266.38
    $9,245.70
    $9,213.05
    $9,185.67
    $9,124.90
    $8,950.00
    $8,945.74
    $8,928.30
    $8,900.00
    $8,847.60
    $8,834.15
    $8,640.80
    $8,543.28
    $8,514.00
    $8,500.00
    $8,500.00
    $8,499.00
    $8,478.10
    $8,457.50
    $8,415.10
    $8,388.85
    $8,317.55
    $8,240.00
    $8,236.00
    $8,150.00
    $8,083.30
    $8,043.29
    $8,000.00
    $8,000.00
    $8,000.00
    $8,000.00

    50
    531 Total
    405 Total
    1270 Total
    1151 Total
    1134 Total
    349 Total
    1183
    915 Total
    1167
    563 Total
    1276
    580 Total
    1570
    1012 Total
    1077
    1710
    1466
    585 Total
    792
    843 Total
    525 Total
    1120 Total
    837
    1018 Total
    451 Total
    1379 Total
    936 Total
    9 Total
    386 Total
    1196 Total
    28 Total
    695
    1583
    1067 Total
    1350 Total
    902
    359 Total
    1070 Total
    1084 Total
    486 Total
    369 Total
    1101 Total
    764 Total
    1100
    474
    937 Total
    1365 Total
    1089 Total
    208 Total
    263 Total
    1179 Total
    768 Total

    $8,000.00
    $7,999.95
    $7,912.95
    $7,911.74
    $7,902.70
    $7,875.00
    $7,770.00
    $7,762.50
    $7,750.07
    $7,745.32
    $7,684.08
    $7,629.00
    $7,570.00
    $7,560.00
    $7,550.50
    $7,540.00
    $7,500.00
    $7,500.00
    $7,459.00
    $7,450.00
    $7,425.95
    $7,407.46
    $7,385.80
    $7,380.00
    $7,356.60
    $7,328.45
    $7,294.49
    $7,276.26
    $7,274.20
    $7,267.10
    $7,260.00
    $7,241.75
    $7,227.73
    $7,225.00
    $7,220.21
    $7,201.95
    $7,195.20
    $7,102.55
    $7,081.86
    $7,079.00
    $7,066.94
    $7,060.00
    $7,060.00
    $7,016.91
    $7,000.00
    $7,000.00
    $6,969.33
    $6,962.87
    $6,959.30
    $6,950.00
    $6,930.00
    $6,920.70
    $6,892.25

    468 Total
    543 Total
    1344 Total
    1438 Total
    1283 Total
    218 Total
    933 Total
    914
    403 Total
    992 Total
    576 Total
    755 Total
    961 Total
    135 Total
    1013
    80
    1033 Total
    1090 Total
    352 Total
    748
    1091 Total
    90 Total
    24 Total
    1038 Total
    1245 Total
    1168 Total
    1459
    141 Total
    151 Total
    1604 Total
    989 Total
    1465 Total
    633
    1728 Total
    1603 Total
    745 Total
    101 Total
    180 Total
    1058
    1568
    1322 Total
    1376 Total
    1068 Total
    1006 Total
    1704
    1006
    929
    771
    723
    543
    352
    148
    759 Total

    $6,862.90
    $6,860.50
    $6,845.00
    $6,838.20
    $6,792.53
    $6,773.91
    $6,730.30
    $6,650.00
    $6,643.05
    $6,635.28
    $6,625.68
    $6,610.00
    $6,600.00
    $6,522.35
    $6,501.65
    $6,500.00
    $6,485.40
    $6,450.00
    $6,425.00
    $6,400.00
    $6,350.00
    $6,348.27
    $6,338.85
    $6,328.76
    $6,311.05
    $6,302.32
    $6,300.00
    $6,291.20
    $6,284.45
    $6,270.00
    $6,153.20
    $6,110.00
    $6,100.35
    $6,100.00
    $6,100.00
    $6,080.00
    $6,078.46
    $6,074.34
    $6,050.00
    $6,024.45
    $6,023.70
    $6,014.30
    $6,011.50
    $6,000.00
    $6,000.00
    $6,000.00
    $6,000.00
    $6,000.00
    $6,000.00
    $6,000.00
    $6,000.00
    $6,000.00
    $5,996.94

    1221 Total
    1093 Total
    503 Total
    499 Total
    418 Total
    923 Total
    324 Total
    1228 Total
    668 Total
    579 Total
    1218
    1594 Total
    54
    953
    1463 Total
    1534
    1303 Total
    1343 Total
    40 Total
    260 Total
    1366 Total
    1140 Total
    1586 Total
    956 Total
    1143 Total
    1224 Total
    206 Total
    1631 Total
    577 Total
    1302 Total
    14 Total
    27 Total
    187
    622 Total
    36 Total
    1591
    901 Total
    1384
    34
    1664 Total
    1373 Total
    81
    51
    42 Total
    930 Total
    921
    1559 Total
    77 Total
    761
    1186 Total
    1671
    1011
    978 Total

    $5,985.90
    $5,973.55
    $5,962.82
    $5,960.00
    $5,958.25
    $5,954.18
    $5,942.00
    $5,927.20
    $5,900.00
    $5,896.10
    $5,890.00
    $5,878.50
    $5,873.00
    $5,867.00
    $5,855.99
    $5,854.82
    $5,850.00
    $5,833.35
    $5,790.00
    $5,787.90
    $5,764.95
    $5,760.00
    $5,757.66
    $5,754.13
    $5,729.40
    $5,726.27
    $5,706.97
    $5,700.00
    $5,631.95
    $5,623.00
    $5,612.00
    $5,592.95
    $5,571.00
    $5,550.00
    $5,541.60
    $5,540.00
    $5,538.63
    $5,510.00
    $5,500.68
    $5,500.00
    $5,500.00
    $5,500.00
    $5,500.00
    $5,473.00
    $5,470.96
    $5,470.00
    $5,466.00
    $5,422.00
    $5,420.00
    $5,400.00
    $5,400.00
    $5,385.00
    $5,377.79

    1015
    743
    82 Total
    1048
    Total
    Total
    Total
    Total
    Total
    559
    724
    123 Total
    803 Total
    1684 Total
    789 Total
    1589 Total
    1100
    508 Total
    495 Total
    75 Total
    381 Total
    851 Total
    223 Total
    361 Total
    935
    876 Total
    1138
    1593 Total
    1449 Total
    149 Total
    521 Total
    1678 Total
    1428 Total
    1638
    1589
    1569
    1569
    1391
    1016
    953
    724
    499
    1033
    84 Total
    182 Total
    1609 Total
    1653 Total
    928 Total
    1095 Total
    81
    1540 Total
    319 Total
    1534
    787
    754
    202
    513
    343

    $5,363.94
    $5,360.00
    $5,329.64
    $5,300.00
    $5,292.00
    $5,283.55
    $5,278.34
    $5,265.40
    $5,260.00
    $5,255.00
    $5,245.00
    $5,242.30
    $5,234.55
    $5,229.01
    $5,224.50
    $5,200.00
    $5,200.00
    $5,188.55
    $5,170.00
    $5,159.42
    $5,149.40
    $5,131.75
    $5,129.50
    $5,100.00
    $5,100.00
    $5,080.00
    $5,080.00
    $5,075.00
    $5,074.50
    $5,065.00
    $5,050.50
    $5,000.00
    $5,000.00
    $5,000.00
    $5,000.00
    $5,000.00
    $5,000.00
    $5,000.00
    $5,000.00
    $5,000.00
    $5,000.00
    $5,000.00
    $4,990.00
    $4,952.00
    $4,925.00
    $4,918.50
    $4,891.00
    $4,885.26
    $4,885.00
    $4,884.00
    $4,866.00
    $4,864.00
    $4,850.00

    916
    795
    52 Total
    143
    1040 Total
    322 Total
    427 Total
    407 Total
    1061 Total
    160 Total
    985 Total
    1563 Total
    1529
    585
    102 Total
    1009 Total
    835 Total
    34
    1568
    1643 Total
    364 Total
    1464
    728 Total
    1429
    433 Total
    1374 Total
    614 Total
    1550 Total
    814 Total
    433
    1072 Total
    1164 Total
    1529
    1391
    1082
    965
    1693 Total
    34
    1025 Total
    654 Total
    73 Total
    1633 Total
    46 Total
    419 Total
    767 Total
    415 Total
    79 Total
    1344
    576
    1588 Total
    1492 Total
    1083
    898

    $4,850.00
    $4,842.92
    $4,802.14
    $4,800.00
    $4,793.95
    $4,775.00
    $4,760.00
    $4,748.50
    $4,737.00
    $4,733.75
    $4,700.00
    $4,700.00
    $4,700.00
    $4,700.00
    $4,686.44
    $4,665.19
    $4,658.45
    $4,654.55
    $4,638.50
    $4,624.00
    $4,620.50
    $4,620.10
    $4,603.25
    $4,601.21
    $4,600.00
    $4,590.05
    $4,580.00
    $4,580.00
    $4,559.50
    $4,515.00
    $4,510.00
    $4,500.00
    $4,500.00
    $4,500.00
    $4,500.00
    $4,500.00
    $4,489.59
    $4,478.64
    $4,476.25
    $4,475.95
    $4,471.12
    $4,470.75
    $4,450.00
    $4,450.00
    $4,439.36
    $4,427.50
    $4,426.10
    $4,400.00
    $4,400.00
    $4,398.00
    $4,394.14
    $4,380.00
    $4,375.00

    1175 Total
    1183
    1240 Total
    38 Total
    774 Total
    76 Total
    965
    86 Total
    147 Total
    14
    23 Total
    763 Total
    1162
    235 Total
    1014 Total
    812 Total
    687 Total
    935
    1184
    900 Total
    1564 Total
    962 Total
    225 Total
    194 Total
    511
    89 Total
    875 Total
    95 Total
    1280 Total
    1448 Total
    416
    1108 Total
    1477 Total
    1074 Total
    205 Total
    790 Total
    1265 Total
    1534
    1095
    1082
    965
    951
    943
    916
    913
    837
    788
    756
    529
    361
    162
    1658 Total
    1331 Total

    $4,372.00
    $4,353.56
    $4,344.35
    $4,343.00
    $4,334.50
    $4,332.00
    $4,318.85
    $4,306.17
    $4,300.00
    $4,300.00
    $4,247.00
    $4,240.00
    $4,221.00
    $4,219.25
    $4,212.35
    $4,179.00
    $4,170.00
    $4,169.54
    $4,165.00
    $4,158.15
    $4,110.00
    $4,109.10
    $4,100.00
    $4,100.00
    $4,100.00
    $4,091.00
    $4,088.50
    $4,082.20
    $4,080.00
    $4,056.98
    $4,050.00
    $4,038.00
    $4,031.00
    $4,024.75
    $4,020.00
    $4,019.50
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $4,000.00
    $3,990.00
    $3,989.90

    1312 Total
    94 Total
    1400 Total
    1394 Total
    783 Total
    48 Total
    1509 Total
    816 Total
    1695 Total
    1012
    1290 Total
    1290
    975
    324
    162
    990 Total
    121 Total
    330 Total
    459 Total
    105 Total
    1294 Total
    1473 Total
    1121 Total
    618 Total
    250 Total
    1273 Total
    740 Total
    1634 Total
    1010 Total
    1010
    44
    1713
    1664
    1396
    1276
    1134
    935
    935
    849
    841
    789
    764
    754
    563
    549
    430
    404
    343
    184 Total
    1070
    1045 Total
    592 Total
    1133 Total

    $3,977.21
    $3,970.00
    $3,970.00
    $3,966.05
    $3,949.81
    $3,910.53
    $3,908.10
    $3,908.00
    $3,905.00
    $3,900.50
    $3,900.00
    $3,900.00
    $3,900.00
    $3,900.00
    $3,900.00
    $3,898.50
    $3,898.25
    $3,891.60
    $3,885.00
    $3,883.51
    $3,871.62
    $3,855.00
    $3,852.80
    $3,850.00
    $3,848.25
    $3,830.00
    $3,825.00
    $3,822.00
    $3,819.85
    $3,819.85
    $3,805.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,800.00
    $3,797.40
    $3,791.97
    $3,790.00
    $3,786.00
    $3,778.25

    1032 Total
    179 Total
    1558 Total
    796 Total
    139 Total
    942 Total
    1120
    1090
    525
    349
    18 Total
    820 Total
    140 Total
    840 Total
    411 Total
    10 Total
    1660 Total
    1235 Total
    142 Total
    1127 Total
    879 Total
    1725 Total
    944 Total
    838 Total
    1257 Total
    1512 Total
    1292 Total
    35 Total
    958 Total
    1166
    1072
    317
    1287 Total
    721 Total
    397 Total
    169 Total
    1688
    1428
    1238
    1238
    1452 Total
    1328 Total
    63 Total
    76
    922 Total
    562 Total
    1263 Total
    1013
    998 Total
    1362 Total
    973 Total
    1377 Total
    1635 Total

    $3,775.75
    $3,742.00
    $3,732.65
    $3,725.95
    $3,714.75
    $3,702.00
    $3,700.00
    $3,700.00
    $3,700.00
    $3,700.00
    $3,695.50
    $3,695.40
    $3,690.00
    $3,680.00
    $3,678.10
    $3,674.91
    $3,672.00
    $3,671.61
    $3,670.75
    $3,670.50
    $3,669.30
    $3,664.75
    $3,662.50
    $3,661.50
    $3,625.00
    $3,622.49
    $3,620.00
    $3,616.40
    $3,612.00
    $3,610.00
    $3,610.00
    $3,609.28
    $3,601.50
    $3,600.00
    $3,600.00
    $3,600.00
    $3,600.00
    $3,600.00
    $3,600.00
    $3,600.00
    $3,592.00
    $3,590.00
    $3,585.00
    $3,582.00
    $3,576.95
    $3,570.00
    $3,565.00
    $3,553.00
    $3,550.00
    $3,540.00
    $3,526.00
    $3,525.00
    $3,521.00

    402 Total
    948 Total
    1678
    1275
    741
    579
    539
    539
    511
    24
    43 Total
    1468
    629 Total
    847 Total
    709 Total
    554 Total
    995 Total
    1116 Total
    1590 Total
    245 Total
    741
    1030 Total
    726 Total
    1494 Total
    757 Total
    1291 Total
    1575 Total
    1122 Total
    54
    54
    1357 Total
    1209 Total
    1547
    1449
    122
    1360 Total
    1699 Total
    247 Total
    779
    1730
    1559
    1225
    1016
    965
    916
    899
    763
    1167
    544 Total
    1704
    1510 Total
    1457 Total
    1380 Total

    $3,509.45
    $3,502.78
    $3,500.00
    $3,500.00
    $3,500.00
    $3,500.00
    $3,500.00
    $3,500.00
    $3,500.00
    $3,500.00
    $3,495.00
    $3,494.00
    $3,493.00
    $3,492.20
    $3,489.40
    $3,487.58
    $3,479.75
    $3,476.00
    $3,470.00
    $3,465.00
    $3,460.00
    $3,457.93
    $3,451.50
    $3,450.74
    $3,450.50
    $3,450.00
    $3,439.58
    $3,435.00
    $3,427.00
    $3,427.00
    $3,426.25
    $3,420.00
    $3,420.00
    $3,420.00
    $3,420.00
    $3,411.95
    $3,410.40
    $3,409.00
    $3,408.00
    $3,400.00
    $3,400.00
    $3,400.00
    $3,400.00
    $3,400.00
    $3,400.00
    $3,400.00
    $3,400.00
    $3,390.00
    $3,381.00
    $3,380.00
    $3,366.00
    $3,355.00
    $3,352.00

    502 Total
    1101
    1555 Total
    1100
    614
    612 Total
    648 Total
    21 Total
    1523 Total
    1539 Total
    909 Total
    1068
    28
    1135 Total
    1057
    1057
    1057
    1057
    1057
    689 Total
    429 Total
    1319 Total
    1399 Total
    101
    12 Total
    555 Total
    800 Total
    1687 Total
    1250 Total
    1705 Total
    1359 Total
    1435 Total
    137 Total
    450 Total
    1123 Total
    1321 Total
    1136 Total
    852 Total
    1375 Total
    1215 Total
    1330 Total
    173 Total
    832 Total
    1197
    51
    370 Total
    1046 Total
    923
    701 Total
    1061
    591 Total
    410 Total
    1373

    $3,351.70
    $3,344.00
    $3,332.00
    $3,330.00
    $3,330.00
    $3,326.00
    $3,325.00
    $3,322.70
    $3,315.00
    $3,314.25
    $3,312.00
    $3,300.00
    $3,300.00
    $3,297.50
    $3,285.00
    $3,285.00
    $3,285.00
    $3,285.00
    $3,285.00
    $3,282.95
    $3,281.13
    $3,280.00
    $3,275.20
    $3,271.25
    $3,264.00
    $3,262.00
    $3,258.75
    $3,252.55
    $3,250.00
    $3,245.00
    $3,232.00
    $3,231.00
    $3,226.75
    $3,223.38
    $3,221.80
    $3,215.00
    $3,212.00
    $3,211.50
    $3,209.80
    $3,206.00
    $3,200.00
    $3,194.62
    $3,191.64
    $3,185.72
    $3,182.25
    $3,181.50
    $3,176.00
    $3,160.00
    $3,150.00
    $3,150.00
    $3,145.50
    $3,141.06
    $3,140.00

    846 Total
    903 Total
    963 Total
    1153 Total
    34
    1491 Total
    788
    149
    1073 Total
    423
    840
    1381 Total
    685 Total
    818 Total
    622
    1130 Total
    1487 Total
    1296 Total
    375 Total
    599 Total
    1277 Total
    473 Total
    937
    275 Total
    1738 Total
    1544 Total
    1361 Total
    1237 Total
    1034 Total
    1738
    1693
    1631
    1529
    1518
    1265
    1225
    1091
    1018
    961
    654
    641
    612
    536
    531
    474
    275
    225
    80
    770
    770
    955 Total
    486
    441 Total

    $3,122.00
    $3,118.00
    $3,112.00
    $3,107.28
    $3,104.36
    $3,100.00
    $3,100.00
    $3,095.00
    $3,092.60
    $3,090.00
    $3,080.00
    $3,079.90
    $3,060.00
    $3,050.00
    $3,050.00
    $3,048.50
    $3,040.00
    $3,030.00
    $3,014.00
    $3,012.70
    $3,010.40
    $3,010.00
    $3,007.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $3,000.00
    $2,990.00
    $2,990.00
    $2,986.20
    $2,984.95
    $2,981.30

    87 Total
    947 Total
    1683 Total
    177 Total
    1079 Total
    1142
    455 Total
    1459
    1148
    1470 Total
    1557 Total
    675 Total
    1191 Total
    1348 Total
    484 Total
    345 Total
    1231 Total
    604 Total
    362 Total
    1333 Total
    1143
    68 Total
    227 Total
    1685 Total
    968 Total
    1499 Total
    134 Total
    1726 Total
    49 Total
    30 Total
    1142
    436 Total
    954
    779
    671 Total
    1437 Total
    51
    303 Total
    146 Total
    116 Total
    1098 Total
    90
    1332 Total
    1587 Total
    786 Total
    409 Total
    1606 Total
    921
    536
    46
    1547
    1412 Total
    1724 Total

    $2,980.00
    $2,973.96
    $2,971.00
    $2,964.00
    $2,960.38
    $2,960.02
    $2,960.00
    $2,960.00
    $2,960.00
    $2,957.60
    $2,952.75
    $2,945.00
    $2,940.00
    $2,930.00
    $2,926.30
    $2,920.00
    $2,916.40
    $2,905.35
    $2,900.00
    $2,895.00
    $2,890.80
    $2,889.50
    $2,881.75
    $2,878.75
    $2,875.50
    $2,875.00
    $2,874.92
    $2,872.00
    $2,869.09
    $2,864.50
    $2,862.50
    $2,860.65
    $2,860.00
    $2,852.00
    $2,850.00
    $2,850.00
    $2,850.00
    $2,840.00
    $2,834.00
    $2,830.75
    $2,830.00
    $2,825.00
    $2,818.66
    $2,812.00
    $2,800.00
    $2,800.00
    $2,800.00
    $2,800.00
    $2,800.00
    $2,800.00
    $2,796.00
    $2,792.00
    $2,782.00

    967 Total
    727 Total
    549
    1583
    667 Total
    1513 Total
    187
    1160 Total
    306 Total
    1242 Total
    870 Total
    1386 Total
    1219 Total
    20 Total
    1384
    580
    1429
    296 Total
    1119 Total
    431 Total
    582 Total
    1192 Total
    1175
    1567 Total
    620 Total
    726
    731 Total
    717 Total
    272 Total
    236 Total
    1594
    943
    938
    182
    1275
    1055 Total
    631 Total
    1393 Total
    1729 Total
    1292
    919
    1688
    228 Total
    159 Total
    1578 Total
    344 Total
    833 Total
    617 Total
    11 Total
    1013
    1178 Total
    771
    1690 Total

    $2,780.00
    $2,778.24
    $2,776.00
    $2,775.00
    $2,773.95
    $2,772.00
    $2,772.00
    $2,766.65
    $2,765.00
    $2,761.07
    $2,760.75
    $2,760.00
    $2,760.00
    $2,751.06
    $2,750.00
    $2,750.00
    $2,746.20
    $2,741.40
    $2,738.64
    $2,736.50
    $2,729.45
    $2,725.00
    $2,716.00
    $2,714.00
    $2,710.00
    $2,708.25
    $2,701.50
    $2,700.00
    $2,700.00
    $2,700.00
    $2,700.00
    $2,700.00
    $2,700.00
    $2,700.00
    $2,698.20
    $2,696.50
    $2,696.00
    $2,695.40
    $2,690.00
    $2,690.00
    $2,690.00
    $2,681.97
    $2,680.00
    $2,679.25
    $2,675.40
    $2,671.50
    $2,670.00
    $2,670.00
    $2,665.00
    $2,655.25
    $2,655.00
    $2,653.04
    $2,650.00

    1471 Total
    980 Total
    884 Total
    1410 Total
    1505
    1212 Total
    1212
    1588
    54
    1671
    682
    503
    208
    59
    982 Total
    226 Total
    1186
    1665 Total
    972
    794 Total
    782 Total
    1125 Total
    1039 Total
    318 Total
    758
    148
    1207 Total
    1207
    857 Total
    1395 Total
    1686 Total
    1191
    1189 Total
    807 Total
    1257
    988
    220 Total
    1024 Total
    535 Total
    55 Total
    1234 Total
    93 Total
    858 Total
    399 Total
    348 Total
    136 Total
    1603
    1505
    1487
    1459
    1437
    1394
    1221

    $2,644.00
    $2,630.00
    $2,626.54
    $2,625.25
    $2,617.48
    $2,606.40
    $2,606.40
    $2,605.50
    $2,601.50
    $2,600.00
    $2,600.00
    $2,600.00
    $2,600.00
    $2,600.00
    $2,596.00
    $2,594.00
    $2,590.00
    $2,585.45
    $2,585.00
    $2,582.50
    $2,580.00
    $2,580.00
    $2,576.00
    $2,570.00
    $2,555.00
    $2,550.00
    $2,548.80
    $2,548.80
    $2,546.00
    $2,545.00
    $2,544.30
    $2,540.00
    $2,535.00
    $2,521.20
    $2,520.00
    $2,518.30
    $2,515.00
    $2,515.00
    $2,507.50
    $2,503.00
    $2,502.25
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00

    1196
    1087
    985
    919
    818
    700
    695
    644
    559
    474
    348
    23
    1639 Total
    940
    160
    1156 Total
    456 Total
    392 Total
    231 Total
    456
    427
    737 Total
    1699
    1494
    1183
    322
    1206 Total
    1505
    916
    445 Total
    1030
    215 Total
    1205 Total
    214 Total
    458 Total
    155 Total
    66 Total
    1669 Total
    1501 Total
    1111 Total
    1058
    1573 Total
    1278 Total
    1668 Total
    1463
    100 Total
    250
    739 Total
    1121
    1115 Total
    687
    1036 Total
    1267 Total

    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,500.00
    $2,495.50
    $2,495.00
    $2,495.00
    $2,492.45
    $2,490.00
    $2,490.00
    $2,490.00
    $2,490.00
    $2,490.00
    $2,486.40
    $2,484.00
    $2,480.37
    $2,475.00
    $2,475.00
    $2,473.82
    $2,472.50
    $2,470.68
    $2,464.10
    $2,457.00
    $2,454.20
    $2,452.80
    $2,452.00
    $2,450.00
    $2,447.25
    $2,443.15
    $2,441.15
    $2,440.00
    $2,440.00
    $2,437.50
    $2,434.20
    $2,433.41
    $2,430.00
    $2,430.00
    $2,426.75
    $2,422.50
    $2,421.86
    $2,420.80
    $2,420.00
    $2,420.00
    $2,413.00
    $2,406.75

    581 Total
    1566 Total
    269 Total
    1611
    1604
    1518
    1518
    1491
    1459
    1391
    1303
    1138
    954
    911
    899
    577
    468
    423
    397
    3
    515 Total
    1046
    787
    921
    246 Total
    1712 Total
    780 Total
    841
    1596 Total
    699 Total
    167 Total
    1194 Total
    1354 Total
    562
    1258 Total
    311 Total
    181 Total
    852
    255 Total
    1358 Total
    533 Total
    843
    42
    370
    389 Total
    34
    1430 Total
    1239 Total
    67 Total
    1314 Total
    1289 Total
    711 Total
    1728

    $2,403.00
    $2,400.75
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,400.00
    $2,399.00
    $2,396.00
    $2,396.00
    $2,395.00
    $2,390.75
    $2,388.06
    $2,375.00
    $2,375.00
    $2,370.00
    $2,360.00
    $2,360.00
    $2,355.00
    $2,352.00
    $2,350.00
    $2,346.69
    $2,343.25
    $2,339.00
    $2,335.50
    $2,335.00
    $2,331.00
    $2,325.30
    $2,325.00
    $2,325.00
    $2,323.25
    $2,320.98
    $2,315.18
    $2,315.00
    $2,315.00
    $2,312.00
    $2,312.00
    $2,312.00
    $2,308.50
    $2,300.00

    1361
    898
    986 Total
    1500 Total
    931 Total
    253 Total
    1311 Total
    1184
    1599 Total
    83 Total
    540 Total
    427
    63
    1635
    39 Total
    1607 Total
    949 Total
    827 Total
    390 Total
    1054 Total
    1695
    1465
    1302
    771
    5 Total
    952
    1472 Total
    1057
    1057
    408 Total
    1477
    607 Total
    412 Total
    1547
    1488 Total
    1123
    1440 Total
    1180 Total
    1057
    1057
    774
    1198 Total
    329 Total
    1677 Total
    1457
    1225
    1012
    782
    745
    721
    507
    62
    59

    $2,300.00
    $2,300.00
    $2,298.20
    $2,295.70
    $2,292.00
    $2,291.47
    $2,286.28
    $2,280.00
    $2,279.00
    $2,270.00
    $2,270.00
    $2,270.00
    $2,270.00
    $2,265.50
    $2,264.35
    $2,260.00
    $2,251.67
    $2,250.00
    $2,250.00
    $2,250.00
    $2,250.00
    $2,250.00
    $2,250.00
    $2,250.00
    $2,247.75
    $2,240.41
    $2,240.00
    $2,235.00
    $2,235.00
    $2,229.83
    $2,225.50
    $2,225.00
    $2,225.00
    $2,220.00
    $2,214.00
    $2,208.00
    $2,205.00
    $2,205.00
    $2,202.00
    $2,202.00
    $2,201.00
    $2,200.75
    $2,200.00
    $2,200.00
    $2,200.00
    $2,200.00
    $2,200.00
    $2,200.00
    $2,200.00
    $2,200.00
    $2,200.00
    $2,200.00
    $2,200.00

    51
    1485 Total
    841
    1018
    306
    11
    1737 Total
    285 Total
    1481 Total
    1583
    227
    885 Total
    1335 Total
    1083
    80
    80
    482 Total
    747 Total
    469 Total
    507
    1474 Total
    902
    872 Total
    1213 Total
    718 Total
    1683
    448 Total
    1241 Total
    151
    638 Total
    1282 Total
    1506 Total
    525
    365 Total
    1464
    1057
    887 Total
    1242
    182
    1654 Total
    1133
    951
    502
    634 Total
    583 Total
    1511 Total
    864 Total
    791 Total
    705 Total
    1698 Total
    1023 Total
    1425
    1183

    $2,200.00
    $2,195.00
    $2,194.50
    $2,190.00
    $2,190.00
    $2,185.00
    $2,181.00
    $2,180.00
    $2,180.00
    $2,180.00
    $2,173.38
    $2,172.00
    $2,170.00
    $2,170.00
    $2,165.85
    $2,165.85
    $2,165.00
    $2,160.00
    $2,160.00
    $2,160.00
    $2,159.40
    $2,159.37
    $2,158.00
    $2,157.80
    $2,157.25
    $2,155.50
    $2,155.00
    $2,155.00
    $2,155.00
    $2,153.50
    $2,152.20
    $2,150.00
    $2,150.00
    $2,145.00
    $2,140.00
    $2,133.00
    $2,130.00
    $2,126.07
    $2,125.00
    $2,124.28
    $2,120.75
    $2,120.75
    $2,120.75
    $2,117.05
    $2,117.00
    $2,116.00
    $2,100.00
    $2,100.00
    $2,100.00
    $2,100.00
    $2,100.00
    $2,100.00
    $2,100.00

    929
    788
    771
    513
    393
    40
    1424 Total
    99 Total
    1608 Total
    1346 Total
    1167
    685
    416
    1580 Total
    855 Total
    1557
    394 Total
    1483 Total
    1203 Total
    976 Total
    1326 Total
    558 Total
    87
    1336 Total
    844 Total
    1435
    916
    405
    386
    1005 Total
    1442 Total
    1724
    1660
    1634
    1380
    1215
    1036
    938
    631
    369
    84
    281 Total
    788
    94
    1243 Total
    82
    82
    1704
    1137 Total
    745
    879
    1534
    927

    $2,100.00
    $2,100.00
    $2,100.00
    $2,100.00
    $2,100.00
    $2,100.00
    $2,094.75
    $2,091.73
    $2,090.00
    $2,090.00
    $2,090.00
    $2,090.00
    $2,090.00
    $2,089.64
    $2,085.00
    $2,082.00
    $2,080.00
    $2,080.00
    $2,080.00
    $2,076.00
    $2,074.60
    $2,070.00
    $2,070.00
    $2,067.00
    $2,066.47
    $2,065.50
    $2,065.50
    $2,065.50
    $2,065.50
    $2,063.45
    $2,060.00
    $2,056.00
    $2,056.00
    $2,056.00
    $2,056.00
    $2,056.00
    $2,056.00
    $2,056.00
    $2,056.00
    $2,056.00
    $2,056.00
    $2,054.00
    $2,050.00
    $2,050.00
    $2,046.00
    $2,046.00
    $2,046.00
    $2,035.00
    $2,031.00
    $2,030.00
    $2,028.80
    $2,028.00
    $2,025.00

    1050 Total
    527 Total
    1508 Total
    257 Total
    1031 Total
    351 Total
    158 Total
    1583
    1544
    1539
    1534
    1466
    1346
    1245
    1234
    1196
    1179
    1164
    1151
    1011
    961
    946
    938
    771
    756
    755
    705
    682
    668
    668
    644
    529
    495
    486
    400
    345
    317
    269
    236
    180
    80
    73
    59
    781 Total
    327 Total
    1222 Total
    1204 Total
    1138
    1053 Total
    54
    1667 Total
    843
    44

    $2,022.00
    $2,014.00
    $2,010.00
    $2,000.49
    $2,000.40
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $2,000.00
    $1,999.00
    $1,995.00
    $1,994.00
    $1,990.00
    $1,990.00
    $1,989.90
    $1,987.75
    $1,982.20
    $1,980.00
    $1,980.00

    1663 Total
    591
    382 Total
    1658
    194
    650 Total
    1291
    263
    169
    149
    222 Total
    1155 Total
    1708 Total
    280 Total
    803
    472 Total
    1684
    1525 Total
    775 Total
    717
    54
    54
    43
    951
    80
    80
    371 Total
    2 Total
    364
    1134
    1320 Total
    927
    1287
    744 Total
    943
    415
    1503 Total
    1547
    580
    403
    809 Total
    1429
    1412
    1376
    988
    1347 Total
    254 Total
    926 Total
    6 Total
    1510
    1505
    1466
    1328

    $1,977.50
    $1,975.50
    $1,975.00
    $1,975.00
    $1,975.00
    $1,971.00
    $1,970.00
    $1,970.00
    $1,970.00
    $1,970.00
    $1,960.00
    $1,958.60
    $1,958.00
    $1,957.40
    $1,956.00
    $1,954.00
    $1,952.98
    $1,952.46
    $1,950.14
    $1,950.00
    $1,947.20
    $1,947.20
    $1,944.00
    $1,940.00
    $1,938.60
    $1,938.60
    $1,937.00
    $1,935.50
    $1,935.50
    $1,935.00
    $1,930.00
    $1,926.63
    $1,925.75
    $1,925.00
    $1,925.00
    $1,925.00
    $1,920.65
    $1,920.00
    $1,920.00
    $1,920.00
    $1,918.10
    $1,916.00
    $1,916.00
    $1,916.00
    $1,916.00
    $1,912.84
    $1,912.00
    $1,910.00
    $1,905.00
    $1,900.00
    $1,900.00
    $1,900.00
    $1,900.00

    1238
    1015
    935
    827
    623 Total
    1065 Total
    360 Total
    958
    418
    820
    153 Total
    1134
    936
    1127
    2
    1016
    838
    758
    898
    898
    1017 Total
    573 Total
    975
    1217 Total
    1498 Total
    1704
    1067
    1425
    378 Total
    1720 Total
    322
    821 Total
    748
    1583
    122
    704 Total
    1398 Total
    641
    1727 Total
    630 Total
    630
    1142
    1099 Total
    1249 Total
    140
    1730
    1163
    1547
    598 Total
    815 Total
    1334 Total
    1324 Total
    632 Total

    $1,900.00
    $1,900.00
    $1,900.00
    $1,900.00
    $1,899.25
    $1,897.20
    $1,896.00
    $1,896.00
    $1,896.00
    $1,895.00
    $1,894.50
    $1,890.00
    $1,890.00
    $1,885.50
    $1,885.50
    $1,883.58
    $1,880.00
    $1,880.00
    $1,875.00
    $1,875.00
    $1,874.00
    $1,873.35
    $1,871.25
    $1,870.00
    $1,860.00
    $1,855.00
    $1,855.00
    $1,854.18
    $1,851.35
    $1,850.00
    $1,850.00
    $1,848.20
    $1,847.00
    $1,840.00
    $1,840.00
    $1,835.00
    $1,834.29
    $1,830.50
    $1,830.00
    $1,826.00
    $1,826.00
    $1,822.50
    $1,821.50
    $1,820.00
    $1,820.00
    $1,819.00
    $1,819.00
    $1,816.00
    $1,815.15
    $1,810.00
    $1,810.00
    $1,807.14
    $1,806.35

    773 Total
    1110 Total
    1631
    1570
    1492
    1468
    1356
    1330
    1302
    1283
    1179
    925
    858
    755
    585
    409
    349
    222
    222
    134
    1275
    77
    1655 Total
    666 Total
    1082
    952
    407
    405
    1593
    271 Total
    177
    395 Total
    347 Total
    473
    263
    9
    16 Total
    375
    1168
    20
    1726
    1464
    1566
    1617 Total
    128 Total
    1100
    185 Total
    468
    363 Total
    1392 Total
    112 Total
    1705
    656 Total

    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,800.00
    $1,798.80
    $1,796.00
    $1,795.00
    $1,792.53
    $1,791.00
    $1,782.76
    $1,780.00
    $1,778.50
    $1,777.50
    $1,775.73
    $1,773.00
    $1,770.00
    $1,770.00
    $1,770.00
    $1,770.00
    $1,770.00
    $1,766.89
    $1,764.00
    $1,760.00
    $1,760.00
    $1,756.00
    $1,756.00
    $1,752.88
    $1,750.00
    $1,750.00
    $1,750.00
    $1,746.00
    $1,744.50
    $1,740.00
    $1,740.00
    $1,740.00
    $1,740.00
    $1,738.20

    104 Total
    732 Total
    1070
    1564
    1089
    965
    992
    419
    401 Total
    1509
    1192
    1138
    168 Total
    438 Total
    1080 Total
    1384
    1334
    964 Total
    467 Total
    1142
    988
    1369 Total
    959 Total
    69 Total
    1263
    1179
    757
    404
    216
    205
    36
    1584 Total
    1390 Total
    1341 Total
    175 Total
    1168
    1127
    758
    648
    521
    1288 Total
    1156
    1325 Total
    1318 Total
    735 Total
    1271 Total
    1111
    404
    848 Total
    918
    1133
    816
    906 Total

    $1,735.00
    $1,734.80
    $1,734.24
    $1,730.00
    $1,730.00
    $1,730.00
    $1,728.00
    $1,723.00
    $1,720.86
    $1,720.00
    $1,720.00
    $1,720.00
    $1,717.00
    $1,716.62
    $1,715.46
    $1,711.50
    $1,710.00
    $1,705.00
    $1,705.00
    $1,704.75
    $1,703.90
    $1,703.56
    $1,700.00
    $1,700.00
    $1,700.00
    $1,700.00
    $1,700.00
    $1,700.00
    $1,700.00
    $1,700.00
    $1,700.00
    $1,698.30
    $1,696.00
    $1,696.00
    $1,695.00
    $1,695.00
    $1,695.00
    $1,695.00
    $1,695.00
    $1,695.00
    $1,686.75
    $1,685.95
    $1,680.00
    $1,676.00
    $1,675.00
    $1,675.00
    $1,674.00
    $1,672.00
    $1,660.00
    $1,660.00
    $1,657.50
    $1,657.50
    $1,657.00

    635 Total
    1142
    1175
    1136
    963
    179
    141
    678 Total
    1733 Total
    1141 Total
    1465
    919
    914
    351
    509 Total
    675
    857
    1568
    1016
    944
    38
    1129 Total
    793 Total
    460 Total
    1000 Total
    1381
    1280
    521
    508
    1197
    935
    1702 Total
    1441 Total
    187
    1328
    480 Total
    886 Total
    670 Total
    800
    391 Total
    259 Total
    1520 Total
    1453 Total
    1686
    1665
    1664
    1593
    1425
    1356
    1331
    1142
    1142
    1115

    $1,657.00
    $1,656.20
    $1,656.00
    $1,656.00
    $1,656.00
    $1,656.00
    $1,656.00
    $1,655.00
    $1,650.00
    $1,650.00
    $1,650.00
    $1,650.00
    $1,650.00
    $1,650.00
    $1,645.00
    $1,645.00
    $1,641.00
    $1,640.00
    $1,640.00
    $1,640.00
    $1,638.00
    $1,633.81
    $1,627.30
    $1,624.84
    $1,620.00
    $1,620.00
    $1,620.00
    $1,615.50
    $1,615.50
    $1,615.44
    $1,615.00
    $1,614.50
    $1,611.40
    $1,611.00
    $1,610.00
    $1,606.50
    $1,606.00
    $1,601.75
    $1,600.20
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00

    1100
    747
    737
    559
    540
    804 Total
    826 Total
    897 Total
    418
    903
    515
    1089
    478 Total
    399
    190 Total
    1048
    137
    454 Total
    1232 Total
    188 Total
    1318
    931
    336 Total
    972
    189 Total
    1585 Total
    1382 Total
    422 Total
    766 Total
    1588
    1675 Total
    1730
    1727
    1429
    940
    503
    619 Total
    906
    635
    1275
    1161 Total
    285
    405
    803
    626 Total
    1551 Total
    223
    851
    728
    1477
    968
    247
    255

    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,600.00
    $1,598.75
    $1,598.29
    $1,598.00
    $1,596.00
    $1,593.00
    $1,593.00
    $1,592.00
    $1,590.00
    $1,590.00
    $1,588.40
    $1,581.80
    $1,581.00
    $1,578.00
    $1,577.80
    $1,577.75
    $1,576.00
    $1,576.00
    $1,575.00
    $1,575.00
    $1,570.50
    $1,561.99
    $1,560.00
    $1,559.30
    $1,555.00
    $1,552.50
    $1,550.00
    $1,550.00
    $1,550.00
    $1,550.00
    $1,550.00
    $1,549.00
    $1,548.90
    $1,547.00
    $1,547.00
    $1,545.09
    $1,545.00
    $1,540.00
    $1,539.00
    $1,534.55
    $1,530.25
    $1,530.00
    $1,530.00
    $1,525.75
    $1,525.75
    $1,525.50
    $1,525.50
    $1,525.50
    $1,525.00

    9
    341 Total
    1530 Total
    1471
    1438
    1348
    1140
    1140
    648
    1660
    1644
    1634
    1429
    1379
    1359
    982
    978
    958
    790
    727
    43
    30
    108
    971 Total
    61 Total
    1618 Total
    1458 Total
    561 Total
    556 Total
    1083
    921
    1372 Total
    1702
    1410
    54
    54
    388 Total
    1251 Total
    831 Total
    234 Total
    209 Total
    1723 Total
    1620 Total
    1677
    1570
    1534
    1459
    1425
    1399
    1275
    1273
    1237
    1225

    $1,520.40
    $1,520.00
    $1,520.00
    $1,520.00
    $1,520.00
    $1,520.00
    $1,520.00
    $1,520.00
    $1,520.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,516.00
    $1,515.75
    $1,515.00
    $1,515.00
    $1,515.00
    $1,510.90
    $1,510.00
    $1,510.00
    $1,507.68
    $1,507.00
    $1,505.00
    $1,504.50
    $1,504.50
    $1,504.30
    $1,504.30
    $1,503.00
    $1,500.05
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00

    1218
    1101
    1089
    992
    973
    946
    923
    870
    812
    792
    786
    743
    741
    739
    641
    633
    549
    459
    458
    403
    369
    364
    318
    234
    162
    147
    44
    24
    851
    9
    170 Total
    34
    709
    1270
    1622 Total
    151
    251 Total
    1486 Total
    362
    386
    800
    1523
    1344
    231
    295 Total
    946
    223
    935
    226
    476 Total
    1357
    157 Total
    1117 Total

    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,500.00
    $1,496.00
    $1,495.00
    $1,492.00
    $1,491.55
    $1,491.40
    $1,488.44
    $1,485.00
    $1,485.00
    $1,483.05
    $1,481.90
    $1,480.00
    $1,479.20
    $1,478.55
    $1,475.51
    $1,475.00
    $1,475.00
    $1,470.00
    $1,470.00
    $1,470.00
    $1,465.28
    $1,464.00
    $1,463.50
    $1,462.00
    $1,460.00
    $1,457.20

    707 Total
    1598 Total
    1472
    914
    671
    169
    752 Total
    1084
    1153
    1032
    1438
    1038
    535
    42
    903
    485 Total
    1583
    1531 Total
    725 Total
    62
    171 Total
    1704
    700
    911
    911
    22 Total
    1009
    1511
    582
    1464
    64 Total
    532 Total
    242 Total
    42
    55
    13 Total
    983 Total
    895 Total
    590 Total
    516 Total
    368 Total
    195 Total
    1742 Total
    1694 Total
    1676 Total
    1405 Total
    1617
    1481
    1428
    1382
    1362
    1312
    1239

    $1,450.00
    $1,450.00
    $1,450.00
    $1,450.00
    $1,450.00
    $1,450.00
    $1,445.00
    $1,445.00
    $1,440.75
    $1,440.75
    $1,440.00
    $1,440.00
    $1,440.00
    $1,440.00
    $1,435.00
    $1,434.07
    $1,432.28
    $1,432.00
    $1,430.00
    $1,425.90
    $1,423.25
    $1,422.00
    $1,421.50
    $1,421.00
    $1,420.00
    $1,418.80
    $1,418.70
    $1,416.00
    $1,413.00
    $1,412.00
    $1,410.00
    $1,410.00
    $1,410.00
    $1,408.00
    $1,405.50
    $1,401.86
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00

    1016
    876
    743
    721
    644
    633
    531
    513
    441
    167
    147
    49
    1540
    1469 Total
    1452
    1705
    1653
    1540
    1153
    838
    448
    412
    319
    272
    1209
    487 Total
    425 Total
    1291
    446
    15 Total
    1545
    1545
    1545
    1545
    1545
    1545
    274 Total
    124 Total
    991 Total
    889 Total
    224 Total
    891 Total
    1116
    1247 Total
    279 Total
    1434 Total
    393
    1495 Total
    247
    1701 Total
    505 Total
    1186
    1583

    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,400.00
    $1,399.50
    $1,398.00
    $1,395.50
    $1,395.00
    $1,395.00
    $1,395.00
    $1,395.00
    $1,395.00
    $1,395.00
    $1,395.00
    $1,395.00
    $1,395.00
    $1,392.00
    $1,390.00
    $1,390.00
    $1,390.00
    $1,390.00
    $1,388.50
    $1,387.50
    $1,387.50
    $1,387.50
    $1,387.50
    $1,387.50
    $1,387.50
    $1,387.50
    $1,387.43
    $1,387.15
    $1,387.10
    $1,387.00
    $1,386.77
    $1,386.00
    $1,384.00
    $1,380.00
    $1,380.00
    $1,380.00
    $1,375.00
    $1,375.00
    $1,374.00
    $1,370.00
    $1,370.00
    $1,365.00

    975
    286 Total
    165 Total
    1713
    956
    1587
    1587
    1379
    1136
    963
    731
    84
    250
    137
    522 Total
    844
    702 Total
    241 Total
    1582 Total
    1306 Total
    1598
    1330
    1194
    989
    989
    81
    841
    344
    1322
    1140
    1174 Total
    82
    406 Total
    1586
    915
    48
    794
    617
    587 Total
    930
    1496 Total
    1451 Total
    123
    44
    48
    889
    1231
    1287
    919
    711
    544
    1567
    1122

    $1,365.00
    $1,360.00
    $1,360.00
    $1,360.00
    $1,360.00
    $1,356.00
    $1,356.00
    $1,356.00
    $1,356.00
    $1,356.00
    $1,356.00
    $1,356.00
    $1,355.75
    $1,355.75
    $1,355.00
    $1,350.50
    $1,350.00
    $1,350.00
    $1,350.00
    $1,350.00
    $1,350.00
    $1,350.00
    $1,350.00
    $1,350.00
    $1,350.00
    $1,350.00
    $1,346.15
    $1,345.50
    $1,345.00
    $1,345.00
    $1,344.50
    $1,343.64
    $1,343.47
    $1,342.14
    $1,341.84
    $1,341.00
    $1,340.00
    $1,340.00
    $1,338.50
    $1,331.26
    $1,330.00
    $1,330.00
    $1,330.00
    $1,330.00
    $1,327.50
    $1,327.10
    $1,326.40
    $1,325.75
    $1,325.00
    $1,323.00
    $1,323.00
    $1,320.00
    $1,320.00

    421
    140
    359
    1049 Total
    41 Total
    920 Total
    99
    919
    451
    1712
    941 Total
    1155
    1372
    869 Total
    4 Total
    912 Total
    677 Total
    1088 Total
    1348
    1335
    986
    913
    667
    622
    618
    507
    93
    69
    1655
    1319
    988
    555
    1307 Total
    1294
    1059 Total
    1378 Total
    62
    1555
    1430
    1567
    795
    54
    54
    1226 Total
    703 Total
    1225
    1039
    980
    935
    511
    729 Total
    1653
    1459

    $1,320.00
    $1,320.00
    $1,316.00
    $1,315.95
    $1,315.00
    $1,313.25
    $1,312.50
    $1,310.00
    $1,310.00
    $1,308.06
    $1,306.43
    $1,306.00
    $1,305.00
    $1,304.80
    $1,301.94
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,300.00
    $1,295.00
    $1,295.00
    $1,295.00
    $1,295.00
    $1,294.25
    $1,293.63
    $1,293.55
    $1,293.00
    $1,292.00
    $1,290.00
    $1,285.00
    $1,284.00
    $1,283.45
    $1,282.00
    $1,282.00
    $1,280.10
    $1,280.00
    $1,280.00
    $1,280.00
    $1,280.00
    $1,280.00
    $1,280.00
    $1,279.75
    $1,276.00
    $1,276.00

    1359
    921
    872
    369
    1377
    1366
    135
    193 Total
    935
    1226
    426 Total
    1530
    1225
    544
    1591
    1366
    989
    693 Total
    1718 Total
    936
    814
    507
    50
    942
    731
    641
    1374
    239 Total
    1473
    1303
    910
    864
    671
    259
    128
    1024
    1236 Total
    1336
    564 Total
    925
    723
    108
    398 Total
    359
    1121
    1225
    178 Total
    1473
    386
    1090
    54
    1190 Total
    988

    $1,276.00
    $1,276.00
    $1,276.00
    $1,276.00
    $1,275.00
    $1,275.00
    $1,275.00
    $1,272.60
    $1,270.75
    $1,270.10
    $1,270.00
    $1,270.00
    $1,269.38
    $1,268.00
    $1,265.39
    $1,265.00
    $1,265.00
    $1,261.47
    $1,260.00
    $1,260.00
    $1,260.00
    $1,260.00
    $1,258.00
    $1,256.00
    $1,255.50
    $1,255.50
    $1,251.80
    $1,250.00
    $1,250.00
    $1,250.00
    $1,250.00
    $1,250.00
    $1,250.00
    $1,250.00
    $1,250.00
    $1,245.00
    $1,242.27
    $1,242.00
    $1,241.00
    $1,240.00
    $1,240.00
    $1,240.00
    $1,237.00
    $1,236.00
    $1,232.00
    $1,231.66
    $1,228.63
    $1,228.00
    $1,227.80
    $1,225.00
    $1,224.60
    $1,223.65
    $1,223.40

    913
    802 Total
    537 Total
    493 Total
    1349 Total
    272
    1654
    841
    311
    1629 Total
    1644
    423
    1297 Total
    79
    1523
    785 Total
    1512
    1512
    488 Total
    1014
    5
    325 Total
    908 Total
    470 Total
    462 Total
    1542 Total
    1528 Total
    1416 Total
    1223 Total
    1729
    1694
    1638
    1611
    1596
    1542
    1529
    1505
    1468
    1468
    1466
    1459
    1442
    1434
    1416
    1356
    1356
    1356
    1183
    1164
    1151
    1151
    1045
    1045

    $1,221.00
    $1,220.00
    $1,220.00
    $1,220.00
    $1,220.00
    $1,220.00
    $1,217.28
    $1,216.90
    $1,216.62
    $1,216.00
    $1,216.00
    $1,216.00
    $1,215.00
    $1,215.00
    $1,214.49
    $1,212.00
    $1,211.25
    $1,211.24
    $1,207.50
    $1,207.00
    $1,207.00
    $1,200.40
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00

    1024
    1015
    1015
    998
    961
    921
    914
    876
    851
    831
    812
    796
    771
    757
    677
    558
    539
    529
    455
    450
    423
    341
    241
    205
    202
    116
    100
    77
    1671
    1513
    1438
    1380
    1314
    1039
    942
    938
    67
    1624 Total
    1465
    1395
    1140
    803
    1737
    935
    690 Total
    392
    1102 Total
    1739 Total
    1644
    907 Total
    1224
    1087
    694 Total

    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,200.00
    $1,196.00
    $1,196.00
    $1,196.00
    $1,196.00
    $1,196.00
    $1,196.00
    $1,196.00
    $1,196.00
    $1,196.00
    $1,195.00
    $1,195.00
    $1,195.00
    $1,195.00
    $1,194.00
    $1,192.50
    $1,192.00
    $1,190.00
    $1,190.00
    $1,187.00
    $1,185.00
    $1,184.00
    $1,181.69
    $1,180.00
    $1,180.00
    $1,178.35

    884
    1389 Total
    507
    1632 Total
    1608
    968
    1635
    508
    1240
    1037 Total
    1384
    713 Total
    1232
    832
    194
    928
    925
    925
    246
    277 Total
    1056 Total
    894 Total
    650
    596 Total
    129 Total
    1350
    529
    90
    996 Total
    1505
    1505
    1066 Total
    728
    1531
    1253 Total
    81
    935
    400
    969 Total
    1673 Total
    1670 Total
    1221
    990
    930
    563
    112
    108
    174 Total
    924 Total
    913
    180
    63
    1639

    $1,176.00
    $1,175.00
    $1,175.00
    $1,170.00
    $1,170.00
    $1,170.00
    $1,165.50
    $1,165.50
    $1,163.35
    $1,162.50
    $1,160.50
    $1,160.00
    $1,160.00
    $1,160.00
    $1,160.00
    $1,156.00
    $1,155.68
    $1,155.68
    $1,152.87
    $1,152.75
    $1,152.00
    $1,151.25
    $1,150.17
    $1,150.00
    $1,150.00
    $1,150.00
    $1,150.00
    $1,150.00
    $1,148.75
    $1,147.90
    $1,147.90
    $1,147.50
    $1,147.50
    $1,145.60
    $1,145.00
    $1,143.60
    $1,141.30
    $1,140.80
    $1,140.00
    $1,140.00
    $1,140.00
    $1,140.00
    $1,140.00
    $1,140.00
    $1,140.00
    $1,140.00
    $1,140.00
    $1,139.00
    $1,137.09
    $1,137.00
    $1,135.55
    $1,135.00
    $1,134.25

    834 Total
    29 Total
    610 Total
    1218
    967
    820
    532
    279
    767
    1424
    1180
    898
    68
    475 Total
    1321
    1406 Total
    1680 Total
    1535 Total
    271
    494 Total
    126 Total
    1181 Total
    362
    214
    3
    3
    1629
    846
    67
    1417 Total
    865 Total
    428 Total
    778 Total
    542 Total
    975
    1721 Total
    572 Total
    925
    1716 Total
    1689 Total
    1592 Total
    1461 Total
    1309 Total
    1177 Total
    1063 Total
    1052 Total
    1713
    1505
    1485
    1400
    1177
    937
    926

    $1,132.00
    $1,132.00
    $1,131.00
    $1,130.00
    $1,130.00
    $1,130.00
    $1,130.00
    $1,130.00
    $1,126.62
    $1,126.25
    $1,125.00
    $1,125.00
    $1,124.75
    $1,124.50
    $1,124.25
    $1,124.00
    $1,123.10
    $1,122.50
    $1,122.38
    $1,120.00
    $1,120.00
    $1,120.00
    $1,120.00
    $1,120.00
    $1,116.33
    $1,116.33
    $1,116.00
    $1,116.00
    $1,116.00
    $1,115.16
    $1,111.65
    $1,111.00
    $1,110.00
    $1,110.00
    $1,110.00
    $1,109.45
    $1,109.40
    $1,109.10
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00

    876
    695
    441
    416
    363
    360
    257
    218
    175
    28
    65 Total
    145 Total
    1197
    880 Total
    1596
    1485
    1389
    1025
    364
    1464
    36
    528 Total
    310 Total
    197 Total
    751 Total
    400
    1681 Total
    68
    1606
    1459
    1241
    1198
    1197
    1116
    855
    849
    849
    591
    797 Total
    1067
    639 Total
    131 Total
    1304 Total
    1609
    814
    1620
    1271
    848
    524 Total
    611 Total
    1679 Total
    314 Total
    291 Total

    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,100.00
    $1,099.50
    $1,098.58
    $1,097.10
    $1,095.00
    $1,095.00
    $1,095.00
    $1,095.00
    $1,095.00
    $1,095.00
    $1,094.90
    $1,093.00
    $1,088.70
    $1,086.50
    $1,086.50
    $1,085.00
    $1,084.80
    $1,083.39
    $1,081.00
    $1,080.00
    $1,080.00
    $1,080.00
    $1,080.00
    $1,080.00
    $1,080.00
    $1,080.00
    $1,080.00
    $1,080.00
    $1,080.00
    $1,078.90
    $1,076.70
    $1,076.00
    $1,076.00
    $1,075.76
    $1,075.50
    $1,075.50
    $1,075.00
    $1,075.00
    $1,075.00
    $1,073.90
    $1,070.75
    $1,067.45
    $1,065.00
    $1,065.00

    232 Total
    794
    1074
    1112 Total
    1083
    1323 Total
    1493 Total
    1063
    142
    1593
    1258
    1317 Total
    1365
    34
    769 Total
    698 Total
    1109 Total
    1590
    1583
    1297
    975
    967
    954
    935
    911
    847
    846
    759
    701
    618
    397
    365
    324
    184
    104
    14
    1016
    1244 Total
    451
    281
    1281 Total
    806 Total
    1730
    1007 Total
    1643
    1590
    1186
    1184
    909
    632
    347
    75
    296

    $1,065.00
    $1,062.50
    $1,062.00
    $1,060.00
    $1,060.00
    $1,058.69
    $1,058.25
    $1,058.00
    $1,057.87
    $1,057.50
    $1,056.00
    $1,055.00
    $1,053.00
    $1,052.52
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,050.00
    $1,047.60
    $1,046.25
    $1,045.00
    $1,044.00
    $1,043.60
    $1,041.59
    $1,041.25
    $1,040.70
    $1,040.00
    $1,040.00
    $1,040.00
    $1,040.00
    $1,040.00
    $1,040.00
    $1,040.00
    $1,038.40
    $1,037.40

    311
    885
    885
    263
    254
    177
    1448
    915
    1124 Total
    907
    253
    1243
    518 Total
    1252 Total
    1096 Total
    216
    623
    1197
    1672 Total
    910
    514 Total
    508
    1591
    1708
    1578
    1032
    576
    1726
    1314
    978
    787
    141
    102
    1268 Total
    935
    1471
    1480 Total
    1154 Total
    1480
    1270
    1108
    239
    1706 Total
    527
    1452
    772 Total
    510 Total
    1736 Total
    1735 Total
    1411 Total
    1371 Total
    1159 Total
    1103 Total

    $1,036.63
    $1,036.00
    $1,036.00
    $1,036.00
    $1,036.00
    $1,036.00
    $1,035.00
    $1,035.00
    $1,034.70
    $1,034.06
    $1,032.08
    $1,030.50
    $1,030.00
    $1,030.00
    $1,030.00
    $1,030.00
    $1,028.50
    $1,025.02
    $1,025.00
    $1,025.00
    $1,023.73
    $1,020.50
    $1,020.35
    $1,020.00
    $1,020.00
    $1,020.00
    $1,020.00
    $1,016.00
    $1,016.00
    $1,016.00
    $1,016.00
    $1,016.00
    $1,015.00
    $1,014.39
    $1,014.23
    $1,014.00
    $1,010.00
    $1,010.00
    $1,010.00
    $1,010.00
    $1,010.00
    $1,010.00
    $1,005.00
    $1,004.00
    $1,000.50
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00

    1728
    1698
    1688
    1678
    1544
    1529
    1529
    1459
    1405
    1365
    1365
    1265
    1245
    1218
    1217
    1120
    1120
    1087
    1048
    1023
    913
    837
    837
    833
    809
    786
    668
    641
    638
    511
    459
    409
    403
    330
    202
    184
    181
    139
    54
    280
    955
    849
    758
    365
    1321
    407
    375
    902
    261 Total
    108
    914
    357 Total
    1241

    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $1,000.00
    $997.40
    $996.20
    $995.00
    $995.00
    $995.00
    $993.75
    $990.00
    $990.00
    $988.55
    $987.15
    $987.00
    $985.50
    $985.00
    $985.00

    373 Total
    918
    385 Total
    1659 Total
    1456 Total
    1130
    1684
    421
    825 Total
    304 Total
    1674 Total
    1653
    1180
    1061
    535
    874 Total
    593 Total
    1657 Total
    816
    602 Total
    1717 Total
    1214 Total
    1643
    919
    602
    416
    280
    160
    1235
    449 Total
    121
    142
    917 Total
    413 Total
    1308 Total
    1299 Total
    1720
    1534
    1377
    1308
    1103
    1093
    965
    155
    3
    634
    88 Total
    709
    101
    246
    842 Total
    875
    730 Total

    $984.55
    $982.91
    $981.20
    $980.00
    $980.00
    $980.00
    $976.49
    $975.00
    $970.00
    $970.00
    $970.00
    $970.00
    $970.00
    $969.00
    $967.50
    $966.00
    $964.75
    $963.70
    $960.50
    $960.00
    $960.00
    $960.00
    $960.00
    $960.00
    $960.00
    $960.00
    $960.00
    $960.00
    $958.50
    $957.00
    $956.25
    $952.88
    $950.00
    $950.00
    $950.00
    $950.00
    $950.00
    $950.00
    $950.00
    $950.00
    $950.00
    $950.00
    $950.00
    $950.00
    $950.00
    $949.35
    $949.00
    $948.00
    $947.94
    $947.88
    $945.75
    $945.75
    $945.40

    72 Total
    172 Total
    744
    473
    1365
    1365
    960 Total
    1415 Total
    689
    692 Total
    1294
    1198
    1014
    5
    804
    1243
    1719 Total
    1108
    972
    678
    231
    1284 Total
    192 Total
    319
    823 Total
    1462 Total
    1669
    1395
    1005
    228
    52
    1289
    400
    1503
    1239
    775
    33 Total
    911
    625 Total
    293 Total
    1520
    685
    554
    423
    399
    1579 Total
    520 Total
    299 Total
    472
    1586
    910
    1209
    512 Total

    $944.20
    $940.00
    $940.00
    $940.00
    $937.76
    $937.76
    $936.50
    $936.40
    $935.00
    $932.23
    $930.75
    $930.75
    $930.75
    $930.75
    $927.00
    $925.50
    $925.00
    $925.00
    $925.00
    $925.00
    $925.00
    $923.50
    $923.44
    $923.00
    $920.00
    $920.00
    $920.00
    $920.00
    $920.00
    $920.00
    $918.00
    $916.00
    $915.20
    $915.00
    $915.00
    $914.64
    $912.10
    $910.44
    $910.00
    $910.00
    $910.00
    $910.00
    $910.00
    $910.00
    $910.00
    $909.35
    $908.73
    $904.00
    $904.00
    $903.80
    $903.80
    $903.60
    $903.45

    970 Total
    904 Total
    708 Total
    1202 Total
    1026 Total
    1742
    1720
    1604
    1563
    1545
    1498
    1486
    1430
    1343
    1270
    1238
    1228
    1225
    1178
    1162
    1148
    1072
    1066
    1049
    1025
    1011
    998
    970
    935
    935
    914
    834
    788
    770
    735
    682
    667
    638
    580
    549
    531
    527
    522
    507
    462
    349
    235
    216
    215
    158
    81
    80
    1517 Total

    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $900.00
    $899.70

    1275
    1448
    711
    1495
    1344
    1319
    1218
    1194
    1192
    1143
    935
    245
    716 Total
    1305 Total
    594 Total
    994 Total
    1551
    1550
    127 Total
    323 Total
    1365
    915
    1494
    680 Total
    621 Total
    326 Total
    1642 Total
    1188 Total
    1386
    1257
    1250
    1178
    897
    421
    1473
    1067
    547 Total
    1513
    852
    263
    131
    1532 Total
    106 Total
    989
    759
    744
    381
    892 Total
    1591
    1639
    925
    873 Total
    1388 Total

    $899.40
    $895.50
    $895.50
    $895.00
    $895.00
    $895.00
    $895.00
    $895.00
    $895.00
    $895.00
    $895.00
    $895.00
    $894.55
    $892.15
    $890.10
    $890.00
    $890.00
    $890.00
    $889.00
    $885.00
    $884.40
    $881.55
    $880.37
    $880.00
    $880.00
    $880.00
    $880.00
    $880.00
    $880.00
    $880.00
    $880.00
    $880.00
    $880.00
    $880.00
    $877.00
    $876.98
    $876.25
    $876.00
    $876.00
    $876.00
    $876.00
    $875.00
    $875.00
    $875.00
    $875.00
    $875.00
    $875.00
    $873.45
    $871.00
    $870.75
    $870.10
    $870.00
    $870.00

    617
    1633
    111 Total
    1205
    918
    552 Total
    995
    400
    16
    616 Total
    273 Total
    273
    1098
    1454 Total
    133 Total
    1591
    1464
    1373
    960
    944
    935
    925
    62
    830 Total
    1424
    52
    249 Total
    1470
    110 Total
    914
    940
    849
    244 Total
    1616 Total
    1615 Total
    1439 Total
    1310 Total
    1158 Total
    1468
    1311
    1310
    1079
    1065
    951
    610
    345
    317
    165
    1584
    1584
    185
    1447 Total
    117 Total

    $870.00
    $869.40
    $869.25
    $868.80
    $868.12
    $866.35
    $865.00
    $865.00
    $865.00
    $863.50
    $863.00
    $863.00
    $862.50
    $860.00
    $860.00
    $860.00
    $860.00
    $860.00
    $860.00
    $860.00
    $860.00
    $859.20
    $859.14
    $858.50
    $858.50
    $858.19
    $857.16
    $857.00
    $855.00
    $855.00
    $854.75
    $850.35
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $850.00
    $849.15
    $849.15
    $848.26
    $847.00
    $847.00

    1288
    344
    1307
    842
    756
    793
    918
    1583
    670
    385
    9
    1366
    1288
    923
    832
    507
    469
    50
    27
    27
    27
    27
    3
    1650 Total
    461 Total
    775
    1132 Total
    909
    9
    278 Total
    765 Total
    1425
    1145 Total
    1508
    1467
    396 Total
    1466
    1294
    1139 Total
    47 Total
    1709 Total
    1438
    728
    1619 Total
    1340 Total
    27
    1015
    947
    95
    584 Total
    1150 Total
    1586
    1586

    $846.75
    $846.00
    $845.75
    $845.75
    $845.75
    $845.00
    $843.18
    $842.72
    $841.75
    $841.20
    $841.00
    $840.17
    $840.00
    $840.00
    $840.00
    $840.00
    $840.00
    $840.00
    $840.00
    $840.00
    $840.00
    $840.00
    $840.00
    $837.00
    $836.65
    $835.50
    $835.00
    $835.00
    $834.40
    $833.35
    $832.35
    $831.60
    $830.50
    $830.00
    $830.00
    $825.00
    $825.00
    $825.00
    $823.45
    $820.00
    $820.00
    $820.00
    $820.00
    $819.50
    $819.00
    $819.00
    $818.12
    $818.12
    $815.00
    $813.00
    $811.92
    $811.52
    $811.52

    508
    1479 Total
    1035 Total
    1162
    1135
    1083
    969
    255
    6
    925
    1106 Total
    185
    1594
    936
    1142
    422
    451
    916
    952
    839 Total
    819 Total
    657 Total
    653 Total
    636 Total
    624 Total
    606 Total
    597 Total
    1697 Total
    1524 Total
    1460 Total
    1426 Total
    1423 Total
    1315 Total
    1227 Total
    1085 Total
    1060 Total
    1728
    1706
    1676
    1603
    1594
    1582
    1573
    1547
    1534
    1534
    1505
    1499
    1498
    1459
    1459
    1453
    1453

    $810.50
    $810.00
    $810.00
    $810.00
    $810.00
    $810.00
    $810.00
    $810.00
    $810.00
    $809.40
    $809.00
    $807.74
    $805.50
    $805.50
    $805.20
    $805.20
    $805.00
    $803.20
    $802.44
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00

    1440
    1425
    1425
    1425
    1392
    1391
    1390
    1360
    1335
    1332
    1332
    1282
    1275
    1275
    1267
    1245
    1237
    1224
    1221
    1217
    1215
    1213
    1204
    1203
    1183
    1166
    1151
    1151
    1085
    1084
    1083
    1054
    1034
    1016
    1016
    1012
    992
    985
    973
    965
    959
    937
    935
    912
    911
    910
    910
    910
    849
    849
    814
    796
    758

    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00

    756
    756
    745
    689
    636
    587
    581
    580
    577
    558
    521
    511
    421
    419
    411
    404
    398
    398
    329
    329
    319
    303
    244
    225
    122
    80
    44
    55
    1266 Total
    1390
    573
    141
    141
    501 Total
    1272 Total
    1725
    857
    155
    94
    6
    872
    835
    901
    934 Total
    643 Total
    1731 Total
    118 Total
    90
    3
    972
    771
    171
    159

    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $800.00
    $797.50
    $796.80
    $796.00
    $796.00
    $796.00
    $796.00
    $795.30
    $795.00
    $795.00
    $795.00
    $795.00
    $795.00
    $795.00
    $792.00
    $791.20
    $790.91
    $790.00
    $790.00
    $790.00
    $790.00
    $790.00
    $789.10
    $787.50
    $786.25
    $786.25
    $786.25

    810 Total
    754
    1699
    121
    900
    770
    824 Total
    78 Total
    490 Total
    1690
    1659
    1607
    1442
    1273
    1164
    1125
    1125
    86
    73
    46
    1504 Total
    1583
    1412
    978
    790
    254
    981 Total
    31 Total
    1396
    108
    115 Total
    1289
    1652 Total
    370
    1545
    1545
    1545
    1545
    1545
    1545
    38
    901
    795
    795
    795
    650
    1557
    1410
    623
    529
    1591
    230 Total
    198 Total

    $786.00
    $783.55
    $782.40
    $782.00
    $781.76
    $781.41
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $780.00
    $779.95
    $776.00
    $776.00
    $776.00
    $776.00
    $776.00
    $775.00
    $775.00
    $775.00
    $775.00
    $771.50
    $771.00
    $770.05
    $768.25
    $768.00
    $768.00
    $768.00
    $768.00
    $768.00
    $768.00
    $765.00
    $764.27
    $762.91
    $762.91
    $762.91
    $760.83
    $760.75
    $760.75
    $760.75
    $760.75
    $760.70
    $760.00
    $760.00

    1502 Total
    1146 Total
    1440
    1371
    1080
    916
    563
    578 Total
    1329 Total
    756
    1278
    767
    27
    706 Total
    854 Total
    70 Total
    379 Total
    308 Total
    1455 Total
    1313 Total
    1097 Total
    1069 Total
    1730
    1609
    1591
    1472
    1466
    1455
    1386
    1376
    1166
    1122
    1119
    1068
    1067
    1018
    1016
    942
    935
    919
    913
    717
    713
    620
    486
    478
    407
    245
    224
    218
    129
    93
    70

    $760.00
    $760.00
    $760.00
    $760.00
    $760.00
    $760.00
    $760.00
    $758.00
    $756.10
    $756.00
    $753.41
    $751.08
    $750.50
    $750.25
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00
    $750.00

    720 Total
    868 Total
    1089
    995
    1295 Total
    12
    1027 Total
    845 Total
    722 Total
    466 Total
    333 Total
    1519 Total
    1445 Total
    1668
    1633
    1392
    887
    392
    681 Total
    777 Total
    1636 Total
    1555
    948
    948
    948
    783
    116
    1470
    1283
    768
    1577 Total
    1363 Total
    1029 Total
    672 Total
    1044 Total
    206
    1687
    783
    396
    220
    875
    1611
    1280
    1091
    1091
    582
    411
    388
    915
    946
    931
    785
    515

    $746.60
    $745.00
    $745.00
    $745.00
    $744.50
    $744.00
    $741.50
    $740.00
    $740.00
    $740.00
    $740.00
    $740.00
    $740.00
    $740.00
    $740.00
    $740.00
    $740.00
    $740.00
    $736.00
    $735.99
    $734.60
    $733.50
    $731.69
    $731.69
    $731.69
    $731.48
    $730.75
    $730.00
    $730.00
    $730.00
    $729.00
    $728.30
    $728.00
    $727.80
    $726.25
    $726.00
    $725.00
    $725.00
    $725.00
    $725.00
    $723.19
    $720.80
    $720.00
    $720.00
    $720.00
    $720.00
    $720.00
    $720.00
    $719.72
    $716.00
    $716.00
    $716.00
    $716.00

    360
    179
    844
    714 Total
    237 Total
    1269 Total
    1459
    1331
    509
    327
    61
    599
    1176 Total
    1354
    1004 Total
    569 Total
    764
    1541 Total
    1200 Total
    295
    1579
    997 Total
    1098
    62
    1285 Total
    1534
    470
    402
    570 Total
    439 Total
    1605 Total
    916
    905 Total
    605 Total
    457 Total
    437 Total
    414 Total
    346 Total
    32 Total
    176 Total
    1515 Total
    1497 Total
    1338 Total
    114 Total
    1695
    1693
    1685
    1675
    1643
    1604
    1563
    1550
    1528

    $716.00
    $716.00
    $715.97
    $715.00
    $715.00
    $715.00
    $715.00
    $715.00
    $715.00
    $715.00
    $715.00
    $712.70
    $712.50
    $712.50
    $712.30
    $711.00
    $710.60
    $710.00
    $710.00
    $710.00
    $709.35
    $709.10
    $707.50
    $706.50
    $705.00
    $705.00
    $705.00
    $705.00
    $703.40
    $703.00
    $701.90
    $701.25
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00

    1518
    1505
    1497
    1481
    1474
    1470
    1466
    1425
    1425
    1411
    1376
    1375
    1361
    1358
    1338
    1317
    1273
    1270
    1190
    1189
    1160
    1148
    1148
    1135
    1130
    1087
    1084
    1067
    1065
    1025
    962
    946
    935
    921
    913
    908
    904
    899
    858
    789
    781
    771
    768
    759
    759
    701
    675
    657
    622
    620
    581
    576
    562

    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00

    518
    510
    484
    482
    457
    414
    410
    402
    391
    303
    286
    206
    146
    142
    79
    44
    1358
    1100
    354 Total
    1144 Total
    1144
    1452
    1550
    780
    1093
    1725
    1520
    1350
    1273
    590
    123
    18
    321 Total
    1161
    1737
    966 Total
    966
    1100
    519 Total
    1415
    337 Total
    1710
    821
    219 Total
    925
    1300 Total
    85 Total
    1668
    1357
    1249
    1219
    1046
    982

    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $700.00
    $699.00
    $698.48
    $698.00
    $696.86
    $696.86
    $696.50
    $695.00
    $695.00
    $691.44
    $690.00
    $690.00
    $690.00
    $690.00
    $690.00
    $690.00
    $690.00
    $689.60
    $689.00
    $688.50
    $688.00
    $688.00
    $687.95
    $686.50
    $686.40
    $684.50
    $684.25
    $684.20
    $683.39
    $682.20
    $682.00
    $680.00
    $680.00
    $680.00
    $680.00
    $680.00
    $680.00
    $680.00

    61
    21
    821
    1016
    1016
    875
    1074
    988
    1533 Total
    1658
    1525
    1499
    1394
    1336
    1225
    1087
    1038
    752
    1009
    783
    1374
    1339 Total
    260
    87
    10
    629
    213 Total
    948
    1657
    1401 Total
    1558
    1400
    1400
    1400
    1228
    1228
    1168
    929
    752
    670
    555
    448
    136
    108
    170
    1233 Total
    884
    1228
    1311
    726
    1185 Total
    190
    389

    $680.00
    $680.00
    $679.00
    $678.92
    $678.92
    $677.06
    $675.75
    $675.75
    $675.00
    $675.00
    $675.00
    $675.00
    $675.00
    $675.00
    $675.00
    $675.00
    $675.00
    $675.00
    $674.50
    $672.58
    $672.00
    $670.00
    $670.00
    $670.00
    $670.00
    $668.00
    $667.33
    $664.11
    $663.70
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $660.00
    $656.00
    $655.55
    $655.30
    $655.00
    $654.03
    $653.25
    $652.50
    $652.50
    $652.00

    1083
    686 Total
    264 Total
    1647 Total
    1443 Total
    1353 Total
    1255 Total
    1078 Total
    1735
    1688
    1669
    1550
    1467
    1375
    1353
    1263
    1219
    1078
    1054
    991
    988
    930
    921
    788
    779
    666
    629
    599
    581
    533
    488
    430
    304
    40
    3
    1343
    1643
    1711 Total
    1038
    3
    715 Total
    34
    1122
    1721
    1240
    1294
    734 Total
    797
    625
    368
    102
    75
    75

    $651.95
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $650.00
    $649.50
    $649.00
    $648.50
    $646.62
    $646.15
    $645.50
    $645.36
    $645.00
    $644.55
    $643.30
    $642.24
    $640.00
    $640.00
    $640.00
    $640.00
    $640.00
    $640.00
    $640.00

    878

    974
    183

    545

    548
    628
    268

    902
    430
    1015
    946
    1685
    1374
    1374
    946
    215
    31
    317
    1525
    101
    935
    Total
    1284
    1083
    1069
    972
    783
    771
    611
    Total
    897
    Total
    1135
    767
    767
    3
    1683
    405
    102
    Total
    1137
    1032
    928
    607
    545
    260
    1176
    Total
    Total
    Total
    1570
    1249
    1225
    678
    554
    421
    268
    236
    227
    1016

    $639.88
    $639.00
    $637.10
    $635.80
    $635.00
    $635.00
    $635.00
    $635.00
    $635.00
    $635.00
    $634.00
    $631.96
    $631.96
    $631.82
    $631.05
    $630.00
    $630.00
    $630.00
    $630.00
    $630.00
    $629.00
    $628.83
    $628.50
    $628.00
    $627.99
    $627.50
    $625.90
    $625.90
    $625.80
    $625.50
    $625.50
    $625.50
    $625.00
    $625.00
    $625.00
    $625.00
    $625.00
    $625.00
    $625.00
    $622.50
    $620.35
    $620.20
    $620.00
    $620.00
    $620.00
    $620.00
    $620.00
    $620.00
    $620.00
    $620.00
    $620.00
    $618.37
    $617.70

    221 Total
    1179
    946
    1123
    132 Total
    584
    813 Total
    665 Total
    1286 Total
    1381
    1324
    1166
    1087
    1084
    854
    703
    122
    913
    3
    1654
    1174
    933
    451
    528
    753 Total
    1644
    1259 Total
    860 Total
    719 Total
    565 Total
    444 Total
    301 Total
    294 Total
    211 Total
    210 Total
    1703 Total
    1691 Total
    1621 Total
    1490 Total
    144 Total
    1220 Total
    1104 Total
    1042 Total
    1008 Total
    1729
    1725
    1725
    1723
    1704
    1703
    1676
    1631
    1622

    $617.20
    $617.10
    $615.00
    $613.80
    $613.70
    $613.00
    $612.00
    $612.00
    $610.00
    $610.00
    $610.00
    $610.00
    $610.00
    $610.00
    $610.00
    $610.00
    $610.00
    $608.00
    $607.02
    $607.00
    $605.00
    $605.00
    $605.00
    $604.95
    $604.00
    $604.00
    $601.95
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00

    1585
    1583
    1580
    1573
    1539
    1534
    1511
    1488
    1488
    1483
    1468
    1467
    1466
    1459
    1451
    1439
    1396
    1396
    1333
    1325
    1322
    1312
    1278
    1238
    1236
    1227
    1225
    1225
    1224
    1223
    1202
    1196
    1196
    1178
    1156
    1146
    1101
    1100
    1059
    1042
    1040
    1034
    1015
    974
    967
    959
    935
    933
    930
    929
    926
    910
    876

    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00

    869
    845
    840
    826
    826
    823
    791
    783
    771
    741
    735
    724
    704
    675
    654
    653
    641
    641
    634
    633
    624
    620
    616
    597
    592
    592
    563
    554
    552
    549
    539
    537
    536
    520
    499
    495
    494
    455
    455
    446
    445
    423
    402
    390
    386
    379
    378
    349
    327
    317
    208
    208
    208

    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00

    208
    208
    205
    193
    181
    162
    162
    139
    116
    112
    110
    108
    52
    40
    38
    3
    3
    1376
    1 Total
    1
    1082
    1082
    626
    52
    108
    54
    938
    600 Total
    81
    566 Total
    451
    592
    203 Total
    1642
    1396
    194
    150 Total
    924
    431
    105
    1599
    1031
    848
    135
    51
    438
    658 Total
    1555
    258 Total
    1337 Total
    1578
    1464
    1184

    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $600.00
    $598.75
    $598.00
    $598.00
    $597.00
    $597.00
    $597.00
    $596.25
    $595.00
    $595.00
    $593.74
    $592.85
    $591.90
    $591.50
    $591.25
    $591.00
    $590.50
    $590.00
    $590.00
    $590.00
    $589.10
    $587.74
    $586.50
    $585.31
    $585.00
    $585.00
    $585.00
    $585.00
    $585.00
    $581.80
    $581.75
    $580.55
    $580.00
    $580.00
    $580.00
    $580.00
    $580.00

    1084
    761
    493
    235
    1302
    1302
    1332
    883 Total
    424 Total
    1195 Total
    1020 Total
    1710
    1441
    1270
    1082
    429
    195
    104
    946
    68
    1500
    1633
    265 Total
    1501
    561
    363
    330
    1056
    1222
    1079
    1019 Total
    741
    447 Total
    263
    271
    988
    1074
    500 Total
    1591
    338 Total
    334 Total
    1630 Total
    1701
    1697
    1583
    1396
    1280
    579
    529
    529
    209
    101
    1566

    $580.00
    $580.00
    $580.00
    $580.00
    $578.85
    $578.85
    $578.66
    $576.00
    $575.00
    $575.00
    $575.00
    $575.00
    $575.00
    $575.00
    $575.00
    $575.00
    $575.00
    $575.00
    $574.80
    $573.75
    $572.30
    $571.40
    $570.00
    $570.00
    $570.00
    $570.00
    $567.50
    $567.00
    $566.10
    $566.00
    $565.00
    $565.00
    $564.95
    $564.00
    $563.35
    $562.25
    $561.00
    $560.70
    $560.36
    $560.00
    $560.00
    $560.00
    $560.00
    $560.00
    $560.00
    $560.00
    $560.00
    $560.00
    $560.00
    $560.00
    $560.00
    $560.00
    $557.87

    1638
    1283
    915
    770
    30
    1258
    1005
    237
    3
    89
    1187 Total
    1591
    1205
    1301 Total
    939 Total
    738 Total
    684 Total
    613 Total
    1732 Total
    1427 Total
    1262 Total
    1730
    1730
    1687
    1687
    1618
    1582
    1459
    1350
    1141
    1109
    980
    780
    614
    607
    536
    480
    480
    408
    192
    135
    76
    1595 Total
    86
    125 Total
    868
    704
    865
    564
    152 Total
    1118 Total
    1684
    1399

    $556.00
    $556.00
    $556.00
    $556.00
    $556.00
    $555.00
    $555.00
    $555.00
    $554.20
    $553.50
    $552.85
    $552.07
    $552.00
    $551.35
    $550.45
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $550.00
    $548.90
    $547.62
    $547.50
    $545.00
    $545.00
    $541.65
    $541.00
    $540.00
    $540.00
    $540.00
    $540.00

    1347
    1224
    1213
    1116
    1083
    990
    933
    796
    423
    389
    235
    167
    108
    918
    615 Total
    479 Total
    492 Total
    1222
    226
    299
    874
    135
    316 Total
    566
    1546 Total
    1546
    89
    89
    89
    1120
    805 Total
    56 Total
    710 Total
    1645 Total
    1561 Total
    933
    891
    740
    490
    81
    161 Total
    995
    995
    160
    660 Total
    439
    369
    171
    159
    588 Total
    553 Total
    1672
    1540

    $540.00
    $540.00
    $540.00
    $540.00
    $540.00
    $540.00
    $540.00
    $540.00
    $540.00
    $540.00
    $540.00
    $540.00
    $540.00
    $539.90
    $539.40
    $539.00
    $538.97
    $537.90
    $536.00
    $535.80
    $535.50
    $535.00
    $534.25
    $533.50
    $533.00
    $533.00
    $532.50
    $532.50
    $532.50
    $532.00
    $530.90
    $530.50
    $530.00
    $530.00
    $530.00
    $530.00
    $530.00
    $530.00
    $530.00
    $530.00
    $529.91
    $529.75
    $529.75
    $528.75
    $528.70
    $528.00
    $528.00
    $527.00
    $527.00
    $525.15
    $525.00
    $525.00
    $525.00

    1532
    1223
    1163
    767
    759
    751
    484
    20
    884
    700
    913
    1235
    742 Total
    1637 Total
    1680
    1668
    1499
    1483
    1204
    940
    724
    719
    695
    438
    209
    160
    1093
    1093
    915
    507
    35
    1062 Total
    298 Total
    547
    777
    773
    694
    393
    124
    450
    902
    828 Total
    288 Total
    1041 Total
    1687
    1535
    1329
    1325
    1204
    1148
    770
    770
    190

    $525.00
    $525.00
    $525.00
    $525.00
    $525.00
    $525.00
    $525.00
    $524.57
    $524.24
    $523.00
    $522.90
    $520.80
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $520.00
    $518.58
    $518.58
    $518.00
    $517.80
    $517.60
    $517.20
    $516.70
    $516.00
    $515.99
    $515.00
    $515.00
    $515.00
    $515.00
    $513.38
    $512.00
    $511.00
    $510.00
    $510.00
    $510.00
    $510.00
    $510.00
    $510.00
    $510.00
    $510.00
    $510.00
    $510.00
    $508.50

    1100
    393
    1137
    740
    1279 Total
    1285
    962
    855
    339 Total
    186 Total
    930
    807
    1435
    18
    950 Total
    932 Total
    853 Total
    696 Total
    491 Total
    340 Total
    315 Total
    1707 Total
    1628 Total
    1553 Total
    1507 Total
    1421 Total
    1420 Total
    1364 Total
    1229 Total
    1216 Total
    1165 Total
    1022 Total
    1742
    1732
    1730
    1723
    1708
    1707
    1704
    1704
    1693
    1685
    1669
    1667
    1658
    1655
    1615
    1609
    1606
    1604
    1583
    1583
    1580

    $507.64
    $507.11
    $506.00
    $505.05
    $505.00
    $505.00
    $505.00
    $505.00
    $503.00
    $503.00
    $502.26
    $501.20
    $500.50
    $500.10
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00

    1569
    1569
    1569
    1563
    1558
    1545
    1528
    1506
    1501
    1501
    1483
    1461
    1460
    1459
    1458
    1454
    1425
    1425
    1391
    1384
    1377
    1377
    1373
    1364
    1321
    1283
    1278
    1277
    1270
    1250
    1250
    1247
    1245
    1245
    1181
    1166
    1165
    1159
    1148
    1130
    1109
    1100
    1087
    1082
    1079
    1068
    1052
    1040
    1025
    1023
    1022
    996
    985

    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00

    980
    975
    971
    965
    965
    962
    953
    951
    950
    946
    946
    941
    935
    935
    935
    925
    924
    916
    913
    910
    910
    908
    865
    851
    833
    815
    812
    781
    772
    772
    769
    756
    755
    747
    725
    718
    718
    700
    699
    699
    696
    656
    656
    644
    629
    629
    622
    621
    577
    537
    536
    536
    536

    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00

    531
    529
    525
    516
    503
    495
    491
    484
    468
    458
    444
    410
    410
    403
    402
    390
    386
    369
    315
    310
    308
    303
    260
    260
    260
    260
    260
    218
    202
    184
    184
    180
    158
    146
    128
    122
    118
    114
    108
    95
    89
    77
    77
    72
    51
    1452
    393
    910
    918
    1360
    446
    422
    1507

    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $500.00
    $499.50
    $498.85
    $498.45
    $496.16
    $496.00
    $496.00
    $495.60
    $495.00

    1240
    1019
    470
    740
    1015
    898
    168
    1304
    918
    3
    276 Total
    1342 Total
    1586
    847
    668
    487
    382
    52
    181
    108
    1552 Total
    1516 Total
    517 Total
    189
    101
    899
    138 Total
    810
    882 Total
    1141
    1450 Total
    226
    1609
    189
    200 Total
    692
    1463
    60 Total
    1385 Total
    1211 Total
    1583
    1509
    1479
    1451
    1343
    1280
    992
    929
    899
    879
    643
    579
    393

    $495.00
    $495.00
    $495.00
    $494.95
    $494.68
    $494.31
    $491.00
    $490.69
    $490.69
    $490.50
    $490.00
    $490.00
    $490.00
    $490.00
    $490.00
    $490.00
    $490.00
    $490.00
    $489.00
    $488.45
    $488.15
    $488.15
    $488.00
    $487.50
    $487.31
    $486.60
    $486.00
    $486.00
    $485.00
    $485.00
    $484.10
    $484.00
    $483.40
    $483.00
    $482.80
    $482.23
    $481.88
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00

    388
    368
    223
    198
    179
    16
    3
    3
    373
    1447
    583
    1685
    1724
    1376
    1283
    973
    886
    883
    846
    573
    319
    307 Total
    1055
    1033
    1000
    981
    424
    400
    108
    106
    21
    21
    913
    925
    979 Total
    1185
    223
    1057
    835
    1071 Total
    1739
    1501
    1115
    916
    755
    542
    346
    325
    83
    1429
    1559
    81
    1578

    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $480.00
    $479.90
    $479.90
    $479.55
    $477.00
    $477.00
    $476.25
    $476.00
    $476.00
    $476.00
    $476.00
    $476.00
    $476.00
    $476.00
    $476.00
    $476.00
    $475.00
    $475.00
    $475.00
    $475.00
    $475.00
    $475.00
    $475.00
    $475.00
    $475.00
    $474.60
    $474.60
    $473.82
    $473.48
    $472.60
    $472.50
    $472.50
    $471.39
    $470.40
    $470.00
    $470.00
    $470.00
    $470.00
    $470.00
    $470.00
    $470.00
    $470.00
    $470.00
    $470.00
    $469.00
    $466.00
    $465.50
    $465.40

    1626 Total
    359
    39
    554
    256 Total
    944
    1240
    681
    822 Total
    332 Total
    289 Total
    243 Total
    1562 Total
    1712
    1633
    1606
    1341
    1184
    728
    600
    577
    503
    476
    404
    330
    281
    235
    85
    1381
    1554 Total
    762 Total
    206
    449
    1681
    1119
    1119
    429
    105
    1124
    572
    811 Total
    141
    1512
    35
    1011
    1011
    15
    647 Total
    893 Total
    733 Total
    674 Total
    453 Total
    443 Total

    $465.00
    $465.00
    $465.00
    $464.25
    $464.00
    $462.50
    $462.00
    $460.80
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $460.00
    $459.90
    $457.80
    $457.35
    $457.32
    $457.00
    $455.00
    $455.00
    $455.00
    $455.00
    $455.00
    $454.70
    $454.70
    $453.00
    $452.20
    $452.00
    $451.70
    $451.02
    $451.02
    $451.00
    $450.40
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00

    1574 Total
    1431 Total
    1733
    1733
    1675
    1673
    1673
    1592
    1591
    1591
    1574
    1564
    1503
    1502
    1468
    1459
    1356
    1245
    1238
    1189
    1167
    1151
    1151
    1151
    1122
    1112
    1110
    1110
    1108
    1108
    1099
    1095
    1083
    1062
    1048
    1045
    1041
    1034
    992
    973
    955
    951
    951
    951
    951
    951
    951
    946
    910
    843
    841
    835
    833

    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00

    812
    807
    769
    733
    730
    709
    703
    692
    598
    533
    521
    495
    482
    469
    451
    451
    430
    430
    430
    419
    419
    404
    393
    343
    314
    278
    228
    180
    146
    139
    139
    124
    123
    121
    51
    46
    1003 Total
    1173 Total
    400
    835
    498 Total
    1419 Total
    400
    1248 Total
    1413 Total
    1375
    1575
    1575
    502
    1172 Total
    910
    338
    1656 Total

    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $450.00
    $449.95
    $448.20
    $448.00
    $447.95
    $447.45
    $447.30
    $447.00
    $445.95
    $445.00
    $445.00
    $443.25
    $442.25
    $442.00
    $441.80
    $441.00
    $441.00
    $440.70

    430
    661 Total
    659 Total
    530 Total
    1527 Total
    1599
    1517
    1400
    1379
    1374
    1369
    1286
    1276
    1225
    1138
    1132
    1091
    1088
    1018
    1007
    911
    832
    766
    725
    700
    583
    467
    421
    412
    405
    333
    257
    10
    1213
    253
    1464
    1708
    81
    740
    740
    740
    740
    756
    393
    1713
    773
    549
    1275
    637 Total
    292 Total
    814
    814
    1323

    $440.50
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $440.00
    $439.80
    $439.39
    $439.00
    $438.00
    $438.00
    $437.95
    $437.95
    $437.95
    $437.95
    $437.00
    $437.00
    $435.00
    $435.00
    $435.00
    $434.70
    $433.95
    $433.00
    $432.00
    $432.00
    $430.74

    642 Total
    1337
    108
    218
    350 Total
    1448
    1448
    1715 Total
    1594
    18
    328 Total
    1316 Total
    1289
    946
    94
    62
    62
    1475 Total
    1686
    34
    35
    750 Total
    1031
    1044
    1083
    548
    957 Total
    746 Total
    691 Total
    282 Total
    1444 Total
    1403 Total
    1713
    1647
    1624
    1564
    1518
    1518
    1349
    1272
    957
    918
    641
    592
    592
    425
    386
    1414 Total
    512
    770
    756
    451
    451

    $430.00
    $430.00
    $430.00
    $428.14
    $428.00
    $427.50
    $427.50
    $426.33
    $425.50
    $425.50
    $425.00
    $425.00
    $425.00
    $425.00
    $425.00
    $425.00
    $425.00
    $424.50
    $424.30
    $424.30
    $423.10
    $421.00
    $421.00
    $420.75
    $420.60
    $420.35
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $420.00
    $419.80
    $419.47
    $418.95
    $418.65
    $418.61
    $418.60
    $418.60

    206
    1379
    1492
    988
    933
    753
    1396
    551 Total
    1586
    229 Total
    229
    81
    218
    1093
    1093
    1093
    26 Total
    1094 Total
    1536 Total
    1040
    668
    570
    232
    83
    947
    947
    947
    947
    947
    218
    1293 Total
    1357
    918
    918
    1458
    207 Total
    1369
    1025
    1366
    1366
    1366
    421
    421
    421
    1251
    1142
    849
    732
    583
    555
    425
    373
    115

    $417.75
    $415.58
    $415.38
    $415.00
    $415.00
    $415.00
    $414.00
    $413.65
    $413.37
    $413.25
    $413.25
    $413.00
    $412.05
    $412.04
    $412.04
    $412.00
    $410.40
    $410.10
    $410.00
    $410.00
    $410.00
    $410.00
    $410.00
    $410.00
    $409.60
    $409.06
    $409.06
    $409.06
    $409.06
    $407.75
    $407.50
    $407.50
    $407.47
    $407.47
    $407.00
    $406.31
    $406.26
    $406.25
    $405.76
    $405.76
    $405.76
    $405.76
    $405.76
    $405.76
    $405.00
    $405.00
    $405.00
    $405.00
    $405.00
    $405.00
    $405.00
    $405.00
    $405.00

    411
    945 Total
    881 Total
    808 Total
    8 Total
    749 Total
    662 Total
    481 Total
    477 Total
    464 Total
    358 Total
    313 Total
    309 Total
    305 Total
    302 Total
    297 Total
    290 Total
    1741 Total
    1692 Total
    1651 Total
    1649 Total
    1274 Total
    1256 Total
    109 Total
    1028 Total
    1741
    1728
    1723
    1718
    1717
    1716
    1704
    1698
    1698
    1691
    1684
    1677
    1675
    1674
    1663
    1658
    1653
    1650
    1644
    1638
    1638
    1633
    1630
    1628
    1622
    1621
    1619
    1608

    $400.48
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00

    1608
    1606
    1604
    1603
    1599
    1590
    1583
    1573
    1570
    1563
    1558
    1558
    1550
    1547
    1547
    1534
    1534
    1533
    1529
    1525
    1524
    1524
    1518
    1518
    1510
    1508
    1506
    1506
    1503
    1501
    1492
    1474
    1473
    1468
    1467
    1466
    1464
    1461
    1445
    1438
    1438
    1429
    1427
    1426
    1425
    1421
    1406
    1399
    1388
    1384
    1384
    1384
    1379

    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00

    1373
    1373
    1366
    1354
    1350
    1343
    1333
    1332
    1331
    1326
    1323
    1322
    1322
    1322
    1320
    1315
    1315
    1309
    1303
    1303
    1303
    1301
    1299
    1296
    1281
    1278
    1277
    1275
    1270
    1270
    1263
    1252
    1237
    1236
    1235
    1220
    1218
    1189
    1189
    1186
    1184
    1184
    1183
    1174
    1166
    1166
    1166
    1166
    1161
    1160
    1143
    1143
    1123

    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00

    1119
    1117
    1110
    1101
    1100
    1093
    1090
    1089
    1084
    1084
    1084
    1083
    1074
    1074
    1073
    1070
    1067
    1060
    1054
    1054
    1053
    1053
    1050
    1048
    1045
    1040
    1038
    1034
    1028
    1017
    1016
    1009
    1008
    1000
    997
    988
    979
    975
    962
    961
    956
    951
    951
    946
    945
    944
    942
    937
    936
    935
    935
    935
    935

    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00

    935
    928
    925
    923
    915
    913
    912
    911
    911
    911
    911
    911
    910
    901
    894
    887
    879
    873
    870
    870
    869
    853
    849
    847
    843
    843
    843
    841
    835
    833
    824
    819
    819
    816
    815
    815
    809
    796
    787
    780
    768
    768
    766
    766
    764
    761
    756
    755
    755
    751
    745
    742
    737

    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00

    729
    729
    728
    727
    715
    707
    700
    699
    695
    690
    687
    687
    687
    687
    680
    680
    662
    656
    639
    629
    628
    614
    607
    606
    606
    599
    598
    598
    598
    596
    593
    588
    579
    577
    564
    556
    549
    540
    539
    529
    522
    516
    513
    509
    507
    507
    505
    501
    488
    478
    477
    472
    468

    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00

    464
    459
    447
    446
    446
    446
    445
    437
    436
    431
    430
    430
    423
    423
    415
    415
    410
    394
    393
    393
    390
    389
    386
    381
    371
    361
    358
    343
    336
    324
    319
    318
    313
    309
    303
    298
    297
    296
    296
    294
    293
    291
    291
    290
    265
    264
    245
    228
    220
    220
    218
    208
    206

    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00

    206
    206
    206
    203
    180
    180
    173
    173
    170
    170
    157
    153
    146
    144
    141
    136
    135
    135
    135
    129
    126
    125
    123
    122
    122
    106
    100
    94
    90
    90
    90
    88
    84
    80
    79
    69
    66
    64
    64
    62
    62
    44
    38
    36
    36
    22
    21
    18
    9
    1504
    3
    1004
    418

    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $400.00
    $399.95
    $399.40
    $399.00
    $399.00

    81
    1671
    1343
    946
    930
    886
    785
    86
    3
    918
    911
    1695
    1643
    1225
    1148
    21
    153
    1240
    1240
    1225
    1016
    1696 Total
    900
    888 Total
    1383 Total
    1169 Total
    1701
    1495
    1231
    1196
    1168
    1129
    998
    436
    152
    1609
    1224
    134
    34
    206
    655 Total
    1709
    1162
    821
    32
    789
    75
    962
    918
    533
    619
    576
    538 Total

    $398.00
    $396.00
    $396.00
    $396.00
    $396.00
    $396.00
    $396.00
    $396.00
    $396.00
    $395.83
    $395.83
    $395.00
    $395.00
    $395.00
    $395.00
    $395.00
    $394.50
    $393.05
    $393.05
    $393.00
    $393.00
    $391.00
    $390.88
    $390.00
    $390.00
    $390.00
    $390.00
    $390.00
    $390.00
    $390.00
    $390.00
    $390.00
    $390.00
    $390.00
    $390.00
    $389.60
    $388.50
    $388.50
    $386.15
    $385.90
    $385.00
    $385.00
    $385.00
    $385.00
    $385.00
    $384.50
    $384.09
    $383.76
    $383.53
    $383.30
    $381.90
    $380.10
    $380.00

    483 Total
    19 Total
    1549 Total
    1261 Total
    1607
    1467
    1429
    1417
    1221
    1219
    986
    935
    919
    882
    846
    748
    161
    65
    1014
    877 Total
    359
    1662 Total
    1312
    1213
    949
    34
    429
    574 Total
    374 Total
    71 Total
    1731
    1711
    1644
    1580
    1350
    1313
    1283
    1270
    1129
    1120
    1090
    962
    951
    951
    946
    937
    928
    919
    835
    770
    748
    700
    605

    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $380.00
    $379.95
    $379.45
    $379.00
    $378.99
    $378.35
    $378.00
    $376.45
    $376.04
    $375.93
    $375.90
    $375.65
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00

    569
    529
    475
    430
    413
    413
    381
    194
    173
    173
    71
    22
    102
    836 Total
    1378
    949
    914
    283 Total
    454
    435 Total
    1661 Total
    1583
    1583
    1491
    1447
    1362
    1322
    1093
    994
    816
    778
    700
    543
    4
    758
    1484 Total
    1037
    248 Total
    1100
    1244
    223
    1422 Total
    965
    592
    62
    1038
    377 Total
    1393
    1592
    1358
    1141
    879
    319

    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $375.00
    $373.80
    $373.50
    $372.00
    $372.00
    $371.40
    $371.33
    $370.50
    $370.26
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $370.00
    $369.15
    $369.00
    $369.00
    $368.00
    $367.82
    $367.00
    $367.00
    $366.70
    $366.21
    $366.00
    $366.00
    $365.98
    $365.65
    $365.40
    $365.00
    $365.00
    $365.00
    $365.00
    $365.00

    534 Total
    1040
    445
    1548 Total
    1591
    1585
    611
    779
    916
    933
    59
    1147 Total
    173
    500
    867 Total
    866 Total
    801 Total
    776 Total
    679 Total
    489 Total
    240 Total
    1254 Total
    1718
    1717
    1644
    1644
    1643
    1605
    1604
    1603
    1541
    1474
    1459
    1454
    1435
    1378
    1349
    1320
    1303
    1303
    1296
    1267
    1254
    1228
    1228
    1224
    1209
    1209
    1205
    1163
    1125
    1084
    1082

    $364.50
    $364.44
    $364.10
    $364.05
    $363.85
    $361.99
    $361.92
    $361.50
    $361.47
    $361.30
    $361.20
    $361.00
    $360.75
    $360.70
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00

    1055
    1052
    1027
    1009
    943
    936
    936
    933
    921
    909
    905
    900
    830
    801
    790
    779
    768
    768
    761
    699
    679
    631
    542
    512
    505
    485
    455
    428
    408
    407
    405
    337
    327
    295
    263
    245
    242
    178
    159
    139
    138
    126
    121
    1312
    359
    3
    213
    890 Total
    1305
    549
    1009
    386
    936

    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $360.00
    $359.10
    $359.00
    $358.50
    $358.20
    $358.05
    $357.00
    $357.00
    $356.99
    $356.80
    $355.50

    1534
    1279
    946
    764
    451
    1168
    928
    1441
    529
    1396
    39
    1429
    759
    75
    900
    977 Total
    856 Total
    420 Total
    387 Total
    356 Total
    312 Total
    1610 Total
    1482 Total
    1446 Total
    1418 Total
    1131 Total
    1735
    1733
    1716
    1690
    1690
    1684
    1645
    1644
    1632
    1620
    1615
    1611
    1611
    1610
    1604
    1585
    1551
    1545
    1541
    1532
    1509
    1506
    1490
    1474
    1464
    1418
    1360

    $355.00
    $355.00
    $355.00
    $355.00
    $355.00
    $354.05
    $353.35
    $353.00
    $352.75
    $352.50
    $352.50
    $352.00
    $351.94
    $351.30
    $351.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00

    1360
    1356
    1356
    1326
    1306
    1292
    1267
    1255
    1219
    1216
    1203
    1184
    1163
    1158
    1131
    1115
    1102
    1089
    1077
    1077
    1067
    1055
    1050
    1050
    1014
    1012
    1009
    1009
    992
    992
    989
    956
    954
    951
    951
    951
    951
    949
    937
    936
    929
    929
    922
    913
    913
    900
    899
    893
    864
    856
    822
    815
    814

    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00

    803
    802
    790
    780
    768
    761
    759
    759
    759
    754
    754
    743
    732
    708
    704
    700
    700
    700
    693
    693
    690
    674
    613
    607
    599
    596
    539
    525
    509
    494
    482
    469
    469
    454
    454
    453
    452
    446
    420
    419
    418
    415
    415
    395
    391
    390
    382
    378
    369
    351
    349
    347
    336

    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00

    318
    303
    259
    228
    218
    218
    208
    188
    184
    173
    165
    121
    82
    66
    62
    47
    12
    8
    3
    3
    3
    1100
    1307
    1586
    788
    1357
    1730
    1093
    1206
    1739
    1719
    1319
    429
    381
    75
    3
    3
    267 Total
    573
    122
    874
    915
    164 Total
    163 Total
    1496
    1342
    1225
    1197
    1145
    1118
    1034
    990
    956

    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $350.00
    $349.24
    $348.50
    $347.31
    $346.81
    $346.75
    $346.50
    $345.72
    $345.60
    $345.00
    $345.00
    $345.00
    $345.00
    $345.00
    $343.47
    $343.30
    $343.30
    $342.50
    $341.35
    $340.74
    $340.50
    $340.15
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00

    934
    895
    796
    739
    734
    394
    389
    357
    176
    172
    127
    122
    81
    81
    81
    81
    59
    40
    40
    28
    10
    62
    1245
    933
    929
    781
    757
    529
    901
    901
    901
    901
    224
    941
    892
    1283
    62
    1171 Total
    526 Total
    1296
    1296
    583
    544
    145
    119 Total
    1612 Total
    596
    485
    652 Total
    878
    359
    1476 Total
    120 Total

    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $340.00
    $339.99
    $339.00
    $339.00
    $338.10
    $338.00
    $338.00
    $338.00
    $337.50
    $337.50
    $337.50
    $337.50
    $337.00
    $336.00
    $336.00
    $335.98
    $335.75
    $335.60
    $335.00
    $335.00
    $335.00
    $335.00
    $335.00
    $335.00
    $334.26
    $334.00
    $333.50
    $333.12
    $331.20
    $331.05
    $331.00
    $330.00
    $330.00

    1603
    1466
    1354
    1242
    1117
    1108
    1055
    929
    296
    230
    80
    28
    28
    579
    1600 Total
    25 Total
    847
    608 Total
    35
    35
    764
    1688
    756
    756
    1021 Total
    1253
    1135
    1056
    1021
    989
    770
    426
    426
    426
    404
    401
    151
    3
    421
    421
    1406
    86
    933
    922
    849
    48
    1644
    1616
    1496
    1458
    1326
    1280
    1225

    $330.00
    $330.00
    $330.00
    $330.00
    $330.00
    $330.00
    $330.00
    $330.00
    $330.00
    $330.00
    $330.00
    $330.00
    $330.00
    $328.60
    $328.50
    $327.70
    $327.50
    $327.35
    $327.00
    $327.00
    $326.50
    $326.00
    $326.00
    $326.00
    $325.00
    $325.00
    $325.00
    $325.00
    $325.00
    $325.00
    $325.00
    $325.00
    $325.00
    $325.00
    $325.00
    $325.00
    $325.00
    $324.95
    $324.50
    $324.50
    $324.00
    $324.00
    $322.50
    $322.00
    $321.40
    $321.03
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00

    1222
    1219
    1138
    1138
    1138
    1138
    1116
    1071
    1015
    1000
    994
    929
    929
    919
    911
    911
    866
    763
    639
    577
    429
    403
    400
    381
    343
    318
    304
    142
    123
    100
    79
    13
    215
    928
    1685
    920
    12
    12
    12
    12
    918
    1448
    132
    484
    1374
    1238
    1228
    1225
    964
    964
    481
    695
    1196

    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $320.00
    $319.20
    $317.72
    $317.50
    $317.50
    $317.50
    $317.50
    $317.50
    $317.50
    $317.36
    $316.10
    $315.70
    $315.40
    $315.00
    $315.00
    $315.00
    $315.00
    $315.00
    $315.00
    $315.00
    $314.49
    $313.85

    1179
    649 Total
    1366
    649
    1075 Total
    1591
    1312
    1312
    1016
    992
    559
    1586
    771
    461
    1251
    939
    335 Total
    1575
    1443
    1388
    1276
    1112
    976
    976
    976
    976
    976
    913
    913
    401
    401
    276
    242
    142
    503
    943
    916
    1160
    102
    1644
    1644
    879
    1228
    135
    1687
    1396
    1224
    971
    706
    1002 Total
    1233
    1225
    1013

    $313.60
    $313.50
    $313.50
    $313.50
    $313.00
    $312.88
    $312.88
    $312.88
    $312.88
    $312.88
    $312.30
    $312.00
    $312.00
    $311.15
    $310.65
    $310.45
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $310.00
    $309.80
    $309.50
    $308.61
    $307.50
    $306.36
    $306.00
    $306.00
    $306.00
    $305.20
    $305.05
    $305.00
    $305.00
    $305.00
    $305.00
    $305.00
    $304.89
    $304.80
    $304.00
    $303.80

    1038
    66
    1283
    9
    933
    3
    984 Total
    896 Total
    829 Total
    736 Total
    697 Total
    676 Total
    664 Total
    568 Total
    560 Total
    550 Total
    53 Total
    506 Total
    471 Total
    465 Total
    463 Total
    432 Total
    287 Total
    217 Total
    191 Total
    1700 Total
    1682 Total
    1648 Total
    1576 Total
    1571 Total
    1514 Total
    1433 Total
    1298 Total
    1264 Total
    1260 Total
    1114 Total
    1086 Total
    107 Total
    1064 Total
    1047 Total
    1736
    1736
    1730
    1730
    1728
    1719
    1715
    1713
    1700
    1698
    1695
    1690
    1688

    $303.55
    $303.55
    $303.48
    $303.40
    $302.00
    $300.90
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    1688
    1688
    1686
    1679
    1679
    1679
    1678
    1677
    1672
    1670
    1667
    1667
    1662
    1657
    1654
    1653
    1652
    1652
    1648
    1644
    1633
    1632
    1631
    1624
    1622
    1611
    1611
    1611
    1611
    1611
    1611
    1609
    1607
    1604
    1600
    1599
    1595
    1594
    1593
    1591
    1591
    1591
    1591
    1590
    1578
    1577
    1576
    1575
    1571
    1568
    1563
    1563
    1558

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    1553
    1550
    1547
    1545
    1540
    1539
    1515
    1512
    1510
    1506
    1500
    1500
    1499
    1496
    1493
    1491
    1488
    1487
    1467
    1466
    1466
    1465
    1464
    1463
    1463
    1449
    1449
    1449
    1444
    1433
    1429
    1425
    1425
    1423
    1423
    1422
    1411
    1401
    1400
    1396
    1393
    1393
    1393
    1393
    1393
    1386
    1376
    1376
    1375
    1366
    1365
    1363
    1362

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    1362
    1360
    1360
    1350
    1350
    1350
    1350
    1350
    1347
    1347
    1343
    1343
    1343
    1343
    1343
    1343
    1340
    1339
    1333
    1322
    1322
    1321
    1316
    1311
    1306
    1305
    1298
    1283
    1282
    1281
    1277
    1271
    1271
    1268
    1264
    1263
    1262
    1259
    1255
    1251
    1250
    1250
    1249
    1247
    1238
    1237
    1234
    1233
    1229
    1225
    1224
    1224
    1219

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    1203
    1203
    1202
    1200
    1195
    1190
    1187
    1184
    1174
    1168
    1168
    1167
    1167
    1166
    1163
    1163
    1163
    1160
    1159
    1154
    1148
    1148
    1143
    1143
    1143
    1139
    1137
    1137
    1137
    1129
    1129
    1124
    1120
    1120
    1114
    1104
    1104
    1101
    1101
    1100
    1097
    1096
    1096
    1095
    1091
    1090
    1090
    1088
    1088
    1087
    1086
    1084
    1083

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    1082
    1073
    1073
    1073
    1073
    1070
    1067
    1064
    1057
    1055
    1050
    1045
    1033
    1033
    1033
    1031
    1026
    1026
    1026
    1025
    1023
    1023
    1017
    1016
    1015
    1015
    1015
    1013
    1012
    1009
    1007
    998
    995
    990
    990
    988
    985
    985
    984
    983
    980
    978
    973
    972
    965
    959
    956
    956
    956
    956
    954
    949
    940

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    938
    937
    936
    935
    932
    929
    929
    929
    925
    922
    922
    921
    919
    916
    914
    913
    910
    910
    910
    909
    900
    900
    887
    887
    881
    878
    875
    873
    851
    839
    839
    831
    826
    824
    813
    810
    802
    792
    791
    791
    791
    791
    791
    790
    788
    787
    786
    781
    781
    774
    773
    773
    768

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    765
    761
    761
    756
    756
    746
    739
    736
    716
    709
    709
    707
    702
    702
    701
    701
    701
    700
    700
    700
    699
    698
    698
    698
    697
    695
    693
    689
    689
    672
    666
    664
    654
    641
    618
    618
    618
    617
    614
    607
    604
    604
    604
    599
    599
    599
    592
    590
    587
    585
    580
    579
    578

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    577
    565
    565
    564
    563
    561
    560
    556
    554
    549
    544
    538
    536
    534
    533
    529
    529
    513
    513
    513
    510
    505
    503
    502
    499
    495
    487
    487
    485
    471
    468
    468
    467
    466
    462
    460
    460
    460
    449
    446
    445
    437
    436
    432
    431
    431
    421
    421
    419
    418
    418
    416
    416

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    415
    412
    411
    411
    410
    407
    405
    400
    395
    393
    393
    393
    392
    391
    381
    381
    381
    377
    371
    369
    369
    362
    361
    359
    352
    340
    339
    329
    329
    322
    321
    316
    306
    305
    301
    301
    289
    286
    281
    277
    261
    261
    260
    260
    258
    253
    253
    247
    245
    245
    242
    235
    235

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    228
    225
    224
    218
    209
    208
    208
    206
    206
    205
    202
    202
    202
    197
    197
    191
    188
    188
    187
    187
    183
    180
    178
    175
    174
    173
    173
    158
    157
    153
    148
    147
    147
    141
    136
    135
    135
    134
    133
    133
    124
    123
    123
    123
    121
    117
    116
    108
    108
    107
    105
    105
    99

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00

    93
    88
    84
    82
    82
    82
    82
    82
    82
    82
    80
    80
    80
    78
    77
    75
    72
    66
    64
    62
    55
    54
    54
    53
    52
    50
    50
    49
    40
    40
    40
    36
    29
    28
    28
    24
    23
    21
    10
    10
    6
    3
    1073
    1206
    1322
    1082
    524
    1150
    1398
    1470
    909
    33
    761

    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $300.00
    $299.80
    $299.52
    $298.70
    $298.50
    $297.90
    $297.81
    $297.36
    $297.00
    $297.00
    $296.00
    $295.90

    359
    1113 Total
    936
    986
    426
    22
    1543 Total
    517
    296
    1206
    1168
    524
    900
    756
    514
    513
    3
    3
    918
    1492
    1468
    1425
    1376
    1349
    1325
    1232
    1228
    1225
    983
    962
    807
    314
    288
    285
    179
    105
    405
    150
    1374
    218
    299
    151
    1210 Total
    1378
    1211
    1210
    1205
    398
    1354
    1011
    1531
    102
    102

    $295.80
    $295.45
    $295.26
    $295.00
    $295.00
    $295.00
    $294.18
    $294.00
    $294.00
    $293.76
    $292.50
    $291.00
    $290.90
    $290.50
    $290.45
    $290.40
    $290.20
    $290.20
    $290.09
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $290.00
    $289.45
    $289.10
    $288.75
    $288.75
    $288.20
    $288.15
    $288.00
    $288.00
    $288.00
    $288.00
    $288.00
    $288.00
    $287.50
    $286.60
    $286.40
    $285.94
    $285.94

    353 Total
    1633
    1341
    1189
    1082
    1055
    964
    761
    655
    49
    41
    1295
    402
    146
    1246 Total
    1591
    507
    34
    34
    418
    774
    940
    212 Total
    1521 Total
    1721
    1713
    1710
    1674
    1591
    1591
    1573
    1527
    1521
    1500
    1500
    1499
    1477
    1476
    1431
    1386
    1369
    1350
    1333
    1326
    1322
    1322
    1222
    1138
    1053
    1053
    1009
    935
    935

    $285.00
    $285.00
    $285.00
    $285.00
    $285.00
    $285.00
    $285.00
    $285.00
    $285.00
    $285.00
    $285.00
    $284.50
    $284.45
    $284.00
    $283.70
    $283.40
    $283.07
    $282.00
    $282.00
    $281.75
    $280.65
    $280.60
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00

    935
    934
    909
    901
    807
    768
    666
    652
    642
    641
    604
    604
    555
    532
    493
    436
    428
    421
    403
    403
    359
    344
    324
    269
    258
    235
    235
    230
    221
    202
    176
    136
    122
    108
    108
    79
    78
    75
    54
    38
    23
    1583
    495
    1014
    23
    180
    571 Total
    1379
    1089
    929
    849
    817 Total
    817

    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $280.00
    $279.32
    $279.00
    $278.64
    $278.40
    $278.30
    $277.50
    $277.50
    $277.50
    $277.31
    $277.20
    $276.90
    $276.90

    1016
    1324
    1641 Total
    73
    774
    1594
    1533
    1440
    1225
    1099
    1020
    940
    914
    914
    778
    475
    323
    159
    18
    18
    1240
    1150
    238 Total
    66
    913
    913
    1378
    1073
    1225
    400
    1478 Total
    202
    202
    45 Total
    130 Total
    1730
    1689
    1358
    1277
    1083
    820
    758
    758
    689
    495
    415
    214
    168
    157
    130
    531
    1160
    1117

    $276.50
    $275.90
    $275.75
    $275.75
    $275.20
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $275.00
    $274.60
    $274.32
    $274.00
    $274.00
    $273.50
    $273.07
    $273.00
    $273.00
    $272.00
    $271.20
    $270.95
    $270.45
    $270.45
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $270.00
    $269.97
    $269.90
    $269.80

    389
    689
    1155
    1093
    474
    928
    459
    1398
    764
    1417
    847
    610
    10
    1269
    1017
    770
    421
    381
    307
    251
    36
    173
    98 Total
    284 Total
    1205
    359
    1345 Total
    1059
    929
    336
    793
    1369
    665
    956
    1516
    1464
    1277
    586 Total
    417 Total
    366 Total
    1355 Total
    1076 Total
    1733
    1718
    1701
    1695
    1680
    1680
    1653
    1638
    1618
    1618
    1605

    $268.98
    $268.70
    $268.00
    $268.00
    $268.00
    $267.12
    $267.00
    $266.75
    $266.75
    $266.53
    $266.20
    $266.00
    $266.00
    $265.00
    $265.00
    $265.00
    $265.00
    $265.00
    $265.00
    $265.00
    $265.00
    $264.48
    $264.40
    $264.20
    $264.00
    $264.00
    $263.60
    $263.55
    $262.50
    $262.50
    $262.30
    $262.29
    $262.00
    $261.98
    $261.80
    $261.00
    $260.40
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00

    1603
    1517
    1482
    1406
    1393
    1393
    1379
    1362
    1357
    1355
    1296
    1296
    1296
    1295
    1268
    1221
    1167
    1125
    1076
    1035
    1034
    1013
    1013
    971
    954
    930
    917
    901
    832
    805
    802
    779
    767
    723
    619
    590
    586
    574
    531
    530
    518
    495
    484
    479
    460
    460
    431
    421
    411
    395
    395
    366
    357

    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00

    257
    235
    220
    133
    105
    65
    39
    11
    468
    34
    201 Total
    637
    1687
    1331
    1360
    762
    1327 Total
    1068
    15
    1049
    1038
    317
    1296
    492
    933
    1119
    1089
    779
    1151
    1106
    16
    134
    913
    647
    993 Total
    784 Total
    663 Total
    651 Total
    58 Total
    575 Total
    496 Total
    442 Total
    1734 Total
    1556 Total
    1537 Total
    1402 Total
    1387 Total
    113 Total
    1001 Total
    1734
    1725
    1724
    1712

    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $260.00
    $259.95
    $259.90
    $259.00
    $258.25
    $258.00
    $257.90
    $257.56
    $257.35
    $257.30
    $257.00
    $257.00
    $255.95
    $255.31
    $255.18
    $255.00
    $255.00
    $254.85
    $254.84
    $254.80
    $253.00
    $252.70
    $252.00
    $251.89
    $251.72
    $251.30
    $250.40
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00

    1709
    1690
    1685
    1665
    1661
    1636
    1634
    1626
    1618
    1616
    1609
    1609
    1603
    1585
    1580
    1534
    1530
    1515
    1505
    1505
    1492
    1490
    1488
    1488
    1462
    1459
    1457
    1451
    1439
    1438
    1438
    1420
    1415
    1410
    1402
    1399
    1395
    1387
    1384
    1383
    1365
    1365
    1365
    1350
    1350
    1343
    1339
    1331
    1324
    1306
    1304
    1302
    1266

    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00

    1262
    1262
    1250
    1215
    1214
    1191
    1183
    1178
    1163
    1145
    1141
    1130
    1130
    1130
    1111
    1102
    1102
    1102
    1099
    1098
    1097
    1083
    1083
    1083
    1074
    1067
    1044
    1040
    1037
    1037
    1032
    1018
    1013
    1001
    993
    977
    951
    949
    948
    946
    941
    937
    935
    935
    935
    928
    925
    916
    913
    913
    910
    910
    910

    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00

    888
    880
    880
    864
    855
    855
    843
    841
    818
    816
    807
    806
    787
    784
    764
    713
    700
    695
    695
    695
    695
    676
    663
    651
    634
    618
    575
    551
    549
    531
    529
    528
    519
    511
    511
    496
    495
    490
    486
    482
    476
    472
    468
    468
    465
    454
    442
    431
    428
    425
    425
    416
    410

    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00

    401
    401
    390
    387
    381
    349
    330
    323
    314
    291
    264
    243
    220
    215
    215
    187
    181
    168
    157
    147
    147
    136
    135
    135
    121
    105
    82
    79
    77
    62
    58
    54
    51
    51
    40
    25
    4
    3
    33
    103 Total
    7 Total
    1555
    1066
    790
    593
    100
    1684
    52
    1540
    62
    1108
    1221
    1627 Total

    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $250.00
    $248.85
    $248.80
    $248.00
    $247.95
    $247.50
    $247.50
    $246.95
    $246.75
    $246.48
    $245.70
    $245.00
    $245.00
    $244.00
    $243.40
    $242.99

    768
    563
    563
    1343
    74 Total
    1163
    1083
    919
    748
    159
    1145
    712 Total
    850 Total
    1714 Total
    166 Total
    1157 Total
    1126 Total
    1725
    1719
    1714
    1638
    1633
    1633
    1611
    1611
    1611
    1603
    1591
    1578
    1562
    1500
    1492
    1450
    1379
    1362
    1332
    1299
    1270
    1270
    1246
    1240
    1231
    1209
    1206
    1181
    1164
    1163
    1158
    1157
    1125
    1067
    1032
    1005

    $242.90
    $242.55
    $242.55
    $242.00
    $241.95
    $241.80
    $241.00
    $241.00
    $241.00
    $241.00
    $240.50
    $240.10
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00

    983
    983
    978
    939
    935
    930
    929
    929
    929
    929
    922
    917
    900
    898
    894
    825
    811
    797
    793
    750
    740
    700
    690
    661
    658
    632
    615
    594
    571
    562
    556
    554
    549
    531
    531
    531
    466
    463
    430
    430
    395
    394
    393
    330
    323
    256
    242
    239
    220
    214
    166
    148
    94

    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00

    89
    89
    89
    89
    87
    82
    82
    75
    66
    62
    29
    20
    15
    12
    10
    450
    1038
    1267
    911
    877
    1688
    1379
    174
    1438
    608
    911
    1408 Total
    756
    557 Total
    1575
    1016
    940
    1417
    1468
    1359
    1350
    1287
    1263
    1231
    1195
    467
    316
    886
    656
    151
    899
    834
    629
    410
    51
    1270
    1696
    629

    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $240.00
    $239.99
    $239.97
    $239.85
    $239.64
    $239.45
    $239.40
    $239.00
    $239.00
    $238.50
    $237.00
    $236.97
    $236.65
    $236.60
    $236.50
    $236.35
    $235.90
    $235.90
    $235.63
    $235.00
    $235.00
    $235.00
    $235.00
    $235.00
    $235.00
    $235.00
    $235.00
    $234.25
    $234.00
    $233.50
    $232.80
    $232.75
    $232.00
    $232.00
    $232.00
    $232.00
    $231.30
    $231.00
    $231.00

    180
    1644
    1632
    1583
    1583
    1499
    1459
    1426
    1405
    1292
    1261
    1253
    1027
    849
    807
    741
    741
    691
    621
    604
    529
    476
    446
    347
    346
    102
    89
    764
    10
    902
    806
    694
    1173
    1083
    350
    672
    572
    572
    1236
    501
    251
    330
    555
    39
    62
    403
    1051 Total
    1644
    1459
    1272
    1257
    1228
    1163

    $230.49
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $230.00
    $229.80
    $228.91
    $228.74
    $228.71
    $228.64
    $228.20
    $228.00
    $228.00
    $227.80
    $227.35
    $227.35
    $227.27
    $226.80
    $226.80
    $226.10
    $226.00
    $225.90
    $225.60
    $225.55
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00

    1163
    1163
    1163
    917
    917
    915
    914
    783
    738
    707
    232
    151
    139
    123
    108
    86
    36
    1015
    256
    192
    192
    720
    730
    1363
    658
    1080
    592
    62
    23
    1639
    628
    871 Total
    640 Total
    252 Total
    1740 Total
    1565 Total
    1152 Total
    1740
    1686
    1609
    1583
    1509
    1425
    1374
    1369
    1293
    1277
    1276
    1235
    1235
    1235
    1231
    1224

    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $225.00
    $224.24
    $224.00
    $223.44
    $223.44
    $223.00
    $222.90
    $222.80
    $221.75
    $221.46
    $221.00
    $220.86
    $220.60
    $220.50
    $220.20
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00

    1152
    1138
    1138
    1138
    1122
    1093
    1093
    1068
    1011
    1011
    978
    948
    922
    922
    915
    900
    895
    849
    789
    759
    740
    506
    402
    381
    295
    151
    140
    140
    46
    35
    35
    1160
    99
    1493
    1414
    1450
    1170 Total
    1425
    937
    33
    702
    1569
    1343
    962
    28
    1510
    1161
    992
    62
    39
    249
    1644
    1317

    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $220.00
    $219.95
    $219.80
    $219.75
    $219.47
    $219.10
    $218.00
    $217.60
    $217.33
    $217.25
    $217.00
    $216.94
    $216.75
    $216.50
    $216.50
    $216.00
    $216.00
    $216.00
    $216.00
    $216.00
    $215.37
    $215.20
    $215.00

    1111
    1068
    887
    780
    708
    450
    382
    1163
    200
    1160
    475
    525
    720
    1283
    922
    34
    1638
    813
    75
    1583
    262 Total
    1581 Total
    1564
    1549
    1457
    1277
    1200
    1132
    1073
    1060
    962
    928
    918
    914
    828
    814
    684
    516
    403
    394
    393
    183
    105
    64
    60
    54
    3
    806
    503
    641
    863 Total
    127
    145

    $215.00
    $215.00
    $215.00
    $215.00
    $215.00
    $215.00
    $215.00
    $214.90
    $214.80
    $214.65
    $214.50
    $213.71
    $213.48
    $213.29
    $212.20
    $212.15
    $212.00
    $212.00
    $211.50
    $210.68
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $210.00
    $209.24
    $209.16
    $209.10
    $209.00
    $209.00
    $208.50

    1417
    935
    135
    1156
    930
    207
    1163
    1363
    990
    1370 Total
    1583
    1017
    876
    1002
    1636
    1464
    1142
    928
    1640 Total
    954
    1322
    1484
    1234
    79
    739
    1143
    1425
    1569
    84
    35
    485
    987 Total
    645 Total
    546 Total
    541 Total
    504 Total
    383 Total
    266 Total
    233 Total
    1538 Total
    1522 Total
    1489 Total
    1407 Total
    1404 Total
    1367 Total
    1193 Total
    1149 Total
    1128 Total
    1107 Total
    1105 Total
    1043 Total
    1737
    1736

    $208.00
    $208.00
    $206.90
    $206.50
    $206.46
    $206.31
    $206.15
    $205.50
    $205.25
    $205.00
    $205.00
    $205.00
    $205.00
    $204.89
    $204.60
    $204.00
    $204.00
    $203.98
    $203.50
    $203.30
    $202.50
    $202.30
    $202.25
    $202.00
    $201.86
    $201.60
    $201.50
    $201.00
    $201.00
    $201.00
    $200.95
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    1736
    1730
    1728
    1728
    1728
    1728
    1728
    1728
    1727
    1717
    1716
    1712
    1704
    1704
    1697
    1694
    1693
    1692
    1690
    1690
    1688
    1688
    1688
    1684
    1684
    1684
    1681
    1672
    1670
    1670
    1669
    1668
    1667
    1665
    1665
    1659
    1650
    1649
    1649
    1644
    1644
    1638
    1627
    1621
    1617
    1612
    1609
    1609
    1607
    1607
    1607
    1606
    1603

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    1603
    1599
    1592
    1590
    1589
    1579
    1577
    1575
    1575
    1575
    1573
    1569
    1563
    1563
    1563
    1563
    1563
    1563
    1562
    1561
    1559
    1558
    1554
    1550
    1550
    1548
    1547
    1545
    1545
    1545
    1545
    1543
    1538
    1535
    1535
    1529
    1523
    1522
    1518
    1518
    1513
    1513
    1513
    1510
    1510
    1508
    1506
    1504
    1493
    1492
    1489
    1479
    1478

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    1474
    1467
    1463
    1463
    1462
    1462
    1462
    1459
    1459
    1459
    1459
    1459
    1457
    1457
    1449
    1449
    1446
    1445
    1443
    1440
    1429
    1423
    1414
    1407
    1404
    1403
    1399
    1394
    1394
    1394
    1393
    1391
    1386
    1385
    1381
    1379
    1379
    1377
    1375
    1373
    1372
    1367
    1362
    1354
    1347
    1347
    1343
    1341
    1333
    1331
    1331
    1327
    1325

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    1324
    1322
    1322
    1312
    1309
    1309
    1309
    1306
    1306
    1304
    1296
    1295
    1289
    1285
    1283
    1283
    1266
    1263
    1253
    1247
    1247
    1245
    1235
    1231
    1231
    1229
    1228
    1228
    1227
    1224
    1221
    1220
    1214
    1196
    1196
    1196
    1193
    1189
    1188
    1188
    1184
    1179
    1179
    1167
    1166
    1166
    1160
    1159
    1154
    1154
    1154
    1151
    1136

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    1128
    1121
    1119
    1105
    1100
    1100
    1099
    1099
    1097
    1096
    1088
    1087
    1087
    1084
    1084
    1083
    1074
    1070
    1070
    1070
    1055
    1053
    1050
    1043
    1040
    1035
    1031
    1031
    1031
    1030
    1030
    1030
    1025
    1025
    1020
    1018
    1016
    1016
    1016
    1014
    1008
    1007
    1003
    1003
    998
    997
    992
    991
    990
    990
    988
    988
    988

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    986
    985
    982
    981
    978
    978
    978
    978
    978
    975
    971
    971
    965
    965
    964
    964
    964
    958
    956
    956
    956
    955
    955
    954
    949
    946
    946
    946
    944
    940
    940
    940
    940
    936
    935
    935
    935
    922
    922
    922
    921
    918
    918
    915
    915
    915
    914
    914
    913
    913
    913
    913
    909

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    905
    904
    901
    901
    901
    900
    898
    896
    895
    886
    884
    880
    876
    876
    875
    875
    869
    868
    860
    860
    860
    850
    847
    847
    843
    843
    843
    843
    841
    836
    825
    820
    808
    805
    804
    804
    803
    792
    790
    787
    787
    787
    779
    776
    774
    774
    774
    770
    770
    770
    768
    768
    767

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    766
    765
    764
    763
    762
    759
    756
    756
    749
    745
    745
    745
    741
    732
    727
    723
    723
    718
    718
    718
    716
    706
    701
    690
    689
    686
    686
    672
    666
    665
    661
    654
    654
    653
    647
    632
    624
    620
    619
    619
    619
    613
    612
    605
    604
    597
    587
    585
    585
    583
    582
    581
    580

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    572
    568
    557
    556
    554
    549
    548
    546
    541
    533
    529
    528
    525
    521
    519
    514
    504
    500
    498
    498
    495
    492
    487
    486
    486
    484
    483
    472
    468
    467
    466
    461
    461
    455
    450
    450
    445
    445
    445
    445
    436
    431
    431
    430
    430
    429
    423
    423
    421
    421
    421
    421
    421

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    421
    418
    417
    410
    406
    406
    404
    403
    394
    394
    394
    381
    371
    361
    359
    359
    356
    340
    330
    328
    321
    310
    308
    302
    294
    292
    288
    286
    285
    278
    274
    274
    274
    274
    267
    266
    260
    260
    252
    242
    233
    232
    221
    220
    218
    218
    218
    218
    218
    217
    216
    213
    212

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    211
    211
    211
    210
    210
    210
    207
    206
    197
    195
    188
    188
    187
    187
    179
    178
    172
    172
    172
    168
    164
    159
    153
    153
    153
    148
    147
    145
    144
    142
    141
    136
    136
    135
    135
    132
    131
    126
    123
    123
    122
    121
    117
    117
    114
    111
    109
    109
    108
    105
    99
    95
    95

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00

    95
    95
    95
    86
    86
    86
    86
    82
    82
    79
    79
    78
    73
    65
    62
    62
    56
    52
    49
    47
    42
    41
    40
    40
    39
    39
    38
    36
    36
    36
    35
    32
    28
    27
    27
    22
    21
    20
    18
    18
    15
    13
    13
    7
    4
    1073
    1619
    1519
    529
    393
    965
    756
    1519

    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $199.80
    $199.50
    $199.50
    $199.50
    $199.50
    $199.15
    $199.04
    $199.00

    1519
    1108
    154 Total
    1575
    1322
    915
    569
    902
    774
    1168
    1644
    1624
    1155
    880
    421
    359
    910
    386
    1399
    1258
    381
    202
    73
    919
    73
    406
    105
    935
    1259
    1211
    406
    381
    1558
    1409 Total
    190
    1526 Total
    193
    1070
    203
    529
    891
    1398
    1456
    1385
    1381
    1256
    1091
    1061
    1060
    843
    691
    400
    326

    $199.00
    $199.00
    $198.00
    $198.00
    $197.50
    $197.25
    $196.00
    $195.72
    $195.65
    $195.48
    $195.00
    $195.00
    $195.00
    $195.00
    $195.00
    $194.90
    $194.60
    $194.00
    $193.60
    $193.54
    $193.50
    $193.45
    $193.44
    $193.20
    $193.02
    $192.50
    $192.50
    $192.48
    $192.45
    $192.00
    $192.00
    $191.90
    $191.50
    $191.41
    $191.40
    $191.10
    $191.00
    $190.65
    $190.50
    $190.40
    $190.25
    $190.18
    $190.00
    $190.00
    $190.00
    $190.00
    $190.00
    $190.00
    $190.00
    $190.00
    $190.00
    $190.00
    $190.00

    281
    249
    249
    249
    60
    41
    41
    1138
    933
    1646 Total
    1305
    1016
    81
    34
    1190
    995
    1029
    261
    508
    693
    933
    1375
    270 Total
    756
    199 Total
    1709
    1622
    1561
    1266
    1214
    1171
    1147
    1132
    1100
    727
    694
    430
    199
    30
    30
    21
    1721
    529
    529
    430
    956
    1079
    1350
    406
    359
    1458
    446
    626

    $190.00
    $190.00
    $190.00
    $190.00
    $190.00
    $190.00
    $190.00
    $189.70
    $189.70
    $189.00
    $189.00
    $189.00
    $189.00
    $189.00
    $188.40
    $188.25
    $188.00
    $187.15
    $186.55
    $186.47
    $185.90
    $185.85
    $185.15
    $185.15
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $185.00
    $184.90
    $184.85
    $184.85
    $184.54
    $184.40
    $184.15
    $184.00
    $184.00
    $184.00
    $183.90
    $183.50
    $183.35

    278
    151
    95
    1379
    1187
    601 Total
    1300
    962
    214
    1625 Total
    1153
    441
    1150
    56
    15
    799 Total
    609 Total
    372 Total
    1602 Total
    1352 Total
    1230 Total
    1182 Total
    1729
    1689
    1688
    1663
    1651
    1645
    1643
    1643
    1599
    1591
    1564
    1552
    1539
    1518
    1518
    1508
    1504
    1449
    1441
    1425
    1396
    1340
    1333
    1324
    1313
    1283
    1283
    1283
    1280
    1278
    1260

    $183.35
    $183.20
    $183.00
    $182.97
    $182.85
    $182.80
    $182.00
    $182.00
    $182.00
    $181.60
    $181.53
    $181.30
    $180.68
    $180.50
    $180.50
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00

    1252
    1252
    1251
    1235
    1228
    1225
    1206
    1203
    1185
    1166
    1162
    1162
    1162
    1161
    1124
    1059
    1059
    1050
    1040
    1040
    1040
    1040
    1036
    1017
    991
    991
    969
    968
    955
    955
    946
    935
    935
    935
    933
    933
    933
    933
    933
    929
    919
    910
    890
    875
    835
    835
    800
    799
    794
    793
    768
    763
    737

    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00

    732
    727
    716
    631
    625
    609
    594
    582
    562
    543
    509
    485
    483
    480
    478
    436
    429
    418
    408
    293
    276
    260
    251
    251
    151
    146
    139
    139
    137
    135
    101
    88
    81
    74
    63
    49
    18
    18
    18
    10
    10
    10
    1311
    1235
    1340
    827
    479
    1120
    900
    122
    1016
    774
    1594

    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $180.00
    $179.40
    $179.30
    $179.10
    $179.00
    $179.00
    $178.80
    $178.63
    $178.35
    $178.12
    $178.00
    $177.50

    3
    646 Total
    1117
    646
    604
    1147
    654
    594
    637
    820
    1093
    380 Total
    1667
    1603
    1603
    1575
    1523
    1492
    1459
    1386
    1341
    1270
    1200
    1163
    1163
    1162
    1099
    1037
    956
    922
    922
    910
    895
    829
    553
    553
    553
    513
    459
    446
    175
    141
    127
    48
    13
    841
    935
    1142
    1238
    1599
    263
    52
    421

    $176.40
    $176.25
    $176.25
    $176.25
    $176.10
    $176.00
    $175.95
    $175.85
    $175.70
    $175.40
    $175.15
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $175.00
    $174.65
    $174.49
    $174.42
    $174.40
    $174.00
    $174.00
    $174.00
    $173.49

    918
    1013
    595 Total
    595
    95
    95
    95
    95
    277
    836
    324
    783
    965
    827
    812
    756
    1558
    1525
    1225
    761
    543
    283
    1681
    430
    1652
    1729
    1632
    1545
    1508
    1475
    1470
    1463
    1437
    1431
    1426
    1405
    1354
    1286
    1276
    1253
    1138
    1138
    1117
    1067
    937
    934
    901
    891
    792
    790
    768
    469
    421

    $173.40
    $173.04
    $173.00
    $173.00
    $173.00
    $173.00
    $173.00
    $173.00
    $172.75
    $172.00
    $172.00
    $171.57
    $171.15
    $171.00
    $171.00
    $171.00
    $170.50
    $170.50
    $170.50
    $170.50
    $170.50
    $170.50
    $170.40
    $170.25
    $170.05
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00
    $170.00

    402
    214
    206
    23
    933
    139
    218
    204 Total
    933
    235
    629
    501
    401
    1065
    1208 Total
    1208
    1206
    1206
    830
    429
    400
    248
    218
    1015
    666
    122
    1206
    441
    3
    1083
    1081 Total
    1517
    1302
    1731
    1556
    1413
    1297
    1184
    1166
    435
    353
    73
    35
    1268
    765
    901
    1464
    915
    330
    159
    202
    476
    1469

    $170.00
    $170.00
    $170.00
    $170.00
    $169.95
    $169.75
    $169.57
    $169.50
    $169.50
    $169.25
    $169.00
    $168.50
    $168.44
    $168.20
    $168.00
    $168.00
    $168.00
    $168.00
    $168.00
    $168.00
    $168.00
    $168.00
    $167.65
    $167.30
    $167.30
    $167.16
    $167.04
    $167.00
    $167.00
    $166.60
    $166.00
    $165.50
    $165.30
    $165.00
    $165.00
    $165.00
    $165.00
    $165.00
    $165.00
    $165.00
    $165.00
    $165.00
    $165.00
    $164.99
    $164.85
    $164.70
    $164.00
    $164.00
    $164.00
    $164.00
    $163.99
    $163.50
    $163.00

    915
    756
    756
    1311
    1591
    956
    929
    835
    1245
    13
    1281
    1463
    788
    781
    436
    325
    764
    1729
    1713
    1713
    1696
    1647
    1639
    1633
    1630
    1611
    1606
    1591
    1590
    1583
    1583
    1583
    1583
    1583
    1583
    1564
    1555
    1555
    1555
    1527
    1516
    1509
    1483
    1448
    1448
    1419
    1419
    1413
    1408
    1401
    1398
    1398
    1396

    $163.00
    $163.00
    $163.00
    $162.85
    $162.50
    $162.50
    $162.50
    $162.50
    $162.00
    $161.86
    $161.85
    $161.75
    $161.38
    $161.00
    $160.65
    $160.40
    $160.26
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00

    1388
    1382
    1358
    1357
    1350
    1347
    1345
    1343
    1333
    1331
    1329
    1300
    1277
    1267
    1267
    1248
    1240
    1235
    1204
    1181
    1181
    1148
    1146
    1135
    1126
    1108
    1108
    1094
    1094
    1080
    1056
    1049
    1018
    1014
    1004
    996
    996
    983
    954
    940
    929
    929
    929
    870
    863
    835
    835
    832
    828
    823
    815
    807
    807

    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00

    802
    796
    782
    777
    776
    768
    768
    768
    768
    768
    768
    764
    751
    725
    722
    700
    700
    700
    700
    681
    660
    660
    645
    643
    639
    634
    626
    626
    620
    620
    594
    578
    578
    573
    549
    531
    467
    459
    454
    450
    450
    438
    438
    438
    429
    429
    421
    421
    416
    411
    411
    411
    408

    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00

    406
    402
    395
    388
    368
    341
    333
    330
    330
    326
    326
    325
    289
    277
    240
    237
    222
    222
    219
    219
    219
    202
    202
    201
    198
    163
    151
    151
    150
    115
    115
    105
    103
    95
    73
    65
    48
    39
    28
    28
    19
    13
    13
    12
    3
    1168
    502
    30
    24
    1575
    812
    1087
    920

    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $160.00
    $159.88
    $159.79
    $159.70
    $159.60
    $159.30
    $159.08
    $159.00
    $158.85
    $158.75

    920
    920
    920
    920
    604
    764
    862 Total
    1356
    488
    418
    727
    105
    1139
    1016
    1710
    1611
    1101
    577
    1614 Total
    1706
    1540
    526
    186
    337
    1366
    393
    1016
    95
    835
    1493
    1038
    1429
    1058
    1163
    1268
    86
    48
    1244
    919
    1106
    102
    832
    1067
    861 Total
    1027
    1301
    563
    767
    1171
    913
    1436 Total
    598
    148

    $158.75
    $158.75
    $158.75
    $158.75
    $158.40
    $158.00
    $157.60
    $157.50
    $157.50
    $157.50
    $157.24
    $156.75
    $156.45
    $156.11
    $156.00
    $156.00
    $156.00
    $155.95
    $155.00
    $155.00
    $155.00
    $155.00
    $155.00
    $154.50
    $154.00
    $154.00
    $153.85
    $153.75
    $153.55
    $153.50
    $153.45
    $153.30
    $153.30
    $153.00
    $152.90
    $152.55
    $152.41
    $152.25
    $152.10
    $152.00
    $151.78
    $151.64
    $151.53
    $151.50
    $151.50
    $151.35
    $151.20
    $151.07
    $150.60
    $150.50
    $150.40
    $150.15
    $150.08

    96 Total
    91 Total
    384 Total
    1597 Total
    1560 Total
    1739
    1731
    1725
    1716
    1690
    1688
    1682
    1681
    1678
    1668
    1667
    1644
    1642
    1641
    1638
    1638
    1636
    1617
    1602
    1597
    1586
    1577
    1575
    1565
    1564
    1564
    1564
    1564
    1560
    1550
    1549
    1540
    1537
    1535
    1510
    1509
    1492
    1483
    1483
    1469
    1465
    1465
    1463
    1457
    1446
    1441
    1441
    1427

    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00

    1420
    1401
    1400
    1396
    1384
    1379
    1376
    1376
    1376
    1376
    1350
    1350
    1349
    1342
    1341
    1336
    1320
    1320
    1320
    1320
    1320
    1292
    1282
    1281
    1279
    1272
    1269
    1261
    1258
    1258
    1253
    1250
    1250
    1244
    1244
    1244
    1225
    1224
    1216
    1191
    1170
    1169
    1163
    1163
    1163
    1134
    1116
    1098
    1098
    1098
    1074
    1071
    1068

    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00

    1068
    1058
    1047
    1040
    1035
    1034
    1017
    1011
    1011
    1011
    1000
    1000
    990
    990
    989
    969
    962
    951
    949
    949
    946
    943
    940
    929
    929
    928
    913
    910
    910
    901
    887
    876
    864
    843
    835
    830
    825
    825
    825
    818
    818
    816
    787
    775
    770
    761
    761
    759
    756
    755
    738
    710
    707

    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00

    702
    701
    700
    698
    687
    684
    642
    626
    621
    619
    618
    590
    580
    580
    577
    550
    540
    531
    526
    525
    502
    468
    467
    459
    458
    447
    428
    421
    421
    415
    407
    405
    397
    393
    392
    391
    379
    375
    371
    371
    371
    371
    369
    356
    349
    347
    343
    336
    336
    336
    334
    334
    328

    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00

    322
    312
    312
    285
    282
    282
    279
    260
    253
    245
    243
    241
    235
    230
    223
    218
    206
    206
    206
    192
    192
    168
    167
    155
    155
    155
    152
    151
    151
    146
    136
    123
    123
    113
    111
    111
    108
    108
    108
    105
    90
    90
    86
    86
    84
    83
    83
    83
    83
    83
    80
    79
    79

    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00

    79
    79
    77
    75
    75
    75
    56
    54
    52
    47
    45
    38
    36
    33
    29
    22
    14
    10
    10
    4
    4
    3
    563
    1270
    406
    260
    689
    111
    760 Total
    1379
    398
    84
    1595
    48
    1711
    992
    36
    411
    907
    125
    1658
    1228
    374
    797
    1196
    1166
    1394
    706
    36
    1502
    1270
    1017
    768

    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $150.00
    $149.55
    $149.50
    $149.48
    $149.45
    $149.25
    $149.25
    $149.20
    $149.00
    $149.00
    $149.00
    $148.90
    $148.59
    $148.50
    $148.40
    $148.05
    $147.97
    $147.63
    $147.50
    $147.00
    $147.00
    $146.65
    $146.30
    $146.15
    $146.00
    $145.30
    $145.25
    $145.25
    $145.00
    $145.00
    $145.00
    $145.00

    604
    484
    930
    1425
    376 Total
    376
    284
    72
    1699
    1206
    996
    946
    1129
    57 Total
    1519
    1224
    267
    421
    1201 Total
    1201
    1201
    1591
    193
    378
    1038
    715
    669 Total
    367 Total
    1739
    1733
    1729
    1729
    1689
    1689
    1679
    1674
    1665
    1663
    1663
    1663
    1663
    1663
    1656
    1651
    1646
    1644
    1624
    1624
    1616
    1616
    1604
    1594
    1591

    $145.00
    $145.00
    $144.98
    $144.50
    $144.40
    $144.40
    $144.20
    $144.20
    $144.00
    $144.00
    $144.00
    $144.00
    $143.81
    $143.50
    $142.50
    $142.50
    $142.50
    $141.92
    $141.71
    $141.71
    $141.71
    $141.70
    $141.60
    $141.35
    $141.05
    $141.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00

    1591
    1591
    1591
    1591
    1588
    1586
    1581
    1540
    1514
    1514
    1502
    1500
    1496
    1488
    1486
    1486
    1445
    1443
    1438
    1429
    1425
    1425
    1409
    1406
    1383
    1375
    1350
    1350
    1350
    1340
    1333
    1326
    1326
    1326
    1326
    1317
    1312
    1303
    1303
    1300
    1300
    1296
    1282
    1269
    1218
    1169
    1149
    1139
    1138
    1138
    1138
    1138
    1138

    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00

    1135
    1112
    1110
    1106
    1101
    1091
    1091
    1091
    1080
    1080
    1075
    1068
    1055
    1053
    1052
    1038
    1038
    1038
    1038
    1038
    1038
    1038
    1038
    1035
    1030
    1029
    1029
    1013
    1013
    998
    995
    995
    964
    956
    955
    955
    936
    935
    929
    929
    929
    929
    929
    929
    929
    929
    919
    911
    911
    910
    905
    894
    894

    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00

    888
    877
    870
    867
    861
    854
    830
    806
    778
    768
    763
    761
    755
    750
    749
    737
    734
    729
    729
    728
    727
    712
    669
    616
    604
    592
    580
    570
    556
    536
    536
    524
    517
    505
    493
    484
    478
    475
    451
    451
    451
    450
    439
    430
    421
    421
    408
    408
    404
    385
    381
    367
    354

    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00

    354
    344
    343
    335
    327
    326
    326
    324
    317
    262
    251
    251
    251
    214
    200
    195
    186
    174
    174
    174
    164
    157
    150
    127
    121
    108
    108
    108
    105
    102
    98
    85
    77
    66
    66
    59
    49
    41
    31
    24
    24
    24
    24
    23
    19
    1669
    915
    416
    1018
    422
    1014
    221
    1268

    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $140.00
    $139.65
    $139.50
    $139.30
    $138.50
    $138.50
    $137.99
    $137.20
    $136.50

    400
    1486
    1583
    1561
    1553
    1536
    1487
    1125
    1100
    1095
    1091
    792
    710
    436
    436
    436
    436
    436
    431
    228
    163
    73
    59
    30
    438
    73
    925
    134
    1113
    1199 Total
    1061
    875
    892
    1014
    1658
    702
    459
    441
    1509
    1687
    901
    1509
    1061
    601
    4
    922
    695
    1397 Total
    1689
    1640
    1611
    1552
    1463

    $136.00
    $135.20
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $135.00
    $134.95
    $134.82
    $134.75
    $134.70
    $134.70
    $134.65
    $134.50
    $134.00
    $133.50
    $133.45
    $133.32
    $133.00
    $133.00
    $133.00
    $133.00
    $132.65
    $132.55
    $132.07
    $132.00
    $132.00
    $131.20
    $130.90
    $130.75
    $130.71
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00

    1437
    1430
    1397
    1362
    1292
    1270
    1184
    1184
    1172
    1172
    1155
    1138
    1091
    1091
    1068
    956
    954
    936
    936
    933
    933
    933
    932
    880
    809
    768
    756
    580
    423
    421
    416
    359
    319
    232
    189
    145
    23
    21
    486
    918
    411
    23
    779
    585
    585
    615
    901
    812
    418
    381
    1163
    1391
    1684

    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $130.00
    $129.99
    $129.80
    $129.65
    $129.60
    $129.50
    $129.50
    $129.50
    $129.10
    $129.00
    $129.00
    $129.00
    $129.00
    $128.90
    $128.50
    $128.20

    809
    1225
    1135
    592
    200
    1323
    1053
    768
    1667
    188
    579
    162
    1283
    951
    919
    1139
    729
    1100
    1040
    1448
    1448
    737
    1459
    1050
    168
    718
    761
    1048
    576
    461
    567 Total
    1611
    1375
    1322
    1322
    1319
    1316
    1258
    1252
    1242
    1221
    1214
    1163
    1129
    1051
    1047
    1009
    1000
    829
    738
    735
    671
    593

    $128.10
    $128.00
    $128.00
    $128.00
    $128.00
    $127.95
    $127.95
    $127.90
    $127.80
    $127.75
    $127.50
    $127.30
    $127.28
    $127.18
    $127.03
    $127.00
    $127.00
    $126.91
    $126.64
    $126.44
    $126.44
    $126.40
    $126.00
    $126.00
    $126.00
    $125.95
    $125.90
    $125.75
    $125.58
    $125.50
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00

    567
    460
    394
    357
    352
    120
    79
    951
    804
    1633
    98
    1360
    1379
    732
    1119
    616
    986
    1347
    34
    1713
    531
    124
    1331
    1266
    724
    1238
    18
    990
    122
    1463
    641
    37 Total
    320 Total
    300 Total
    196 Total
    1730
    1730
    1713
    1712
    1673
    1673
    1663
    1663
    1661
    1644
    1644
    1644
    1619
    1608
    1604
    1593
    1591
    1575

    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $125.00
    $124.99
    $124.99
    $124.95
    $124.40
    $124.00
    $123.99
    $123.90
    $123.80
    $123.50
    $123.20
    $122.95
    $122.85
    $122.55
    $122.49
    $122.43
    $122.00
    $121.80
    $121.75
    $121.50
    $121.50
    $121.25
    $120.75
    $120.47
    $120.45
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00

    1551
    1550
    1547
    1540
    1508
    1496
    1492
    1469
    1468
    1441
    1440
    1413
    1396
    1396
    1384
    1375
    1371
    1371
    1370
    1362
    1350
    1350
    1333
    1333
    1333
    1320
    1312
    1282
    1280
    1270
    1260
    1250
    1249
    1242
    1240
    1230
    1228
    1221
    1218
    1206
    1206
    1205
    1197
    1173
    1164
    1138
    1118
    1107
    1106
    1106
    1101
    1098
    1084

    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00

    1081
    1069
    1045
    1045
    990
    976
    956
    954
    940
    929
    929
    929
    928
    928
    922
    915
    914
    899
    892
    892
    890
    871
    835
    835
    833
    833
    816
    811
    809
    809
    782
    768
    759
    755
    755
    755
    746
    742
    720
    720
    716
    714
    714
    714
    704
    703
    658
    643
    640
    632
    620
    619
    604

    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00

    584
    561
    561
    555
    555
    540
    521
    519
    516
    516
    493
    476
    476
    476
    475
    473
    446
    435
    430
    430
    422
    400
    400
    393
    393
    393
    389
    374
    359
    337
    307
    302
    296
    296
    284
    282
    277
    269
    261
    260
    223
    223
    223
    216
    214
    214
    205
    198
    197
    196
    195
    189
    189

    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00

    184
    168
    160
    154
    135
    111
    102
    102
    102
    96
    95
    86
    83
    83
    81
    81
    77
    77
    75
    61
    50
    50
    49
    49
    47
    44
    37
    16
    11
    925
    1084
    1082
    1638
    1033
    1005
    338
    1130
    1037
    257
    260
    1245
    1221
    1206
    184
    35
    35
    563
    519
    1016
    574
    1048
    681
    1558

    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $120.00
    $119.80
    $119.50
    $119.25
    $119.00
    $119.00
    $119.00
    $119.00
    $118.50
    $118.50
    $118.50
    $118.45
    $118.05
    $117.50
    $117.50
    $117.40
    $117.25
    $117.25
    $116.69
    $116.50
    $116.40
    $115.90
    $115.50
    $115.20
    $115.00

    1558
    1539
    1464
    1341
    1188
    1113
    895
    835
    766
    756
    467
    260
    32
    1503
    626
    756
    594
    1665
    330
    1591
    400
    918
    757
    24
    1168
    429
    941
    922
    604
    533
    408
    400
    1656
    1548
    940
    1644
    251
    555
    26
    1540
    718
    531
    1666 Total
    156 Total
    1705
    1702
    1692
    1666
    1639
    1625
    1591
    1569
    1567

    $115.00
    $115.00
    $115.00
    $115.00
    $115.00
    $115.00
    $115.00
    $115.00
    $115.00
    $115.00
    $115.00
    $115.00
    $115.00
    $114.90
    $114.90
    $114.50
    $114.25
    $114.00
    $114.00
    $113.75
    $113.30
    $112.50
    $112.50
    $112.50
    $112.35
    $112.20
    $112.00
    $112.00
    $112.00
    $112.00
    $112.00
    $112.00
    $111.95
    $111.95
    $111.95
    $111.60
    $111.25
    $111.00
    $110.40
    $110.25
    $110.15
    $110.07
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00

    1557
    1512
    1496
    1475
    1471
    1459
    1438
    1425
    1424
    1410
    1393
    1384
    1384
    1384
    1357
    1348
    1270
    1248
    1196
    1194
    1192
    1180
    1163
    1154
    1111
    1108
    1089
    1079
    1074
    1074
    1025
    1014
    1013
    988
    975
    947
    946
    940
    940
    940
    935
    935
    919
    906
    900
    894
    857
    851
    838
    838
    822
    771
    752

    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00

    744
    728
    725
    678
    667
    648
    635
    623
    617
    556
    550
    527
    520
    520
    514
    502
    473
    429
    408
    392
    375
    359
    359
    341
    319
    245
    226
    184
    179
    171
    167
    160
    159
    156
    140
    137
    121
    104
    68
    62
    62
    62
    50
    48
    41
    26
    9
    5
    355 Total
    1259
    446
    400
    1638

    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $110.00
    $109.99
    $109.50
    $109.50
    $109.50
    $109.20

    997
    1375
    918
    39
    468
    941
    1038
    102
    1038
    1552
    102
    1644
    600
    1004
    1463
    1235
    666
    1068
    1251
    768
    641
    1117
    1074
    639
    910
    1575
    1040
    919
    615
    161
    1636
    1583
    1487
    1435
    1343
    1320
    1096
    1040
    1040
    1040
    1040
    913
    882
    774
    467
    405
    394
    110
    62
    552
    694
    1725
    929

    $109.10
    $108.95
    $108.82
    $108.75
    $108.45
    $108.43
    $108.41
    $108.41
    $108.23
    $108.15
    $108.01
    $108.00
    $107.85
    $107.45
    $107.16
    $107.10
    $106.88
    $106.80
    $106.45
    $106.45
    $106.20
    $106.15
    $106.00
    $106.00
    $105.80
    $105.65
    $105.45
    $105.42
    $105.30
    $105.23
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $105.00
    $104.95
    $104.72
    $104.00
    $104.00

    753
    949
    36
    1470
    1449
    1345
    783
    1540
    430
    1448
    1084
    95
    75
    1512
    563
    1172
    951
    119
    1163
    123
    1138
    1030
    178
    1007
    965
    712
    999 Total
    92 Total
    859 Total
    798 Total
    683 Total
    627 Total
    603 Total
    523 Total
    440 Total
    331 Total
    17 Total
    1613 Total
    1601 Total
    1572 Total
    1368 Total
    1351 Total
    1737
    1731
    1730
    1730
    1730
    1730
    1730
    1729
    1728
    1726
    1725

    $104.00
    $103.82
    $103.80
    $103.60
    $103.60
    $103.60
    $102.98
    $102.80
    $102.75
    $102.70
    $102.50
    $102.50
    $102.38
    $102.00
    $101.99
    $101.80
    $101.51
    $101.33
    $101.32
    $101.30
    $101.00
    $100.93
    $100.80
    $100.70
    $100.60
    $100.10
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    1718
    1711
    1710
    1691
    1691
    1689
    1687
    1683
    1682
    1671
    1670
    1670
    1667
    1667
    1660
    1658
    1656
    1653
    1644
    1643
    1638
    1637
    1637
    1637
    1632
    1629
    1628
    1619
    1614
    1613
    1609
    1604
    1603
    1601
    1598
    1590
    1590
    1588
    1587
    1583
    1575
    1575
    1572
    1563
    1563
    1563
    1563
    1559
    1559
    1559
    1559
    1559
    1559

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    1559
    1559
    1559
    1558
    1551
    1547
    1539
    1537
    1536
    1523
    1518
    1515
    1513
    1512
    1512
    1511
    1492
    1484
    1470
    1469
    1469
    1469
    1469
    1469
    1469
    1469
    1467
    1464
    1463
    1463
    1463
    1463
    1463
    1461
    1461
    1460
    1460
    1460
    1459
    1458
    1448
    1448
    1436
    1435
    1435
    1434
    1429
    1421
    1420
    1412
    1403
    1398
    1392

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    1392
    1390
    1386
    1380
    1379
    1379
    1379
    1379
    1379
    1377
    1375
    1368
    1362
    1359
    1352
    1351
    1341
    1341
    1334
    1321
    1321
    1320
    1319
    1319
    1318
    1314
    1312
    1311
    1309
    1307
    1299
    1296
    1293
    1287
    1284
    1283
    1277
    1277
    1276
    1274
    1274
    1256
    1250
    1247
    1245
    1232
    1228
    1225
    1225
    1221
    1218
    1215
    1214

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    1214
    1203
    1198
    1189
    1188
    1188
    1184
    1184
    1184
    1182
    1173
    1169
    1158
    1158
    1138
    1135
    1135
    1134
    1124
    1119
    1110
    1101
    1101
    1100
    1100
    1100
    1099
    1090
    1087
    1087
    1087
    1082
    1079
    1079
    1073
    1073
    1067
    1057
    1057
    1057
    1057
    1057
    1057
    1057
    1057
    1057
    1056
    1052
    1050
    1048
    1046
    1039
    1038

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    1038
    1036
    1032
    1032
    1020
    1002
    999
    998
    998
    998
    992
    991
    989
    989
    989
    989
    988
    988
    987
    987
    985
    982
    982
    978
    977
    976
    976
    965
    963
    962
    955
    955
    955
    955
    955
    946
    944
    942
    940
    938
    936
    936
    936
    935
    935
    935
    935
    929
    928
    922
    916
    916
    914

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    914
    912
    911
    910
    910
    896
    895
    895
    891
    891
    891
    886
    886
    886
    885
    883
    881
    875
    875
    870
    862
    859
    847
    847
    847
    847
    847
    846
    842
    839
    839
    832
    823
    821
    813
    808
    808
    807
    807
    802
    798
    796
    793
    790
    787
    785
    782
    778
    774
    770
    769
    768
    768

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    767
    765
    761
    760
    757
    755
    755
    734
    732
    732
    730
    730
    725
    723
    722
    722
    722
    718
    715
    708
    707
    707
    706
    704
    703
    700
    700
    700
    700
    700
    699
    699
    694
    686
    684
    683
    677
    670
    667
    667
    665
    659
    657
    655
    640
    638
    631
    627
    618
    618
    603
    593
    583

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    583
    582
    582
    580
    577
    573
    569
    562
    561
    561
    547
    547
    539
    535
    533
    533
    530
    524
    523
    514
    514
    508
    507
    493
    489
    489
    487
    486
    486
    486
    482
    482
    480
    479
    478
    474
    472
    472
    459
    458
    458
    453
    451
    451
    451
    451
    450
    449
    449
    448
    446
    446
    446

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    446
    446
    446
    444
    443
    443
    443
    443
    440
    419
    419
    419
    418
    415
    415
    413
    407
    407
    407
    404
    404
    402
    400
    400
    400
    400
    400
    396
    387
    384
    383
    383
    382
    382
    382
    382
    382
    382
    382
    382
    381
    381
    380
    378
    378
    378
    378
    378
    378
    373
    371
    371
    371

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    369
    368
    365
    361
    361
    359
    359
    359
    357
    357
    354
    354
    353
    350
    350
    335
    334
    332
    332
    332
    331
    330
    327
    325
    325
    321
    320
    319
    310
    310
    306
    306
    305
    300
    295
    292
    287
    287
    287
    286
    283
    283
    279
    277
    277
    277
    274
    274
    274
    274
    270
    260
    254

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    251
    248
    248
    247
    246
    246
    245
    245
    232
    228
    223
    223
    223
    219
    217
    216
    215
    202
    195
    195
    193
    193
    190
    190
    186
    182
    180
    180
    180
    179
    179
    178
    174
    165
    158
    158
    158
    157
    153
    147
    141
    141
    141
    141
    141
    139
    126
    122
    108
    100
    92
    91
    89

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00

    86
    86
    86
    86
    84
    84
    83
    83
    80
    79
    76
    73
    64
    62
    62
    62
    62
    62
    54
    52
    52
    51
    48
    46
    42
    41
    41
    30
    29
    29
    28
    27
    26
    17
    12
    12
    11
    3
    935
    1591
    1014
    774
    201
    62
    901
    901
    1040
    826
    1199
    673 Total
    976
    835
    354

    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $99.80
    $99.60
    $99.60
    $99.00
    $99.00
    $99.00
    $98.99
    $98.99
    $98.29
    $98.29
    $98.25
    $98.00
    $98.00
    $98.00
    $98.00

    132
    1569
    632
    1425
    1258
    928
    1321
    629
    1350
    804
    891
    849
    835
    1005
    1526
    1350
    1282
    1225
    1209
    1061
    796
    1526
    1663
    1663
    1456
    1456
    1456
    1444
    1339
    1320
    1267
    1224
    1098
    1098
    1091
    722
    714
    336
    175
    911
    529
    716
    1475
    1374
    1018
    965
    35
    1611
    667
    1554
    525
    57
    1160

    $98.00
    $97.85
    $97.85
    $97.35
    $97.20
    $97.09
    $97.00
    $97.00
    $96.95
    $96.76
    $96.52
    $96.50
    $96.50
    $96.45
    $96.00
    $96.00
    $96.00
    $96.00
    $96.00
    $96.00
    $96.00
    $95.10
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $95.00
    $94.70
    $94.60
    $94.55
    $94.50
    $94.50
    $94.50
    $94.50
    $94.10
    $94.00
    $93.95
    $93.90
    $93.75
    $93.50
    $93.35

    965
    1075
    1005
    811
    1016
    1068
    1100
    1162
    1245
    956
    62
    1540
    783
    1040
    1354
    480
    608
    1094
    434 Total
    1722 Total
    1722
    1692
    1683
    1670
    1653
    1635
    1570
    1566
    1536
    1523
    1495
    1494
    1479
    1459
    1395
    1395
    1379
    1354
    1294
    1294
    1291
    1243
    1241
    1198
    1179
    1176
    1153
    1140
    1140
    1127
    1110
    1017
    928

    $93.03
    $93.00
    $93.00
    $93.00
    $92.91
    $92.70
    $92.56
    $92.25
    $92.00
    $91.75
    $91.50
    $91.20
    $91.20
    $91.11
    $91.00
    $90.50
    $90.35
    $90.10
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00

    903
    897
    875
    875
    874
    872
    838
    768
    756
    731
    726
    713
    711
    684
    641
    639
    605
    591
    544
    542
    521
    515
    508
    508
    434
    412
    393
    372
    372
    370
    364
    332
    326
    325
    319
    311
    303
    293
    293
    271
    263
    263
    246
    231
    227
    214
    195
    185
    179
    177
    169
    169
    167

    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00

    146
    145
    142
    83
    77
    29
    26
    935
    1396
    796
    321
    1693
    1275
    416
    103
    1379
    1083
    197
    1681
    151
    1293
    1080
    27
    95
    1459
    512
    65
    1379
    1206
    806
    34
    1329
    79
    138
    123
    1725
    446
    54
    1304
    97 Total
    1592
    1558
    1556
    1550
    1540
    1425
    1425
    1331
    1188
    1111
    1084
    1014
    988

    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $90.00
    $89.99
    $89.95
    $89.95
    $89.60
    $89.59
    $89.10
    $88.90
    $88.80
    $88.49
    $88.20
    $88.00
    $87.99
    $87.99
    $87.50
    $87.50
    $87.50
    $87.30
    $87.00
    $87.00
    $87.00
    $86.45
    $86.40
    $86.33
    $86.14
    $86.10
    $86.10
    $86.00
    $86.00
    $85.75
    $85.50
    $85.40
    $85.07
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00

    927
    895
    867
    780
    778
    773
    773
    770
    761
    753
    708
    634
    626
    556
    508
    481
    435
    433
    272
    97
    900
    1163
    732
    77
    1543
    1284
    915
    1612
    1247
    1079
    1079
    411
    238
    62
    35
    492
    1554
    1031
    21
    90
    740
    1168
    1680
    1687
    1111
    976
    552
    388
    145
    454
    1083
    578
    257

    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $85.00
    $84.98
    $84.96
    $84.95
    $84.80
    $84.19
    $84.15
    $84.06
    $84.00
    $84.00
    $84.00
    $84.00
    $84.00
    $84.00
    $84.00
    $84.00
    $83.97
    $83.90
    $83.60
    $83.50
    $83.27
    $83.20
    $83.15
    $83.10
    $83.00
    $83.00
    $83.00
    $83.00
    $83.00
    $82.95
    $82.74
    $82.57
    $82.00
    $81.99

    1605
    95
    1580
    996
    828
    29
    1163
    531
    342 Total
    1739
    1727
    1689
    1674
    1642
    1626
    1583
    1583
    1564
    1564
    1564
    1558
    1558
    1509
    1509
    1509
    1509
    1508
    1498
    1492
    1481
    1465
    1465
    1463
    1463
    1456
    1456
    1456
    1442
    1429
    1425
    1425
    1398
    1398
    1389
    1379
    1379
    1370
    1360
    1359
    1356
    1328
    1325
    1319

    $81.90
    $81.15
    $81.06
    $81.00
    $81.00
    $81.00
    $80.60
    $80.43
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00

    1319
    1282
    1282
    1277
    1277
    1276
    1276
    1273
    1273
    1263
    1256
    1248
    1235
    1235
    1231
    1225
    1222
    1222
    1222
    1219
    1188
    1164
    1164
    1112
    1112
    1107
    1102
    1098
    1075
    1073
    1055
    1029
    1014
    998
    981
    965
    926
    875
    875
    869
    867
    833
    832
    825
    824
    780
    761
    739
    719
    714
    714
    710
    710

    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00

    708
    704
    702
    701
    700
    700
    700
    700
    700
    682
    680
    667
    659
    659
    659
    626
    611
    584
    579
    543
    538
    530
    524
    521
    514
    514
    506
    505
    494
    486
    429
    408
    408
    408
    403
    400
    395
    393
    378
    360
    339
    334
    333
    330
    330
    327
    323
    310
    302
    299
    295
    293
    261

    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00

    240
    236
    212
    204
    202
    193
    189
    189
    178
    176
    146
    120
    118
    118
    110
    105
    100
    95
    93
    89
    85
    80
    62
    62
    60
    51
    40
    38
    38
    38
    19
    12
    12
    460
    1448
    1138
    948
    1577
    1065
    1662
    155
    638
    197
    552
    771
    154
    1379
    25
    446
    49
    1641
    1036
    419

    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $80.00
    $79.84
    $79.80
    $79.75
    $79.50
    $79.00
    $79.00
    $78.99
    $78.75
    $78.50
    $78.50
    $78.40
    $78.00
    $78.00
    $77.99
    $77.70
    $77.35
    $77.10
    $77.00
    $77.00
    $77.00

    391
    531
    1573
    1408
    960
    838
    151
    1163
    1425
    1474
    935
    1688
    1637
    1620
    1609
    1609
    1607
    1607
    1596
    1580
    1580
    1573
    1550
    1469
    1465
    1463
    1457
    1441
    1399
    1386
    1375
    1344
    1319
    1277
    1274
    1274
    1252
    1228
    1228
    1223
    1163
    1163
    1163
    1139
    1135
    1110
    1096
    1065
    1053
    1051
    1040
    1040
    1040

    $77.00
    $76.99
    $76.95
    $76.65
    $76.50
    $76.50
    $76.31
    $76.00
    $75.70
    $75.30
    $75.25
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00

    1040
    1030
    914
    891
    871
    748
    693
    638
    524
    489
    408
    404
    390
    390
    381
    354
    328
    319
    306
    188
    151
    151
    113
    108
    81
    76
    46
    24
    14
    1080
    430
    119
    446
    1474
    1162
    946
    910
    767
    1438
    1079
    155
    979
    588
    730
    1425
    1248
    486
    943
    249
    1625
    1099
    554
    1558

    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $75.00
    $74.90
    $74.90
    $74.67
    $74.30
    $74.10
    $74.00
    $74.00
    $73.85
    $73.79
    $73.70
    $73.58
    $73.50
    $72.60
    $72.55
    $72.50
    $72.00
    $72.00
    $72.00
    $71.80
    $71.79
    $71.60
    $71.50
    $71.30
    $70.95

    1478
    805
    507
    66
    66
    1500
    1690
    1674
    1670
    1653
    1650
    1647
    1626
    1618
    1611
    1594
    1593
    1590
    1581
    1578
    1570
    1565
    1558
    1552
    1509
    1509
    1509
    1505
    1499
    1493
    1465
    1463
    1463
    1463
    1457
    1456
    1419
    1398
    1360
    1360
    1356
    1337
    1335
    1333
    1333
    1333
    1323
    1313
    1313
    1299
    1292
    1269
    1253

    $70.95
    $70.90
    $70.77
    $70.30
    $70.30
    $70.20
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00

    1252
    1217
    1197
    1187
    1184
    1184
    1138
    1138
    1118
    1110
    1098
    1079
    1073
    1059
    1024
    1019
    994
    994
    990
    946
    946
    932
    926
    910
    893
    880
    875
    873
    865
    789
    778
    755
    755
    713
    708
    707
    705
    702
    701
    700
    700
    561
    561
    558
    542
    518
    482
    482
    480
    473
    446
    431
    424

    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00

    423
    421
    421
    421
    413
    405
    402
    400
    395
    381
    363
    345
    330
    293
    265
    253
    250
    238
    219
    189
    167
    120
    118
    110
    105
    105
    93
    89
    86
    84
    77
    73
    66
    52
    45
    40
    38
    28
    28
    12
    551
    1282
    1251
    213
    929
    502
    1701
    418
    88
    393
    632
    247
    1209

    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $70.00
    $69.95
    $69.80
    $69.50
    $69.39
    $69.26
    $69.25
    $69.00
    $69.00
    $69.00
    $68.56
    $68.50
    $68.50
    $68.40

    18
    1170
    849
    292
    951
    183
    274
    988
    765
    660
    403
    806
    1650
    978
    1484
    1422
    918
    1591
    656
    596
    1516
    1715
    1061
    612
    480
    86
    377
    406
    135
    1626
    1611
    1553
    1550
    1469
    1399
    1172
    1084
    1079
    1030
    1025
    864
    853
    773
    699
    615
    579
    544
    524
    458
    430
    292
    177
    39

    $68.40
    $68.00
    $68.00
    $68.00
    $67.99
    $67.99
    $67.55
    $67.50
    $67.50
    $67.50
    $67.50
    $67.31
    $67.00
    $66.74
    $66.70
    $66.70
    $66.69
    $66.50
    $66.50
    $66.50
    $66.35
    $66.33
    $66.00
    $66.00
    $66.00
    $66.00
    $65.65
    $65.49
    $65.40
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00
    $65.00

    1638
    534
    1360
    117
    1166
    1379
    1656
    1016
    339
    54
    1324
    1058
    551
    1282
    393
    1167
    589 Total
    1053
    589
    35
    1369
    718
    28
    870
    450
    62
    688 Total
    497 Total
    1713
    1689
    1643
    1642
    1611
    1611
    1611
    1603
    1594
    1593
    1593
    1591
    1570
    1564
    1564
    1559
    1558
    1536
    1523
    1492
    1486
    1469
    1465
    1456
    1456

    $64.50
    $64.50
    $64.39
    $64.10
    $63.90
    $63.82
    $63.30
    $63.00
    $63.00
    $63.00
    $62.79
    $62.50
    $62.50
    $62.40
    $62.05
    $62.00
    $61.95
    $61.95
    $61.95
    $61.40
    $61.26
    $61.15
    $61.00
    $60.75
    $60.01
    $60.01
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00

    1429
    1398
    1398
    1396
    1375
    1362
    1362
    1333
    1324
    1319
    1319
    1299
    1282
    1282
    1282
    1277
    1277
    1242
    1230
    1218
    1181
    1161
    1158
    1135
    1093
    1088
    1084
    1084
    1083
    1082
    1055
    1035
    1029
    1029
    1017
    994
    988
    983
    983
    978
    926
    914
    910
    898
    889
    875
    845
    828
    823
    806
    777
    749
    734

    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00

    732
    732
    725
    725
    718
    710
    689
    688
    685
    673
    650
    625
    612
    583
    570
    568
    547
    543
    537
    499
    497
    485
    482
    463
    451
    446
    446
    446
    421
    417
    407
    405
    403
    400
    394
    388
    382
    380
    378
    359
    359
    357
    344
    342
    339
    335
    334
    333
    325
    325
    307
    298
    286

    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00

    281
    260
    243
    240
    240
    238
    238
    216
    209
    209
    193
    186
    168
    165
    136
    126
    118
    111
    94
    83
    40
    23
    355
    570
    988
    1558
    901
    1155
    446
    956
    415
    99
    1083
    410
    892
    875
    3
    1464
    604
    1038
    841
    566
    178
    862
    1663
    554
    520
    1492
    3
    1327
    933
    1486
    298

    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $60.00
    $59.99
    $59.90
    $59.75
    $59.70
    $59.70
    $59.60
    $59.55
    $59.50
    $59.50
    $59.43
    $59.28
    $59.06
    $59.00
    $59.00
    $58.85
    $58.50
    $58.35
    $58.19
    $58.10
    $58.00
    $57.83
    $57.60
    $57.50
    $57.50
    $57.40
    $57.38
    $57.35
    $57.30
    $57.30
    $56.70
    $56.70

    1038
    310
    393
    1324
    578
    102
    446
    1044
    978
    1663
    1663
    1637
    1591
    1591
    1482
    1403
    1352
    1313
    1284
    1218
    1182
    1080
    892
    867
    843
    761
    759
    722
    707
    522
    489
    405
    317
    174
    120
    86
    77
    35
    1326
    923
    1312
    1267
    1251
    1017
    946
    940
    517
    634
    119
    119
    1500
    581
    890

    $56.51
    $56.50
    $56.34
    $56.00
    $56.00
    $56.00
    $55.85
    $55.50
    $55.10
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $55.00
    $54.60
    $54.18
    $54.00
    $54.00
    $54.00
    $54.00
    $54.00
    $54.00
    $54.00
    $53.80
    $53.33
    $53.33
    $53.20
    $53.00
    $52.80

    797
    588
    1062
    879
    1580
    145
    1084
    990
    29
    117
    484
    1080
    601
    446
    1409
    894
    593
    652
    948
    1055
    277
    1233
    910
    1436
    956
    1235
    547
    24
    1732
    1725
    1718
    1718
    1715
    1712
    1706
    1701
    1682
    1678
    1668
    1664
    1664
    1651
    1650
    1650
    1644
    1638
    1612
    1609
    1603
    1595
    1594
    1594
    1591

    $52.60
    $52.60
    $52.50
    $52.40
    $52.28
    $52.13
    $52.00
    $52.00
    $52.00
    $51.90
    $51.65
    $51.60
    $51.60
    $51.50
    $51.41
    $51.25
    $51.25
    $51.20
    $51.10
    $51.00
    $51.00
    $50.75
    $50.50
    $50.40
    $50.40
    $50.27
    $50.25
    $50.25
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00

    1580
    1558
    1554
    1551
    1550
    1548
    1525
    1518
    1515
    1493
    1492
    1486
    1475
    1473
    1473
    1465
    1462
    1440
    1437
    1401
    1398
    1398
    1398
    1398
    1398
    1385
    1365
    1360
    1360
    1360
    1358
    1354
    1346
    1330
    1326
    1306
    1304
    1299
    1296
    1282
    1277
    1267
    1267
    1249
    1249
    1235
    1228
    1222
    1163
    1138
    1126
    1122
    1103

    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00

    1100
    1098
    1096
    1091
    1090
    1079
    1073
    1073
    1048
    1018
    1014
    1009
    983
    965
    928
    911
    901
    898
    873
    873
    841
    812
    804
    802
    789
    787
    778
    775
    755
    747
    745
    738
    735
    723
    723
    723
    707
    702
    702
    686
    686
    686
    676
    674
    665
    617
    563
    547
    542
    542
    529
    525
    516

    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00

    514
    505
    494
    465
    443
    436
    430
    428
    425
    421
    421
    416
    407
    405
    401
    355
    341
    337
    314
    312
    310
    308
    265
    265
    244
    205
    205
    195
    184
    183
    180
    168
    155
    155
    153
    153
    148
    148
    100
    86
    83
    82
    79
    79
    66
    57
    51
    48
    45
    28
    28
    28
    27

    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00
    $50.00

    16
    10
    8
    2
    962
    1365
    1003
    940
    393
    924
    760
    1646
    1070
    863
    604
    430
    274
    965
    1641
    1016
    1665
    1399
    748
    186
    79
    51
    1376
    498
    1540
    484
    49
    1267
    849
    274
    115
    989
    1305
    1081
    884
    629
    577
    1004
    1160
    1113
    1394
    1235
    1092 Total
    1092
    666
    270
    1701
    1618
    1500

    $50.00
    $50.00
    $50.00
    $50.00
    $49.99
    $49.95
    $49.95
    $49.90
    $49.88
    $49.35
    $49.20
    $49.00
    $49.00
    $49.00
    $49.00
    $49.00
    $49.00
    $48.90
    $48.75
    $48.60
    $48.50
    $48.40
    $48.40
    $48.00
    $48.00
    $47.75
    $47.60
    $47.45
    $47.25
    $47.25
    $46.99
    $46.90
    $46.80
    $46.80
    $46.50
    $46.20
    $46.15
    $46.00
    $46.00
    $46.00
    $46.00
    $45.85
    $45.80
    $45.80
    $45.75
    $45.64
    $45.50
    $45.50
    $45.50
    $45.15
    $45.00
    $45.00
    $45.00

    1498
    1449
    1434
    1337
    1284
    1280
    1224
    845
    722
    714
    555
    436
    436
    436
    436
    436
    374
    354
    262
    163
    80
    62
    694
    151
    935
    161
    1379
    1079
    74
    770
    371
    1246
    1238
    1640
    948
    446
    1627
    666
    1100
    1244
    1148
    1063
    995
    484
    400
    920
    24
    593
    1324
    720
    359
    1082
    920

    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $45.00
    $44.99
    $44.80
    $44.68
    $44.68
    $44.65
    $44.48
    $44.45
    $44.00
    $44.00
    $43.70
    $43.60
    $43.50
    $43.00
    $43.00
    $42.99
    $42.85
    $42.75
    $42.00
    $42.00
    $42.00
    $42.00
    $42.00
    $42.00
    $41.90
    $41.85
    $41.55
    $41.30
    $41.00
    $41.00
    $40.95
    $40.50

    830
    920
    920
    1224
    1719
    1718
    1697
    1668
    1633
    1633
    1583
    1559
    1559
    1535
    1488
    1479
    1472
    1469
    1403
    1398
    1385
    1341
    1319
    1269
    1266
    1218
    1195
    1138
    1087
    1079
    1073
    1058
    1005
    998
    946
    901
    895
    866
    850
    779
    756
    737
    718
    660
    660
    659
    659
    645
    632
    579
    569
    568
    550

    $40.50
    $40.30
    $40.30
    $40.27
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00

    537
    505
    494
    486
    486
    429
    400
    382
    374
    359
    359
    359
    332
    323
    296
    247
    220
    204
    187
    173
    142
    138
    123
    111
    84
    28
    24
    918
    213
    3
    1174
    1324
    1611
    920
    1583
    408
    587
    23
    656
    956
    1425
    1374
    673
    571
    512
    95
    919
    991
    619
    359
    557
    1238
    1199

    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $40.00
    $39.95
    $39.90
    $39.74
    $39.53
    $39.50
    $39.20
    $39.00
    $39.00
    $38.85
    $38.61
    $38.50
    $38.40
    $38.20
    $38.08
    $38.00
    $38.00
    $38.00
    $37.50
    $37.50
    $37.50
    $37.49
    $37.15
    $37.00
    $36.85
    $36.50
    $36.40
    $36.25

    1163
    1586
    1512
    1464
    1341
    940
    170
    1463
    1376
    604
    1150
    1283
    1190
    1658
    1638
    1618
    1595
    1591
    1498
    1482
    1459
    1434
    1347
    1346
    1341
    1337
    1300
    1280
    1277
    1244
    1203
    1184
    1149
    1143
    1138
    1058
    1055
    1048
    1041
    1029
    996
    989
    910
    894
    894
    864
    853
    845
    761
    729
    722
    718
    699

    $36.07
    $36.00
    $36.00
    $36.00
    $36.00
    $36.00
    $36.00
    $35.95
    $35.95
    $35.80
    $35.64
    $35.50
    $35.25
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00

    674
    605
    556
    458
    450
    439
    431
    400
    395
    95
    95
    91
    80
    66
    62
    43
    35
    15
    1684
    503
    4
    899
    1343
    1488
    400
    1425
    1369
    996
    528
    73
    1018
    570
    219
    1665
    75
    956
    899
    401
    1038
    1135
    1135
    277
    1463
    1324
    962
    1281
    1517
    1040
    1669
    520
    660
    551
    1493

    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $35.00
    $34.86
    $34.86
    $34.44
    $34.15
    $34.10
    $34.00
    $34.00
    $33.99
    $33.75
    $33.75
    $33.75
    $33.69
    $33.60
    $33.50
    $33.39
    $32.95
    $32.68
    $32.50
    $32.50
    $32.42
    $32.37
    $32.00
    $32.00
    $32.00
    $31.99
    $31.95
    $31.90
    $31.75
    $31.70
    $31.66
    $31.50
    $31.33
    $31.20
    $31.20
    $31.00

    1358
    495
    117
    732
    1055
    73
    1183
    1668
    1653
    1651
    1640
    1614
    1611
    1602
    1593
    1554
    1508
    1491
    1419
    1358
    1323
    1299
    1256
    1251
    1224
    1148
    1126
    1079
    940
    914
    893
    847
    787
    761
    714
    705
    700
    700
    667
    667
    667
    660
    643
    625
    580
    561
    561
    533
    526
    495
    489
    424
    413

    $31.00
    $31.00
    $31.00
    $30.95
    $30.50
    $30.47
    $30.21
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00

    400
    384
    307
    180
    178
    100
    96
    84
    12
    1347
    563
    204
    1667
    173
    916
    1379
    1600
    974
    847
    750
    835
    408
    400
    978
    30
    1232
    119
    7
    1679
    1419
    1083
    1015
    1463
    446
    20
    400
    1040
    1358
    843
    27
    1449
    75
    108
    1711
    1663
    1663
    1663
    1663
    1658
    1644
    1637
    1637
    1637

    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $30.00
    $29.89
    $29.55
    $29.50
    $29.40
    $29.39
    $29.32
    $28.99
    $28.50
    $28.50
    $28.50
    $28.50
    $28.35
    $28.00
    $28.00
    $27.95
    $27.95
    $27.80
    $27.60
    $27.50
    $27.45
    $27.30
    $27.24
    $27.00
    $26.79
    $26.50
    $26.49
    $26.40
    $26.36
    $26.00
    $25.95
    $25.95
    $25.90
    $25.60
    $25.35
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00

    1636
    1618
    1614
    1611
    1607
    1607
    1594
    1590
    1590
    1583
    1580
    1559
    1559
    1558
    1536
    1525
    1502
    1476
    1476
    1469
    1463
    1459
    1456
    1456
    1456
    1450
    1444
    1417
    1403
    1359
    1352
    1350
    1347
    1339
    1319
    1300
    1296
    1296
    1296
    1277
    1277
    1274
    1274
    1269
    1269
    1267
    1245
    1245
    1231
    1228
    1228
    1200
    1182

    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00

    1178
    1162
    1151
    1151
    1151
    1151
    1149
    1139
    1125
    1110
    1106
    1100
    1100
    1099
    1099
    1099
    1099
    1098
    1098
    1087
    1080
    1065
    1053
    1051
    1047
    1041
    1029
    1018
    1018
    1017
    972
    971
    971
    964
    964
    956
    954
    954
    951
    951
    946
    946
    940
    935
    915
    910
    910
    910
    910
    895
    892
    892
    891

    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00

    887
    884
    876
    871
    820
    729
    722
    722
    718
    714
    710
    700
    671
    600
    524
    508
    411
    408
    405
    401
    400
    400
    371
    314
    262
    228
    195
    188
    175
    174
    127
    113
    77
    76
    59
    48
    46
    15
    14
    13
    869
    554
    274
    1038
    1687
    1282
    1206
    879
    386
    374
    1248
    1509
    956

    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $25.00
    $24.80
    $24.53
    $24.15
    $24.12
    $24.00
    $24.00
    $24.00
    $24.00
    $24.00
    $24.00
    $23.95
    $23.70
    $23.50

    1150
    1503
    1100
    1111
    391
    1535
    1270
    1163
    77
    1459
    1354
    428
    604
    756
    7
    1681
    1670
    1670
    1670
    1670
    1668
    1632
    1618
    1562
    1559
    1559
    1559
    1559
    1559
    1559
    1559
    1559
    1559
    1559
    1559
    1559
    1559
    1559
    1551
    1549
    1514
    1493
    1463
    1463
    1462
    1398
    1326
    1326
    1326
    1311
    1311
    1224
    1091

    $23.47
    $23.25
    $23.14
    $23.00
    $23.00
    $22.50
    $22.50
    $21.24
    $21.20
    $21.00
    $21.00
    $21.00
    $20.70
    $20.60
    $20.50
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00

    1084
    1073
    1048
    1048
    1030
    996
    991
    991
    981
    976
    933
    915
    812
    809
    778
    732
    732
    720
    704
    704
    659
    620
    594
    542
    537
    486
    478
    474
    408
    408
    408
    384
    382
    378
    371
    368
    353
    349
    342
    334
    332
    330
    320
    300
    288
    270
    270
    252
    204
    190
    86
    12
    12

    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00
    $20.00

    1258
    1340
    1016
    1656
    1539
    634
    933
    1057
    371
    1503
    1163
    336
    74
    1016
    4
    582
    1251
    1267
    1070
    1050
    411
    190
    159
    119
    1251
    1160
    1138
    1687
    1637
    1611
    1595
    1559
    1559
    1500
    1425
    1425
    1287
    1236
    1203
    1172
    1048
    996
    773
    674
    610
    598
    579
    482
    454
    425
    415
    411
    395

    $19.95
    $19.90
    $19.79
    $19.45
    $19.25
    $18.90
    $18.30
    $18.00
    $18.00
    $17.50
    $17.50
    $17.50
    $17.50
    $17.35
    $16.60
    $16.45
    $16.10
    $16.00
    $16.00
    $16.00
    $16.00
    $16.00
    $16.00
    $16.00
    $15.95
    $15.50
    $15.25
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $15.00

    380
    371
    371
    291
    91
    962
    447
    965
    1062
    28
    1493
    1100
    105
    514
    879
    919
    729
    750
    65
    1251
    14
    861
    36
    151
    39
    108
    1611
    108
    1031
    1016
    1014
    1425
    1715
    1561
    1226
    1224
    1197
    1163
    1118
    990
    756
    747
    359
    335
    332
    29
    1543
    1509
    956
    1284
    1079
    720
    1163

    $15.00
    $15.00
    $15.00
    $15.00
    $15.00
    $14.95
    $14.95
    $14.78
    $14.70
    $14.25
    $14.00
    $14.00
    $13.95
    $13.28
    $13.10
    $13.00
    $12.75
    $12.50
    $12.50
    $12.40
    $12.00
    $11.50
    $11.50
    $11.20
    $11.20
    $11.16
    $11.00
    $10.95
    $10.80
    $10.32
    $10.10
    $10.05
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $10.00
    $9.99
    $9.75
    $9.52
    $9.35
    $9.17
    $9.12
    $9.02

    29
    408
    446
    407
    1441
    1135
    415
    277
    119
    1163
    393
    277
    1143
    989
    400
    1464
    1492
    1580
    1656
    1102
    1016
    890
    1396
    1507
    1370
    1346
    1333
    1117
    976
    715
    1379
    1396
    1399
    108
    1517
    1573
    408
    1548
    277
    1102
    1033
    952 Total
    1201
    192
    79
    222
    82
    192
    82
    1262
    695
    79
    34

    $9.00
    $8.98
    $8.65
    $8.50
    $8.40
    $8.00
    $8.00
    $8.00
    $8.00
    $7.83
    $7.25
    $7.20
    $7.00
    $7.00
    $6.60
    $6.50
    $6.38
    $6.30
    $6.00
    $5.60
    $5.40
    $5.25
    $5.22
    $5.00
    $5.00
    $5.00
    $5.00
    $5.00
    $5.00
    $4.50
    $4.06
    $4.00
    $3.20
    $2.79
    $2.50
    $2.25
    $2.24
    $2.10
    $1.80
    $1.40
    $1.40
    $0.00
    ($141.71)
    ($150.00)
    ($150.00)
    ($160.00)
    ($200.00)
    ($223.44)
    ($240.00)
    ($250.00)
    ($250.00)
    ($250.00)
    ($282.00)

    781
    82
    82
    82
    82
    398
    952
    54
    54
    952
    222
    54
    82
    952
    54
    54

    ($300.00)
    ($300.00)
    ($300.00)
    ($300.00)
    ($350.00)
    ($800.00)
    ($802.44)
    ($1,282.00)
    ($1,504.30)
    ($1,782.76)
    ($1,800.00)
    ($1,947.20)
    ($2,046.00)
    ($2,240.41)
    ($3,427.00)
    ($10,983.36)

    ANSWER 1: List patients by subtotals in claim in a high to low spending order


    ANSWER 2: Define how many patients spend 50% of the total claims
    ANSWER 3: Define how much money was spent by the 10% of the High spenders

    List of patients by claim subtotals sorted high to


    low
    Sum of Amount
    Beneficiary ID

    Total

    Cummulative
    Total

    748
    143
    54
    1466
    935
    148
    536
    81
    972
    1016
    965
    1100
    756
    51
    1391
    951
    943
    898
    841
    788
    1057
    452
    1583
    1459
    644
    914
    34
    1534
    80
    1225
    916
    1218
    743
    317
    1570
    549

    152,856.40
    133,100.00
    125,291.11
    82,405.00
    79,079.61
    77,592.62
    72,926.55
    67,656.00
    64,527.50
    55,128.57
    52,476.89
    46,279.79
    39,687.75
    39,084.00
    38,947.20
    37,068.30
    35,525.30
    35,516.30
    33,031.07
    30,874.57
    29,121.39
    28,790.00
    28,204.85
    27,465.00
    26,899.00
    25,931.83
    25,581.37
    25,492.82
    23,448.90
    21,924.54
    21,470.03
    21,330.00
    20,610.00
    20,143.46
    20,100.00
    19,918.00

    152,856.40
    285,956.40
    411,247.51
    493,652.51
    572,732.12
    650,324.74
    723,251.29
    790,907.29
    855,434.79
    910,563.36
    963,040.25
    1,009,320.04
    1,049,007.79
    1,088,091.79
    1,127,038.99
    1,164,107.29
    1,199,632.59
    1,235,148.89
    1,268,179.96
    1,299,054.53
    1,328,175.92
    1,356,965.92
    1,385,170.77
    1,412,635.77
    1,439,534.77
    1,465,466.60
    1,491,047.97
    1,516,540.79
    1,539,989.69
    1,561,914.23
    1,583,384.26
    1,604,714.26
    1,625,324.26
    1,645,467.72
    1,665,567.72
    1,685,485.72

    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20
    21
    22
    23
    24
    25
    26
    27
    28
    29
    30
    31
    32
    33
    34
    35
    36

    771

    19,418.29

    1,704,904.01

    37

    1183

    19,371.27

    1,724,275.28

    38

    3
    1591
    1148
    929
    1704

    18,710.99
    18,149.05
    17,497.00
    17,123.67
    17,092.00

    1,742,986.27
    1,761,135.32
    1,778,632.32
    1,795,755.99
    1,812,847.99

    39
    40
    41
    42
    43

    921
    913
    59
    1083
    446

    16,858.00
    16,736.09
    16,701.20
    16,293.12
    16,186.20

    1,829,705.99
    1,846,442.08
    1,863,143.28
    1,879,436.40
    1,895,622.60

    44
    45
    46
    47
    48

    1505

    16,155.78

    1,911,778.38

    49

    1162

    16,069.85

    1,927,848.23

    50

    1425
    1529
    1545
    1138
    1142
    927
    1429
    1464
    216
    1167
    1013
    682
    1547
    1275
    529
    946
    1082
    919
    1015
    1384
    1467
    837
    695
    62
    474
    988
    1276
    108
    1568
    911
    1569
    1730
    910
    1238
    902
    925
    507
    770
    421

    16,016.47
    16,000.00
    15,953.00
    15,890.70
    15,794.59
    15,611.63
    14,963.71
    14,897.00
    14,810.00
    14,797.32
    14,646.74
    14,530.00
    14,492.00
    14,465.29
    14,380.70
    14,139.60
    14,123.70
    13,859.24
    13,852.38
    13,682.00
    13,460.00
    13,380.00
    13,242.93
    13,132.25
    12,888.00
    12,841.85
    12,829.00
    12,626.45
    12,602.95
    12,478.58
    12,325.79
    12,316.75
    12,303.00
    12,040.90
    11,919.46
    11,859.34
    11,606.64
    11,600.06
    11,586.69

    1,943,864.70
    1,959,864.70
    1,975,817.70
    1,991,708.40
    2,007,502.99
    2,023,114.62
    2,038,078.33
    2,052,975.33
    2,067,785.33
    2,082,582.65
    2,097,229.39
    2,111,759.39
    2,126,251.39
    2,140,716.68
    2,155,097.38
    2,169,236.98
    2,183,360.68
    2,197,219.92
    2,211,072.30
    2,224,754.30
    2,238,214.30
    2,251,594.30
    2,264,837.23
    2,277,969.48
    2,290,857.48
    2,303,699.33
    2,316,528.33
    2,329,154.78
    2,341,757.73
    2,354,236.31
    2,366,562.10
    2,378,878.85
    2,391,181.85
    2,403,222.75
    2,415,142.21
    2,427,001.55
    2,438,608.19
    2,450,208.25
    2,461,794.94

    51
    52
    53
    54
    55
    56
    57
    58
    59
    60
    61
    62
    63
    64
    65
    66
    67
    68
    69
    70
    71
    72
    73
    74
    75
    76
    77
    78
    79
    80
    81
    82
    83
    84
    85
    86
    87
    88
    89

    724
    849
    953
    423
    641
    187
    511
    1184
    1518
    50
    700
    162
    1468
    44
    975
    1432
    1688
    1011
    400
    741
    430
    1644
    404
    393
    792
    918
    122
    1671
    559
    539
    416
    633
    761
    1710
    1638
    1048
    1396
    1166
    938
    1058
    758
    1611
    1197
    779
    940
    1356
    795
    1087
    1713
    1077
    899
    723
    954

    11,486.75
    11,470.25
    11,367.00
    11,356.00
    11,311.75
    11,244.00
    11,180.00
    11,075.00
    11,050.00
    11,048.00
    10,884.50
    10,727.30
    10,639.00
    10,635.00
    10,506.25
    10,500.00
    10,402.37
    10,363.64
    10,337.80
    10,285.00
    10,195.94
    9,906.80
    9,822.00
    9,795.54
    9,755.00
    9,743.82
    9,697.00
    9,692.00
    9,667.30
    9,650.00
    9,618.20
    9,600.35
    9,412.30
    9,295.25
    9,245.70
    9,213.05
    9,185.67
    9,124.90
    8,945.74
    8,928.30
    8,834.15
    8,640.80
    8,543.28
    8,514.00
    8,478.10
    8,457.50
    8,415.10
    8,388.85
    8,317.55
    8,240.00
    8,236.00
    8,150.00
    8,083.30

    2,473,281.69
    2,484,751.94
    2,496,118.94
    2,507,474.94
    2,518,786.69
    2,530,030.69
    2,541,210.69
    2,552,285.69
    2,563,335.69
    2,574,383.69
    2,585,268.19
    2,595,995.49
    2,606,634.49
    2,617,269.49
    2,627,775.74
    2,638,275.74
    2,648,678.11
    2,659,041.75
    2,669,379.55
    2,679,664.55
    2,689,860.49
    2,699,767.29
    2,709,589.29
    2,719,384.83
    2,729,139.83
    2,738,883.65
    2,748,580.65
    2,758,272.65
    2,767,939.95
    2,777,589.95
    2,787,208.15
    2,796,808.50
    2,806,220.80
    2,815,516.05
    2,824,761.75
    2,833,974.80
    2,843,160.47
    2,852,285.37
    2,861,231.11
    2,870,159.41
    2,878,993.56
    2,887,634.36
    2,896,177.64
    2,904,691.64
    2,913,169.74
    2,921,627.24
    2,930,042.34
    2,938,431.19
    2,946,748.74
    2,954,988.74
    2,963,224.74
    2,971,374.74
    2,979,458.04

    90
    91
    92
    93
    94
    95
    96
    97
    98
    99
    100
    101
    102
    103
    104
    105
    106
    107
    108
    109
    110
    111
    112
    113
    114
    115
    116
    117
    118
    119
    120
    121
    122
    123
    124
    125
    126
    127
    128
    129
    130
    131
    132
    133
    134
    135
    136
    137
    138
    139
    140
    141
    142

    1163
    531
    405
    1270
    1151
    1134
    349
    915
    563
    580
    1012
    585
    843
    525
    1120
    1018
    451
    1379
    936
    9
    386
    1196
    28
    1067
    1350
    359
    1070
    1084
    486
    369
    1101
    764
    937
    1365
    1089
    208
    263
    1179
    768
    468
    543
    1344
    1438
    1283
    218
    933
    403
    992
    576
    755
    961
    135
    1033

    8,043.29
    7,999.95
    7,912.95
    7,911.74
    7,902.70
    7,875.00
    7,770.00
    7,750.07
    7,684.08
    7,570.00
    7,550.50
    7,459.00
    7,425.95
    7,407.46
    7,385.80
    7,356.60
    7,328.45
    7,294.49
    7,276.26
    7,274.20
    7,267.10
    7,260.00
    7,241.75
    7,220.21
    7,201.95
    7,102.55
    7,081.86
    7,079.00
    7,066.94
    7,060.00
    7,060.00
    7,016.91
    6,969.33
    6,962.87
    6,959.30
    6,950.00
    6,930.00
    6,920.70
    6,892.25
    6,862.90
    6,860.50
    6,845.00
    6,838.20
    6,792.53
    6,773.91
    6,730.30
    6,643.05
    6,635.28
    6,625.68
    6,610.00
    6,600.00
    6,522.35
    6,485.40

    2,987,501.33
    2,995,501.28
    3,003,414.23
    3,011,325.97
    3,019,228.67
    3,027,103.67
    3,034,873.67
    3,042,623.74
    3,050,307.82
    3,057,877.82
    3,065,428.32
    3,072,887.32
    3,080,313.27
    3,087,720.73
    3,095,106.53
    3,102,463.13
    3,109,791.58
    3,117,086.07
    3,124,362.33
    3,131,636.53
    3,138,903.63
    3,146,163.63
    3,153,405.38
    3,160,625.59
    3,167,827.54
    3,174,930.09
    3,182,011.95
    3,189,090.95
    3,196,157.89
    3,203,217.89
    3,210,277.89
    3,217,294.80
    3,224,264.13
    3,231,227.00
    3,238,186.30
    3,245,136.30
    3,252,066.30
    3,258,987.00
    3,265,879.25
    3,272,742.15
    3,279,602.65
    3,286,447.65
    3,293,285.85
    3,300,078.38
    3,306,852.29
    3,313,582.59
    3,320,225.64
    3,326,860.92
    3,333,486.60
    3,340,096.60
    3,346,696.60
    3,353,218.95
    3,359,704.35

    143
    144
    145
    146
    147
    148
    149
    150
    151 "50%
    152
    153
    154
    155
    156
    157
    158
    159
    160
    161
    162
    163
    164
    165
    166
    167
    168
    169
    170
    171
    172
    173
    174 "10%
    175
    176
    177
    178
    179
    180
    181
    182
    183
    184
    185
    186
    187
    188
    189
    190
    191
    192
    193
    194
    195

    1090
    352
    1091
    90
    24
    1038
    1245
    1168
    141
    151
    1604
    989
    1465
    1603
    1728
    745
    101
    180
    1322
    1376
    1068
    1006
    759
    1221
    1093
    503
    499
    418
    923
    324
    1228
    668
    579
    1594
    1463
    1303
    1343
    40
    260
    1366
    1140
    1586
    956
    1143
    1224
    206
    1631
    577
    1302
    14
    27
    622
    36

    6,450.00
    6,425.00
    6,350.00
    6,348.27
    6,338.85
    6,328.76
    6,311.05
    6,302.32
    6,291.20
    6,284.45
    6,270.00
    6,153.20
    6,110.00
    6,100.00
    6,100.00
    6,080.00
    6,078.46
    6,074.34
    6,023.70
    6,014.30
    6,011.50
    6,000.00
    5,996.94
    5,985.90
    5,973.55
    5,962.82
    5,960.00
    5,958.25
    5,954.18
    5,942.00
    5,927.20
    5,900.00
    5,896.10
    5,878.50
    5,855.99
    5,850.00
    5,833.35
    5,790.00
    5,787.90
    5,764.95
    5,760.00
    5,757.66
    5,754.13
    5,729.40
    5,726.27
    5,706.97
    5,700.00
    5,631.95
    5,623.00
    5,612.00
    5,592.95
    5,550.00
    5,541.60

    3,366,154.35
    3,372,579.35
    3,378,929.35
    3,385,277.62
    3,391,616.47
    3,397,945.23
    3,404,256.28
    3,410,558.60
    3,416,849.80
    3,423,134.25
    3,429,404.25
    3,435,557.45
    3,441,667.45
    3,447,767.45
    3,453,867.45
    3,459,947.45
    3,466,025.91
    3,472,100.25
    3,478,123.95
    3,484,138.25
    3,490,149.75
    3,496,149.75
    3,502,146.69
    3,508,132.59
    3,514,106.14
    3,520,068.96
    3,526,028.96
    3,531,987.21
    3,537,941.39
    3,543,883.39
    3,549,810.59
    3,555,710.59
    3,561,606.69
    3,567,485.19
    3,573,341.18
    3,579,191.18
    3,585,024.53
    3,590,814.53
    3,596,602.43
    3,602,367.38
    3,608,127.38
    3,613,885.04
    3,619,639.17
    3,625,368.57
    3,631,094.84
    3,636,801.81
    3,642,501.81
    3,648,133.76
    3,653,756.76
    3,659,368.76
    3,664,961.71
    3,670,511.71
    3,676,053.31

    196
    197
    198
    199
    200
    201
    202
    203
    204
    205
    206
    207
    208
    209
    210
    211
    212
    213
    214
    215
    216
    217
    218
    219
    220
    221
    222
    223
    224
    225
    226
    227
    228
    229
    230
    231
    232
    233
    234
    235
    236
    237
    238
    239
    240
    241
    242
    243
    244
    245
    246
    247
    248

    901
    1373
    1664
    42
    930
    1559
    77
    1186
    978
    82
    787
    754
    202
    513
    343
    123
    803
    1684
    789
    1589
    508
    495
    75
    381
    851
    223
    361
    876
    1593
    1449
    149
    521
    1428
    1678
    84
    182
    1609
    1653
    928
    1095
    1540
    319
    52
    1040
    322
    427
    407
    1061
    160
    1563
    985
    102
    1009

    5,538.63
    5,500.00
    5,500.00
    5,473.00
    5,470.96
    5,466.00
    5,422.00
    5,400.00
    5,377.79
    5,329.64
    5,292.00
    5,283.55
    5,278.34
    5,265.40
    5,260.00
    5,242.30
    5,234.55
    5,229.01
    5,224.50
    5,200.00
    5,188.55
    5,170.00
    5,159.42
    5,149.40
    5,131.75
    5,129.50
    5,100.00
    5,080.00
    5,075.00
    5,074.50
    5,065.00
    5,050.50
    5,000.00
    5,000.00
    4,952.00
    4,925.00
    4,918.50
    4,891.00
    4,885.26
    4,885.00
    4,866.00
    4,864.00
    4,802.14
    4,793.95
    4,775.00
    4,760.00
    4,748.50
    4,737.00
    4,733.75
    4,700.00
    4,700.00
    4,686.44
    4,665.19

    3,681,591.94
    3,687,091.94
    3,692,591.94
    3,698,064.94
    3,703,535.90
    3,709,001.90
    3,714,423.90
    3,719,823.90
    3,725,201.69
    3,730,531.33
    3,735,823.33
    3,741,106.88
    3,746,385.22
    3,751,650.62
    3,756,910.62
    3,762,152.92
    3,767,387.47
    3,772,616.48
    3,777,840.98
    3,783,040.98
    3,788,229.53
    3,793,399.53
    3,798,558.95
    3,803,708.35
    3,808,840.10
    3,813,969.60
    3,819,069.60
    3,824,149.60
    3,829,224.60
    3,834,299.10
    3,839,364.10
    3,844,414.60
    3,849,414.60
    3,854,414.60
    3,859,366.60
    3,864,291.60
    3,869,210.10
    3,874,101.10
    3,878,986.36
    3,883,871.36
    3,888,737.36
    3,893,601.36
    3,898,403.50
    3,903,197.45
    3,907,972.45
    3,912,732.45
    3,917,480.95
    3,922,217.95
    3,926,951.70
    3,931,651.70
    3,936,351.70
    3,941,038.14
    3,945,703.33

    249
    250
    251
    252
    253
    254
    255
    256
    257
    258
    259
    260
    261
    262
    263
    264
    265
    266
    267
    268
    269
    270
    271
    272
    273
    274
    275
    276
    277
    278
    279
    280
    281
    282
    283
    284
    285
    286
    287
    288
    289
    290
    291
    292
    293
    294
    295
    296
    297
    298
    299
    300
    301

    835
    1643
    364
    728
    433
    1374
    614
    1550
    814
    1072
    1164
    1693
    1025
    654
    73
    1633
    419
    46
    767
    415
    79
    1588
    1492
    1175
    1240
    38
    774
    76
    86
    147
    23
    763
    235
    1014
    812
    687
    900
    1564
    962
    194
    225
    89
    875
    95
    1280
    1448
    1108
    1477
    1074
    205
    790
    1265
    1658

    4,658.45
    4,624.00
    4,620.50
    4,603.25
    4,600.00
    4,590.05
    4,580.00
    4,580.00
    4,559.50
    4,510.00
    4,500.00
    4,489.59
    4,476.25
    4,475.95
    4,471.12
    4,470.75
    4,450.00
    4,450.00
    4,439.36
    4,427.50
    4,426.10
    4,398.00
    4,394.14
    4,372.00
    4,344.35
    4,343.00
    4,334.50
    4,332.00
    4,306.17
    4,300.00
    4,247.00
    4,240.00
    4,219.25
    4,212.35
    4,179.00
    4,170.00
    4,158.15
    4,110.00
    4,109.10
    4,100.00
    4,100.00
    4,091.00
    4,088.50
    4,082.20
    4,080.00
    4,056.98
    4,038.00
    4,031.00
    4,024.75
    4,020.00
    4,019.50
    4,000.00
    3,990.00

    3,950,361.78
    3,954,985.78
    3,959,606.28
    3,964,209.53
    3,968,809.53
    3,973,399.58
    3,977,979.58
    3,982,559.58
    3,987,119.08
    3,991,629.08
    3,996,129.08
    4,000,618.67
    4,005,094.92
    4,009,570.87
    4,014,041.99
    4,018,512.74
    4,022,962.74
    4,027,412.74
    4,031,852.10
    4,036,279.60
    4,040,705.70
    4,045,103.70
    4,049,497.84
    4,053,869.84
    4,058,214.19
    4,062,557.19
    4,066,891.69
    4,071,223.69
    4,075,529.86
    4,079,829.86
    4,084,076.86
    4,088,316.86
    4,092,536.11
    4,096,748.46
    4,100,927.46
    4,105,097.46
    4,109,255.61
    4,113,365.61
    4,117,474.71
    4,121,574.71
    4,125,674.71
    4,129,765.71
    4,133,854.21
    4,137,936.41
    4,142,016.41
    4,146,073.39
    4,150,111.39
    4,154,142.39
    4,158,167.14
    4,162,187.14
    4,166,206.64
    4,170,206.64
    4,174,196.64

    302
    303
    304
    305
    306
    307
    308
    309
    310
    311
    312
    313
    314
    315
    316
    317
    318
    319
    320
    321
    322
    323
    324
    325
    326
    327
    328
    329
    330
    331
    332
    333
    334
    335
    336
    337
    338
    339
    340
    341
    342
    343
    344
    345
    346
    347
    348
    349
    350
    351
    352
    353
    354

    1331
    1312
    1400
    94
    1394
    783
    48
    1509
    816
    1695
    1290
    990
    121
    330
    459
    105
    1294
    1473
    1121
    618
    250
    1273
    740
    1634
    1010
    184
    1045
    592
    1133
    1032
    179
    1558
    796
    139
    942
    18
    820
    140
    840
    411
    10
    1660
    1235
    142
    1127
    879
    1725
    944
    838
    1257
    1512
    1292
    35

    3,989.90
    3,977.21
    3,970.00
    3,970.00
    3,966.05
    3,949.81
    3,910.53
    3,908.10
    3,908.00
    3,905.00
    3,900.00
    3,898.50
    3,898.25
    3,891.60
    3,885.00
    3,883.51
    3,871.62
    3,855.00
    3,852.80
    3,850.00
    3,848.25
    3,830.00
    3,825.00
    3,822.00
    3,819.85
    3,797.40
    3,790.00
    3,786.00
    3,778.25
    3,775.75
    3,742.00
    3,732.65
    3,725.95
    3,714.75
    3,702.00
    3,695.50
    3,695.40
    3,690.00
    3,680.00
    3,678.10
    3,674.91
    3,672.00
    3,671.61
    3,670.75
    3,670.50
    3,669.30
    3,664.75
    3,662.50
    3,661.50
    3,625.00
    3,622.49
    3,620.00
    3,616.40

    4,178,186.54
    4,182,163.75
    4,186,133.75
    4,190,103.75
    4,194,069.80
    4,198,019.61
    4,201,930.14
    4,205,838.24
    4,209,746.24
    4,213,651.24
    4,217,551.24
    4,221,449.74
    4,225,347.99
    4,229,239.59
    4,233,124.59
    4,237,008.10
    4,240,879.72
    4,244,734.72
    4,248,587.52
    4,252,437.52
    4,256,285.77
    4,260,115.77
    4,263,940.77
    4,267,762.77
    4,271,582.62
    4,275,380.02
    4,279,170.02
    4,282,956.02
    4,286,734.27
    4,290,510.02
    4,294,252.02
    4,297,984.67
    4,301,710.62
    4,305,425.37
    4,309,127.37
    4,312,822.87
    4,316,518.27
    4,320,208.27
    4,323,888.27
    4,327,566.37
    4,331,241.28
    4,334,913.28
    4,338,584.89
    4,342,255.64
    4,345,926.14
    4,349,595.44
    4,353,260.19
    4,356,922.69
    4,360,584.19
    4,364,209.19
    4,367,831.68
    4,371,451.68
    4,375,068.08

    355
    356
    357
    358
    359
    360
    361
    362
    363
    364
    365
    366
    367
    368
    369
    370
    371
    372
    373
    374
    375
    376
    377
    378
    379
    380
    381
    382
    383
    384
    385
    386
    387
    388
    389
    390
    391
    392
    393
    394
    395
    396
    397
    398
    399
    400
    401
    402
    403
    404
    405
    406
    407

    958
    1287
    721
    169
    397
    1452
    1328
    63
    922
    562
    1263
    998
    1362
    973
    1377
    1635
    402
    948
    43
    629
    847
    709
    554
    995
    1116
    1590
    245
    1030
    726
    1494
    757
    1291
    1575
    1122
    1357
    1209
    1360
    1699
    247
    544
    1510
    1457
    1380
    502
    1555
    612
    648
    21
    1523
    1539
    909
    1135
    689

    3,612.00
    3,601.50
    3,600.00
    3,600.00
    3,600.00
    3,592.00
    3,590.00
    3,585.00
    3,576.95
    3,570.00
    3,565.00
    3,550.00
    3,540.00
    3,526.00
    3,525.00
    3,521.00
    3,509.45
    3,502.78
    3,495.00
    3,493.00
    3,492.20
    3,489.40
    3,487.58
    3,479.75
    3,476.00
    3,470.00
    3,465.00
    3,457.93
    3,451.50
    3,450.74
    3,450.50
    3,450.00
    3,439.58
    3,435.00
    3,426.25
    3,420.00
    3,411.95
    3,410.40
    3,409.00
    3,381.00
    3,366.00
    3,355.00
    3,352.00
    3,351.70
    3,332.00
    3,326.00
    3,325.00
    3,322.70
    3,315.00
    3,314.25
    3,312.00
    3,297.50
    3,282.95

    4,378,680.08
    4,382,281.58
    4,385,881.58
    4,389,481.58
    4,393,081.58
    4,396,673.58
    4,400,263.58
    4,403,848.58
    4,407,425.53
    4,410,995.53
    4,414,560.53
    4,418,110.53
    4,421,650.53
    4,425,176.53
    4,428,701.53
    4,432,222.53
    4,435,731.98
    4,439,234.76
    4,442,729.76
    4,446,222.76
    4,449,714.96
    4,453,204.36
    4,456,691.94
    4,460,171.69
    4,463,647.69
    4,467,117.69
    4,470,582.69
    4,474,040.62
    4,477,492.12
    4,480,942.86
    4,484,393.36
    4,487,843.36
    4,491,282.94
    4,494,717.94
    4,498,144.19
    4,501,564.19
    4,504,976.14
    4,508,386.54
    4,511,795.54
    4,515,176.54
    4,518,542.54
    4,521,897.54
    4,525,249.54
    4,528,601.24
    4,531,933.24
    4,535,259.24
    4,538,584.24
    4,541,906.94
    4,545,221.94
    4,548,536.19
    4,551,848.19
    4,555,145.69
    4,558,428.64

    408
    409
    410
    411
    412
    413
    414
    415
    416
    417
    418
    419
    420
    421
    422
    423
    424
    425
    426
    427
    428
    429
    430
    431
    432
    433
    434
    435
    436
    437
    438
    439
    440
    441
    442
    443
    444
    445
    446
    447
    448
    449
    450
    451
    452
    453
    454
    455
    456
    457
    458
    459
    460

    429
    1319
    1399
    12
    555
    800
    1687
    1250
    1705
    1359
    1435
    137
    450
    1123
    1321
    1136
    852
    1375
    1215
    1330
    173
    832
    370
    1046
    701
    591
    410
    846
    903
    963
    1153
    1491
    1073
    1381
    685
    818
    1130
    1487
    1296
    375
    599
    1277
    473
    1034
    275
    1544
    1361
    1237
    1738
    955
    441
    87
    947

    3,281.13
    3,280.00
    3,275.20
    3,264.00
    3,262.00
    3,258.75
    3,252.55
    3,250.00
    3,245.00
    3,232.00
    3,231.00
    3,226.75
    3,223.38
    3,221.80
    3,215.00
    3,212.00
    3,211.50
    3,209.80
    3,206.00
    3,200.00
    3,194.62
    3,191.64
    3,181.50
    3,176.00
    3,150.00
    3,145.50
    3,141.06
    3,122.00
    3,118.00
    3,112.00
    3,107.28
    3,100.00
    3,092.60
    3,079.90
    3,060.00
    3,050.00
    3,048.50
    3,040.00
    3,030.00
    3,014.00
    3,012.70
    3,010.40
    3,010.00
    3,000.00
    3,000.00
    3,000.00
    3,000.00
    3,000.00
    3,000.00
    2,986.20
    2,981.30
    2,980.00
    2,973.96

    4,561,709.77
    4,564,989.77
    4,568,264.97
    4,571,528.97
    4,574,790.97
    4,578,049.72
    4,581,302.27
    4,584,552.27
    4,587,797.27
    4,591,029.27
    4,594,260.27
    4,597,487.02
    4,600,710.40
    4,603,932.20
    4,607,147.20
    4,610,359.20
    4,613,570.70
    4,616,780.50
    4,619,986.50
    4,623,186.50
    4,626,381.12
    4,629,572.76
    4,632,754.26
    4,635,930.26
    4,639,080.26
    4,642,225.76
    4,645,366.82
    4,648,488.82
    4,651,606.82
    4,654,718.82
    4,657,826.10
    4,660,926.10
    4,664,018.70
    4,667,098.60
    4,670,158.60
    4,673,208.60
    4,676,257.10
    4,679,297.10
    4,682,327.10
    4,685,341.10
    4,688,353.80
    4,691,364.20
    4,694,374.20
    4,697,374.20
    4,700,374.20
    4,703,374.20
    4,706,374.20
    4,709,374.20
    4,712,374.20
    4,715,360.40
    4,718,341.70
    4,721,321.70
    4,724,295.66

    461
    462
    463
    464
    465
    466
    467
    468
    469
    470
    471
    472
    473
    474
    475
    476
    477
    478
    479
    480
    481
    482
    483
    484
    485
    486
    487
    488
    489
    490
    491
    492
    493
    494
    495
    496
    497
    498
    499
    500
    501
    502
    503
    504
    505
    506
    507
    508
    509
    510
    511
    512
    513

    1683
    177
    1079
    455
    1470
    1557
    675
    1191
    1348
    484
    345
    1231
    604
    362
    1333
    68
    227
    1685
    968
    1499
    134
    1726
    49
    30
    436
    671
    1437
    303
    146
    116
    1098
    1332
    1587
    409
    1606
    786
    1412
    1724
    967
    727
    667
    1513
    1160
    306
    1242
    870
    1386
    1219
    20
    296
    1119
    431
    582

    2,971.00
    2,964.00
    2,960.38
    2,960.00
    2,957.60
    2,952.75
    2,945.00
    2,940.00
    2,930.00
    2,926.30
    2,920.00
    2,916.40
    2,905.35
    2,900.00
    2,895.00
    2,889.50
    2,881.75
    2,878.75
    2,875.50
    2,875.00
    2,874.92
    2,872.00
    2,869.09
    2,864.50
    2,860.65
    2,850.00
    2,850.00
    2,840.00
    2,834.00
    2,830.75
    2,830.00
    2,818.66
    2,812.00
    2,800.00
    2,800.00
    2,800.00
    2,792.00
    2,782.00
    2,780.00
    2,778.24
    2,773.95
    2,772.00
    2,766.65
    2,765.00
    2,761.07
    2,760.75
    2,760.00
    2,760.00
    2,751.06
    2,741.40
    2,738.64
    2,736.50
    2,729.45

    4,727,266.66
    4,730,230.66
    4,733,191.04
    4,736,151.04
    4,739,108.64
    4,742,061.39
    4,745,006.39
    4,747,946.39
    4,750,876.39
    4,753,802.69
    4,756,722.69
    4,759,639.09
    4,762,544.44
    4,765,444.44
    4,768,339.44
    4,771,228.94
    4,774,110.69
    4,776,989.44
    4,779,864.94
    4,782,739.94
    4,785,614.86
    4,788,486.86
    4,791,355.95
    4,794,220.45
    4,797,081.10
    4,799,931.10
    4,802,781.10
    4,805,621.10
    4,808,455.10
    4,811,285.85
    4,814,115.85
    4,816,934.51
    4,819,746.51
    4,822,546.51
    4,825,346.51
    4,828,146.51
    4,830,938.51
    4,833,720.51
    4,836,500.51
    4,839,278.75
    4,842,052.70
    4,844,824.70
    4,847,591.35
    4,850,356.35
    4,853,117.42
    4,855,878.17
    4,858,638.17
    4,861,398.17
    4,864,149.23
    4,866,890.63
    4,869,629.27
    4,872,365.77
    4,875,095.22

    514
    515
    516
    517
    518
    519
    520
    521
    522
    523
    524
    525
    526
    527
    528
    529
    530
    531
    532
    533
    534
    535
    536
    537
    538
    539
    540
    541
    542
    543
    544
    545
    546
    547
    548
    549
    550
    551
    552
    553
    554
    555
    556
    557
    558
    559
    560
    561
    562
    563
    564
    565
    566

    1192
    1567
    620
    731
    272
    717
    236
    1055
    631
    1393
    1729
    228
    159
    1578
    344
    617
    833
    11
    1178
    1690
    1471
    980
    884
    1410
    1212
    982
    226
    1665
    794
    782
    1125
    1039
    318
    1207
    857
    1395
    1686
    1189
    807
    220
    1024
    535
    55
    1234
    136
    858
    93
    399
    348
    1639
    1156
    456
    392

    2,725.00
    2,714.00
    2,710.00
    2,701.50
    2,700.00
    2,700.00
    2,700.00
    2,696.50
    2,696.00
    2,695.40
    2,690.00
    2,680.00
    2,679.25
    2,675.40
    2,671.50
    2,670.00
    2,670.00
    2,665.00
    2,655.00
    2,650.00
    2,644.00
    2,630.00
    2,626.54
    2,625.25
    2,606.40
    2,596.00
    2,594.00
    2,585.45
    2,582.50
    2,580.00
    2,580.00
    2,576.00
    2,570.00
    2,548.80
    2,546.00
    2,545.00
    2,544.30
    2,535.00
    2,521.20
    2,515.00
    2,515.00
    2,507.50
    2,503.00
    2,502.25
    2,500.00
    2,500.00
    2,500.00
    2,500.00
    2,500.00
    2,495.50
    2,492.45
    2,490.00
    2,490.00

    4,877,820.22
    4,880,534.22
    4,883,244.22
    4,885,945.72
    4,888,645.72
    4,891,345.72
    4,894,045.72
    4,896,742.22
    4,899,438.22
    4,902,133.62
    4,904,823.62
    4,907,503.62
    4,910,182.87
    4,912,858.27
    4,915,529.77
    4,918,199.77
    4,920,869.77
    4,923,534.77
    4,926,189.77
    4,928,839.77
    4,931,483.77
    4,934,113.77
    4,936,740.31
    4,939,365.56
    4,941,971.96
    4,944,567.96
    4,947,161.96
    4,949,747.41
    4,952,329.91
    4,954,909.91
    4,957,489.91
    4,960,065.91
    4,962,635.91
    4,965,184.71
    4,967,730.71
    4,970,275.71
    4,972,820.01
    4,975,355.01
    4,977,876.21
    4,980,391.21
    4,982,906.21
    4,985,413.71
    4,987,916.71
    4,990,418.96
    4,992,918.96
    4,995,418.96
    4,997,918.96
    5,000,418.96
    5,002,918.96
    5,005,414.46
    5,007,906.91
    5,010,396.91
    5,012,886.91

    567
    568
    569
    570
    571
    572
    573
    574
    575
    576
    577
    578
    579
    580
    581
    582
    583
    584
    585
    586
    587
    588
    589
    590
    591
    592
    593
    594
    595
    596
    597
    598
    599
    600
    601
    602
    603
    604
    605
    606
    607
    608
    609
    610
    611
    612
    613
    614
    615
    616
    617
    618
    619

    231
    737
    1206
    445
    215
    1205
    214
    458
    155
    66
    1669
    1111
    1501
    1573
    1278
    1668
    100
    739
    1115
    1036
    1267
    581
    1566
    269
    515
    246
    1712
    780
    1596
    167
    699
    1194
    1354
    1258
    311
    181
    255
    1358
    533
    389
    1430
    1239
    67
    1289
    1314
    711
    986
    1500
    931
    253
    1311
    1599
    540

    2,490.00
    2,486.40
    2,473.82
    2,464.10
    2,454.20
    2,452.80
    2,452.00
    2,450.00
    2,447.25
    2,443.15
    2,441.15
    2,440.00
    2,440.00
    2,434.20
    2,433.41
    2,430.00
    2,426.75
    2,421.86
    2,420.00
    2,413.00
    2,406.75
    2,403.00
    2,400.75
    2,400.00
    2,399.00
    2,390.75
    2,388.06
    2,375.00
    2,370.00
    2,360.00
    2,360.00
    2,355.00
    2,352.00
    2,346.69
    2,343.25
    2,339.00
    2,335.00
    2,331.00
    2,325.30
    2,320.98
    2,315.00
    2,315.00
    2,312.00
    2,312.00
    2,312.00
    2,308.50
    2,298.20
    2,295.70
    2,292.00
    2,291.47
    2,286.28
    2,279.00
    2,270.00

    5,015,376.91
    5,017,863.31
    5,020,337.13
    5,022,801.23
    5,025,255.43
    5,027,708.23
    5,030,160.23
    5,032,610.23
    5,035,057.48
    5,037,500.63
    5,039,941.78
    5,042,381.78
    5,044,821.78
    5,047,255.98
    5,049,689.39
    5,052,119.39
    5,054,546.14
    5,056,968.00
    5,059,388.00
    5,061,801.00
    5,064,207.75
    5,066,610.75
    5,069,011.50
    5,071,411.50
    5,073,810.50
    5,076,201.25
    5,078,589.31
    5,080,964.31
    5,083,334.31
    5,085,694.31
    5,088,054.31
    5,090,409.31
    5,092,761.31
    5,095,108.00
    5,097,451.25
    5,099,790.25
    5,102,125.25
    5,104,456.25
    5,106,781.55
    5,109,102.53
    5,111,417.53
    5,113,732.53
    5,116,044.53
    5,118,356.53
    5,120,668.53
    5,122,977.03
    5,125,275.23
    5,127,570.93
    5,129,862.93
    5,132,154.40
    5,134,440.68
    5,136,719.68
    5,138,989.68

    620
    621
    622
    623
    624
    625
    626
    627
    628
    629
    630
    631
    632
    633
    634
    635
    636
    637
    638
    639
    640
    641
    642
    643
    644
    645
    646
    647
    648
    649
    650
    651
    652
    653
    654
    655
    656
    657
    658
    659
    660
    661
    662
    663
    664
    665
    666
    667
    668
    669
    670
    671
    672

    83
    39
    1607
    949
    827
    390
    1054
    5
    1472
    408
    607
    412
    1488
    1180
    1440
    1198
    1677
    329
    1485
    1737
    285
    1481
    885
    1335
    482
    747
    469
    1474
    872
    1213
    718
    1241
    448
    638
    1282
    1506
    365
    887
    1654
    634
    583
    1511
    705
    791
    1023
    1698
    864
    1424
    99
    1346
    1608
    1580
    855

    2,270.00
    2,264.35
    2,260.00
    2,251.67
    2,250.00
    2,250.00
    2,250.00
    2,247.75
    2,240.00
    2,229.83
    2,225.00
    2,225.00
    2,214.00
    2,205.00
    2,205.00
    2,200.75
    2,200.00
    2,200.00
    2,195.00
    2,181.00
    2,180.00
    2,180.00
    2,172.00
    2,170.00
    2,165.00
    2,160.00
    2,160.00
    2,159.40
    2,158.00
    2,157.80
    2,157.25
    2,155.00
    2,155.00
    2,153.50
    2,152.20
    2,150.00
    2,145.00
    2,130.00
    2,124.28
    2,117.05
    2,117.00
    2,116.00
    2,100.00
    2,100.00
    2,100.00
    2,100.00
    2,100.00
    2,094.75
    2,091.73
    2,090.00
    2,090.00
    2,089.64
    2,085.00

    5,141,259.68
    5,143,524.03
    5,145,784.03
    5,148,035.70
    5,150,285.70
    5,152,535.70
    5,154,785.70
    5,157,033.45
    5,159,273.45
    5,161,503.28
    5,163,728.28
    5,165,953.28
    5,168,167.28
    5,170,372.28
    5,172,577.28
    5,174,778.03
    5,176,978.03
    5,179,178.03
    5,181,373.03
    5,183,554.03
    5,185,734.03
    5,187,914.03
    5,190,086.03
    5,192,256.03
    5,194,421.03
    5,196,581.03
    5,198,741.03
    5,200,900.43
    5,203,058.43
    5,205,216.23
    5,207,373.48
    5,209,528.48
    5,211,683.48
    5,213,836.98
    5,215,989.18
    5,218,139.18
    5,220,284.18
    5,222,414.18
    5,224,538.46
    5,226,655.51
    5,228,772.51
    5,230,888.51
    5,232,988.51
    5,235,088.51
    5,237,188.51
    5,239,288.51
    5,241,388.51
    5,243,483.26
    5,245,574.99
    5,247,664.99
    5,249,754.99
    5,251,844.63
    5,253,929.63

    673
    674
    675
    676
    677
    678
    679
    680
    681
    682
    683
    684
    685
    686
    687
    688
    689
    690
    691
    692
    693
    694
    695
    696
    697
    698
    699
    700
    701
    702
    703
    704
    705
    706
    707
    708
    709
    710
    711
    712
    713
    714
    715
    716
    717
    718
    719
    720
    721
    722
    723
    724
    725

    394
    1203
    1483
    976
    1326
    558
    1336
    844
    1005
    1442
    281
    1243
    1137
    1050
    527
    1508
    257
    1031
    158
    351
    781
    327
    1222
    1204
    1053
    1667
    1663
    382
    650
    222
    1155
    1708
    280
    472
    1525
    775
    371
    2
    1320
    744
    1503
    809
    1347
    254
    926
    6
    623
    1065
    360
    153
    1017
    573
    1217

    2,080.00
    2,080.00
    2,080.00
    2,076.00
    2,074.60
    2,070.00
    2,067.00
    2,066.47
    2,063.45
    2,060.00
    2,054.00
    2,046.00
    2,031.00
    2,022.00
    2,014.00
    2,010.00
    2,000.49
    2,000.40
    2,000.00
    2,000.00
    1,999.00
    1,995.00
    1,994.00
    1,990.00
    1,989.90
    1,982.20
    1,977.50
    1,975.00
    1,971.00
    1,960.00
    1,958.60
    1,958.00
    1,957.40
    1,954.00
    1,952.46
    1,950.14
    1,937.00
    1,935.50
    1,930.00
    1,925.00
    1,920.65
    1,918.10
    1,912.84
    1,912.00
    1,910.00
    1,905.00
    1,899.25
    1,897.20
    1,896.00
    1,894.50
    1,874.00
    1,873.35
    1,870.00

    5,256,009.63
    5,258,089.63
    5,260,169.63
    5,262,245.63
    5,264,320.23
    5,266,390.23
    5,268,457.23
    5,270,523.70
    5,272,587.15
    5,274,647.15
    5,276,701.15
    5,278,747.15
    5,280,778.15
    5,282,800.15
    5,284,814.15
    5,286,824.15
    5,288,824.64
    5,290,825.04
    5,292,825.04
    5,294,825.04
    5,296,824.04
    5,298,819.04
    5,300,813.04
    5,302,803.04
    5,304,792.94
    5,306,775.14
    5,308,752.64
    5,310,727.64
    5,312,698.64
    5,314,658.64
    5,316,617.24
    5,318,575.24
    5,320,532.64
    5,322,486.64
    5,324,439.10
    5,326,389.24
    5,328,326.24
    5,330,261.74
    5,332,191.74
    5,334,116.74
    5,336,037.39
    5,337,955.49
    5,339,868.33
    5,341,780.33
    5,343,690.33
    5,345,595.33
    5,347,494.58
    5,349,391.78
    5,351,287.78
    5,353,182.28
    5,355,056.28
    5,356,929.63
    5,358,799.63

    726
    727
    728
    729
    730
    731
    732
    733
    734
    735
    736
    737
    738
    739
    740
    741
    742
    743
    744
    745
    746
    747
    748
    749
    750
    751
    752
    753
    754
    755
    756
    757
    758
    759
    760
    761
    762
    763
    764
    765
    766
    767
    768
    769
    770
    771
    772
    773
    774
    775
    776
    777
    778

    1498
    378
    1720
    821
    704
    1398
    1727
    630
    1099
    1249
    598
    815
    1334
    1324
    632
    773
    1110
    1655
    666
    271
    395
    347
    16
    128
    1617
    185
    363
    112
    1392
    656
    104
    732
    401
    168
    438
    1080
    964
    467
    1369
    959
    69
    1584
    1390
    1341
    175
    1288
    1325
    1318
    1271
    735
    848
    635
    906

    1,860.00
    1,851.35
    1,850.00
    1,848.20
    1,835.00
    1,834.29
    1,830.00
    1,826.00
    1,821.50
    1,820.00
    1,815.15
    1,810.00
    1,810.00
    1,807.14
    1,806.35
    1,800.00
    1,800.00
    1,795.00
    1,792.53
    1,775.73
    1,770.00
    1,770.00
    1,766.89
    1,750.00
    1,750.00
    1,746.00
    1,740.00
    1,740.00
    1,740.00
    1,738.20
    1,735.00
    1,734.80
    1,720.86
    1,717.00
    1,716.62
    1,715.46
    1,705.00
    1,705.00
    1,703.56
    1,700.00
    1,700.00
    1,698.30
    1,696.00
    1,696.00
    1,695.00
    1,686.75
    1,680.00
    1,676.00
    1,675.00
    1,675.00
    1,660.00
    1,657.00
    1,657.00

    5,360,659.63
    5,362,510.98
    5,364,360.98
    5,366,209.18
    5,368,044.18
    5,369,878.47
    5,371,708.47
    5,373,534.47
    5,375,355.97
    5,377,175.97
    5,378,991.12
    5,380,801.12
    5,382,611.12
    5,384,418.26
    5,386,224.61
    5,388,024.61
    5,389,824.61
    5,391,619.61
    5,393,412.14
    5,395,187.87
    5,396,957.87
    5,398,727.87
    5,400,494.76
    5,402,244.76
    5,403,994.76
    5,405,740.76
    5,407,480.76
    5,409,220.76
    5,410,960.76
    5,412,698.96
    5,414,433.96
    5,416,168.76
    5,417,889.62
    5,419,606.62
    5,421,323.24
    5,423,038.70
    5,424,743.70
    5,426,448.70
    5,428,152.26
    5,429,852.26
    5,431,552.26
    5,433,250.56
    5,434,946.56
    5,436,642.56
    5,438,337.56
    5,440,024.31
    5,441,704.31
    5,443,380.31
    5,445,055.31
    5,446,730.31
    5,448,390.31
    5,450,047.31
    5,451,704.31

    779
    780
    781
    782
    783
    784
    785
    786
    787
    788
    789
    790
    791
    792
    793
    794
    795
    796
    797
    798
    799
    800
    801
    802
    803
    804
    805
    806
    807
    808
    809
    810
    811
    812
    813
    814
    815
    816
    817
    818
    819
    820
    821
    822
    823
    824
    825
    826
    827
    828
    829
    830
    831

    678
    1141
    1733
    509
    1129
    793
    460
    1000
    1702
    1441
    480
    886
    670
    1453
    1520
    391
    259
    804
    826
    897
    478
    190
    454
    1232
    188
    336
    189
    1585
    1382
    422
    766
    1675
    619
    1161
    626
    1551
    1530
    341
    61
    971
    1618
    1458
    561
    556
    1372
    388
    1251
    1620
    234
    1723
    209
    831
    170

    1,655.00
    1,650.00
    1,650.00
    1,645.00
    1,633.81
    1,627.30
    1,624.84
    1,620.00
    1,614.50
    1,611.40
    1,606.50
    1,606.00
    1,601.75
    1,600.00
    1,600.00
    1,600.00
    1,600.00
    1,598.75
    1,598.29
    1,598.00
    1,590.00
    1,588.40
    1,578.00
    1,577.80
    1,577.75
    1,575.00
    1,570.50
    1,561.99
    1,560.00
    1,559.30
    1,555.00
    1,550.00
    1,548.90
    1,545.00
    1,530.25
    1,530.00
    1,520.00
    1,520.00
    1,515.00
    1,515.00
    1,515.00
    1,510.90
    1,510.00
    1,510.00
    1,505.00
    1,503.00
    1,500.05
    1,500.00
    1,500.00
    1,500.00
    1,500.00
    1,500.00
    1,492.00

    5,453,359.31
    5,455,009.31
    5,456,659.31
    5,458,304.31
    5,459,938.12
    5,461,565.42
    5,463,190.26
    5,464,810.26
    5,466,424.76
    5,468,036.16
    5,469,642.66
    5,471,248.66
    5,472,850.41
    5,474,450.41
    5,476,050.41
    5,477,650.41
    5,479,250.41
    5,480,849.16
    5,482,447.45
    5,484,045.45
    5,485,635.45
    5,487,223.85
    5,488,801.85
    5,490,379.65
    5,491,957.40
    5,493,532.40
    5,495,102.90
    5,496,664.89
    5,498,224.89
    5,499,784.19
    5,501,339.19
    5,502,889.19
    5,504,438.09
    5,505,983.09
    5,507,513.34
    5,509,043.34
    5,510,563.34
    5,512,083.34
    5,513,598.34
    5,515,113.34
    5,516,628.34
    5,518,139.24
    5,519,649.24
    5,521,159.24
    5,522,664.24
    5,524,167.24
    5,525,667.29
    5,527,167.29
    5,528,667.29
    5,530,167.29
    5,531,667.29
    5,533,167.29
    5,534,659.29

    832
    833
    834
    835
    836
    837
    838
    839
    840
    841
    842
    843
    844
    845
    846
    847
    848
    849
    850
    851
    852
    853
    854
    855
    856
    857
    858
    859
    860
    861
    862
    863
    864
    865
    866
    867
    868
    869
    870
    871
    872
    873
    874
    875
    876
    877
    878
    879
    880
    881
    882
    883
    884

    1622
    251
    1486
    295
    476
    157
    1117
    707
    1598
    752
    485
    1531
    725
    171
    22
    64
    242
    532
    13
    195
    1676
    1694
    590
    983
    895
    516
    368
    1742
    1405
    1469
    487
    425
    15
    274
    124
    991
    889
    224
    891
    1247
    279
    1434
    1495
    1701
    505
    286
    165
    522
    241
    702
    1306
    1582
    1174

    1,485.00
    1,483.05
    1,481.90
    1,470.00
    1,463.50
    1,460.00
    1,457.20
    1,450.00
    1,450.00
    1,445.00
    1,434.07
    1,432.00
    1,430.00
    1,423.25
    1,418.80
    1,410.00
    1,410.00
    1,410.00
    1,401.86
    1,400.00
    1,400.00
    1,400.00
    1,400.00
    1,400.00
    1,400.00
    1,400.00
    1,400.00
    1,400.00
    1,400.00
    1,398.00
    1,390.00
    1,390.00
    1,388.50
    1,387.50
    1,387.43
    1,387.15
    1,387.10
    1,387.00
    1,386.77
    1,384.00
    1,380.00
    1,380.00
    1,375.00
    1,374.00
    1,370.00
    1,360.00
    1,360.00
    1,355.00
    1,350.00
    1,350.00
    1,350.00
    1,350.00
    1,344.50

    5,536,144.29
    5,537,627.34
    5,539,109.24
    5,540,579.24
    5,542,042.74
    5,543,502.74
    5,544,959.94
    5,546,409.94
    5,547,859.94
    5,549,304.94
    5,550,739.01
    5,552,171.01
    5,553,601.01
    5,555,024.26
    5,556,443.06
    5,557,853.06
    5,559,263.06
    5,560,673.06
    5,562,074.92
    5,563,474.92
    5,564,874.92
    5,566,274.92
    5,567,674.92
    5,569,074.92
    5,570,474.92
    5,571,874.92
    5,573,274.92
    5,574,674.92
    5,576,074.92
    5,577,472.92
    5,578,862.92
    5,580,252.92
    5,581,641.42
    5,583,028.92
    5,584,416.35
    5,585,803.50
    5,587,190.60
    5,588,577.60
    5,589,964.37
    5,591,348.37
    5,592,728.37
    5,594,108.37
    5,595,483.37
    5,596,857.37
    5,598,227.37
    5,599,587.37
    5,600,947.37
    5,602,302.37
    5,603,652.37
    5,605,002.37
    5,606,352.37
    5,607,702.37
    5,609,046.87

    885
    886
    887
    888
    889
    890
    891
    892
    893
    894
    895
    896
    897
    898
    899
    900
    901
    902
    903
    904
    905
    906
    907
    908
    909
    910
    911
    912
    913
    914
    915
    916
    917
    918
    919
    920
    921
    922
    923
    924
    925
    926
    927
    928
    929
    930
    931
    932
    933
    934
    935
    936
    937

    406
    587
    1451
    1496
    1049
    41
    920
    941
    869
    4
    912
    677
    1088
    1307
    1059
    1378
    1226
    703
    729
    193
    426
    693
    1718
    239
    1236
    564
    398
    178
    1190
    1349
    537
    802
    493
    1629
    1297
    785
    488
    325
    908
    1416
    1542
    1528
    1223
    470
    462
    1624
    690
    1102
    1739
    907
    694
    1389
    1632

    1,343.47
    1,338.50
    1,330.00
    1,330.00
    1,315.95
    1,315.00
    1,313.25
    1,306.43
    1,304.80
    1,301.94
    1,300.00
    1,300.00
    1,300.00
    1,294.25
    1,293.55
    1,293.00
    1,280.10
    1,280.00
    1,279.75
    1,272.60
    1,270.00
    1,261.47
    1,260.00
    1,250.00
    1,242.27
    1,241.00
    1,237.00
    1,228.63
    1,223.65
    1,220.00
    1,220.00
    1,220.00
    1,220.00
    1,216.00
    1,215.00
    1,212.00
    1,207.50
    1,200.40
    1,200.00
    1,200.00
    1,200.00
    1,200.00
    1,200.00
    1,200.00
    1,200.00
    1,195.00
    1,190.00
    1,187.00
    1,185.00
    1,181.69
    1,178.35
    1,175.00
    1,170.00

    5,610,390.34
    5,611,728.84
    5,613,058.84
    5,614,388.84
    5,615,704.79
    5,617,019.79
    5,618,333.04
    5,619,639.47
    5,620,944.27
    5,622,246.21
    5,623,546.21
    5,624,846.21
    5,626,146.21
    5,627,440.46
    5,628,734.01
    5,630,027.01
    5,631,307.11
    5,632,587.11
    5,633,866.86
    5,635,139.46
    5,636,409.46
    5,637,670.93
    5,638,930.93
    5,640,180.93
    5,641,423.20
    5,642,664.20
    5,643,901.20
    5,645,129.83
    5,646,353.48
    5,647,573.48
    5,648,793.48
    5,650,013.48
    5,651,233.48
    5,652,449.48
    5,653,664.48
    5,654,876.48
    5,656,083.98
    5,657,284.38
    5,658,484.38
    5,659,684.38
    5,660,884.38
    5,662,084.38
    5,663,284.38
    5,664,484.38
    5,665,684.38
    5,666,879.38
    5,668,069.38
    5,669,256.38
    5,670,441.38
    5,671,623.07
    5,672,801.42
    5,673,976.42
    5,675,146.42

    938
    939
    940
    941
    942
    943
    944
    945
    946
    947
    948
    949
    950
    951
    952
    953
    954
    955
    956
    957
    958
    959
    960
    961
    962
    963
    964
    965
    966
    967
    968
    969
    970
    971
    972
    973
    974
    975
    976
    977
    978
    979
    980
    981
    982
    983
    984
    985
    986
    987
    988
    989
    990

    1037
    713
    277
    1056
    894
    596
    129
    996
    1066
    1253
    1670
    1673
    969
    174
    924
    834
    29
    610
    475
    1406
    1680
    1535
    126
    1181
    494
    1417
    865
    428
    542
    778
    1721
    572
    1689
    1716
    1461
    1592
    1309
    1177
    1052
    1063
    65
    145
    880
    528
    197
    310
    751
    1681
    797
    639
    131
    1304
    524

    1,162.50
    1,160.00
    1,152.75
    1,152.00
    1,151.25
    1,150.00
    1,150.00
    1,148.75
    1,147.50
    1,145.00
    1,140.00
    1,140.00
    1,140.00
    1,139.00
    1,137.09
    1,132.00
    1,132.00
    1,131.00
    1,124.50
    1,124.00
    1,123.10
    1,122.50
    1,120.00
    1,120.00
    1,120.00
    1,115.16
    1,111.65
    1,111.00
    1,110.00
    1,110.00
    1,109.45
    1,109.40
    1,100.00
    1,100.00
    1,100.00
    1,100.00
    1,100.00
    1,100.00
    1,100.00
    1,100.00
    1,099.50
    1,098.58
    1,095.00
    1,088.70
    1,086.50
    1,086.50
    1,085.00
    1,083.39
    1,078.90
    1,076.00
    1,076.00
    1,075.76
    1,073.90

    5,676,308.92
    5,677,468.92
    5,678,621.67
    5,679,773.67
    5,680,924.92
    5,682,074.92
    5,683,224.92
    5,684,373.67
    5,685,521.17
    5,686,666.17
    5,687,806.17
    5,688,946.17
    5,690,086.17
    5,691,225.17
    5,692,362.26
    5,693,494.26
    5,694,626.26
    5,695,757.26
    5,696,881.76
    5,698,005.76
    5,699,128.86
    5,700,251.36
    5,701,371.36
    5,702,491.36
    5,703,611.36
    5,704,726.52
    5,705,838.17
    5,706,949.17
    5,708,059.17
    5,709,169.17
    5,710,278.62
    5,711,388.02
    5,712,488.02
    5,713,588.02
    5,714,688.02
    5,715,788.02
    5,716,888.02
    5,717,988.02
    5,719,088.02
    5,720,188.02
    5,721,287.52
    5,722,386.10
    5,723,481.10
    5,724,569.80
    5,725,656.30
    5,726,742.80
    5,727,827.80
    5,728,911.19
    5,729,990.09
    5,731,066.09
    5,732,142.09
    5,733,217.85
    5,734,291.75

    991
    992
    993
    994
    995
    996
    997
    998
    999
    1000
    1001
    1002
    1003
    1004
    1005
    1006
    1007
    1008
    1009
    1010
    1011
    1012
    1013
    1014
    1015
    1016
    1017
    1018
    1019
    1020
    1021
    1022
    1023
    1024
    1025
    1026
    1027
    1028
    1029
    1030
    1031
    1032
    1033
    1034
    1035
    1036
    1037
    1038
    1039
    1040
    1041
    1042
    1043

    611
    1679
    232
    291
    314
    1112
    1323
    1493
    1317
    1109
    769
    698
    1244
    1281
    806
    1007
    1124
    1252
    1096
    518
    1672
    514
    1268
    1480
    1154
    1706
    1103
    1159
    1735
    772
    510
    1411
    1371
    1736
    261
    357
    373
    385
    1659
    1456
    825
    1674
    304
    874
    593
    1657
    602
    1214
    1717
    449
    1299
    413
    1308

    1,070.75
    1,067.45
    1,065.00
    1,065.00
    1,065.00
    1,060.00
    1,058.69
    1,058.25
    1,055.00
    1,050.00
    1,050.00
    1,050.00
    1,046.25
    1,043.60
    1,041.59
    1,040.70
    1,034.70
    1,030.00
    1,030.00
    1,030.00
    1,025.00
    1,023.73
    1,014.39
    1,010.00
    1,010.00
    1,005.00
    1,000.00
    1,000.00
    1,000.00
    1,000.00
    1,000.00
    1,000.00
    1,000.00
    1,000.00
    987.15
    985.00
    984.55
    981.20
    980.00
    980.00
    970.00
    970.00
    970.00
    966.00
    964.75
    963.70
    960.00
    960.00
    960.00
    957.00
    950.00
    950.00
    950.00

    5,735,362.50
    5,736,429.95
    5,737,494.95
    5,738,559.95
    5,739,624.95
    5,740,684.95
    5,741,743.64
    5,742,801.89
    5,743,856.89
    5,744,906.89
    5,745,956.89
    5,747,006.89
    5,748,053.14
    5,749,096.74
    5,750,138.33
    5,751,179.03
    5,752,213.73
    5,753,243.73
    5,754,273.73
    5,755,303.73
    5,756,328.73
    5,757,352.46
    5,758,366.85
    5,759,376.85
    5,760,386.85
    5,761,391.85
    5,762,391.85
    5,763,391.85
    5,764,391.85
    5,765,391.85
    5,766,391.85
    5,767,391.85
    5,768,391.85
    5,769,391.85
    5,770,379.00
    5,771,364.00
    5,772,348.55
    5,773,329.75
    5,774,309.75
    5,775,289.75
    5,776,259.75
    5,777,229.75
    5,778,199.75
    5,779,165.75
    5,780,130.50
    5,781,094.20
    5,782,054.20
    5,783,014.20
    5,783,974.20
    5,784,931.20
    5,785,881.20
    5,786,831.20
    5,787,781.20

    1044
    1045
    1046
    1047
    1048
    1049
    1050
    1051
    1052
    1053
    1054
    1055
    1056
    1057
    1058
    1059
    1060
    1061
    1062
    1063
    1064
    1065
    1066
    1067
    1068
    1069
    1070
    1071
    1072
    1073
    1074
    1075
    1076
    1077
    1078
    1079
    1080
    1081
    1082
    1083
    1084
    1085
    1086
    1087
    1088
    1089
    1090
    1091
    1092
    1093
    1094
    1095
    1096

    917
    88
    842
    730
    72
    172
    960
    1415
    692
    1719
    1284
    192
    1462
    823
    33
    293
    625
    1579
    520
    299
    512
    1026
    970
    1202
    904
    708
    1517
    716
    1305
    594
    994
    127
    323
    680
    621
    1642
    326
    1188
    547
    1532
    106
    892
    1388
    873
    111
    552
    616
    273
    133
    1454
    830
    249
    110

    950.00
    949.00
    945.75
    945.40
    944.20
    940.00
    936.50
    936.40
    932.23
    925.00
    923.50
    923.44
    920.00
    920.00
    912.10
    910.00
    910.00
    909.35
    908.73
    904.00
    903.45
    900.00
    900.00
    900.00
    900.00
    900.00
    899.70
    894.55
    892.15
    890.10
    890.00
    889.00
    885.00
    880.00
    880.00
    880.00
    880.00
    880.00
    876.25
    875.00
    875.00
    873.45
    870.00
    870.00
    869.25
    866.35
    863.50
    863.00
    860.00
    860.00
    858.50
    857.16
    855.00

    5,788,731.20
    5,789,680.20
    5,790,625.95
    5,791,571.35
    5,792,515.55
    5,793,455.55
    5,794,392.05
    5,795,328.45
    5,796,260.68
    5,797,185.68
    5,798,109.18
    5,799,032.62
    5,799,952.62
    5,800,872.62
    5,801,784.72
    5,802,694.72
    5,803,604.72
    5,804,514.07
    5,805,422.80
    5,806,326.80
    5,807,230.25
    5,808,130.25
    5,809,030.25
    5,809,930.25
    5,810,830.25
    5,811,730.25
    5,812,629.95
    5,813,524.50
    5,814,416.65
    5,815,306.75
    5,816,196.75
    5,817,085.75
    5,817,970.75
    5,818,850.75
    5,819,730.75
    5,820,610.75
    5,821,490.75
    5,822,370.75
    5,823,247.00
    5,824,122.00
    5,824,997.00
    5,825,870.45
    5,826,740.45
    5,827,610.45
    5,828,479.70
    5,829,346.05
    5,830,209.55
    5,831,072.55
    5,831,932.55
    5,832,792.55
    5,833,651.05
    5,834,508.21
    5,835,363.21

    1097
    1098
    1099
    1100
    1101
    1102
    1103
    1104
    1105
    1106
    1107
    1108
    1109
    1110
    1111
    1112
    1113
    1114
    1115
    1116
    1117
    1118
    1119
    1120
    1121
    1122
    1123
    1124
    1125
    1126
    1127
    1128
    1129
    1130
    1131
    1132
    1133
    1134
    1135
    1136
    1137
    1138
    1139
    1140
    1141
    1142
    1143
    1144
    1145
    1146
    1147
    1148
    1149

    1616
    244
    1158
    1310
    1615
    1439
    1447
    117
    1650
    461
    1132
    278
    765
    1145
    396
    1139
    1709
    47
    1619
    1340
    584
    1150
    1035
    1479
    1106
    657
    839
    606
    1085
    636
    1060
    1460
    819
    1315
    624
    1227
    597
    653
    1524
    1697
    1423
    1426
    1266
    501
    1272
    934
    1731
    643
    118
    810
    824
    490
    78

    850.00
    850.00
    850.00
    850.00
    850.00
    850.00
    847.00
    847.00
    837.00
    836.65
    835.00
    833.35
    832.35
    830.50
    825.00
    823.45
    820.00
    820.00
    819.50
    819.00
    813.00
    811.92
    810.00
    810.00
    809.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    800.00
    796.80
    795.30
    795.00
    790.00
    790.00
    790.00
    790.00
    786.00
    780.00
    780.00
    780.00

    5,836,213.21
    5,837,063.21
    5,837,913.21
    5,838,763.21
    5,839,613.21
    5,840,463.21
    5,841,310.21
    5,842,157.21
    5,842,994.21
    5,843,830.86
    5,844,665.86
    5,845,499.21
    5,846,331.56
    5,847,162.06
    5,847,987.06
    5,848,810.51
    5,849,630.51
    5,850,450.51
    5,851,270.01
    5,852,089.01
    5,852,902.01
    5,853,713.93
    5,854,523.93
    5,855,333.93
    5,856,142.93
    5,856,942.93
    5,857,742.93
    5,858,542.93
    5,859,342.93
    5,860,142.93
    5,860,942.93
    5,861,742.93
    5,862,542.93
    5,863,342.93
    5,864,142.93
    5,864,942.93
    5,865,742.93
    5,866,542.93
    5,867,342.93
    5,868,142.93
    5,868,942.93
    5,869,742.93
    5,870,539.73
    5,871,335.03
    5,872,130.03
    5,872,920.03
    5,873,710.03
    5,874,500.03
    5,875,290.03
    5,876,076.03
    5,876,856.03
    5,877,636.03
    5,878,416.03

    1150
    1151
    1152
    1153
    1154
    1155
    1156
    1157
    1158
    1159
    1160
    1161
    1162
    1163
    1164
    1165
    1166
    1167
    1168
    1169
    1170
    1171
    1172
    1173
    1174
    1175
    1176
    1177
    1178
    1179
    1180
    1181
    1182
    1183
    1184
    1185
    1186
    1187
    1188
    1189
    1190
    1191
    1192
    1193
    1194
    1195
    1196
    1197
    1198
    1199
    1200
    1201
    1202

    1504
    981
    31
    115
    1652
    230
    1502
    198
    1146
    578
    1329
    706
    1313
    1097
    1455
    1069
    379
    854
    70
    308
    720
    868
    1295
    1027
    333
    466
    722
    845
    1519
    1445
    681
    777
    1636
    1577
    1363
    1029
    672
    1044
    237
    1269
    714
    1176
    1004
    569
    1541
    1200
    997
    1285
    570
    439
    1605
    457
    32

    779.95
    775.00
    775.00
    771.50
    770.05
    760.00
    760.00
    760.00
    760.00
    758.00
    756.10
    750.25
    750.00
    750.00
    750.00
    750.00
    750.00
    750.00
    750.00
    750.00
    746.60
    745.00
    744.50
    741.50
    740.00
    740.00
    740.00
    740.00
    740.00
    740.00
    736.00
    735.99
    734.60
    729.00
    728.30
    728.00
    727.80
    726.25
    715.00
    715.00
    715.00
    712.50
    712.30
    711.00
    710.00
    710.00
    709.10
    705.00
    703.40
    703.00
    701.90
    700.00
    700.00

    5,879,195.98
    5,879,970.98
    5,880,745.98
    5,881,517.48
    5,882,287.53
    5,883,047.53
    5,883,807.53
    5,884,567.53
    5,885,327.53
    5,886,085.53
    5,886,841.63
    5,887,591.88
    5,888,341.88
    5,889,091.88
    5,889,841.88
    5,890,591.88
    5,891,341.88
    5,892,091.88
    5,892,841.88
    5,893,591.88
    5,894,338.48
    5,895,083.48
    5,895,827.98
    5,896,569.48
    5,897,309.48
    5,898,049.48
    5,898,789.48
    5,899,529.48
    5,900,269.48
    5,901,009.48
    5,901,745.48
    5,902,481.47
    5,903,216.07
    5,903,945.07
    5,904,673.37
    5,905,401.37
    5,906,129.17
    5,906,855.42
    5,907,570.42
    5,908,285.42
    5,909,000.42
    5,909,712.92
    5,910,425.22
    5,911,136.22
    5,911,846.22
    5,912,556.22
    5,913,265.32
    5,913,970.32
    5,914,673.72
    5,915,376.72
    5,916,078.62
    5,916,778.62
    5,917,478.62

    1203
    1204
    1205
    1206
    1207
    1208
    1209
    1210
    1211
    1212
    1213
    1214
    1215
    1216
    1217
    1218
    1219
    1220
    1221
    1222
    1223
    1224
    1225
    1226
    1227
    1228
    1229
    1230
    1231
    1232
    1233
    1234
    1235
    1236
    1237
    1238
    1239
    1240
    1241
    1242
    1243
    1244
    1245
    1246
    1247
    1248
    1249
    1250
    1251
    1252
    1253
    1254
    1255

    1497
    605
    176
    414
    905
    346
    437
    1338
    114
    1515
    354
    1144
    321
    966
    519
    337
    219
    1300
    85
    1533
    1339
    213
    1401
    1233
    1185
    1255
    1443
    1078
    264
    1353
    686
    1647
    1711
    715
    734
    878
    974
    183
    545
    548
    628
    268
    221
    132
    813
    665
    1286
    753
    1259
    719
    294
    1008
    211

    700.00
    700.00
    700.00
    700.00
    700.00
    700.00
    700.00
    700.00
    700.00
    700.00
    698.00
    696.86
    689.60
    688.00
    686.50
    684.50
    683.39
    682.00
    680.00
    675.00
    670.00
    667.33
    660.00
    655.55
    652.50
    650.00
    650.00
    650.00
    650.00
    650.00
    650.00
    650.00
    648.50
    645.50
    640.00
    631.05
    628.50
    627.99
    625.00
    620.35
    620.20
    620.00
    617.20
    613.70
    612.00
    612.00
    610.00
    604.00
    601.95
    600.00
    600.00
    600.00
    600.00

    5,918,178.62
    5,918,878.62
    5,919,578.62
    5,920,278.62
    5,920,978.62
    5,921,678.62
    5,922,378.62
    5,923,078.62
    5,923,778.62
    5,924,478.62
    5,925,176.62
    5,925,873.48
    5,926,563.08
    5,927,251.08
    5,927,937.58
    5,928,622.08
    5,929,305.47
    5,929,987.47
    5,930,667.47
    5,931,342.47
    5,932,012.47
    5,932,679.80
    5,933,339.80
    5,933,995.35
    5,934,647.85
    5,935,297.85
    5,935,947.85
    5,936,597.85
    5,937,247.85
    5,937,897.85
    5,938,547.85
    5,939,197.85
    5,939,846.35
    5,940,491.85
    5,941,131.85
    5,941,762.90
    5,942,391.40
    5,943,019.39
    5,943,644.39
    5,944,264.74
    5,944,884.94
    5,945,504.94
    5,946,122.14
    5,946,735.84
    5,947,347.84
    5,947,959.84
    5,948,569.84
    5,949,173.84
    5,949,775.79
    5,950,375.79
    5,950,975.79
    5,951,575.79
    5,952,175.79

    1256
    1257
    1258
    1259
    1260
    1261
    1262
    1263
    1264
    1265
    1266
    1267
    1268
    1269
    1270
    1271
    1272
    1273
    1274
    1275
    1276
    1277
    1278
    1279
    1280
    1281
    1282
    1283
    1284
    1285
    1286
    1287
    1288
    1289
    1290
    1291
    1292
    1293
    1294
    1295
    1296
    1297
    1298
    1299
    1300
    1301
    1302
    1303
    1304
    1305
    1306
    1307
    1308

    860
    565
    1703
    210
    1621
    1490
    1042
    1220
    444
    1691
    301
    1104
    144
    1
    600
    566
    203
    150
    658
    1337
    258
    883
    424
    1020
    1195
    265
    1019
    447
    500
    1630
    338
    334
    1187
    1301
    939
    1732
    738
    1427
    1262
    684
    613
    1595
    125
    1118
    152
    615
    479
    492
    316
    1546
    805
    56
    1561

    600.00
    600.00
    600.00
    600.00
    600.00
    600.00
    600.00
    600.00
    600.00
    600.00
    600.00
    600.00
    600.00
    598.00
    592.85
    591.50
    590.50
    589.10
    581.75
    580.00
    580.00
    576.00
    575.00
    575.00
    575.00
    570.00
    565.00
    564.95
    560.70
    560.00
    560.00
    560.00
    552.85
    551.35
    550.45
    550.00
    550.00
    550.00
    550.00
    550.00
    550.00
    548.90
    547.50
    540.00
    540.00
    539.40
    539.00
    538.97
    534.25
    533.00
    530.90
    530.50
    530.00

    5,952,775.79
    5,953,375.79
    5,953,975.79
    5,954,575.79
    5,955,175.79
    5,955,775.79
    5,956,375.79
    5,956,975.79
    5,957,575.79
    5,958,175.79
    5,958,775.79
    5,959,375.79
    5,959,975.79
    5,960,573.79
    5,961,166.64
    5,961,758.14
    5,962,348.64
    5,962,937.74
    5,963,519.49
    5,964,099.49
    5,964,679.49
    5,965,255.49
    5,965,830.49
    5,966,405.49
    5,966,980.49
    5,967,550.49
    5,968,115.49
    5,968,680.44
    5,969,241.14
    5,969,801.14
    5,970,361.14
    5,970,921.14
    5,971,473.99
    5,972,025.34
    5,972,575.79
    5,973,125.79
    5,973,675.79
    5,974,225.79
    5,974,775.79
    5,975,325.79
    5,975,875.79
    5,976,424.69
    5,976,972.19
    5,977,512.19
    5,978,052.19
    5,978,591.59
    5,979,130.59
    5,979,669.56
    5,980,203.81
    5,980,736.81
    5,981,267.71
    5,981,798.21
    5,982,328.21

    1309
    1310
    1311
    1312
    1313
    1314
    1315
    1316
    1317
    1318
    1319
    1320
    1321
    1322
    1323
    1324
    1325
    1326
    1327
    1328
    1329
    1330
    1331
    1332
    1333
    1334
    1335
    1336
    1337
    1338
    1339
    1340
    1341
    1342
    1343
    1344
    1345
    1346
    1347
    1348
    1349
    1350
    1351
    1352
    1353
    1354
    1355
    1356
    1357
    1358
    1359
    1360
    1361

    710
    1645
    161
    660
    588
    553
    742
    1637
    1062
    298
    828
    288
    1041
    1279
    186
    339
    315
    1707
    932
    1165
    1421
    491
    1507
    1553
    1628
    1216
    1420
    1364
    696
    950
    1022
    853
    340
    1229
    1342
    276
    1552
    1516
    517
    138
    882
    1450
    200
    1385
    60
    1211
    307
    979
    1071
    1626
    256
    289
    1562

    530.00
    530.00
    529.91
    528.70
    525.15
    525.00
    520.00
    520.00
    517.20
    516.70
    511.00
    510.00
    510.00
    505.00
    503.00
    503.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    500.00
    490.00
    490.00
    488.15
    488.15
    488.00
    486.00
    485.00
    484.10
    482.80
    480.00
    480.00
    480.00
    475.00
    472.60
    470.00
    465.00
    464.00
    460.00
    460.00

    5,982,858.21
    5,983,388.21
    5,983,918.12
    5,984,446.82
    5,984,971.97
    5,985,496.97
    5,986,016.97
    5,986,536.97
    5,987,054.17
    5,987,570.87
    5,988,081.87
    5,988,591.87
    5,989,101.87
    5,989,606.87
    5,990,109.87
    5,990,612.87
    5,991,112.87
    5,991,612.87
    5,992,112.87
    5,992,612.87
    5,993,112.87
    5,993,612.87
    5,994,112.87
    5,994,612.87
    5,995,112.87
    5,995,612.87
    5,996,112.87
    5,996,612.87
    5,997,112.87
    5,997,612.87
    5,998,112.87
    5,998,612.87
    5,999,112.87
    5,999,612.87
    6,000,102.87
    6,000,592.87
    6,001,081.02
    6,001,569.17
    6,002,057.17
    6,002,543.17
    6,003,028.17
    6,003,512.27
    6,003,995.07
    6,004,475.07
    6,004,955.07
    6,005,435.07
    6,005,910.07
    6,006,382.67
    6,006,852.67
    6,007,317.67
    6,007,781.67
    6,008,241.67
    6,008,701.67

    1362
    1363
    1364
    1365
    1366
    1367
    1368
    1369
    1370
    1371
    1372
    1373
    1374
    1375
    1376
    1377
    1378
    1379
    1380
    1381
    1382
    1383
    1384
    1385
    1386
    1387
    1388
    1389
    1390
    1391
    1392
    1393
    1394
    1395
    1396
    1397
    1398
    1399
    1400
    1401
    1402
    1403
    1404
    1405
    1406
    1407
    1408
    1409
    1410
    1411
    1412
    1413
    1414

    243
    822
    332
    1554
    762
    811
    647
    674
    453
    1431
    733
    893
    443
    1574
    1003
    1173
    498
    1419
    1248
    1413
    1172
    1656
    659
    530
    1527
    661
    637
    292
    642
    350
    1715
    328
    1316
    1475
    750
    1444
    746
    691
    957
    1403
    282
    1414
    551
    229
    26
    1094
    1536
    1293
    207
    1741
    1256
    1274
    945

    460.00
    460.00
    460.00
    457.80
    457.35
    453.00
    450.40
    450.00
    450.00
    450.00
    450.00
    450.00
    450.00
    450.00
    449.95
    448.20
    447.45
    447.30
    445.95
    445.00
    441.80
    440.70
    440.00
    440.00
    440.00
    440.00
    433.95
    433.00
    430.00
    428.00
    426.33
    425.00
    425.00
    424.50
    421.00
    420.00
    420.00
    420.00
    420.00
    420.00
    420.00
    419.47
    413.65
    413.25
    410.40
    410.10
    410.00
    407.50
    406.31
    400.00
    400.00
    400.00
    400.00

    6,009,161.67
    6,009,621.67
    6,010,081.67
    6,010,539.47
    6,010,996.82
    6,011,449.82
    6,011,900.22
    6,012,350.22
    6,012,800.22
    6,013,250.22
    6,013,700.22
    6,014,150.22
    6,014,600.22
    6,015,050.22
    6,015,500.17
    6,015,948.37
    6,016,395.82
    6,016,843.12
    6,017,289.07
    6,017,734.07
    6,018,175.87
    6,018,616.57
    6,019,056.57
    6,019,496.57
    6,019,936.57
    6,020,376.57
    6,020,810.52
    6,021,243.52
    6,021,673.52
    6,022,101.52
    6,022,527.85
    6,022,952.85
    6,023,377.85
    6,023,802.35
    6,024,223.35
    6,024,643.35
    6,025,063.35
    6,025,483.35
    6,025,903.35
    6,026,323.35
    6,026,743.35
    6,027,162.82
    6,027,576.47
    6,027,989.72
    6,028,400.12
    6,028,810.22
    6,029,220.22
    6,029,627.72
    6,030,034.03
    6,030,434.03
    6,030,834.03
    6,031,234.03
    6,031,634.03

    1415
    1416
    1417
    1418
    1419
    1420
    1421
    1422
    1423
    1424
    1425
    1426
    1427
    1428
    1429
    1430
    1431
    1432
    1433
    1434
    1435
    1436
    1437
    1438
    1439
    1440
    1441
    1442
    1443
    1444
    1445
    1446
    1447
    1448
    1449
    1450
    1451
    1452
    1453
    1454
    1455
    1456
    1457
    1458
    1459
    1460
    1461
    1462
    1463
    1464
    1465
    1466
    1467

    481
    297
    808
    290
    302
    1028
    109
    8
    358
    305
    1692
    662
    881
    1649
    749
    1651
    309
    477
    313
    464
    1696
    1383
    1169
    888
    655
    19
    1261
    483
    538
    1549
    877
    1662
    574
    374
    71
    836
    283
    435
    1661
    1484
    248
    1422
    377
    534
    1548
    1147
    866
    867
    489
    776
    1254
    240
    679

    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    400.00
    391.00
    390.00
    390.00
    390.00
    385.00
    380.00
    380.00
    380.00
    380.00
    380.00
    379.45
    378.99
    375.90
    375.65
    375.00
    372.00
    370.50
    370.00
    370.00
    369.00
    368.00
    366.70
    365.65
    364.50
    364.05
    361.00
    360.00
    360.00
    360.00
    360.00
    360.00
    360.00
    360.00

    6,032,034.03
    6,032,434.03
    6,032,834.03
    6,033,234.03
    6,033,634.03
    6,034,034.03
    6,034,434.03
    6,034,834.03
    6,035,234.03
    6,035,634.03
    6,036,034.03
    6,036,434.03
    6,036,834.03
    6,037,234.03
    6,037,634.03
    6,038,034.03
    6,038,434.03
    6,038,834.03
    6,039,234.03
    6,039,634.03
    6,040,025.03
    6,040,415.03
    6,040,805.03
    6,041,195.03
    6,041,580.03
    6,041,960.03
    6,042,340.03
    6,042,720.03
    6,043,100.03
    6,043,480.03
    6,043,859.48
    6,044,238.47
    6,044,614.37
    6,044,990.02
    6,045,365.02
    6,045,737.02
    6,046,107.52
    6,046,477.52
    6,046,847.52
    6,047,216.52
    6,047,584.52
    6,047,951.22
    6,048,316.87
    6,048,681.37
    6,049,045.42
    6,049,406.42
    6,049,766.42
    6,050,126.42
    6,050,486.42
    6,050,846.42
    6,051,206.42
    6,051,566.42
    6,051,926.42

    1468
    1469
    1470
    1471
    1472
    1473
    1474
    1475
    1476
    1477
    1478
    1479
    1480
    1481
    1482
    1483
    1484
    1485
    1486
    1487
    1488
    1489
    1490
    1491
    1492
    1493
    1494
    1495
    1496
    1497
    1498
    1499
    1500
    1501
    1502
    1503
    1504
    1505
    1506
    1507
    1508
    1509
    1510
    1511
    1512
    1513
    1514
    1515
    1516
    1517
    1518
    1519
    1520

    801
    890
    1131
    1482
    387
    420
    1418
    1446
    977
    312
    1610
    856
    356
    267
    163
    164
    1171
    526
    119
    1612
    652
    120
    1476
    1600
    25
    608
    1021
    649
    1075
    335
    1002
    568
    896
    191
    1264
    550
    53
    984
    1682
    1114
    432
    1648
    1433
    463
    107
    1260
    676
    471
    697
    736
    287
    1064
    1576

    360.00
    358.05
    350.00
    350.00
    350.00
    350.00
    350.00
    350.00
    350.00
    350.00
    350.00
    350.00
    350.00
    342.50
    340.00
    340.00
    335.60
    335.00
    334.26
    334.00
    331.20
    330.00
    330.00
    328.50
    327.70
    327.35
    325.00
    313.50
    313.00
    310.00
    304.89
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00

    6,052,286.42
    6,052,644.47
    6,052,994.47
    6,053,344.47
    6,053,694.47
    6,054,044.47
    6,054,394.47
    6,054,744.47
    6,055,094.47
    6,055,444.47
    6,055,794.47
    6,056,144.47
    6,056,494.47
    6,056,836.97
    6,057,176.97
    6,057,516.97
    6,057,852.57
    6,058,187.57
    6,058,521.83
    6,058,855.83
    6,059,187.03
    6,059,517.03
    6,059,847.03
    6,060,175.53
    6,060,503.23
    6,060,830.58
    6,061,155.58
    6,061,469.08
    6,061,782.08
    6,062,092.08
    6,062,396.97
    6,062,696.97
    6,062,996.97
    6,063,296.97
    6,063,596.97
    6,063,896.97
    6,064,196.97
    6,064,496.97
    6,064,796.97
    6,065,096.97
    6,065,396.97
    6,065,696.97
    6,065,996.97
    6,066,296.97
    6,066,596.97
    6,066,896.97
    6,067,196.97
    6,067,496.97
    6,067,796.97
    6,068,096.97
    6,068,396.97
    6,068,696.97
    6,068,996.97

    1521
    1522
    1523
    1524
    1525
    1526
    1527
    1528
    1529
    1530
    1531
    1532
    1533
    1534
    1535
    1536
    1537
    1538
    1539
    1540
    1541
    1542
    1543
    1544
    1545
    1546
    1547
    1548
    1549
    1550
    1551
    1552
    1553
    1554
    1555
    1556
    1557
    1558
    1559
    1560
    1561
    1562
    1563
    1564
    1565
    1566
    1567
    1568
    1569
    1570
    1571
    1572
    1573

    217
    1086
    560
    1514
    829
    664
    506
    465
    1298
    1571
    1700
    1047
    1113
    1543
    1210
    353
    1246
    1521
    212
    571
    817
    1641
    238
    1478
    45
    130
    98
    284
    1345
    417
    586
    1355
    1076
    366
    201
    1327
    442
    1001
    1734
    113
    663
    784
    651
    1556
    496
    575
    1537
    993
    1387
    1402
    58
    103
    7

    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    300.00
    295.45
    294.18
    288.00
    285.00
    283.70
    280.00
    280.00
    277.50
    276.90
    275.75
    274.00
    270.95
    270.00
    270.00
    264.40
    264.20
    263.60
    260.00
    260.00
    260.00
    260.00
    260.00
    259.00
    257.30
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    250.00
    248.80
    248.00

    6,069,296.97
    6,069,596.97
    6,069,896.97
    6,070,196.97
    6,070,496.97
    6,070,796.97
    6,071,096.97
    6,071,396.97
    6,071,696.97
    6,071,996.97
    6,072,296.97
    6,072,596.97
    6,072,892.42
    6,073,186.60
    6,073,474.60
    6,073,759.60
    6,074,043.30
    6,074,323.30
    6,074,603.30
    6,074,880.80
    6,075,157.70
    6,075,433.45
    6,075,707.45
    6,075,978.40
    6,076,248.40
    6,076,518.40
    6,076,782.80
    6,077,047.00
    6,077,310.60
    6,077,570.60
    6,077,830.60
    6,078,090.60
    6,078,350.60
    6,078,610.60
    6,078,869.60
    6,079,126.90
    6,079,376.90
    6,079,626.90
    6,079,876.90
    6,080,126.90
    6,080,376.90
    6,080,626.90
    6,080,876.90
    6,081,126.90
    6,081,376.90
    6,081,626.90
    6,081,876.90
    6,082,126.90
    6,082,376.90
    6,082,626.90
    6,082,876.90
    6,083,125.70
    6,083,373.70

    1574
    1575
    1576
    1577
    1578
    1579
    1580
    1581
    1582
    1583
    1584
    1585
    1586
    1587
    1588
    1589
    1590
    1591
    1592
    1593
    1594
    1595
    1596
    1597
    1598
    1599
    1600
    1601
    1602
    1603
    1604
    1605
    1606
    1607
    1608
    1609
    1610
    1611
    1612
    1613
    1614
    1615
    1616
    1617
    1618
    1619
    1620
    1621
    1622
    1623
    1624
    1625
    1626

    1627
    74
    712
    166
    1126
    1157
    1714
    850
    1408
    557
    1051
    1740
    1152
    252
    1565
    640
    871
    1170
    262
    1581
    863
    1370
    1640
    1367
    1522
    541
    383
    1149
    1404
    1107
    1407
    233
    1489
    546
    645
    266
    1043
    987
    1538
    1128
    1105
    1193
    504
    154
    1409
    1526
    1646
    270
    199
    601
    1625
    1230
    799

    242.99
    241.95
    240.10
    240.00
    240.00
    240.00
    240.00
    240.00
    236.65
    236.50
    225.00
    220.00
    220.00
    220.00
    220.00
    220.00
    220.00
    218.00
    210.00
    210.00
    209.00
    205.00
    203.50
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    200.00
    198.00
    191.41
    191.10
    189.00
    185.15
    185.00
    182.80
    181.60
    180.00
    180.00

    6,083,616.69
    6,083,858.64
    6,084,098.74
    6,084,338.74
    6,084,578.74
    6,084,818.74
    6,085,058.74
    6,085,298.74
    6,085,535.39
    6,085,771.89
    6,085,996.89
    6,086,216.89
    6,086,436.89
    6,086,656.89
    6,086,876.89
    6,087,096.89
    6,087,316.89
    6,087,534.89
    6,087,744.89
    6,087,954.89
    6,088,163.89
    6,088,368.89
    6,088,572.39
    6,088,772.39
    6,088,972.39
    6,089,172.39
    6,089,372.39
    6,089,572.39
    6,089,772.39
    6,089,972.39
    6,090,172.39
    6,090,372.39
    6,090,572.39
    6,090,772.39
    6,090,972.39
    6,091,172.39
    6,091,372.39
    6,091,572.39
    6,091,772.39
    6,091,972.39
    6,092,172.39
    6,092,372.39
    6,092,572.39
    6,092,770.39
    6,092,961.80
    6,093,152.90
    6,093,341.90
    6,093,527.05
    6,093,712.05
    6,093,894.85
    6,094,076.45
    6,094,256.45
    6,094,436.45

    1627
    1628
    1629
    1630
    1631
    1632
    1633
    1634
    1635
    1636
    1637
    1638
    1639
    1640
    1641
    1642
    1643
    1644
    1645
    1646
    1647
    1648
    1649
    1650
    1651
    1652
    1653
    1654
    1655
    1656
    1657
    1658
    1659
    1660
    1661
    1662
    1663
    1664
    1665
    1666
    1667
    1668
    1669
    1670
    1671
    1672
    1673
    1674
    1675
    1676
    1677
    1678
    1679

    372
    609
    1182
    1602
    1352
    646
    380
    595
    204
    1208
    1081
    862
    1614
    861
    1436
    384
    1560
    91
    1597
    96
    760
    376
    57
    1201
    669
    367
    1199
    1397
    567
    37
    300
    320
    196
    156
    1666
    355
    1613
    440
    1601
    798
    1351
    603
    683
    859
    1368
    331
    17
    627
    523
    999
    1572
    92
    673

    180.00
    180.00
    180.00
    180.00
    180.00
    176.25
    175.00
    173.00
    169.50
    168.00
    166.00
    157.60
    155.00
    151.50
    150.40
    150.00
    150.00
    150.00
    150.00
    150.00
    149.20
    144.40
    143.50
    141.71
    140.00
    140.00
    134.50
    130.00
    125.00
    120.00
    120.00
    120.00
    120.00
    110.00
    110.00
    109.99
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    100.00
    98.00

    6,094,616.45
    6,094,796.45
    6,094,976.45
    6,095,156.45
    6,095,336.45
    6,095,512.70
    6,095,687.70
    6,095,860.70
    6,096,030.20
    6,096,198.20
    6,096,364.20
    6,096,521.80
    6,096,676.80
    6,096,828.30
    6,096,978.70
    6,097,128.70
    6,097,278.70
    6,097,428.70
    6,097,578.70
    6,097,728.70
    6,097,877.90
    6,098,022.30
    6,098,165.80
    6,098,307.51
    6,098,447.51
    6,098,587.51
    6,098,722.01
    6,098,852.01
    6,098,977.01
    6,099,097.01
    6,099,217.01
    6,099,337.01
    6,099,457.01
    6,099,567.01
    6,099,677.01
    6,099,787.00
    6,099,887.00
    6,099,987.00
    6,100,087.00
    6,100,187.00
    6,100,287.00
    6,100,387.00
    6,100,487.00
    6,100,587.00
    6,100,687.00
    6,100,787.00
    6,100,887.00
    6,100,987.00
    6,101,087.00
    6,101,187.00
    6,101,287.00
    6,101,387.00
    6,101,485.00

    1680
    1681
    1682
    1683
    1684
    1685
    1686
    1687
    1688
    1689
    1690
    1691
    1692
    1693
    1694
    1695
    1696
    1697
    1698
    1699
    1700
    1701
    1702
    1703
    1704
    1705
    1706
    1707
    1708
    1709
    1710
    1711
    1712
    1713
    1714
    1715
    1716
    1717
    1718
    1719
    1720
    1721
    1722
    1723
    1724
    1725
    1726
    1727
    1728
    1729
    1730
    1731
    1732

    434
    1722
    97
    342
    589
    497
    688
    1092
    952
    Grand Total

    90.00
    90.00
    85.00
    80.00
    61.95
    60.00
    60.00
    45.50
    6,102,057.45

    6,101,575.00
    6,101,665.00
    6,101,750.00
    6,101,830.00
    6,101,891.95
    6,101,951.95
    6,102,011.95
    6,102,057.45
    6,102,057.45

    1733
    1734
    1735
    1736
    1737
    1738
    1739
    1740
    1741

    nding order

    High spenders

    SEE ANSWERS BELOW!!


    ANSWER 1

    ANSWER 1: List patients by subtotals in claim in a high to

    See Table

    Data verification:
    Consider data for ID = "81". The totals are the same when taken from the raw data and compared with the one
    It is therefore correct!!
    Beneficiary ID

    ANSWER 2
    WORKINGS

    CLAIM #
    81 03889
    81 03889
    81 03889
    81 03889
    81 03889
    81 03889.1
    81 03889.1
    81 03889.1
    81 03889.2
    81 03889.2
    81 03889.2
    81 03889.2
    81 03889.2
    81 04891
    81 04891
    81 05740
    81 05740
    81 06518
    81 06518
    81 06518
    81 07263
    81 07263
    81 07264

    Seq

    CAUSE DESCRIPTION
    SERVICE DESCRIPTION
    1 BONE & CARTILAGE
    HOSPITALDISORDER
    LOCAL ROOM
    2 BONE & CARTILAGE
    HOSPITALDISORDER
    LOCAL ROOM
    3 BONE & CARTILAGE
    HOSPITALDISORDER
    MISC-LOCAL
    4 BONE & CARTILAGE
    SURGICAL
    DISORDER
    ANAESTHESIA
    5 BONE & CARTILAGE
    SURGICAL
    DISORDER
    INPATIENT
    1 BONE & CARTILAGE
    OTHER DISORDER
    2 BONE & CARTILAGE
    OTHER DISORDER
    3 BONE & CARTILAGE
    MISC OUTDISORDER
    HOSP-ORAL D
    1 BONE & CARTILAGE
    PHYSICIAN
    DISORDER
    VISIT-OFFICE
    2 BONE & CARTILAGE
    PHYSICIAN
    DISORDER
    VISIT-OFFICE
    3 BONE & CARTILAGE
    DIAGNOSTIC
    DISORDER
    LABORATO
    4 BONE & CARTILAGE
    DIAGNOSTIC
    DISORDER
    X-RAY
    5 BONE & CARTILAGE
    OTHER DISORDER
    1 BACK PAIN PHYSICIAN VISIT-OFFICE
    2 BACK PAIN MISC OUT HOSP-ORAL D
    1 BACK PAIN PHYSICIAN VISIT-OFFICE
    2 BACK PAIN MISC OUT HOSP-ORAL D
    1
    SPECIALIST CNSLT-OFFIC
    2
    DIAGNOSTIC X-RAY
    3
    OTHER
    1 RENAL DYSFUNCTION
    PHYSICIAN VISIT-OFFICE
    2 RENAL DYSFUNCTION
    MISC OUT HOSP-ORAL D
    1 RADICULOPATHY
    SPECIALIST
    INFLAME
    CNSLT-OFFIC
    NERVE R

    ANSWER 2: Define how many patients spend 50% of the to

    Grand Total=

    6,102,057.45

    50% Grand Total =

    3,051,028.73

    The cummulative total for 151 patients is =


    Therefore 151 patients spend 50% of the
    claims.

    ANSWER 3
    WORKINGS

    3,050,307.82

    ANSWER 3: Define how much money was spent by the 10%

    WHAT IS THE CORRECT ANSWER????


    The answer depends on the definition of the "High Spenders".
    If high spenders mean of the top 50% of claims then the 10% will be the 15 top of the 151 patients identified in
    Then the answers is = 1,127,038.99

    If the high spenders are defined as of all the 1,741 patients, then 10% is the top 174 patients.
    Then the answers is =
    3,217,294.80

    in claim in a high to low spending order

    compared with the one in the table

    PROCEDURE
    PROV1
    DESCRIPTION
    Amount
    HOSPITAL LOCAL ROOM
    H048
    $900.00
    HOSPITAL LOCAL ROOM
    H048
    $1,350.00
    HOSPITAL MISC-LOCALH048
    $14,480.00
    SURGICAL ANAESTHESIA
    M755
    $5,500.00
    JOINT: INCISION
    S217FOR DIAG$22,450.00
    OR TREATMNT-INTRA-ARTICULAR STRUCTURES
    H048
    $12,068.00
    H048
    $4,884.00
    MISC OUT HOSP-ORAL DRUGS
    H005
    $1,143.60
    HYSICIAN VISIT-OFFICE
    M607
    $75.00
    HYSICIAN VISIT-OFFICE
    M607
    $180.00
    DIAGNOSTIC LABORATORY
    H048
    $398.00
    DIAGNOSTIC X-RAY
    H048
    $438.00
    MM06
    $465.50
    HYSICIAN VISIT-OFFICE
    S217
    $340.00
    MISC OUT HOSP-ORAL DRUGS
    P231
    $591.90
    HYSICIAN VISIT-OFFICE
    S217
    $340.00
    MISC OUT HOSP-ORAL DRUGS
    P020
    $189.00
    SPECIALIST CNSLT-OFFICE
    S217
    $340.00
    DIAGNOSTIC X-RAY
    S217
    $413.00
    MM07
    $530.00
    HYSICIAN VISIT-OFFICE
    M483
    $120.00
    MISC OUT HOSP-ORAL DRUGS
    P020
    $120.00
    SPECIALIST CNSLT-OFFICE
    S217
    $340.00
    Total
    $67,656.00

    s spend 50% of the total claims

    was spent by the 10% of the High spenders

    1 patients identified in answer #2 above

    ANSWER 4: Define how much was spent in Pharmacy and in Hospital

    Sum of Amount
    SERVICE DESCRIPTION
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    EMERGENCY ACCIDENT
    HOSPITAL INTENSIVE CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-MISCARRIAGE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    OTHER
    PHYSICIAN VISIT-HOME
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PREVENTATIVE
    PRIVATE DUTY NURSING CARE
    SPECIALIST CNSLT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    SURGICAL OUTPATIENT
    VISION CARE
    Grand Total

    ANSWER 4
    Total
    860,782.09
    358,851.23
    394,048.03
    975.00
    4,800.00
    75,617.00
    615,808.21
    74,528.64
    6,935.00
    93,330.21
    62,236.75
    87,664.66
    823,871.92
    99,029.34
    112,005.30
    800.00
    60,105.04
    487,825.90
    85,010.00
    28,137.00
    300.00
    26,300.00
    148,226.00
    98,732.78
    314,632.12
    332,027.00
    849,478.23
    6,102,057.45

    Which ones are the hospi

    H
    H
    H
    H
    H
    H
    H
    H
    H
    P
    H

    All costs except the one h


    Is this correct?

    If it is then, the cost is as

    ANSWER 4

    ANSWER 4: Define how much was spent in Pharmacy and in Hospital

    Which ones are the hospital costs and which are the pharmacy costs?

    All costs except the one highlighted with a "P" seems to suggest are hospital costs.
    s this correct?

    f it is then, the cost is as follows


    PHARMACY =
    HOSPITAL =
    GRAND TOTAL =

    823,871.92
    5,278,185.53
    6,102,057.45

    d in Hospital

    ANSWER 5: Define which are the 3 "Cause" that spend more money

    List of "CAUSE" by subtotals sorted high to


    low
    Sum of Amount
    CAUSE DESCRIPTION
    DENTAL CARE
    VISION CARE
    (blank)
    HEART
    MISCARRIAGE
    HYPERTENSION
    DIAB'ETES
    BACK PAIN
    HYPERLIPIDERMIA - CHOLESTEROL
    ABDOMINAL PAINS
    CANCER-BREAST
    AMMENORRHOEA
    EYE DISORDER
    DEVIATED NASAL SEPTUM
    BONE & CARTILAGE DISORDER
    RENAL DYSFUNCTION
    OBESITY
    CHEST PAIN
    PAIN-BACK/SHOULDER
    CERVICAL SPONDYLOSIS
    PROSTATE
    DILATION & CURRETAGE
    ABSCESS
    CONSTIPATION
    FEVER
    OVARIAN CYST
    CATARACT
    VARICOSE
    INTESTINAL COLIC
    GASTRIC - PEPTIC ULCER/GERD
    DENGUE
    ARTHRITIS
    BARTHOLIN'S CYST
    GLAUCOMA
    ALLERGIC REACTION
    KNEE INTERNAL DERANGEMENT
    DEPRESSION
    ANXIETY
    HEADACHE- MIGRAINE TENSION
    SINUSITIS
    THYROID
    HEART- ISCHEMIC HEART DISEASE

    Total
    863,219.65
    846,777.27
    575,393.57
    566,248.33
    263,793.10
    198,597.42
    137,569.04
    133,013.59
    115,822.34
    113,998.45
    101,401.48
    98,080.40
    97,700.92
    92,946.54
    85,977.10
    79,533.16
    75,400.00
    70,105.78
    69,273.82
    67,387.37
    65,592.18
    61,475.62
    59,543.32
    57,167.72
    55,867.84
    54,230.37
    52,185.00
    49,103.83
    47,714.16
    45,306.59
    44,927.50
    44,560.95
    36,100.66
    34,101.16
    33,831.63
    28,338.00
    26,512.20
    25,031.75
    24,982.68
    23,791.52
    22,070.35
    19,333.59

    ASTHMA
    BURSITIS
    SKIN - ATOPIC DERMATITIS
    MUSCULAR PAIN
    STONE - URETER
    OTITIS - EAR
    CIRCULATORY DISORDER
    PAINFUL LEGS
    CHOSTOCHRONDITIS
    ALLERGIC RHINITIS
    SKIN - ECZEMA
    ANAEMIA
    INGROWING TOE NAIL
    CYST
    BRONCHITIS - ACUTE
    EPILEPSY
    TONSILLITIS
    HORMONE REPLACMENT THERAPY
    APPENDICITIS
    BREAST DISORDERS
    LUNG DISEASE
    COUGH - AIRWAY OBSTRUCTION
    PAINFUL HEEL
    KIDNEY DISEASE
    TENDONITIS
    FRACTURE - HAND BONES
    RETINOPATY
    SKIN - LESION
    FATIGUE
    EAR DYSFUNCTION
    PHARYNGITIS
    BRONCHITIS
    SOFT TISSUE DISORDERS/DISEASE
    ACUTE ENTERITIS
    PNEUMONIA
    STROKE
    SKIN - LOCAL INFECTION
    URTICARIA
    ALOPECIA
    BEHAVIOURIAL PROBLEMS
    INJURY - OPEN WOUND
    CERVICAL STRAIN
    PHIMOSIS
    CANDIDIASIS
    PSORIASIS
    RECTAL BLEEDING
    RECTAL ABCESS
    CERVICITIS
    INFECTION THUMB
    ENDOCRINE DISORDERS
    THROMBOSIS
    CONJUNCTIVITIS - EYE
    LARYNGITIS

    19,008.97
    18,839.78
    18,314.64
    18,166.31
    18,154.33
    15,754.03
    15,023.99
    14,314.25
    14,314.18
    14,118.64
    14,115.60
    13,989.99
    13,725.79
    13,567.00
    13,296.47
    13,020.63
    12,914.81
    12,067.20
    12,028.44
    11,484.99
    11,270.05
    10,920.89
    9,644.26
    9,550.04
    9,341.10
    8,955.11
    8,797.85
    8,065.07
    7,645.00
    7,515.59
    7,482.21
    7,185.51
    6,959.88
    6,947.95
    6,352.13
    6,198.95
    6,129.42
    5,756.15
    5,699.80
    5,401.55
    5,231.89
    5,226.20
    4,774.05
    4,576.77
    4,369.85
    4,317.00
    4,150.00
    3,468.05
    3,349.98
    3,081.00
    2,938.75
    2,633.95
    2,611.45

    EPIDIDMYITIS
    ENDOMETROSIS
    HEMORRHOIDS
    HEARING LOSS
    INFECTION - MALE GENITAL
    ALLERGY
    ADENOTONSILLITIS ALLERGIC
    HERPES ZOSTER
    CHlCKEN POX
    JAUNDICE
    CYSTITIS
    HEMATURIA
    NASAL POLYP
    LACERATION TO FOOT
    LIVER CIRRHOSIS
    LUPUS
    INJURY - UNSPECIFIED
    BASAL CELL CARCINOMA
    RADICULOPATHY INFLAME NERVE ROOT
    INSECT STING
    BLOOD DISORDER
    REMOVAL OF MOLE
    GENERAL PAIN
    CIRCUMCISION
    TRAUMA
    ILL DEFINED - FAINTING
    Grand Total

    2,574.68
    2,470.00
    2,350.26
    2,130.00
    2,091.00
    1,882.77
    1,880.17
    1,835.50
    1,712.75
    1,676.00
    1,602.20
    1,480.00
    1,435.30
    1,418.63
    1,230.00
    1,211.35
    1,102.69
    1,000.00
    891.96
    800.00
    780.00
    600.00
    521.00
    205.00
    200.75
    200.00
    6102057.45

    ANSWER 5
    WORKINGS

    ANSWER 5: Define which are the 3 "Cause" that spend more money

    Base on this table, the top three causes are:


    DENTAL CARE
    VISION CARE
    HEART

    863,219.65
    846,777.27
    566,248.33

    Note that "blank" in the cause represent things such as physician visit without any specific cause for example.

    c cause for example.

    Beneficiary CLAIM
    ID
    #
    1 06994
    2 05140
    2 05140
    3 03489
    3 03729
    3 03729
    3 03729.1
    3 03730
    3 03814
    3 03814
    3 03814.1
    3 04368
    3 04883
    3 05104
    3 05365
    3 05365
    3 05365
    3 05365
    3 05369
    3 05369
    3 05672
    3 05816
    3 05816
    3 06025
    3 06025.1
    3 06214
    3 06214
    3 06405
    3 06632
    3 06888
    3 06888
    3 06888
    3 06889
    3 07098
    3 07099
    3 07402
    3 07402
    3 07480
    3 08634
    3 08635
    3 08636
    3 08636.1
    4 04070
    4 04070
    4 05676
    4 05676
    4 05676
    4 05676
    4 05676
    4 05676.1
    5 04083
    5 04083

    Seq

    CAUSE DESCRIPTION
    1 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    1 PROSTATE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 SKIN - ECZEMA
    1 GLAUCOMA
    1
    2
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 CATARACT
    1 PROSTATE
    1 HYPERTENSION
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    4 PROSTATE
    1 GLAUCOMA
    2 GLAUCOMA
    1
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 HYPERTENSION
    1 GLAUCOMA
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 PROSTATE
    1 CATARACT
    1 PROSTATE
    2 PROSTATE
    1 BACK PAIN
    1 PROSTATE
    1 GLAUCOMA
    1 BURSITIS
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE

    5 04083
    6 05474
    6 05474
    6 05474
    7 08882
    7 08882
    7 08882
    8 08278
    8 08278
    9 04380
    9 04380
    9 05505
    9 05505.1
    9 06517
    9 06892
    9 06892
    9 06892
    10 04939
    10 04939
    10 04939
    10 04939
    10 06250
    10 08275
    10 08275
    10 08275
    10 08275.1
    10 08275.1
    10 08275.1
    10 08276
    10 08276
    10 08277
    11 04759
    11 08242
    11 08242
    11 08242
    12 05373
    12 05373
    12 05373.1
    12 05373.1
    12 05373.1
    12 05373.1
    12 05373.2
    12 06742
    12 07151
    12 07151
    12 07151
    12 07577
    12 08741
    12 08894
    12 08894
    12 08894.1
    13 03612
    13 03612

    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    1 PROSTATE
    2 PROSTATE
    1 PROSTATE
    1 HYPERTENSION
    1 PROSTATE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    3 FRACTURE - HAND BONES
    4 FRACTURE - HAND BONES
    1 FRACTURE - HAND BONES
    1 THYROID
    2 THYROID
    3 THYROID
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANXIETY
    2 ANXIETY
    1 SKIN - LESION
    1 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 HYPERTENSION
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    1 HYPERTENSION
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 HEMORRHOIDS
    1
    2

    13 03612
    13 04707
    13 04707
    13 08462
    13 08462
    13 08462.1
    14 06945
    14 06945
    14 06945
    14 07157
    14 07157
    14 07157
    15 04065
    15 04065
    15 04065
    15 04065
    15 05605
    15 05605
    15 09044
    16 07146
    16 07146
    16 07146
    16 07146.1
    16 07146.1
    17 05141
    18 03491
    18 03491
    18 05106
    18 05106
    18 05106
    18 05317
    18 05317
    18 06746
    18 06746
    18 07769
    18 07769
    18 07769.1
    18 07769.1
    19 04228
    19 04228
    19 04228
    20 05103
    20 05103
    20 05103.1
    20 05103.2
    20 05103.2
    21 04272
    21 04272
    21 04272.1
    21 07149
    21 07149
    21 07150
    21 07150

    3
    1 BACK PAIN
    2 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 HYPERTENSION
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 THYROID
    2 THYROID
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 ARTHRITIS
    1 SINUSITIS
    2 SINUSITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 JAUNDICE
    1 EYE DISORDER
    2 EYE DISORDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    21 08241
    21 08241
    21 08241
    22 03608
    22 03886
    22 05041
    22 07142
    22 07142
    23 05606
    23 05606
    23 05606
    23 05606
    23 05606
    23 06024
    23 06024
    23 06024
    23 06639
    23 06639
    23 06639
    24 04441
    24 04441
    24 04441
    24 05295
    24 05295
    24 05295
    24 05295
    24 06748
    24 06748
    24 07992
    24 07992
    24 08464
    24 08464
    25 07403
    25 07403
    26 03610
    26 05017
    26 06106
    26 08731
    27 03523
    27 04436
    27 05040
    27 05040
    27 05040.1
    27 05612
    27 06406
    27 07501
    27 08240
    27 08240
    27 08240
    27 08405
    28 03672
    28 03672
    28 04361

    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1
    1
    1 DILATION & CURRETAGE
    1 ANXIETY
    2 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    3 PAINFUL HEEL
    4 PAINFUL HEEL
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    1 AMMENORRHOEA
    1 AMMENORRHOEA
    1 AMMENORRHOEA
    1 HYPERTENSION
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 EAR DYSFUNCTION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    1 BACK PAIN
    2 BACK PAIN
    1 EPILEPSY

    28 04361
    28 04362
    28 04362
    28 05917
    28 05917
    28 05917
    28 05917
    28 05918
    28 05918
    28 05918
    28 05918
    28 06845
    28 06845
    28 07585
    28 07585
    28 07585
    28 08260
    29 03531
    29 03531
    29 03531
    29 03531
    29 03531
    29 03531.1
    29 03531.1
    29 03531.2
    29 03531.2
    29 06067
    30 05172
    30 05172.2
    30 05172.2
    30 05172.3
    30 05172.3
    30 08279
    30 08279
    30 08279
    31 06348
    31 06348
    32 07931
    32 07931
    32 08067
    33 06057
    33 06057
    33 06057
    33 06057.1
    34 04437
    34 04437
    34 04437
    34 04437
    34 04437
    34 04437.1
    34 04437.2
    34 04437.2
    34 04758

    2 EPILEPSY
    1 HYPERLIPIDERMIA 2 HYPERLIPIDERMIA 1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 BACK PAIN
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    2 FEVER
    1 DENGUE
    2 DENGUE
    1 PAINFUL HEEL
    1 INFECTION THUMB
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BARTHOLIN'S CYST
    1 HYPERLIPIDERMIA 2 HYPERLIPIDERMIA 3 HYPERLIPIDERMIA 4 HYPERLIPIDERMIA 5 HYPERLIPIDERMIA 1 HYPERLIPIDERMIA 1 HYPERLIPIDERMIA 2 HYPERLIPIDERMIA 1 DIAB'ETES

    CHOLESTEROL
    CHOLESTEROL

    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL

    34 05503
    34 07100
    34 07100
    34 07100
    34 07451
    34 07451.1
    34 08347
    34 08347
    34 08347.1
    34 08347.1
    35 03524
    35 03525
    35 04366
    35 04366
    35 04366
    35 04367
    35 04367
    35 06007
    35 06007
    35 06007
    35 06546
    35 06547
    35 07927
    35 07928
    35 07928
    35 08638
    35 08639
    36 05366
    36 05367
    36 06645
    36 06844
    36 06844
    36 06844
    36 06844
    36 06844
    36 06844.1
    36 07041
    36 07041
    36 07321
    36 07503
    36 07699
    36 07930
    37 06021
    38 04109
    38 04109
    38 04109
    38 04109
    38 04110
    38 04110
    38 04110
    38 04110
    38 05980
    38 05980

    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 ACUTE ENTERITIS
    1 HEART
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 HEART
    2 HEART
    1 GLAUCOMA
    1 THYROID
    1 THYROID
    2 THYROID
    3 THYROID
    1 CATARACT
    2 CATARACT
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    1 THYROID
    1 GLAUCOMA
    1 THYROID
    1 GLAUCOMA
    2 GLAUCOMA
    1 THYROID
    1 CATARACT
    1 VISION CARE
    1 DILATION & CURRETAGE
    1 MUSCULAR PAIN
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN
    1 HYPERTENSION
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 BACK PAIN
    1 CHOSTOCHRONDITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE

    38 05980
    39 03487
    39 03728
    39 04589
    39 04589
    39 04589
    39 05471
    39 05471.1
    39 05471.1
    39 05471.1
    39 06644
    39 06644
    40 03670
    40 03671
    40 04273
    40 04274
    40 05169
    40 05170
    40 06596
    40 06596
    40 06596
    40 06596
    40 06810
    40 08028
    40 08028
    40 08028
    41 05013
    41 05013
    41 05818
    41 05818
    41 05819
    41 05819
    41 05819
    41 05819
    42 04178
    42 04178
    42 04178
    42 04660
    42 04660
    43 08144
    43 08144
    43 08144
    44 03883
    44 03883
    44 03883
    44 06840
    44 06840
    44 06840
    44 06841
    44 06841
    45 06351
    45 06351
    45 06351.1

    3 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1
    2
    3
    1 CIRCULATORY DISORDER
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 SKIN - ECZEMA
    1 BARTHOLIN'S CYST
    1 COUGH - AIRWAY OBSTRUCTION
    1 COUGH - AIRWAY OBSTRUCTION
    1 INFECTION - MALE GENITAL
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 MUSCULAR PAIN

    46 04171
    46 04171
    46 04171
    46 05473
    46 05473
    46 05473
    46 05473
    47 07520
    47 07520
    47 07520.1
    47 07520.1
    48 03530
    48 03530
    48 05042
    48 05042
    48 05042
    48 05042
    48 05042
    48 05042.1
    48 06329
    48 06329
    48 06329
    49 03488
    49 03488
    49 03488
    49 05687
    49 05687
    49 05687
    49 05687
    49 06022
    49 06022
    49 06330
    50 04066
    50 04066
    50 04066
    50 04066
    50 04066
    50 04066.1
    50 06808
    50 06808
    51 05105
    51 06248
    51 06253
    51 06253
    51 06347
    51 06347.1
    51 06352
    51 07042
    51 07042
    51 07042
    51 07042
    51 07809
    51 07809

    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    5
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1
    2
    3
    4
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    1 FRACTURE - HAND BONES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 SKIN - ATOPIC DERMATITIS
    1 DENTAL CARE
    1
    2
    1
    1
    1
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    1 FEVER
    2 FEVER

    51 07809
    51 07809
    51 07809
    52 05981
    52 05982
    52 05982
    52 05983
    52 05983
    52 05983
    52 05983
    52 05983.1
    52 08680
    52 08680
    52 08681
    52 08681
    52 08681
    53 08317
    54 04158
    54 04158
    54 04158
    54 04158
    54 04158
    54 04158.1
    54 04158.1
    54 04158.1
    54 04158.1
    54 04158.1
    54 04158.1
    54 04158.2
    54 04158.2
    54 04158.2
    54 05340
    54 05340
    54 05340
    54 05340
    54 05340
    54 05340.1
    54 05340.1
    54 06017
    54 06516
    54 06516
    54 06516
    54 06516
    54 06638
    54 06638.1
    54 06638.1
    54 07399
    54 07399.1
    54 07399.1
    54 08533
    54 08533
    55 08742
    55 08742

    3 FEVER
    4 FEVER
    5 FEVER
    1 HYPERTENSION
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    1 BREAST DISORDERS
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MISCARRIAGE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    1 HEART
    2 HEART
    2 HEART
    3 HEART
    3 HEART
    1 HEART
    2 HEART
    3 HEART
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    3 HEART- ISCHEMIC HEART
    4 HEART- ISCHEMIC HEART
    5 HEART- ISCHEMIC HEART
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    1 HEART
    1
    2
    3
    4
    1 HEART
    1 HEART
    2 HEART
    1 HEART- ISCHEMIC HEART
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE

    DISEASE
    DISEASE

    DISEASE
    DISEASE
    DISEASE
    DISEASE
    DISEASE
    DISEASE
    DISEASE

    DISEASE
    DISEASE
    DISEASE

    55 08742
    56 05603
    56 05603
    56 05603
    57 06659
    57 06659
    58 07046
    59 03882
    59 03882
    59 03882
    59 03882
    59 03882
    59 06066
    59 06066
    59 06066
    59 06066
    60 07516
    60 07516
    60 07516
    61 07452
    61 07452
    61 07452
    62 04275
    62 04275
    62 04275
    62 04275
    62 04276
    62 04276
    62 04276
    62 04276
    62 04935
    62 04935
    62 04935
    62 04935
    62 04935
    62 04935.1
    62 04935.1
    62 04936
    62 04936
    62 05493
    62 05494
    62 05494
    62 05494
    62 05494
    62 05494
    62 05496
    62 05496
    62 05496
    62 05496.1
    62 06407.1
    62 06407.1
    62 06407.1
    62 06407.1

    3 VISION CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    5 DILATION & CURRETAGE
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEART
    2 HEART
    1 BARTHOLIN'S CYST
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE

    62 06640
    62 06640
    62 06640
    62 07239
    62 07239
    62 08341
    62 08341
    62 08341
    63 08406
    63 08406
    63 08406
    64 08682
    64 08682
    64 08682
    64 08682
    64 08682
    65 06544
    65 06544
    65 06544
    65 07484
    65 07484
    65 07484
    66 04107
    66 04108
    66 04108
    66 04108
    66 04225
    66 04225
    66 05814
    66 05814
    66 05815
    66 07326
    66 07326
    66 08340
    66 08340
    67 08321
    67 08321
    68 08532
    68 08532
    68 08532
    68 08532
    69 05314
    69 05314
    70 05288
    71 06280
    72 03533
    72 03533
    72 03533
    73 05335
    73 05335
    73 05335
    73 05335
    73 05866

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 OVARIAN CYST
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1
    2
    1 OVARIAN CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1
    1
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE

    73 05866
    73 05866
    73 08342
    73 08342
    73 08343
    73 08343
    73 08343
    73 08343
    73 08343
    74 08900
    74 08900
    74 08900
    75 06055
    75 06055
    75 06055
    75 06350
    75 06350
    75 07148
    75 07148
    75 07148
    75 07972
    75 07972
    75 07972
    75 07972
    75 08349
    75 08349
    75 08350
    75 08350
    75 08351
    76 05677
    76 05677
    76 05677
    76 08145
    76 08145
    77 03613
    77 03613
    77 03951
    77 03951
    77 03951
    77 03989
    77 03989
    77 03989
    77 03990
    77 03990
    77 03990
    77 06747
    77 06747
    77 06747
    77 08463
    77 08463
    78 07481
    78 07482
    78 07482

    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    3 FEVER
    1
    2
    3
    1 HYPERTENSION
    2 HYPERTENSION
    1
    2
    3
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    3 SOFT TISSUE DISORDERS/DISEASE
    4 SOFT TISSUE DISORDERS/DISEASE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    1 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BACK PAIN
    2 BACK PAIN
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1
    2

    79 03733
    79 03733
    79 03733
    79 03733
    79 03734
    79 03734
    79 03734
    79 03734
    79 03736
    79 03736
    79 03736
    79 03736
    79 03736
    79 03736.1
    79 06254
    79 06254
    79 06254
    79 06254
    79 06254.1
    79 06254.1
    79 06254.1
    80 03527
    80 03529
    80 03529
    80 03529
    80 03529
    80 03529
    80 03812
    80 03812
    80 03812
    80 03812
    80 04446
    80 04446
    80 04446
    80 04446
    80 05139
    80 05139
    80 05248
    80 06839
    80 07991
    81 03889
    81 03889
    81 03889
    81 03889
    81 03889
    81 03889.1
    81 03889.1
    81 03889.1
    81 03889.2
    81 03889.2
    81 03889.2
    81 03889.2
    81 03889.2

    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    5 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    1 HEART
    1 HEART
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER

    81 04891
    81 04891
    81 05740
    81 05740
    81 06518
    81 06518
    81 06518
    81 07263
    81 07263
    81 07264
    82 04859
    82 04859
    82 04859
    82 04859
    82 04859.1
    82 04859.2
    82 04859.2
    82 04859.2
    82 05387
    82 05387
    82 05387
    82 05387
    82 05387
    82 05387
    82 05387.1
    82 05387.1
    82 05387.2
    82 05387.2
    82 05387.3
    82 05387.3
    82 05387.3
    82 05387.4
    82 05387.5
    82 06174
    83 04071
    83 04071
    83 04071
    83 04605
    83 04605
    83 04605
    83 05881
    83 05881
    83 05881
    83 05921
    83 05921
    83 07523
    83 07523
    83 07523.1
    84 04377
    84 04377
    84 04377
    84 04378
    84 04378

    1 BACK PAIN
    2 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1
    2
    3
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 RADICULOPATHY INFLAME NERVE ROOT
    1
    1
    2
    2
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    3 HYPERTENSION
    1 EAR DYSFUNCTION
    1 EAR DYSFUNCTION
    1 PROSTATE
    1 PROSTATE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 EAR DYSFUNCTION
    1 PROSTATE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER
    1 HYPERTENSION
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS

    84 08027.1
    84 08027.1
    84 08027.1
    84 08637
    84 08637
    84 08637
    84 08637
    85 07590
    85 07590
    85 07590
    86 04606
    86 05922
    86 05922
    86 05922
    86 05922
    86 05922
    86 05922.1
    86 05923
    86 05923
    86 05923
    86 05923
    86 05923
    86 06286
    86 07591
    86 07591
    86 07591
    86 07591
    86 08411
    86 08411
    86 08411
    86 08412
    86 08412
    87 03490
    87 03490
    87 03490
    88 04092
    88 04092
    88 04092
    88 06838
    89 04379
    89 04379
    89 05342
    89 05342
    89 06515
    89 06515
    89 08408
    89 08408
    89 08408
    89 08409
    89 08409
    89 08409
    89 08409.1
    90 06026

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND
    1 VISION CARE
    1 ADENOTONSILLITIS ALLERGIC
    2 ADENOTONSILLITIS ALLERGIC
    3 ADENOTONSILLITIS ALLERGIC
    4 ADENOTONSILLITIS ALLERGIC
    5 ADENOTONSILLITIS ALLERGIC
    1 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND
    4 INJURY - OPEN WOUND
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 INTESTINAL COLIC
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 HYPERTENSION
    1 OVARIAN CYST

    90 06027
    90 06027
    90 06027
    90 06027
    90 06027
    90 06408
    90 06408
    90 07863
    91 06890
    91 06890
    91 06890
    92 07406
    93 05675
    93 05675
    93 05675
    93 06728
    93 06728
    94 04843
    94 04843
    94 04843
    94 04843.1
    94 06837
    94 06837
    95 03727
    95 03727
    95 03727
    95 03727.1
    95 03884
    95 03884
    95 03884
    95 03884
    95 03885
    95 03885
    95 04226
    95 04226
    95 04226.1
    95 04227
    95 04227.1
    95 04435
    95 04435
    95 05739
    95 06279
    95 07144
    95 08346
    95 08633
    96 04279
    96 04279
    97 07261
    98 08143
    98 08143
    99 07143
    99 07143
    99 07143

    1
    2
    3
    4
    5
    1
    2
    1 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    1 DILATION & CURRETAGE
    1 BACK PAIN
    2 BACK PAIN
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 PROSTATE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 PROSTATE
    2 PROSTATE
    1 HEART
    1 PROSTATE
    1 DIAB'ETES
    1 SINUSITIS
    2 SINUSITIS
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 INJURY - UNSPECIFIED
    2 INJURY - UNSPECIFIED
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION

    99 07143
    99 07258
    100 04440
    100 04440
    100 04440
    100 04442
    100 04442.1
    100 04442.2
    100 04442.3
    100 06545
    101 04290
    101 04290
    101 04290
    101 04290
    101 04290
    101 08743
    102 03887
    102 05044
    102 05044
    102 05138
    102 05470
    102 05470
    102 05470.1
    102 06331
    102 06811
    102 06811
    102 06811
    102 06811
    102 07145
    102 07145
    102 07145
    102 07145.1
    103 04940
    103 04940
    104 04884
    104 04884
    104 04884
    105 03532
    105 03880
    105 03880
    105 03880
    105 05014
    105 05014
    105 05015
    105 05015
    105 05173
    105 05173
    105 05371
    105 05371
    105 06105
    105 06809
    105 08744
    105 08744

    4 HYPERTENSION
    1 HYPERTENSION
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DILATION & CURRETAGE
    1 HYPERTENSION
    1 CYSTITIS
    1 ANAEMIA
    1 MUSCULAR PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 DIAB'ETES
    1 HYPERTENSION
    1 TENDONITIS
    2 TENDONITIS
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 TENDONITIS
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 BACK PAIN
    2 BACK PAIN
    1 DENTAL CARE
    1 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS

    105 08745
    105 08745
    106 04890
    106 04890
    107 05880
    108 03492
    108 03492
    108 03493
    108 03493
    108 03493
    108 04528
    108 04528
    108 05700
    108 05700
    108 05700
    108 06968
    108 06968.1
    108 06968.1
    108 06968.1
    108 06968.1
    108 06968.1
    108 07259
    108 07259
    108 07323
    108 07323
    108 07324
    108 07324
    108 07324.1
    108 07324.1
    108 07324.1
    108 07324.2
    108 07324.2
    108 07522
    108 07522
    108 07522
    108 07522
    109 04106
    109 06641
    110 06660
    110 06660
    110 06660
    110 06660
    111 05984
    111 05984
    111 05984
    111 05984
    111 07586
    111 07586
    111 08029
    112 03638
    112 04858
    113 06745
    113 06745

    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 LARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 VISION CARE
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    4 INGROWING TOE NAIL
    5 INGROWING TOE NAIL
    1 DENTAL CARE
    2 DENTAL CARE
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1 HEART
    2 HEART
    3 HEART
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 CANCER-BREAST
    1 CANCER-BREAST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    3
    4
    1
    2
    1
    1 DENTAL CARE
    1 DENTAL CARE
    1 ALLERGY
    2 ALLERGY

    113 06745
    114 08407
    114 08407
    115 04439
    115 04439
    115 06991
    115 06991
    116 04363
    116 04363
    116 08274
    116 08274
    117 05247
    117 06597
    117 06597
    117 06597
    117 06597.1
    117 06658
    118 05168
    118 05168
    118 05168
    118 05168
    118 05168
    119 07320
    119 07320
    119 07502
    119 07502
    119 07698
    119 08320
    119 08320
    120 04760
    120 04760
    120 04760
    120 04760
    121 03737
    121 03737
    121 03879
    121 03879
    121 03879
    121 05019
    121 05019
    121 05388
    121 05388
    121 05504
    122 06100
    122 06100
    122 06100
    122 06100
    122 06891
    122 06891
    122 07043
    122 07043
    122 07043.1
    122 07407

    3 ALLERGY
    1 VISION CARE
    2 VISION CARE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1 EYE DISORDER
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 PHARYNGITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 THYROID
    2 THYROID
    1 THYROID
    2 THYROID
    1 THYROID
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1
    2
    1 BONE & CARTILAGE DISORDER
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1
    2
    1
    1 MUSCULAR PAIN

    122 08280
    122 08280
    122 08280
    122 08467
    122 08467
    123 03609
    123 03609
    123 03609.1
    123 03609.1
    123 05502
    123 05502
    123 05879
    123 05879
    123 06656
    123 06656
    123 06656.1
    123 07400
    123 07400.1
    123 07400.1
    123 08273
    123 08273
    124 04438
    124 07405
    124 07405
    124 08679
    125 05372
    125 05372
    126 07521
    126 07521
    126 07521
    126 07521
    126 07521.1
    127 07412
    127 07412
    127 07412
    127 07412
    127 07412
    128 08410
    128 08410
    129 06657
    129 06657
    130 06636
    131 07339
    131 07339
    132 06339
    132 06339
    132 06339.1
    133 07588
    133 07588
    133 07589
    134 07531
    134 07531
    134 07531

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 THYROID
    2 THYROID
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 BURSITIS
    2 BURSITIS
    1 THYROID
    1 BURSITIS
    1 THYROID
    2 THYROID
    1 ARTHRITIS
    2 ARTHRITIS
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 SKIN - ECZEMA
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 BARTHOLIN'S CYST
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 PHIMOSIS
    2 PHIMOSIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 TENDONITIS
    2 TENDONITIS
    1 SINUSITIS
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 SKIN - ECZEMA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    134 07531.1
    134 08954
    135 04979
    135 04979
    135 04981
    135 04981
    135 05507
    135 05507
    135 05507
    135 05507.1
    135 05507.1
    135 05507.1
    135 05507.2
    135 06077
    135 06077
    135 06077.1
    135 06077.1
    135 07505
    135 07505
    135 08247
    136 04169
    136 04169
    136 04170
    136 04987
    136 04987
    136 04987
    136 05893
    136 05894
    136 06012
    137 08378
    137 08378
    137 08378
    137 08379
    138 04986
    138 04986
    138 04986
    139 04984
    139 04984
    139 04984
    139 04984
    139 08254
    139 08254
    139 08254
    139 08254
    139 08856
    139 08856
    140 03947
    140 05776
    140 05776
    140 05776
    140 08246
    141 07166
    141 07166

    1 HYPERTENSION
    1 BACK PAIN
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1
    2
    3
    1 ALLERGIC RHINITIS
    1 GLAUCOMA
    2 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST

    141 08948
    141 08948
    141 08948.1
    141 08948.1
    141 08949
    141 08949
    141 08949
    141 08950
    141 08950
    141 08950
    141 08951
    141 08951
    142 03811
    142 03811
    142 03811
    142 05777
    142 05777
    142 05777
    142 05777.1
    142 06103
    143 08186
    143 08186
    143 08186
    143 08186
    143 08186
    144 05779
    144 05779
    145 07876
    145 07876
    145 07876
    145 07876
    145 07876
    145 07876.1
    145 07876.1
    146 04167
    146 04167
    146 04167
    146 04985
    146 04985
    146 05223
    146 05223
    146 06684
    146 06684
    147 08381
    147 08381
    147 08382
    147 08382
    147 08382
    147 08382
    147 08382
    147 08857
    148 04160
    148 04160

    1 FEVER
    2 FEVER
    1 HEART
    2 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALOPECIA
    2 ALOPECIA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 ALLERGIC REACTION
    1 ALLERGIC REACTION
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CYST
    2 CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 ABDOMINAL PAINS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS

    148 06281.1
    148 06281.1
    148 06281.1
    148 06281.1
    148 06281.1
    148 08248
    148 08248
    148 08248
    148 08248
    149 04159
    149 04159
    150 08728
    150 08729
    150 08729
    151 03944
    151 03944
    151 03944
    151 04164
    151 04164
    151 04164
    151 04164
    151 04164.1
    151 04166
    151 05508
    151 05508
    151 05508
    151 05508
    151 06011
    151 06011
    151 06035
    151 06035
    151 06035
    151 06035
    152 04356
    152 04356
    153 04359
    153 04359.1
    153 04988
    153 04988
    153 04988
    153 07879.1
    153 07879.1
    153 08956
    153 08956.1
    154 08380
    154 08380
    155 03810
    155 03810
    155 05780
    155 05780
    155 05780
    155 08252
    155 08252

    1
    2
    3
    4
    5
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 THYROID
    2 THYROID
    3 THYROID
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    1 SKIN - ATOPIC DERMATITIS
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    1
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 SKIN - ECZEMA
    1
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERTENSION
    2 HYPERTENSION

    155 08252.1
    155 08252.1
    156 08952
    157 04526
    157 04527
    157 04527.1
    157 08255
    157 08256
    157 08256.1
    158 08375
    158 08375
    158 08375
    158 08375
    158 08375
    158 08375.1
    159 04168
    159 07506
    159 07506
    159 08257
    159 08257
    159 08257
    159 08426
    159 08426
    159 08426
    160 04162
    160 04163
    160 04163
    160 07378
    160 07378
    160 07378
    161 04978
    161 04978
    161 04978
    162 06682
    162 06682
    162 06682
    162 06682
    162 06682
    162 06682.1
    163 08953
    163 08953
    163 08953.1
    164 03809
    164 03809
    165 06685
    165 06685
    165 06685
    165 06685
    166 06681
    167 08250
    167 08251
    167 08251
    167 08251

    1 TENDONITIS
    2 TENDONITIS
    1 VISION CARE
    1 OVARIAN CYST
    1 RECTAL ABCESS
    1
    1 FRACTURE - HAND BONES
    1 EAR DYSFUNCTION
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    3
    1
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 BONE & CARTILAGE DISORDER
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 ALLERGIC RHINITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ASTHMA
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    167 08251
    167 08251
    168 04161
    168 04161
    168 04357
    168 04358
    168 04982
    168 04982
    168 04982.1
    168 04983
    168 04983
    169 06133
    169 06133
    169 06134
    169 06134
    170 07464
    170 07465
    170 07881
    170 07881
    171 05481
    171 05481
    171 05481
    172 05271
    172 05272
    172 05272
    172 05273
    173 03496
    173 03496
    173 06135
    173 06135
    173 06137
    173 06138
    173 07273
    173 07274
    173 07275
    173 07275.1
    173 07275.1
    174 04627
    174 04627
    174 04627
    174 04627
    174 04627
    174 04721
    174 04721
    174 04721
    175 06036
    175 06036
    175 06036
    175 06036
    175 06036
    176 07656
    176 07656
    176 07656

    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DEPRESSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 OTITIS - EAR
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 BEHAVIOURIAL PROBLEMS
    2 BEHAVIOURIAL PROBLEMS
    1 ABDOMINAL PAINS
    1 DEVIATED NASAL SEPTUM
    1 TONSILLITIS
    1 ANAEMIA
    1 ANAEMIA
    1 ANAEMIA
    2 ANAEMIA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    3 FEVER
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    177 07487
    177 07487
    177 07487
    177 07487
    178 05270
    178 05270
    178 05270
    178 07655
    178 07655
    178 07655
    178 07655
    178 07655
    179 06976
    179 06976
    179 06976
    179 07880
    179 07880
    179 07880
    179 07880
    179 08159
    179 08159
    180 03619
    180 03619
    180 03619
    180 04628
    180 04628
    180 04628
    180 04628
    180 04628
    180 06037
    180 06037
    180 06037
    180 06037
    180 06037
    180 06037.1
    181 04463.1
    181 04463.1
    181 04463.1
    181 04464
    182 08213
    182 08213
    182 08213
    183 03699
    183 03699
    183 07193
    183 07193
    184 03680
    184 03680
    184 03681
    184 03681
    184 03681
    184 04449
    184 04449

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    5 ASTHMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    184 07170
    184 07170
    185 05954
    185 05954
    185 05954
    186 05109
    186 05109
    186 05109
    186 05110
    186 05110
    187 04448
    187 04448
    187 04448
    187 04448.1
    187 04448.1
    187 07724
    187 07724
    187 07724
    187 07724
    188 04450
    188 04450
    188 05051
    188 05051
    188 05051
    188 05052
    188 05052
    188 05052
    189 05512
    189 05512
    189 05512
    189 06362
    189 06362
    189 07725
    189 07725
    189 07725
    190 03686
    190 03686
    190 03686.1
    190 03686.1
    190 06758
    190 06758
    190 06758.1
    191 05055
    192 04453
    192 04453
    192 04453
    192 04453
    192 04453.1
    192 04453.1
    192 04453.1
    193 03714
    193 03714
    193 03715

    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 HEART
    2 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    3
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    1 DIAB'ETES
    2 DIAB'ETES
    1
    2
    1 DIAB'ETES
    2 DIAB'ETES
    1 SKIN - ECZEMA
    1 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 BRONCHITIS - ACUTE

    193 03715
    193 03715
    193 03717
    193 03717
    194 05514
    194 05514
    194 05514
    194 05514
    195 04457
    195 04457
    195 04457
    195 04457
    195 06368
    195 06368
    195 06368
    195 08192
    195 08192
    196 03684
    197 04455
    197 04455
    197 04455.1
    197 05941
    197 05941
    197 05941
    198 05111
    198 05111
    198 05111
    199 04458
    200 07171
    200 07171
    200 07171
    201 03685
    201 03685.1
    202 03687
    202 04461
    202 05516
    202 06759
    202 06759
    202 06759
    202 06759
    202 06760
    202 06760
    202 06760
    202 06760
    202 08194
    202 08194
    202 08195
    202 08195
    203 05515
    203 05515
    204 05056
    204 05056
    204 05056

    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 HYPERTENSION
    1 AMMENORRHOEA
    1 SINUSITIS
    1 ALLERGIC RHINITIS
    1 ALLERGY
    1 LACERATION TO FOOT
    2 LACERATION TO FOOT
    3 LACERATION TO FOOT
    4 LACERATION TO FOOT
    1
    2
    3
    4
    1 CHEST PAIN
    2 CHEST PAIN
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION

    204 05056.1
    205 05948
    205 05948
    205 05948
    205 05948
    205 05948
    205 05948.1
    205 05948.1
    206 05048
    206 05048
    206 05048
    206 05049
    206 05049
    206 05939
    206 05939
    206 05939
    206 05939
    206 05939
    206 05939.1
    206 06757
    206 06757
    206 06757.1
    206 06757.1
    206 08187
    207 06366
    207 06366
    208 03708
    208 03709
    208 04492
    208 04493
    208 05157
    208 05158
    208 05158
    208 06398
    208 06776
    208 08228
    209 05059
    209 05059
    209 05059
    209 06370
    209 06370
    210 08199
    210 08199.1
    210 08199.2
    211 08197
    211 08197.1
    211 08197.2
    212 07177
    212 07177
    213 05062
    213 05062
    213 05300
    213 05300

    1 CONSTIPATION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 FEVER
    2 FEVER
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    4 HORMONE REPLACMENT THERAPY
    5 HORMONE REPLACMENT THERAPY
    1 HORMONE REPLACMENT THERAPY
    1 BACK PAIN
    2 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 AMMENORRHOEA
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 OVARIAN CYST
    1 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    1 FEVER
    1 OTITIS - EAR
    1 RENAL DYSFUNCTION
    1 FEVER
    1 PAIN-BACK/SHOULDER
    1 EYE DISORDER
    2 EYE DISORDER
    1 SINUSITIS
    2 SINUSITIS
    1 BACK PAIN
    2 BACK PAIN

    214 04460
    214 04460
    214 04460.1
    214 04460.1
    214 04460.1
    214 04460.2
    214 04460.2
    214 08193
    214 08193
    215 03701
    215 03701
    215 03701.1
    215 03702
    215 05531
    215 05531
    216 05528
    216 05528
    216 05528
    216 07191
    216 07739
    216 07739
    216 07739
    216 08212
    217 07176
    217 07176
    218 05050
    218 05050
    218 05050
    218 05937
    218 05937
    218 05938.1
    218 05938.1
    218 06756
    218 06756
    218 07167
    218 07167
    218 07167
    218 07167
    218 07168
    218 07168
    218 07168
    218 07168
    218 08188
    218 08188
    219 05455
    219 05455
    219 05455.1
    219 06374
    219 06374.1
    219 06374.1
    220 04462
    220 04462
    220 06369

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HYPERTENSION
    2 HYPERTENSION
    1 BONE & CARTILAGE DISORDER
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 VARICOSE
    2 VARICOSE
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 VARICOSE
    2 VARICOSE
    1
    2
    3
    4
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    1 VARICOSE
    2 VARICOSE
    1
    2
    1 TONSILLITIS
    1 HYPERTENSION
    1
    2
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 HORMONE REPLACMENT THERAPY

    220 06369
    220 06369
    220 06369.1
    220 06369.1
    220 07728
    221 06360
    221 06360
    221 06360
    222 03621
    222 03621
    222 03621
    222 03621
    222 03621.1
    222 03621.1
    223 04490
    223 04490
    223 04490
    223 05156
    223 05156
    223 06774
    223 06774
    223 06774
    223 07756
    223 07756
    223 08226
    223 08226
    224 03705
    224 03705
    224 03705
    225 06761
    225 06761
    225 06762
    226 05161
    226 05161
    226 05161
    226 05161
    227 03691
    227 03691
    227 03691
    228 05112
    228 05113
    228 05114
    228 05114
    228 05114
    228 05114
    228 05114
    228 05114.1
    229 03694
    230 05148
    230 05148
    230 05148
    231 07179
    231 07179

    2 HORMONE REPLACMENT THERAPY


    3 HORMONE REPLACMENT THERAPY
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 ENDOMETROSIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 CHEST PAIN
    2 CHEST PAIN
    1 HEART- ISCHEMIC HEART DISEASE
    2 HEART- ISCHEMIC HEART DISEASE
    3 HEART- ISCHEMIC HEART DISEASE
    1 TONSILLITIS
    2 TONSILLITIS
    1 HEART
    2 HEART
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 ALLERGIC REACTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 OTITIS - EAR
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE

    231 07179
    232 05153
    232 05153
    232 05153
    232 05538
    232 05538
    233 07172
    234 05956
    235 03692
    235 03692
    235 03692
    235 07183
    235 07183
    235 07183
    235 07183
    235 07183
    235 07183.1
    235 07186
    235 07186
    236 06375
    236 06375
    236 06375
    237 06765
    237 06765
    238 06769
    238 06769
    238 06769
    238 06769
    239 03711
    239 03711
    240 05061
    240 07175
    240 07175
    240 07175
    241 07734
    241 07734
    242 04483
    242 04484
    242 04484
    242 05537
    242 05537
    243 08198
    243 08198
    243 08198
    244 08206
    244 08206
    245 05942
    245 05942
    245 07174
    245 07174
    245 07174
    245 07730
    245 07730

    3 VISION CARE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 URTICARIA
    2 URTICARIA
    1 DEPRESSION
    1
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    4 INGROWING TOE NAIL
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 GLAUCOMA
    1 FEVER
    2 FEVER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE

    245 07730
    245 07730
    245 07730
    246 03718
    246 03719
    246 04500
    246 04500
    246 04500
    247 06387
    247 06387
    247 06387
    247 06486
    247 07182
    247 07182
    248 06775
    248 06775
    248 06775
    249 05053
    249 05511
    249 05511
    249 06361
    249 06361
    250 05943
    250 05943
    250 05943
    251 03690
    251 03690
    251 03690.1
    251 08200
    251 08200
    251 08200
    251 08201
    251 08201
    251 08201
    252 06377
    252 06377
    253 04482
    253 04482
    253 04482
    253 04482
    253 04482.1
    253 04482.1
    254 05522
    254 05522
    254 05522
    255 07198
    255 07198
    256 07192
    256 07192
    257 08227
    257 08227
    257 08227
    257 08227

    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    3 CERVICAL STRAIN
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABSCESS
    2 ABSCESS
    1 HYPERTENSION
    1
    2
    3
    1
    2
    3
    1 DIAB'ETES
    2 DIAB'ETES
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 CYSTITIS
    2 CYSTITIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION

    257 08227.1
    258 05517
    258 05517
    259 03693
    259 03693
    260 03712
    260 03712
    260 03712
    260 04497
    260 04497
    260 04497
    260 04497
    260 04497
    260 04497.1
    260 04499
    260 05542
    260 07211
    260 07212
    260 07212
    260 07212
    260 07212
    260 07757
    260 08229
    260 08229
    261 03706
    261 03706
    261 04478
    261 04478
    261 04478
    262 07732
    262 07732
    262 07732
    263 05960
    263 05960
    263 05960
    263 05961
    263 05961
    263 05961
    263 07205
    263 07205.1
    263 07205.1
    264 07761
    264 07761
    265 05959
    265 05959
    265 05959
    265 05959
    266 04468
    267 08205
    267 08205
    268 03700
    269 04489
    269 04489

    1 HYPERTENSION
    1 HEARING LOSS
    2 HEARING LOSS
    1 DENTAL CARE
    2 DENTAL CARE
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 LARYNGITIS
    2 LARYNGITIS
    3 LARYNGITIS
    4 LARYNGITIS
    5 LARYNGITIS
    1 LARYNGITIS
    1 DENTAL CARE
    1 CONSTIPATION
    1 ALLERGIC RHINITIS
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    1 ENDOCRINE DISORDERS
    1 CONSTIPATION
    2 CONSTIPATION
    1 FEVER
    2 FEVER
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1
    1 DENTAL CARE
    2 DENTAL CARE

    269 04489
    270 06365
    270 06365
    270 06365
    270 06365
    271 05121
    271 05121
    271 05121
    272 03688
    272 03688
    272 03688
    273 06766
    274 04486
    274 04486
    274 05154
    274 05154
    274 05154
    274 05154.1
    274 05539
    274 05539
    274 05539
    274 07755
    274 07755
    274 07755
    275 05953
    276 05957
    276 05957
    277 04909
    277 06385
    277 06386
    277 06978
    277 06978
    277 06978
    277 06978
    277 06978
    277 07882
    277 07882
    277 07882
    277 07882
    278 05525
    278 05525
    278 05525
    279 05521
    279 05521
    279 05521
    280 04472
    280 04472
    281 07190
    281 07190
    281 07190
    281 07190
    281 08208
    282 06379

    3 DENTAL CARE
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    3 CERVICAL STRAIN
    4 CERVICAL STRAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 SKIN - ECZEMA
    1 BACK PAIN
    2 BACK PAIN
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 BACK PAIN
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    1 GLAUCOMA
    1 DIAB'ETES
    2 DIAB'ETES
    1 OTITIS - EAR
    1 VISION CARE
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1
    2
    3
    4
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 HYPERTENSION

    282 06379
    282 06379
    283 06384
    283 06384.1
    283 06384.1
    284 07208
    284 07208
    285 07203
    285 07203
    285 07203
    285 07203
    286 05952
    286 05952
    286 05952
    286 05952
    286 06383
    287 07754
    287 07754
    287 07754
    288 06392
    288 06392
    288 06392
    289 07206
    289 07206
    290 06363
    291 05117
    291 05117
    291 05117
    291 06770
    292 06764
    292 06764
    292 06764
    292 06764.1
    293 05054.1
    293 05054.1
    293 05054.1
    293 06364
    293 06364
    293 06364
    294 06763
    294 06763
    295 05115
    295 05115
    295 05526
    295 05526
    295 05526
    296 05060
    296 05060
    296 06372
    296 06372
    296 06372
    296 06373
    296 06373

    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    1 SKIN - LESION
    2 SKIN - LESION
    1 HYPERTENSION
    2 HYPERTENSION
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 CHEST PAIN
    2 CHEST PAIN
    1 BONE & CARTILAGE DISORDER
    1 INFECTION - MALE GENITAL
    2 INFECTION - MALE GENITAL
    3 INFECTION - MALE GENITAL
    1 BARTHOLIN'S CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 OTITIS - EAR
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 CHlCKEN POX
    2 CHlCKEN POX
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN

    296 06373
    297 05940
    298 03689
    298 03689
    298 03689
    299 06367
    299 06367
    299 06367
    300 05524
    300 05524
    301 05155
    301 06773
    302 07188
    302 07188
    302 07188
    303 04466
    303 04466
    303 04466
    303 04467
    303 05518
    303 05944
    304 05520
    304 05520
    305 05541
    305 05541
    306 06380
    306 06380.1
    306 06380.1
    306 06381
    306 06381.1
    307 05872
    307 05872
    307 07187
    307 07187
    308 07748
    308 07748
    308 07748
    309 05955
    310 04488
    310 04488
    310 04488
    310 04488
    310 06772
    310 06772
    310 06772
    311 04476
    311 04476
    311 04476
    312 07758
    312 07758
    312 07758
    313 05963
    314 06777

    3 MUSCULAR PAIN
    1
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BLOOD DISORDER
    2 BLOOD DISORDER
    1 HYPERTENSION
    1 HYPERTENSION
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 GLAUCOMA
    1 EYE DISORDER
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 BURSITIS
    2 BURSITIS
    1 FEVER
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    1 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGY
    2 ALLERGY
    3 ALLERGY
    1 ARTHRITIS
    1

    314 07204
    314 07204
    314 07204
    314 07204
    315 04469
    316 07194
    316 07194
    317 04473
    317 04473
    317 04473
    317 04473
    317 04473
    317 04473.1
    317 04473.1
    317 04473.1
    317 04473.1
    318 07729
    318 07729
    318 07729
    318 07729
    319 03695
    319 03695
    319 03695
    319 03695
    319 03864
    319 03864
    319 03864
    319 03864
    319 03864
    319 06977
    319 06977
    320 05118
    320 05118
    321 05119
    321 05119
    321 07740
    321 07740
    322 04474
    322 05120
    322 05120
    322 05120
    323 05124
    323 05124
    323 05124
    323 07197
    323 07197
    324 05532
    324 05532
    324 05532
    324 07726
    324 07727
    324 07727
    325 07743

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    5 VARICOSE
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 DIAB'ETES
    2 DIAB'ETES
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 SINUSITIS
    1 FATIGUE
    2 FATIGUE
    1 DIAB'ETES

    325 07743
    325 07743
    325 07743
    325 07743
    325 07743.1
    325 07743.1
    325 07743.1
    326 07745
    326 07745
    326 07746
    326 07746
    326 07746
    326 07746.1
    327 07747
    327 07747
    327 07747
    327 07747
    327 07747
    327 07747.1
    328 06771
    328 06771
    328 06771
    329 07199
    329 07199
    329 07749
    329 07749
    330 05534
    330 05534
    330 05534
    330 05534
    330 05535
    330 05535
    330 05535
    330 05535
    330 05535.1
    330 05536
    330 05536
    330 05536
    330 05536
    330 07751
    330 07751
    330 07751
    331 04494
    332 05152
    332 05152
    332 05152
    332 05958
    332 05958
    332 08220
    332 08220
    333 03707
    333 03707
    333 05540

    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 OTITIS - EAR
    1 HORMONE REPLACMENT
    2 HORMONE REPLACMENT
    3 HORMONE REPLACMENT
    4 HORMONE REPLACMENT
    5 HORMONE REPLACMENT
    1 HORMONE REPLACMENT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 STROKE
    2 STROKE
    1 STROKE
    2 STROKE
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 CHOSTOCHRONDITIS
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 PSORIASIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER
    1
    2
    1 PAINFUL HEEL

    THERAPY
    THERAPY
    THERAPY
    THERAPY
    THERAPY
    THERAPY

    333 05540
    334 04491
    334 04491
    334 04491
    334 04491
    334 06391
    334 06391
    335 04471
    335 04471
    335 05116
    335 05116
    336 08189
    336 08189
    336 08189
    336 08189
    336 08189
    336 08189.1
    336 08189.1
    336 08190
    337 05162
    337 05162
    337 05162
    337 05162
    338 07243
    338 07243
    339 05163
    339 05163
    339 05163
    339 05163
    340 06399
    340 06399
    341 06779
    341 06779
    341 06779
    341 06779
    342 04501
    342 04501
    343 04722
    343 04722
    343 04723
    343 04723
    343 04723
    343 04723.1
    344 07752
    344 07752
    344 07753
    344 07753
    344 07753
    345 07189
    345 07189
    345 07189
    346 06376
    346 06376

    2 PAINFUL HEEL
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 SKIN - LESION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    4 OTITIS - EAR
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 BURSITIS
    2 BURSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 FATIGUE
    2 FATIGUE
    3 FATIGUE
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS

    347 05513
    347 05513
    347 05513
    347 05513
    348 08224
    349 04844
    349 04844
    349 04844
    349 04844
    349 05057
    349 05057
    349 05057
    349 05057
    350 05058
    350 05058
    350 05058.1
    351 03696
    351 03696
    352 06371
    352 06371
    352 06371
    353 05510
    353 05510
    353 05510
    354 03622
    354 03622
    354 06388
    354 06388
    354 07242
    354 07242
    354 07242
    355 03683
    355 03683
    356 05302
    356 05302
    357 05108
    357 05108
    357 05523
    357 05523
    357 05523
    357 05523
    358 05945
    359 04475
    359 04475
    359 04475.1
    359 04475.1
    359 04475.2
    359 05122
    359 05122
    359 05123
    359 05123
    359 07195
    359 07195.1

    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 DIAB'ETES
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 FEVER
    2 FEVER
    1 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 FEVER
    2 FEVER
    1 DIAB'ETES
    2 DIAB'ETES
    1 FEVER
    2 FEVER
    3 FEVER
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    1 URTICARIA
    2 URTICARIA
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DIAB'ETES
    1 FEVER
    2 FEVER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 ASTHMA
    2 ASTHMA
    1 BACK PAIN
    1 ASTHMA

    359 07195.1
    359 07195.1
    359 07195.1
    359 07241
    359 07241
    359 07741
    359 07742
    359 08214
    359 08214
    359 08214
    359 08892
    359 08892
    359 08892
    359 08892
    359 08893
    359 08893
    359 08893
    359 08893
    360 05519
    360 05519
    360 05519
    361 05063
    361 05063
    361 05947
    361 07280
    361 08204
    361 08204
    362 06378
    362 06378
    362 06378
    363 03703
    363 03703
    363 03703
    364 07738
    364 07738
    364 07738
    364 07738
    365 07733
    365 07733
    365 07733
    366 07759
    367 08211
    368 07380
    368 07380
    368 07380
    368 07380
    368 07380
    369 04364
    369 04364
    369 04364
    369 06964
    369 06964
    369 06964

    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 VISION CARE
    1 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1
    1 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BACK PAIN
    1 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    369 06964
    369 06966
    369 06966
    369 06966
    370 04465
    370 04465
    370 04465
    371 03697
    371 03697
    371 03697
    371 03698
    371 03698
    371 03698
    371 03698
    371 03698.1
    371 04208
    371 04208
    371 04208
    371 04208
    371 07737
    371 07737
    371 07737
    371 07737
    372 08209
    372 08210
    373 05530
    373 05530
    373 05530.1
    374 04487
    374 04487
    374 04487
    374 04487
    374 04487
    375 08207
    375 08207
    375 08207
    375 08207
    376 05946
    377 07731
    377 07731
    378 04470
    378 04470
    378 04470
    378 05527
    378 05527
    378 05527
    378 05949
    378 05949
    378 05949
    378 07735
    378 07735
    378 07735
    379 06767

    4 DEVIATED NASAL SEPTUM


    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    1 HYPERTENSION
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    1 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERTENSION
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 LARYNGITIS
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    1 DIAB'ETES

    379 06767
    380 07750
    380 07750
    380 07750
    381 04479
    381 04479
    381 04479
    381 04479.1
    381 04479.2
    381 04479.2
    381 05149
    381 05149
    381 05149
    381 05149
    381 08217
    381 08217
    381 08217
    381 08217
    381 08217
    381 08218
    381 08218
    381 08218
    381 08218
    381 08218.1
    382 05150
    382 05150
    382 05151
    382 05151
    382 05151
    382 05159
    382 05159
    382 05159
    382 06389
    382 06389
    382 06390
    382 06390
    382 07202
    382 07202
    383 08219
    383 08219
    384 07201
    384 07201
    384 07201
    385 05533
    385 05533
    386 06393
    386 06393
    386 06393
    386 06393
    386 06393
    386 06395
    386 06395
    386 06397

    2 DIAB'ETES
    1 HEMORRHOIDS
    2 HEMORRHOIDS
    3 HEMORRHOIDS
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 ARTHRITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1
    2
    3
    4
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    1 GASTRIC - PEPTIC ULCER/GERD
    1 DIAB'ETES
    2 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ILL DEFINED - FAINTING
    2 ILL DEFINED - FAINTING
    1 TENDONITIS
    2 TENDONITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1
    2
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    5 VARICOSE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE

    386 06397
    386 06397
    387 05160
    387 05160
    388 04495
    388 04495
    388 05962
    388 05962
    388 07207
    389 05303
    389 05303.1
    389 05304
    389 05304
    389 05304
    389 05304
    390 04405
    390 04405
    390 04405
    390 04405
    390 05069
    390 05069
    390 05069
    391 06780
    391 06780
    391 06781
    391 06781
    391 06781
    391 06781
    392 04809
    392 04809
    392 04809
    392 07490
    392 07492
    393 03507
    393 03507
    393 03507
    393 03507
    393 03507
    393 03507.1
    393 03507.1
    393 03507.1
    393 03507.2
    393 03507.2
    393 03507.2
    393 03507.2
    393 03774
    393 03774
    393 04638
    393 04638
    393 05028
    393 05028
    393 05459
    393 05459

    2 VISION CARE
    3 VISION CARE
    1 HEMATURIA
    2 HEMATURIA
    1 STROKE
    2 STROKE
    1 STROKE
    2 STROKE
    1 EYE DISORDER
    1 RENAL DYSFUNCTION
    1
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 VISION CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    5 SINUSITIS
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS

    393 05459
    393 05459
    393 07493
    393 07493
    393 08121
    393 08121
    393 08121
    393 08121
    394 04077
    394 04077
    394 04077
    394 05027
    394 05275
    394 05684
    394 06243
    394 08386
    394 08386
    394 08387
    395 04639
    395 04639
    395 04639
    395 04640
    395 05280
    395 05280
    395 05280
    395 06577
    395 06577
    395 08388
    396 05276
    396 05276
    397 04132
    397 04132
    397 06692
    398 06695
    398 06695
    398 06695
    398 06695.1
    398 06695.1
    399 06140
    399 06140
    400 04138
    400 04138
    400 04138
    400 04281
    400 04281
    400 04281
    400 04281
    400 04281
    400 04923
    400 04923
    400 04923
    400 04923
    400 04923

    3 SINUSITIS
    4 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 THYROID
    2 THYROID
    3 THYROID
    1
    1 AMMENORRHOEA
    1 CANCER-BREAST
    1
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DEVIATED NASAL SEPTUM
    1 THYROID
    2 THYROID
    1 ANAEMIA
    2 ANAEMIA
    1 ANAEMIA
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 PROSTATE
    2 PROSTATE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC

    400 04923.1
    400 05460
    400 05460
    400 05460
    400 05460
    400 05460
    400 05685
    400 05685
    400 05685
    400 06081
    400 06081
    400 06081
    400 06081
    400 06081
    400 06081.1
    400 06081.1
    400 06081.1
    400 06081.2
    400 08122
    400 08122
    400 08122
    400 08122
    400 08122
    400 08122.1
    401 04133
    401 08541
    401 08541
    401 08541
    401 08542
    401 08543
    401 08544
    401 08544
    401 08544
    402 04135
    402 04135
    402 04135
    402 04135
    402 04135
    402 04136
    402 04136
    402 04136
    402 05278
    402 05278
    403 03652
    403 03652
    403 03652
    403 03652
    403 03652.1
    403 04874
    403 04874
    403 04874
    403 04874
    403 04875

    1 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    5 ALLERGIC REACTION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 HYPERTENSION
    1
    2
    3
    4
    5
    1 HYPERTENSION
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 SINUSITIS
    2 SINUSITIS
    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    4 CANDIDIASIS
    1 CANDIDIASIS
    1
    2
    3
    4
    1 ABDOMINAL PAINS

    403 04875
    403 05713
    403 05713
    404 04134
    404 05277.1
    404 06139
    404 06139
    404 06139
    404 06139
    404 06696
    404 06696
    404 06696
    404 06696
    404 06823
    404 06823
    405 03654
    405 03654
    405 03654
    405 03654
    405 05714
    405 05714
    405 05714
    405 05850
    405 05850
    405 07283
    405 07283
    405 07283
    405 07283
    405 07283
    405 07283.1
    406 03655
    406 03655
    406 03656
    406 05282
    406 05715
    406 05715
    406 05715
    406 07541
    407 04873
    407 05306
    407 05306
    407 05306.1
    407 05306.1
    407 05306.1
    407 05711
    407 05711
    407 05711
    407 05711
    407 08164
    407 08164
    408 04869
    408 04869
    408 04869

    2 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 PAINFUL LEGS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABSCESS
    2 ABSCESS
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    4 COUGH - AIRWAY OBSTRUCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    3 KIDNEY DISEASE
    4 KIDNEY DISEASE
    5 KIDNEY DISEASE
    1 KIDNEY DISEASE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 HYPERTENSION
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    1 BURSITIS
    1 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 HEART
    2 HEART
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    408 04869
    408 04869
    408 04869.1
    408 05544
    408 05544
    408 05544
    408 05544
    408 07797
    408 07797
    408 07797
    408 07797
    408 07797
    408 07797.1
    408 07797.2
    408 07797.2
    408 07797.2
    408 07797.2
    409 07537
    409 07537
    410 03649
    410 03649
    410 03649
    410 03649
    410 07533
    410 07533
    410 07533.1
    410 07533.2
    410 07533.2
    411 07538
    411 07538
    411 07538
    411 07538
    411 07538
    411 07538.1
    411 07538.1
    411 07538.1
    411 08165
    411 08165
    411 08165.1
    411 08165.1
    411 08165.2
    411 08165.2
    411 08166
    412 04871
    412 04871
    412 04872
    412 04872
    413 04131
    413 04131
    413 04131
    413 08540
    413 08540
    414 05708

    4 DEVIATED NASAL SEPTUM


    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    4 HEADACHE- MIGRAINE TENSION
    5 HEADACHE- MIGRAINE TENSION
    1
    1
    2
    3
    4
    1 VISION CARE
    2 VISION CARE
    1 TENDONITIS
    2 TENDONITIS
    3 TENDONITIS
    4 TENDONITIS
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANAEMIA
    2 ANAEMIA
    1 BACK PAIN
    1 ANXIETY
    2 ANXIETY
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE

    415 05710
    415 05710
    415 06697
    415 06697
    415 06697
    415 06697
    415 07534
    415 07534
    415 07534
    415 07534
    415 07534
    415 08163
    415 08163
    416 03653
    416 04139
    416 04139
    416 04876
    416 04876
    416 04876
    416 05281
    416 05281
    416 07535
    416 07535
    416 07535
    416 08167
    417 04137
    417 04137
    418 04866
    418 04866
    418 04866
    418 04866
    418 04867
    418 04867
    418 04867
    418 04867
    418 04867
    418 04867.1
    418 04868
    418 04868
    418 04868
    419 06693
    419 06693
    419 06693
    419 06694
    419 06694
    419 06694
    419 06694
    419 06822
    419 08545
    419 08545
    420 05709
    421 03578
    421 04210

    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    5 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 STROKE
    2 STROKE
    3 STROKE
    1 PAINFUL LEGS
    1 FEVER
    2 FEVER
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 FEVER

    421 04210
    421 04210
    421 04210.1
    421 04210.1
    421 04210.1
    421 04210.1
    421 04210.1
    421 04264
    421 04264
    421 04264
    421 04264
    421 04725
    421 04725
    421 04725
    421 04878
    421 04878
    421 04878
    421 04878
    421 04878
    421 04878.1
    421 04878.1
    421 07507
    421 07507
    421 07507
    421 07507
    421 07507
    421 07507.1
    421 08032.1
    421 08032.1
    421 08032.1
    421 08032.1
    421 08032.1
    421 08172
    421 08172
    421 08172
    421 08438
    421 08884
    422 05656
    422 05656
    422 05656
    422 05656.1
    423 04418
    423 04418
    423 04418
    423 04418
    423 04810
    423 04810
    423 05227
    423 05227
    423 05227
    423 05227
    423 05227
    423 05228

    2 FEVER
    3 FEVER
    1
    2
    3
    4
    5
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE

    423 05228
    424 07027
    424 07027
    424 07027
    425 05897
    425 05897
    425 05897
    425 06825
    425 06825
    425 06825
    426 05896
    426 06039
    426 06039.1
    426 06039.2
    427 03721
    427 06578
    428 03720
    428 03720
    428 04259
    428 04260
    428 05785
    428 05785
    429 03722
    429 03722.1
    429 05659
    429 05659
    429 05659
    429 05659
    429 06541
    429 06541
    429 06541
    429 07664
    429 07664
    429 07664
    429 07664
    429 07664
    430 03576
    430 03576.1
    430 03577
    430 03577
    430 03577
    430 04261
    430 04261
    430 05071
    430 05071
    430 05071.1
    430 05071.2
    430 06185
    430 06185
    430 06186
    430 06186
    430 07382
    430 07382

    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    1 BACK PAIN
    1 FEVER
    2 FEVER
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 VISION CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 PNEUMONIA
    2 PNEUMONIA
    3 PNEUMONIA
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    5 DENGUE
    1 DEVIATED NASAL SEPTUM
    1
    1 DENGUE
    2 DENGUE
    3 DENGUE
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    1
    1 SINUSITIS
    2 SINUSITIS
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 SINUSITIS
    2 SINUSITIS

    430 07382
    430 07382.1
    430 07384
    430 07384
    430 07385
    430 07385
    430 08170
    430 08170.1
    431 04727
    431 04727
    431 04727
    431 05079
    431 05079
    431 05426
    431 05426
    431 05426
    431 07891
    431 07891
    431 07891
    432 05070
    433 05084
    433 05084
    434 06537
    435 04726
    435 04726
    435 07434
    436 05072
    436 05072
    436 05073
    436 05073
    436 05073
    436 05074
    436 05074
    436 05075
    436 05075
    436 05076
    436 05076
    436 05077
    436 05077
    436 05781
    436 05782
    436 05782
    436 05783
    436 05783
    437 07286
    437 07286
    438 04417
    438 04417
    438 04417.1
    438 04646
    438 04646
    438 04646
    439 06532

    3 SINUSITIS
    1 HEART
    1 SINUSITIS
    2 SINUSITIS
    1
    2
    1 HYPERTENSION
    1 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 CERVICAL SPONDYLOSIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1
    2
    1 THYROID
    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    1 GASTRIC - PEPTIC ULCER/GERD

    439 06532
    439 08603
    440 07431
    441 04641
    441 04641
    441 07285
    441 07285
    441 07285
    442 07509
    443 05423
    443 05423
    443 05423
    443 05423
    443 05423
    444 03919
    444 03919
    445 04033
    445 06535
    445 06535.1
    445 08231
    445 08231
    445 08231
    445 09154
    445 04033,1
    446 03580
    446 03580
    446 03581
    446 03581
    446 03581
    446 03582
    446 03582
    446 03582
    446 03582
    446 04408
    446 04409
    446 04410
    446 04411
    446 04412
    446 04412
    446 04645
    446 05653
    446 05653
    446 05653
    446 05653
    446 05654
    446 05654
    446 05654
    446 05654.1
    446 05655
    446 07026
    446 07386
    446 07386
    446 07386

    2 GASTRIC - PEPTIC ULCER/GERD


    1 VISION CARE
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1
    1 ALOPECIA
    1
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 GASTRIC - PEPTIC ULCER/GERD
    1
    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    3 BREAST DISORDERS
    4 BREAST DISORDERS
    1 DENTAL CARE
    1
    1
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 PAINFUL HEEL
    1 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    446 07885
    446 07886
    446 07886
    446 07886
    447 05078
    447 05078
    447 05078
    448 04487
    448 04487
    448 04487
    449 07387
    449 07662
    449 07662
    449 07662
    450 07245
    450 07245
    450 07245
    450 07246
    450 07246
    450 07246.1
    450 07246.1
    450 07887
    450 07887
    450 07887
    450 07888
    450 07890
    451 04142
    451 04142
    451 04142
    451 04142
    451 04142.1
    451 04142.1
    451 04142.1
    451 04142.1
    451 04142.1
    451 04142.2
    451 04142.2
    451 08604
    451 08604
    451 08604
    451 08604
    451 08604
    451 08604.1
    451 08604.1
    452 04422
    452 09006
    453 03579
    453 03579
    454 04140
    454 04140
    454 04140
    454 06531
    454 06531

    1 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MUSCULAR PAIN
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    3
    1 THYROID
    2 THYROID
    1
    2
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 SINUSITIS
    1 THYROID
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    5 ASTHMA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    4 ASTHMA
    5 ASTHMA
    1 ASTHMA
    2 ASTHMA
    1 MISCARRIAGE
    1 DENTAL CARE
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1
    2

    454 06531
    454 06531
    455 05081
    455 06188
    455 06188
    455 06539
    455 07389
    456 05127
    457 04266
    458 03918
    458 03918
    458 03918
    458 03918
    458 03918
    458 04263
    458 04263
    459 04419
    459 04419
    459 05657
    459 07510
    459 07510
    459 07510
    459 07510
    459 07510
    459 07510.1
    460 04423
    460 04424
    460 04424
    460 04647
    460 04648
    460 05786
    460 05786.1
    461 04407
    461 04407
    461 04407
    461 04407
    462 06530
    462 07661
    463 05126
    463 05126
    464 04031
    465 04649
    465 04649
    466 03658
    466 03658
    466 03658.1
    467 04032
    467 04032
    467 04032
    467 08879
    467 08879
    467 08879
    467 08879

    3
    4
    1 DENTAL CARE
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 DENTAL CARE
    1 EYE DISORDER
    1 DENTAL CARE
    1 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 JAUNDICE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 MISCARRIAGE
    1 CERVICAL SPONDYLOSIS
    1 CONSTIPATION
    1
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    1
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 BASAL CELL CARCINOMA
    2 BASAL CELL CARCINOMA
    1 OVARIAN CYST
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE

    467 08879
    468 04141
    468 04141
    468 04141
    468 04141
    468 06533
    468 06533
    468 06533
    468 06533
    468 08497
    468 08497
    468 08497
    468 08497
    469 03659
    469 03659
    469 03659
    469 03659
    469 06534
    470 07388
    470 07388
    471 05869
    472 07543
    472 07543
    472 08304
    472 08304
    472 08304
    472 08304
    473 04642
    473 04642
    473 04642
    473 04642
    473 04642
    474 05492
    474 05492
    474 05492
    474 05492
    474 05492
    474 05492.1
    475 04420
    475 05424
    475 05425
    475 07834
    475 07834
    476 04644
    476 06824
    476 06824
    476 06824
    476 06824
    476 06824
    476 07542
    477 07894
    478 03657
    478 03657

    5 DENTAL CARE
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 TENDONITIS
    2 TENDONITIS
    3 TENDONITIS
    4 TENDONITIS
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 SKIN - LESION
    1 VISION CARE
    2 VISION CARE
    1
    2
    3
    4
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1
    2
    3
    4
    5
    1
    1 MISCARRIAGE
    1 CONSTIPATION
    1 SINUSITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    478 03657
    478 03657
    478 03657
    478 07432
    479 06187
    479 06187
    479 06187
    480 06190
    480 06190
    480 06937
    480 06937
    480 06937
    480 07544
    480 07544
    481 05658
    481 05658
    482 03583
    482 03583
    482 03583
    482 03583
    482 03583
    482 04421
    482 04421
    482 07287
    482 07287
    482 07435
    483 04084
    483 08885
    484 05080
    484 05080
    484 06936
    484 06936
    484 06936
    484 07893
    484 07893
    484 07893
    484 07893
    484 07893
    484 08880
    485 06191
    485 06191
    485 08389
    485 08389
    485 08389
    485 08389
    486 03866
    486 03866
    486 03866
    486 05082
    486 05082
    486 05229
    486 05229
    486 05229

    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    1 FEVER
    1 EYE DISORDER
    2 EYE DISORDER
    1 FEVER
    2 FEVER
    3 FEVER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    4 HEADACHE- MIGRAINE TENSION
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA

    486 05229
    486 08232
    486 08232
    486 08232
    486 08232
    486 08886
    486 08886
    487 05784
    487 05784
    487 09004
    487 09004
    487 09004
    488 04406
    488 04406
    488 06184
    489 06579
    489 06579
    489 06579
    489 06580
    489 06580
    490 04643
    490 04643
    491 03865
    492 06536
    492 06536
    492 06536
    493 05226
    493 05226
    493 05226
    493 08883
    493 08883
    494 08957
    494 08957
    494 08957
    494 08957
    494 08957
    495 04879
    495 04879
    495 04879
    495 05686
    495 05686
    495 05686
    495 05717
    495 05717
    495 05787
    495 07762
    495 07895
    495 07895
    496 08174
    497 03585
    498 06793
    498 06794
    498 06794

    4 AMMENORRHOEA
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 FEVER
    2 FEVER
    3 FEVER
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    1 CIRCUMCISION
    2 CIRCUMCISION
    3 CIRCUMCISION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    1 EYE DISORDER
    2 EYE DISORDER
    1 SKIN - ATOPIC DERMATITIS
    1 HORMONE REPLACMENT THERAPY
    1
    2
    1 CHEST PAIN
    1
    1 ARTHRITIS
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION

    499 08175
    499 08175
    499 08175
    499 08175
    500 04511
    500 04511
    501 05001.1
    501 05001.1
    501 05001.1
    502 03594
    502 03594
    502 03594
    502 05725
    502 05725
    502 05725
    502 05725
    503 05726
    503 05726
    503 05726.1
    503 07443
    503 07443.1
    503 07901
    503 07901
    503 07901
    504 03586
    505 04509
    505 07897
    505 07897
    505 08958
    505 08958
    505 08958
    505 08958
    506 04512
    506 04512
    507 04034
    507 04034
    507 04034.1
    507 04034.1
    507 04514
    507 05002
    507 05002
    507 05002
    507 06796
    507 06796
    507 06796
    507 07028
    507 07900
    508 06044
    508 06044
    508 06044
    508 06044
    508 07440
    508 07440

    1 CYST
    2 CYST
    3 CYST
    4 CYST
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    1 ASTHMA
    2 ASTHMA
    1 HEART
    1 BRONCHITIS - ACUTE
    1 HEART
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 COUGH - AIRWAY OBSTRUCTION
    1 CERVICITIS
    1 CERVICITIS
    2 CERVICITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 TENDONITIS
    2 TENDONITIS
    1
    2
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE

    508 07440
    508 07441
    508 07441
    508 07441
    509 07898
    509 07898
    509 07898
    509 07898.1
    510 05724
    510 06046
    511 05000
    511 05000
    511 06791
    511 06792
    511 06792
    511 07437
    511 07437
    512 06045
    512 06045
    512 06045
    512 06045.1
    513 03593
    513 03593
    513 03593
    513 03593
    513 05722
    513 05722
    513 05722
    513 05722
    514 06041
    514 06041
    514 06041
    514 06041
    514 06042
    514 06042
    514 06042
    514 06042
    514 06043
    515 07438
    515 07438
    515 07438
    516 05718
    516 05718
    516 05718
    516 05718
    516 05718
    516 05718.1
    517 07439
    517 07439
    517 07439
    518 04999
    518 04999
    518 04999

    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1
    1 HEART
    1 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1
    2
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 HYPERTENSION
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    519 03584
    519 03584
    519 08173
    519 08173
    520 03589
    520 03590
    520 04508
    520 04508
    520 04508
    521 06782
    521 06782
    521 06782
    521 06783
    521 06783
    521 06783
    521 06783
    521 06783
    522 06797
    522 06797
    522 07442
    523 05720
    524 04507
    524 04507
    524 04507
    524 04507
    524 04507
    524 04507.1
    524 08503
    524 08503
    525 05870
    525 05870
    525 05870
    525 05870
    525 06795
    525 06795
    525 06795
    525 06795
    525 06795
    526 08959
    526 08959
    526 08959
    527 05721
    527 05721
    527 05721
    528 04506
    528 04506
    528 04997
    528 04997
    529 03587
    529 03588
    529 04504
    529 04505
    529 04505

    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 TONSILLITIS
    2 TONSILLITIS
    1 VISION CARE
    1 VISION CARE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1
    2
    1 DENTAL CARE
    1 VISION CARE
    1 EPILEPSY
    1 TENDONITIS
    2 TENDONITIS

    529 04505
    529 04505
    529 05307
    529 05307
    529 05307
    529 06786
    529 06787
    529 06787
    529 06789
    529 06789
    529 06789
    529 08501
    529 08501
    529 08501
    529 08501.1
    529 08502
    529 08502
    529 08502
    530 05308
    530 05308
    530 05308
    531 04513
    531 04513
    531 04513
    531 04513
    531 04513
    531 04998
    531 04998
    531 04998
    531 04998
    531 04998
    531 04998.1
    531 06040
    531 06040
    531 07896
    531 07896
    531 07896
    532 06790
    532 06790
    533 03591
    533 03591
    533 03591.1
    533 04510
    533 04510
    533 04510
    533 08960
    533 08960
    533 08960
    534 08499
    534 08499
    535 07899
    535 07899
    535 07899

    3 TENDONITIS
    4 TENDONITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 EPILEPSY
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 EPILEPSY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1
    2
    3
    4
    5
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    2 DIAB'ETES
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 RENAL DYSFUNCTION
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    536 04502
    536 04502
    536 04502
    536 04996
    536 04996
    536 06784
    536 06784
    536 06785
    536 07436
    536 07436
    536 07436
    536 07436.1
    536 07436.1
    537 06165
    537 06165
    537 06165
    537 06165
    537 06165
    538 05582
    538 05582
    539 04054
    539 04054
    539 04054
    539 04054
    539 04054
    539 04751
    539 04751
    540 06615
    540 06615
    540 06616
    540 06617
    541 08315
    542 06875
    542 06875
    542 06875
    542 06875
    542 07468
    542 07468
    542 07468
    543 04744
    543 04744
    543 04744
    543 04744
    543 04744
    543 04744.1
    544 05545
    544 05545
    544 05545
    544 06491
    544 06491
    544 06491
    545 06881
    546 07666

    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    1
    2
    1 THROMBOSIS
    2 THROMBOSIS
    1 CANCER-BREAST
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    1 CANCER-BREAST
    2 CANCER-BREAST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 INFECTION THUMB

    547 03783
    547 03783
    547 05232
    547 05232
    547 05232
    547 05232
    548 05236
    548 05236
    549 07133
    549 07133
    549 07133
    549 07134
    549 07134
    549 07134
    549 07134
    549 07134
    549 07134.1
    549 07134.1
    549 07134.1
    549 07134.1
    549 07134.1
    549 07134.2
    550 05794
    550 05794
    550 05970
    551 08511
    551 08511.1
    551 08511.1
    551 08511.1
    552 04150
    552 04330
    552 04330
    552 07840
    553 04151
    553 05806
    553 07088
    554 05971
    554 05971
    554 05971
    554 05971
    554 05971
    554 05973
    554 05973
    554 07672
    554 07672
    554 07672
    555 04817
    555 04817
    555 04817
    555 04817
    555 04818
    555 04818
    555 04818.1

    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 ARTHRITIS
    1 PROSTATE
    1 PROSTATE
    1 PROSTATE
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    4 CHOSTOCHRONDITIS
    5 CHOSTOCHRONDITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 CYSTITIS

    555 04818.1
    555 04818.2
    556 03777
    556 05789
    556 05789
    556 05789
    556 05790
    556 05790
    556 05790
    556 05790.1
    557 07680
    557 07680
    558 04035
    558 04035
    558 04035
    559 06584
    559 06584
    559 06584
    559 06584
    560 05977
    561 03867
    561 03867
    561 03867
    561 03867
    561 03867
    561 03867.1
    561 05486
    561 05486
    561 05486
    561 05486
    562 05231
    562 05231
    562 05231
    562 05231
    562 05231
    563 05233
    563 05233.1
    563 05798
    563 05798
    563 05798
    563 05799
    563 05799
    563 06145
    563 06145
    563 06145
    563 06145
    563 07676
    563 07676
    564 04828
    564 04828
    564 04828.1
    565 05796
    565 05797

    2 CYSTITIS
    1 DIAB'ETES
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DILATION & CURRETAGE
    1 EYE DISORDER
    2 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 EYE DISORDER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ABDOMINAL PAINS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 BACK PAIN
    2 BACK PAIN
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 INTESTINAL COLIC
    1 PAINFUL HEEL
    1 PSORIASIS

    566 08611
    566 08612
    567 03778
    568 05230
    568 05230
    568 05230
    569 05792
    569 05792
    569 05792
    569 05792.1
    570 07675
    570 07675
    570 07675
    570 07675
    570 07675
    571 04823
    571 04823
    572 05805
    572 05805
    572 07683
    572 08517
    573 07079
    573 07079
    573 07079
    573 07080
    573 07080
    574 05801
    574 05801
    575 06583
    576 04816
    576 04816
    576 04816
    576 04816
    576 04816
    577 04812
    577 04812
    577 04812
    577 04812
    577 07837
    577 07837
    577 08505
    577 08505
    577 08505
    577 08505
    577 08505
    578 08514
    578 08514
    578 08514
    578 08514.1
    578 08514.1
    579 06305
    579 06305
    579 06305

    1 DEVIATED NASAL SEPTUM


    1
    1 PAIN-BACK/SHOULDER
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 PROSTATE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 ANXIETY
    2 ANXIETY
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 EYE DISORDER
    2 EYE DISORDER
    1 PAIN-BACK/SHOULDER
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    5 CANCER-BREAST
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    579 06305
    579 06305
    579 06305.1
    579 06306
    579 06306
    579 06306
    579 06307
    579 06307
    580 06144
    580 06304
    580 06304
    580 06304
    580 06304.1
    580 07085
    580 07085
    580 07085
    580 07085
    580 07085
    580 07085.1
    580 07085.1
    581 04825
    581 04825
    581 05975
    581 07678
    581 07678
    582 05234
    582 05234
    582 05235
    582 05235
    582 05235.1
    582 05235.1
    582 05235.1
    583 03787
    583 03787
    583 03787
    583 07679
    583 07679
    583 08395
    583 08395
    583 08395
    584 03788
    584 03788
    584 03788
    585 03775
    585 03775
    585 03775
    585 03775
    585 03775
    585 05788
    585 05788
    586 05974
    587 05791
    587 05791

    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 SOFT TISSUE DISORDERS/DISEASE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERTENSION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1
    2
    1 ANXIETY
    2 ANXIETY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 CHEST PAIN
    2 CHEST PAIN
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    5 CATARACT
    1 CATARACT
    2 CATARACT
    1 EYE DISORDER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION

    587 05791
    587 05791
    588 03925
    588 05803
    588 05978
    589 07084
    590 03789
    590 04827
    590 05804
    590 05804
    591 07677
    591 07677
    591 07677
    592 04328
    592 04328
    592 04328
    592 04328
    592 05795
    592 07082
    592 07082
    592 07082
    592 07082
    592 07082
    593 06142
    593 07670
    593 07670
    593 07670
    593 07670
    593 07839
    594 04821
    594 04821
    594 04821
    594 04821
    594 07081
    594 07081
    595 08613
    596 07682
    596 07682
    596 07682
    596 07682
    597 04822
    597 08393
    598 07684
    598 07684
    598 07685
    598 07685
    598 07685
    598 07685
    599 03921
    599 03921
    599 03921
    599 06582
    599 06582

    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 SKIN - LOCAL INFECTION
    1 BONE & CARTILAGE DISORDER
    1
    1
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 STONE - URETER
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    5 TONSILLITIS
    1 SKIN - ATOPIC DERMATITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PAINFUL HEEL
    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    4 CANDIDIASIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 RENAL DYSFUNCTION
    1 CONSTIPATION
    1 SINUSITIS
    2 SINUSITIS
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD

    599 06582
    599 06582
    600 06141
    600 06141
    600 06141
    601 03920
    601 03920
    602 03923
    603 06622
    604 04148
    604 04148
    604 04148
    604 04148.1
    604 04148.1
    604 04149
    604 04149
    604 04149
    604 04811
    604 04811
    604 06618
    604 06618
    604 06618
    604 06619
    604 06619
    604 07078
    604 07078
    605 07687
    605 07687
    605 07687
    605 07687
    606 06621
    606 06621
    607 04813
    607 04813
    607 04813
    607 04813
    607 07669
    608 03922
    608 03922
    609 03782
    610 04829
    610 04829
    610 04829
    611 04830
    611 04830
    611 04830
    612 08516
    612 08516
    612 08516
    612 08516
    613 06699
    613 06699
    614 05793

    3 GASTRIC - PEPTIC ULCER/GERD


    4 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    3
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    1 MUSCULAR PAIN
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 DEVIATED NASAL SEPTUM
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CYST
    2 CYST
    3 CYST
    4 CYST
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 PAIN-BACK/SHOULDER

    614 05969
    614 07671
    614 08392
    615 05851
    615 08606
    615 08606
    615 08606
    616 04577
    616 04577
    616 04577
    617 04924
    617 04924
    617 04924
    617 05998
    617 05998
    618 06698
    618 06698
    618 06698
    618 06698
    618 07838
    618 07838
    618 07838
    618 07838
    618 07838
    619 04578
    619 04578
    619 04652
    619 04653
    619 04654
    619 07135
    619 08009
    619 08009
    620 05727
    620 05852
    620 05852
    620 05852
    620 08610
    620 08610
    620 08610.1
    620 08610.1
    621 07763
    621 07763
    621 07763
    622 05283
    622 05283
    622 07136
    622 07136
    623 05728
    623 05728
    623 05728
    624 07466
    624 07466
    625 07512

    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1 BACK PAIN
    1 ALLERGIC REACTION
    1 PHIMOSIS
    2 PHIMOSIS
    3 PHIMOSIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CATARACT
    2 CATARACT
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 SKIN - LOCAL INFECTION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 TENDONITIS
    2 TENDONITIS
    1 DIAB'ETES
    2 DIAB'ETES
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEART- ISCHEMIC HEART DISEASE
    2 HEART- ISCHEMIC HEART DISEASE
    1 HEART- ISCHEMIC HEART DISEASE
    2 HEART- ISCHEMIC HEART DISEASE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PROSTATE
    2 PROSTATE
    1 DENTAL CARE

    625 07512
    625 07512
    625 07512
    626 07514
    626 07514
    626 07514
    626 07514
    626 07514.1
    626 07514.1
    626 08614
    626 08614
    627 05856
    628 06798
    628 06798
    629 04581
    629 05666
    629 05857
    629 05857
    629 06000
    629 06000
    629 06623
    629 06980
    629 06980
    629 07446
    630 05329
    631 04658
    631 04658
    631 04658.1
    631 04658.1
    632 04728
    632 04728
    632 05330
    632 05330
    632 05330
    632 05330
    632 05330
    633 05171
    633 05171
    633 05171
    633 05171
    634 04580
    634 04580
    634 05284
    634 05284
    634 06700
    634 06700
    634 06700
    635 06620
    635 06620
    636 04211
    637 05665
    637 08010
    638 04579

    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 EYE DISORDER
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    1 SKIN - ATOPIC DERMATITIS
    1 PAIN-BACK/SHOULDER
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    1 BONE & CARTILAGE DISORDER
    1
    2
    1 CERVICAL SPONDYLOSIS
    1 HYPERTENSION
    1 GLAUCOMA
    2 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    1 CHEST PAIN
    1
    1 GASTRIC - PEPTIC ULCER/GERD
    1 TONSILLITIS

    638 04579
    638 07445
    638 07445
    638 07445
    639 05662
    639 05662
    639 05662
    639 05662
    639 05662
    640 07029
    640 07029
    641 03874
    641 03874
    641 03874
    641 03874.1
    641 03874.1
    641 07139
    641 07139
    641 07139
    641 07139
    641 07513
    641 07513
    641 07513
    641 07513
    641 07513.1
    642 05331
    642 05331
    643 03873
    643 03873
    643 03873
    643 03873
    644 05663
    644 05663
    644 05663
    644 05663
    644 05663
    644 05663.1
    645 05858
    645 07841
    646 06084
    647 05999
    647 05999
    648 07444
    648 07444
    648 07444
    649 03604
    650 07511
    650 07511
    650 07511
    651 04655
    652 05854
    652 05854
    653 07836

    2 TONSILLITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    1 DILATION & CURRETAGE
    1 GLAUCOMA
    2 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    1 MISCARRIAGE
    1 EAR DYSFUNCTION
    1 FEVER
    1 GLAUCOMA
    2 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HEMORRHOIDS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGIC REACTION
    1 EYE DISORDER
    2 EYE DISORDER
    1 CHEST PAIN

    653 07836
    654 04925
    654 08607
    654 08607
    654 08607
    654 08609
    654 08609
    655 05855
    655 06085
    656 04656
    656 04656
    656 04656
    656 04656
    656 04656
    656 06270
    657 07835
    657 07835
    658 04329
    658 04329
    658 06143
    659 03779
    659 03779
    659 03779
    659 03780
    659 03780
    659 03781
    659 03781
    660 04327
    660 04327
    660 04327
    660 04327.1
    660 05968
    660 05968
    660 05968
    661 03776
    661 03776
    662 06581
    663 06148
    664 05976
    665 05802
    665 05802
    665 05802
    665 05802
    666 03784
    666 03784
    666 03784
    666 03784
    666 06147
    666 07087
    666 07087
    666 07087
    667 04819
    667 04819

    2 CHEST PAIN
    1 BACK PAIN
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DILATION & CURRETAGE
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 HYPERTENSION
    1 FEVER
    2 FEVER
    3 FEVER
    1
    2
    1 STONE - URETER
    1
    1 EYE DISORDER
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    4 CIRCULATORY DISORDER
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    3 SKIN - LOCAL INFECTION
    4 SKIN - LOCAL INFECTION
    1 OVARIAN CYST
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE

    667 04819
    667 04820
    667 04820
    667 04820
    667 08513
    667 08513
    667 08513
    667 08513
    668 03793
    668 03793
    668 03793
    668 08019
    668 08019
    669 03790
    670 08018
    670 08018
    670 08018
    671 03792
    671 03792
    671 03792
    671 03792
    672 08016
    672 08016
    672 08017
    673 03791
    673 03791
    674 08258
    674 08258
    674 08258
    674 08258
    675 04152
    675 04152
    675 04152
    676 08259
    676 08259
    677 06871
    677 06871
    678 08306
    678 08306
    678 08306
    679 03986
    680 06244
    680 06244
    680 06244
    681 06802
    681 06802
    681 06802
    682 06803.1
    682 06803.1
    682 06803.1
    682 06803.1
    682 06803.1
    683 07338

    3 VISION CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    5 DILATION & CURRETAGE
    1 VISION CARE

    684 08519
    684 08519
    684 08519
    684 08519
    685 04282
    685 04282
    685 04282
    686 06272
    686 06272
    686 06272
    686 06273
    686 06273
    686 06273
    687 03806
    687 03807
    687 03807
    687 04215
    687 04216
    687 06246
    688 04591
    689 04214
    689 04214
    689 04214
    689 06593
    689 06593
    689 06593.1
    689 06594
    689 06594
    689 06594.1
    690 03513
    690 07999
    690 07999
    690 07999
    691 06592
    691 06592
    692 08624
    692 08624
    693 05362
    693 05362.1
    693 05362.1
    693 05362.2
    693 05362.2
    694 05871
    694 05871
    694 05871
    694 05871
    694 05871
    694 05871.1
    695 03805.2
    695 03805.2
    695 03805.2
    695 03805.2
    695 03805.2

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1
    2
    1 FRACTURE - HAND BONES
    1 FRACTURE - HAND BONES
    1 KNEE INTERNAL DERANGEMENT
    1 DIAB'ETES
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    1
    1 VARICOSE
    2 VARICOSE
    1 HORMONE REPLACMENT THERAPY
    1 FEVER
    1
    2
    3
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 ASTHMA
    2 ASTHMA
    1
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    1 APPENDICITIS
    2 APPENDICITIS
    3 APPENDICITIS
    4 APPENDICITIS
    5 APPENDICITIS

    695 03805.3
    695 03805.3
    695 04156
    695 04156
    695 04156.1
    695 04156.2
    695 04521
    695 04521
    696 06245
    697 04522
    698 07449
    698 07449
    698 07449
    698 07449.1
    699 03936
    699 03936
    699 03936
    699 03936
    699 03937
    699 03937
    699 03937
    699 03938
    699 03938
    700 03519
    700 03519
    700 03519
    700 03519
    700 03519
    700 03519.1
    700 03519.1
    700 03519.1
    700 04697
    700 04697
    700 04697
    700 04697
    700 04698
    700 04698
    700 04698
    700 04698
    700 04699
    700 04699
    700 04699
    700 04699
    700 04700
    700 04700
    700 04700
    700 04700
    700 04700
    700 04701
    700 04701
    700 04701
    700 04701
    700 04701

    1 APPENDICITIS
    2 APPENDICITIS
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    1
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    700 06705
    700 06705
    700 06705
    700 06705
    700 06705
    700 06705.1
    701 04080
    701 04080
    701 04080
    701 04080
    701 08967
    701 08967
    701 08967
    701 08968
    701 08968
    702 04702
    702 04702
    702 04702
    702 04702
    702 04703
    702 04703
    702 04703
    702 04703
    702 04703
    703 04704
    703 04704
    703 04704
    703 04704
    704 06711
    704 06711
    704 06711
    704 07215
    704 07216
    704 07216
    704 07217
    704 07217
    705 07034
    705 07034
    705 07034
    706 08037
    706 08037
    706 08037.1
    706 08038
    707 04082
    707 04082
    707 04082
    707 04082
    707 05312
    707 05312
    707 05312
    707 05312
    707 05312
    708 07035

    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    5 OVARIAN CYST
    1 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 ARTHRITIS
    1 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE

    708 07035
    708 07036
    708 07036
    708 07036
    708 08969
    709 05310
    709 05310
    709 05311
    709 05311
    709 05311
    710 07033
    710 07033
    710 07033
    710 08039
    710 08039
    710 08039
    711 08520
    711 08520
    711 08520
    712 04696
    712 04696
    713 04079
    713 04079
    713 04079
    713 04079
    714 04081
    714 04081
    714 04081
    714 04081.1
    714 04081.1
    714 06709
    714 06709
    714 06709
    714 06710
    715 04705
    715 04706
    715 04706
    715 04706
    716 05091
    716 05091
    716 05091
    716 08562
    716 08562
    717 08556
    717 08556
    718 04218
    718 04218
    718 04218
    718 04218
    718 04219
    718 04219
    718 04219
    718 06322

    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 AMMENORRHOEA
    1
    2
    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 ANAEMIA
    2 ANAEMIA
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    1 DENTAL CARE
    1 DENTAL CARE
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 HEMORRHOIDS

    718 06322
    718 06322
    718 06323
    718 06323
    718 07317
    719 07309
    719 07309
    720 06325
    720 06325
    720 06325.1
    720 06325.1
    720 06325.1
    720 06325.1
    720 06325.2
    721 06986
    721 06986
    722 06987
    722 06987
    722 06987
    722 06987
    722 06988
    722 06988
    722 06989
    722 06989
    722 06989
    722 06989
    723 05431
    723 07315
    723 07315
    723 07315
    723 07316
    723 07316
    723 07316
    723 08561
    723 08561.1
    724 06317
    724 07848
    724 07848
    724 07848
    724 07848
    725 05429
    725 05429
    725 05429
    725 05429
    725 05429
    725 05429.1
    725 05430
    726 06320
    726 06320
    726 06320
    727 03607
    727 03607
    727 05090

    2 HEMORRHOIDS
    3 HEMORRHOIDS
    1 TONSILLITIS
    2 TONSILLITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    1
    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 DENTAL CARE

    727 07312
    727 07312
    727 07313
    727 07314
    728 07318
    728 07318
    728 07318
    728 07319
    728 07319
    728 07319
    728 07851
    729 05088
    729 05088
    729 05089
    729 05089
    729 05089
    729 08555
    729 08555
    729 08555
    730 05010
    730 05010
    730 05010
    730 05010
    730 05010
    731 06319
    731 06319
    731 06319
    732 05810
    732 05810
    732 05811
    732 05811
    732 06098
    732 06098
    732 06098
    732 07390
    732 07390
    732 07390
    732 07391
    732 07391
    732 07391
    733 08563
    734 07849
    734 07849
    734 07849
    734 07849
    735 04222
    735 04222
    735 04222
    735 04222
    736 05092
    737 06984
    737 06984
    737 06984

    1
    2
    1 VISION CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    5 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE

    737 06984
    737 07311
    737 07311
    738 08554
    738 08554
    738 08554
    738 08554
    739 06313
    739 06313
    739 06313
    739 06313
    739 06313
    740 04217
    740 05087
    740 05087
    740 05087
    740 06315
    740 06982
    740 07308
    740 08558
    740 08558
    740 08558
    741 04220
    741 04220
    741 04220
    741 04220
    741 04221
    741 04221
    741 04221
    741 04221
    742 04223
    742 04223
    743 06321
    743 06321
    743 06321
    743 06321
    743 06321
    744 06316
    744 06316
    744 06316
    745 04224
    745 04224
    745 05094
    745 06324
    745 06324
    745 06324
    745 06324
    745 06324
    746 05093
    746 05093
    747 07850
    747 07850
    747 07850

    4 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    1 DENGUE
    2 DENGUE
    3 DENGUE
    4 DENGUE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CHEST PAIN
    2 CHEST PAIN
    1 ALLERGIC REACTION
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    747 07850
    748 06627.2
    748 06627.2
    748 06627.2
    748 06627.2
    748 06627.2
    748 06627.3
    748 06627.3
    748 06627.3
    748 06627.3
    748 06627.3
    749 05734
    749 05734
    749 05734
    750 05735
    750 05735
    750 05735
    750 07037
    751 05736
    751 05736
    751 05736
    752 06629
    752 06629
    752 06629
    753 07552
    753 07552
    753 07552
    754 08125
    754 08307
    754 08307
    754 08307
    755 05558
    755 05558
    755 05558
    755 05558
    755 05558
    755 05558.1
    755 05560
    755 05560
    755 05560
    755 05561
    755 05561
    755 05561
    755 07852
    755 07852
    755 07852
    755 07852
    756 04044
    756 04044
    756 04044
    756 04044
    756 04044
    756 04588

    4 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 PAIN-BACK/SHOULDER
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    5 CANCER-BREAST
    1 PROSTATE

    756 04588.1
    756 04588.1
    756 04739
    756 04740
    756 05562
    756 05562
    756 05562
    756 05562
    756 05562
    756 05562.1
    756 05564
    756 05565
    756 06502
    756 06503
    756 06713.1
    756 06713.1
    756 06713.1
    756 06713.1
    756 08041
    756 08042
    756 08043
    756 08043
    756 08043
    756 08308
    756 08308
    756 08308.1
    757 07224
    757 07224
    757 07224
    757 07224
    757 07224
    758 05566
    758 05566
    758 05566
    758 05567
    758 05567
    758 08702
    758 08704
    758 08704
    759 04046
    759 04046
    759 04047
    759 04048
    759 04048
    759 04742
    759 05571
    759 06152
    759 06878
    759 07228
    759 07229
    759 07229
    759 07469
    759 08309

    1 PROSTATE
    2 PROSTATE
    1 CANCER-BREAST
    1 HYPERTENSION
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    4 CANCER-BREAST
    5 CANCER-BREAST
    1 CANCER-BREAST
    1 HYPERTENSION
    1 HYPERTENSION
    1 SKIN - ECZEMA
    1 CANCER-BREAST
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    3 FRACTURE - HAND BONES
    4 FRACTURE - HAND BONES
    5 FRACTURE - HAND BONES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    1 VISION CARE
    2 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 PAIN-BACK/SHOULDER
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 PAIN-BACK/SHOULDER
    1 PAIN-BACK/SHOULDER

    760 05579
    760 05579
    761 04744.2
    761 04744.2
    761 04744.2
    761 04744.2
    761 04744.2
    761 04744.3
    761 04744.3
    761 04744.3
    761 04744.3
    761 05580
    761 05580
    761 05580
    761 06715
    761 06715
    761 06716
    761 06716
    761 08310
    761 08310
    761 08310
    761 08310
    762 05584
    762 05584
    763 05585.1
    763 05585.1
    763 05585.1
    763 05585.1
    763 05585.1
    764 05587
    764 05587
    764 05588
    764 05588
    764 06879
    764 06879
    764 07856
    764 07856
    764 07856
    764 07856
    764 08706
    764 08706
    765 06505
    765 06505
    765 06505
    765 06505
    765 06505.1
    766 06507
    766 06507
    766 06507
    766 08709
    766 08709
    767 04053
    767 04053

    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ALOPECIA
    2 ALOPECIA
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 BACK PAIN
    2 BACK PAIN
    1 SINUSITIS
    2 SINUSITIS
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    1 CHlCKEN POX
    2 CHlCKEN POX
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1
    1 CERVICITIS
    2 CERVICITIS
    3 CERVICITIS
    1
    2
    1 EYE DISORDER
    2 EYE DISORDER

    767 06718
    767 06718
    767 06881.1
    767 06881.1
    767 07397
    767 07397
    767 07397
    767 07397
    768 05037
    768 05037.1
    768 05037.1
    768 05037.2
    768 05037.2
    768 05037.3
    768 05037.4
    768 05037.5
    768 05592
    768 05592
    768 05592
    768 05592
    768 05593
    768 05593
    768 05593
    768 05593
    768 05594
    768 05594
    768 05594
    768 05594
    768 05812
    768 05812
    768 06882
    768 06882
    768 06882
    768 06882
    768 08311
    768 08311
    768 08311.1
    769 04750
    769 04750
    769 04750
    770 04054.1
    770 04054.1
    770 04054.1
    770 04054.1
    770 04054.1
    770 04054.2
    770 04054.2
    770 04054.2
    770 04055
    770 04055
    770 04055
    770 04055.1
    770 04751.1

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 CANDIDIASIS
    1 ANAEMIA
    2 ANAEMIA
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 BREAST DISORDERS
    1 CERVICAL SPONDYLOSIS
    1 LIVER CIRRHOSIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 THYROID
    2 THYROID
    3 THYROID
    4 THYROID
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 CERVICAL SPONDYLOSIS
    1 DENTAL CARE

    770 04751.1
    770 04751.1
    770 04751.1
    770 08712
    770 08712
    771 04931
    771 04931
    771 04932
    771 04932
    771 04932
    771 05595
    771 06161
    771 06161
    771 06990
    771 06990
    771 06990
    771 06990
    771 08044
    772 08713
    772 08714
    773 06165.1
    773 06165.1
    773 06165.1
    773 06165.1
    773 06165.1
    773 06165.2
    773 07471
    773 07471
    774 06883
    774 06883
    774 06884
    774 06884
    774 06885
    774 06885
    774 06886
    774 06887
    774 06887
    774 08973
    774 08973
    774 08973
    775 04064
    775 08315.1
    775 08315.1
    775 08974
    776 06169
    776 06169
    777 04737
    777 04737
    777 04737
    778 06875.1
    778 06875.1
    778 06875.1
    778 07468.1

    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 EYE DISORDER
    2 EYE DISORDER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    2
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DILATION & CURRETAGE
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    1 BURSITIS
    2 BURSITIS
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE

    778 07468.1
    778 07468.1
    778 07468.1
    778 07468.1
    779 05130
    779 05130
    779 05130
    779 07038
    779 07038
    779 07038
    779 07038
    779 07038
    779 07038.1
    779 07038.1
    780 05581
    780 05582.1
    780 05582.1
    780 05582.1
    780 07854
    780 07854
    780 07854
    781 04056
    781 04057
    781 04057
    781 04057
    781 06162
    781 06162
    781 06162.1
    782 07234
    782 07234
    782 07234
    782 07234
    783 04062
    783 04062
    783 04063
    783 05598
    783 07859
    783 07859
    783 07859
    783 07859
    783 07859
    784 05557
    785 02244
    785 02244
    785 02244
    786 07470
    786 07470
    786 07470
    787 03521
    787 03521
    787 03521
    787 04049
    787 04049

    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1 EYE DISORDER
    2 EYE DISORDER
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    1 HYPERTENSION
    1
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE

    787 04049
    787 04049
    787 04049
    787 04050
    787 04746
    787 05583
    787 06717
    788 04747
    788 04747
    788 04747
    788 04747
    788 04747
    788 04747.1
    788 06880
    788 06880.1
    788 08707
    788 08707
    788 08707
    789 04045
    789 04045
    789 07222
    789 07222
    789 07222
    789 07222
    790 04432
    790 04432
    790 04432
    790 06154
    790 06154
    790 06154
    790 06155
    790 06155
    790 06157
    791 05556
    791 05556.1
    791 05556.2
    791 06874
    791 06874
    791 07221
    792 05572
    792 05572
    792 05572
    792 05572
    792 06153
    792 06153
    793 03878
    793 03878
    793 03878
    793 04052
    793 04052
    794 06712
    794 06712
    794 06712

    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 CONJUNCTIVITIS - EYE
    1 ALLERGIC REACTION
    1 FEVER
    1 ABDOMINAL PAINS
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    2
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICITIS
    2 CERVICITIS
    3 CERVICITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 FEVER
    1 CERVICAL SPONDYLOSIS
    1 DEVIATED NASAL SEPTUM
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1
    2
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    795 04058
    795 04752
    795 05596
    795 06508
    795 08045
    796 08128
    796 08128
    796 08128
    796 08129
    796 08129
    796 08129
    796 08129
    796 08129
    796 08130
    797 08314
    797 08314
    797 08314
    797 08314
    798 04749
    799 08701
    800 06158
    800 06158
    800 06158
    801 06511
    802 04059
    802 04059
    802 04059
    802 04059
    802 04060
    802 04060
    803 06167
    803 06167
    803 06167
    803 06167
    803 08715
    804 04061
    804 04061
    804 06720
    804 06720
    804 08716
    804 08716
    805 06160
    805 06160
    805 06160
    806 07800
    806 07800
    806 07800
    806 08453
    806 08453
    806 08453
    806 08453
    807 04051
    807 04051.1

    1 ANXIETY
    1 HEART- ISCHEMIC HEART DISEASE
    1 ANXIETY
    1 DEPRESSION
    1 DEPRESSION
    1 JAUNDICE
    2 JAUNDICE
    3 JAUNDICE
    1 PHIMOSIS
    2 PHIMOSIS
    3 PHIMOSIS
    4 PHIMOSIS
    5 PHIMOSIS
    1 OTITIS - EAR
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 VISION CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 HEMORRHOIDS
    2 HEMORRHOIDS
    1 FEVER
    2 FEVER
    3 FEVER
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    3 SKIN - LOCAL INFECTION
    4 SKIN - LOCAL INFECTION
    1 EYE DISORDER
    1 ALLERGIC RHINITIS

    807 05597
    807 05597.1
    807 06719
    807 06719
    807 06719
    807 06719
    807 07857
    807 07857
    808 08316
    808 08719
    808 08719
    809 05599
    809 05599
    809 05599.1
    809 05599.1
    809 06168
    809 06168
    809 06168
    810 04748
    810 04748
    811 08050
    811 08050
    811 08050
    812 08046
    812 08046
    812 08046
    812 08046
    812 08046
    812 08046.1
    812 08046.1
    812 08046.1
    812 08048
    813 08313
    813 08313
    813 08313
    814 04741
    814 04741
    814 04741
    814 06714
    814 06714
    814 08705
    814 08705
    815 04753
    815 04753
    815 08717
    815 08717
    815 08717
    816 07232
    816 07232
    816 07232
    816 07233
    816 07233
    816 07233

    1 ALLERGIC RHINITIS
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1
    1 VISION CARE
    2 VISION CARE
    1 THYROID
    2 THYROID
    1 DEPRESSION
    2 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ANXIETY
    2 ANXIETY
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 NASAL POLYP
    2 NASAL POLYP
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    816 07233
    817 06166
    818 06151
    818 06151
    818 06151
    818 06151
    819 07855
    819 07855
    820 04738
    820 04738
    820 04738
    820 07467
    820 07467
    820 07467
    821 08708
    821 08708
    821 08708
    821 08708
    822 06149
    822 06150
    823 06504
    823 06504
    823 06504
    823 06504
    824 05600
    824 05600
    824 05600
    825 06163
    825 06163
    825 06164
    825 06509
    825 06509
    825 06510
    826 07231
    826 07231
    826 07231
    826 07231
    827 07223
    827 07223
    827 07853
    828 08972
    828 08972
    828 08972
    828 08972
    829 04103
    829 04103
    830 04104
    830 04104
    830 04104
    830 07473
    830 07473
    831 04934
    831 04934

    4 DENTAL CARE
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 HEMORRHOIDS
    1 TONSILLITIS
    2 TONSILLITIS
    1 RENAL DYSFUNCTION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 HERPES ZOSTER
    2 HERPES ZOSTER
    1 VARICOSE
    2 VARICOSE

    832 06199
    832 06199
    832 08721
    832 08721
    832 08721
    832 08722
    832 08723
    832 08723
    833 05131
    833 05131
    833 05131
    833 05131
    833 05131
    833 05131.1
    833 05131.1
    834 07576
    834 07576
    835 04433
    835 04433
    835 04433
    835 04592
    835 04592
    835 04592.1
    835 04593
    835 06326
    835 06326
    835 06806
    835 06806
    835 07235
    835 07235
    835 07235
    835 07236
    835 07236
    835 07236
    835 07236
    835 07236
    836 06200
    836 06200
    837 07040
    837 07040
    837 07040
    837 07040
    838 06327
    838 06327
    838 06327
    838 07860
    838 07860
    838 07860
    839 05132
    839 05132
    839 08176
    839 08176
    840 04105

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 ALLERGIC RHINITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 TENDONITIS
    2 TENDONITIS
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 CONJUNCTIVITIS - EYE
    1
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    3 EAR DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1

    840 04105
    841 05177
    841 05177
    841 05177
    841 05179
    841 05179
    841 05179
    841 07363
    841 07363
    841 07363
    841 08646
    841 08646
    841 08646
    841 08647
    841 08647
    842 05251
    842 05251
    843 03548
    843 03548
    843 03548
    843 03996
    843 03996
    843 03996
    843 03996
    843 03996
    843 03996.1
    843 03996.1
    843 06897
    843 06897
    843 06898
    843 06898
    843 06898
    844 04000
    844 04000
    845 03537
    845 03537
    845 03537
    845 03537
    846 06409
    846 06409
    846 08415
    846 08415
    846 08415
    847 05255
    847 05255.1
    847 05255.1
    847 05256
    847 05256
    847 05256
    847 05256
    847 05256
    847 05256.1
    847 05256.1

    2
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1 LUNG DISEASE
    2 LUNG DISEASE
    3 LUNG DISEASE
    1 LUNG DISEASE
    2 LUNG DISEASE
    3 LUNG DISEASE
    1
    2
    3
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 VISION CARE
    2 VISION CARE
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    3 HYPERLIPIDERMIA
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    4 OTITIS - EAR
    5 OTITIS - EAR
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    1 HYPERLIPIDERMIA
    2 HYPERLIPIDERMIA
    3 HYPERLIPIDERMIA
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 HEART
    2 HEART
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    5 OVARIAN CYST
    1 HEART
    2 HEART

    - CHOLESTEROL
    - CHOLESTEROL
    - CHOLESTEROL

    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL
    CHOLESTEROL

    847 07298
    847 07298
    847 07299
    847 07299
    848 05635
    848 05635
    849 03992
    849 03992
    849 03992
    849 05252
    849 05252
    849 05252
    849 05987
    849 05987
    849 05987
    849 05987
    849 06415
    849 06415
    849 06415
    849 07296
    849 07296
    849 07296
    850 07301
    850 07301
    851 04293
    851 04293
    851 04293
    851 07561
    851 07561
    851 07561
    852 04291
    852 04291
    853 03550
    853 03550
    853 03550
    854 05988
    854 05988
    855 06903
    855 06903
    855 06903.1
    855 06903.1
    856 07294
    857 05989
    857 05989
    857 05989
    858 04762
    858 04762
    859 07559
    860 07557
    860 07557
    860 07557
    861 04299
    861 04299

    1 OTITIS - EAR
    2 OTITIS - EAR
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 CATARACT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS

    862 08416
    862 08416
    863 05615
    863 05615
    864 05260
    864 05260
    864 05260
    864 06460
    864 06460
    864 06460
    865 02467.1
    865 02467.1
    865 02467.1
    866 03616
    866 03616
    867 06445
    867 06445
    867 07558
    867 07558
    868 04292
    868 04292
    869 06900
    869 06900
    869 06900
    869 06901
    869 06902
    870 04767
    870 04767
    870 05261
    870 05633
    870 05991
    870 06462
    870 06462
    871 03999
    871 03999
    871 03999
    872 06444
    872 06444
    872 06444
    873 03536
    873 03536
    873 03536
    873 03536
    873 03536
    874 03993
    874 03993
    874 03993
    875 03822
    875 03822
    875 03822
    875 03822
    875 05253
    875 05253

    1 COUGH - AIRWAY OBSTRUCTION


    2 COUGH - AIRWAY OBSTRUCTION
    1 HYPERTENSION
    2 HYPERTENSION
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    3
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 BONE & CARTILAGE DISORDER
    1 VISION CARE
    1 TRAUMA
    2 TRAUMA
    1 BREAST DISORDERS
    1 INJURY - UNSPECIFIED
    1
    1 CYST
    2 CYST
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    875 05253
    875 05253
    875 05506
    875 05506
    875 05506
    875 06033
    875 06033
    875 06033
    875 06033
    875 06033
    875 07554
    876 07293
    876 07293
    876 07293
    876 08413
    876 08413
    876 08413
    876 08414
    876 08414
    876 08414
    877 06414
    877 06414
    878 05990
    878 05990
    879 05254
    879 05254.1
    879 07705
    879 07705
    879 07705
    879 07705
    879 07705
    879 07705.1
    880 03543
    880 04764
    880 04764
    880 04764
    880 05257
    880 05257
    881 03546
    881 03546
    882 05985
    882 05985
    883 03544
    883 03544
    884 03541
    884 03541
    884 03542
    884 03542
    884 05627
    884 06442
    885 06412
    885 06412
    885 06412

    3 DEVIATED NASAL SEPTUM


    4 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    5 ANAEMIA
    1 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 TENDONITIS
    1 DIAB'ETES
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 AMMENORRHOEA
    1 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 URTICARIA
    2 URTICARIA
    1 HYPERTENSION
    1 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    886 04298
    886 04298
    886 04298
    886 05262
    886 05262
    886 05262
    886 05634
    887 03540
    887 03540
    887 07556
    887 07556
    887 07556.1
    887 07556.1
    887 07556.1
    888 05986
    888 05986
    889 06896
    889 06896
    890 04763
    890 07297
    890 07297
    890 07297
    891 03553
    891 03553
    891 06473
    891 06473
    891 06473
    891 06473
    891 06473.1
    891 06473.1
    891 06473.1
    892 03539
    892 03539
    892 03539
    892 03539
    892 06068
    892 06068
    892 06068
    892 06068
    893 07555
    893 07555
    893 07555
    894 03994
    894 03994
    894 03994
    894 06439
    894 06439
    894 06439
    894 06440
    894 06440
    895 04766
    895 04766
    895 04766

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 VISION CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 TONSILLITIS
    2 TONSILLITIS
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 CERVICITIS
    2 CERVICITIS
    3 CERVICITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 ANAEMIA
    2 ANAEMIA
    1 FEVER
    2 FEVER
    3 FEVER

    895 04766
    895 06899
    895 06899
    895 07300
    895 07300
    895 07300
    895 07300
    896 05258
    896 05258
    897 04761
    897 04761
    897 04761
    898 06999
    898 06999
    898 06999
    898 06999
    898 06999
    898 06999.1
    898 06999.1
    898 06999.1
    898 06999.1
    898 06999.1
    898 06999.2
    898 06999.2
    899 06019
    899 06019
    899 06019
    899 06020
    899 06020
    899 06020
    899 06020
    899 06020
    899 06020.1
    899 06020.1
    900 04381
    900 04381
    900 04381
    900 04381.1
    900 04381.1
    900 04382
    900 04382.1
    900 06729
    900 06729
    900 07413
    900 07413
    900 07413
    900 07413
    900 07413
    901 03830
    901 04184
    901 04947
    901 04947.1
    901 04948

    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    4 BRONCHITIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 ABSCESS
    2 ABSCESS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 LACERATION TO FOOT
    2 LACERATION TO FOOT
    1 VISION CARE
    1 EYE DISORDER
    1
    2
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1 ABDOMINAL PAINS
    1 GLAUCOMA
    1 HYPERTENSION
    1 HYPERTENSION
    1 GLAUCOMA

    901 05182
    901 05182
    901 05182
    901 05322
    901 05322.1
    901 06432
    901 06432.1
    901 06432.2
    901 06997
    901 06997
    901 07603
    901 08282
    901 08282.1
    901 08648
    901 08648
    901 08649
    901 08649
    902 05875
    902 05875.1
    902 05875.1
    902 05875.2
    902 07458
    902 07458.1
    902 07458.2
    903 08653
    903 08653
    903 08653
    904 07610
    904 07610
    905 04203
    905 04203
    905 04962
    906 06678
    906 06678
    907 06413
    907 06413
    908 05323
    908 05323
    909 03836
    909 03836
    909 03836
    909 07107
    909 07108
    909 07108
    909 07109
    910 05744
    910 05744
    910 05744
    910 06452
    910 06452
    910 06452
    910 06452
    910 06453

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    1 ASTHMA
    1 GLAUCOMA
    1 HYPERTENSION
    1 ASTHMA
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 HYPERTENSION
    1 THYROID
    1 HYPERTENSION
    2 HYPERTENSION
    1 BACK PAIN
    2 BACK PAIN
    1 PROSTATE
    1
    2
    1 SKIN - LOCAL INFECTION
    1 PROSTATE
    1 COUGH - AIRWAY OBSTRUCTION
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DILATION & CURRETAGE
    1 VISION CARE
    2 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 GLAUCOMA
    1 HYPERTENSION
    2 HYPERTENSION
    1 CATARACT
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    4 URTICARIA
    1 CERVICAL SPONDYLOSIS

    910 06453
    910 06453
    910 06453
    910 06453
    910 06453.1
    910 06454
    910 06455
    910 06455
    910 06455
    910 06455
    910 06455
    910 07004
    910 07004
    910 07004
    910 07004
    910 07004
    910 07005
    910 07005
    910 07005
    910 07005
    910 07006
    910 07006
    910 07006
    910 07009
    910 07009
    910 07009
    910 07009
    910 07009
    910 07009.1
    911 04607
    911 04607
    911 04607
    911 04608
    911 04943
    911 04943
    911 04944
    911 04944
    911 05434
    911 05434
    911 05434
    911 05434
    911 05435
    911 05435
    911 05435
    911 05435
    911 05435
    911 05435.1
    911 06995
    911 06995
    911 06995
    911 07596
    912 06436
    912 06436

    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 FEVER
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    4 URTICARIA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1
    2
    3
    4
    5
    1
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    5 CONSTIPATION
    1 FEVER
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE

    912 06436
    913 03838
    913 03838
    913 03839
    913 03839
    913 03839
    913 03840
    913 04186
    913 04186
    913 04186.1
    913 04548
    913 05439
    913 05440
    913 05440
    913 06443
    913 06443
    913 06443
    913 06443
    913 06857
    913 06857
    913 06858
    913 06858
    913 06858
    913 06858
    913 06858
    913 06858.1
    913 06858.1
    913 06858.1
    913 07365
    913 07366
    914 03820
    914 03820
    914 03820
    914 04609
    914 04610
    914 05613
    914 05613
    914 05613
    914 05613
    914 05613
    914 05613.1
    914 07864
    914 07864
    914 07864
    914 07864
    914 08640
    914 08641
    914 08642
    914 08642
    914 08643
    914 08643
    914 08643
    915 04192

    3 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    1 OTITIS - EAR
    1 DIAB'ETES
    1 DIAB'ETES
    1 BACK PAIN
    2 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    5 SKIN - ATOPIC DERMATITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    1 HYPERTENSION
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 FEVER
    1 DENTAL CARE
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    5 CATARACT
    1 CATARACT
    1 HEARING LOSS
    2 HEARING LOSS
    3 HEARING LOSS
    4 HEARING LOSS
    1 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION

    915 04192
    915 04192
    915 04193
    915 04193
    915 04193.1
    915 04193.2
    915 05632
    915 05632
    915 05632.1
    915 07012
    915 07012.1
    915 07012.1
    915 07013
    915 07953
    915 07953
    915 07953
    915 07953
    915 07953
    915 07953.1
    915 07953.1
    916 04554
    916 04554
    916 04554
    916 04554
    916 04554
    916 04845
    916 04845.1
    916 04845.2
    916 04956
    916 04956
    916 06449
    916 06675
    916 06675
    916 07002
    916 07608
    916 07608
    916 07608
    917 04185
    917 04185
    917 07993
    917 07993
    918 04360
    918 04360.1
    918 04365
    918 05892
    918 05892
    918 06104
    918 06104.1
    918 06213
    918 06213.1
    918 06328
    918 06946
    918 07251

    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 ANXIETY
    1 ABDOMINAL PAINS
    1 HYPERTENSION
    2 HYPERTENSION
    1 PROSTATE
    1 SKIN - ECZEMA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERTENSION
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    3 PAINFUL HEEL
    4 PAINFUL HEEL
    5 PAINFUL HEEL
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    5 TONSILLITIS
    1 HEART
    1 HEART
    1 HEART
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 AMMENORRHOEA
    1 EYE DISORDER
    2 EYE DISORDER
    1 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA
    1 DIAB'ETES
    1 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS
    1 ABSCESS
    2 ABSCESS
    1 DIAB'ETES
    1 INTESTINAL COLIC
    1 CERVICAL STRAIN
    1 DIAB'ETES
    1 BACK PAIN
    1 CERVICAL SPONDYLOSIS
    1 HYPERTENSION

    918 07251
    918 07251.1
    918 07251.2
    918 07578
    918 07578.1
    918 08237
    918 08821
    918 08822
    918 08822
    918 08899
    918 08899.1
    919 04180
    919 04180
    919 05622
    919 05622
    919 05622
    919 05622
    919 05622
    919 05623
    919 05623
    919 07354
    919 07354
    919 07355
    919 07355
    919 07355
    919 07355
    919 07355
    919 07355.1
    919 07355.1
    919 07357
    919 07357
    919 07357
    920 03813
    920 04246
    920 05446
    920 05747
    920 06247
    920 06247
    920 06851
    920 07612
    920 07612
    920 08281
    920 08645
    921 04955
    921 04955
    921 04955
    921 04955
    921 04955.1
    921 04955.1
    921 04955.1
    921 06671
    921 06671
    921 06859

    2 HYPERTENSION
    1 CERVICAL SPONDYLOSIS
    1 PROSTATE
    1 CERVICAL SPONDYLOSIS
    1 DIAB'ETES
    1 HYPERTENSION
    1 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 DIAB'ETES
    1 INTESTINAL COLIC
    1 FEVER
    2 FEVER
    1
    2
    3
    4
    5
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    5 STONE - URETER
    1 STONE - URETER
    2 STONE - URETER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    1 DIAB'ETES
    1 DIAB'ETES
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    1 DIAB'ETES
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    1 CATARACT
    2 CATARACT
    3 CATARACT
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE

    921 06859
    922 05436
    922 06423
    922 06423
    922 06423
    922 06423
    922 06424
    922 06424
    922 06424
    922 06849
    922 06850
    922 06850
    922 07358
    922 07359
    922 07359
    922 07359.1
    922 07600
    922 07600
    923 05920
    923 05920
    923 05920
    923 05920
    923 05920
    924 04967
    924 04967
    924 04967
    925 06456.1
    925 06456.1
    925 06456.1
    925 06456.1
    925 06456.1
    925 06457.1
    925 07011
    925 07950
    925 07950
    925 07950
    925 07951
    925 07951
    925 07952
    925 08654
    925 08655
    925 08655.1
    926 08089
    926 08089
    926 08089
    926 08089
    926 08089
    927 04258.1
    927 04258.1
    927 06472
    927 06472
    928 04443
    928 04937

    2 VISION CARE
    1 VISION CARE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 INTESTINAL COLIC
    1 BACK PAIN
    2 BACK PAIN
    1 HEART
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    2 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 PAINFUL LEGS
    1 HEART
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HEART
    1 PROSTATE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 CONSTIPATION
    1 CONSTIPATION

    928 05134
    928 05134
    928 05134
    928 05134
    928 05296
    928 05296
    928 05368
    928 06078
    928 06101
    928 07994
    928 07994
    928 07994
    928 07994
    928 08178
    928 08730
    929 04550
    929 04550
    929 04551
    929 04551
    929 04552
    929 04552
    929 05189
    929 05189.1
    929 05629
    929 05630
    929 05630
    929 06447
    929 06447
    929 06863
    929 06863
    929 06863
    929 06864
    929 06864
    929 07939
    929 07939
    929 07939
    929 07940
    929 07940
    929 07940
    929 07941
    929 07941
    929 07941
    929 07941
    929 07942
    929 07942
    929 07942
    929 07942
    929 07942
    929 07943
    929 07943
    929 07944
    929 07944
    929 07945

    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 SINUSITIS
    1 DENTAL CARE
    1 SINUSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CONSTIPATION
    1 CONSTIPATION
    1 RECTAL BLEEDING
    2 RECTAL BLEEDING
    1 TONSILLITIS
    2 TONSILLITIS
    1
    2
    1 OTITIS - EAR
    1 EYE DISORDER
    1 FEVER
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 TONSILLITIS
    2 TONSILLITIS
    1

    929 07945
    929 07946
    929 07946
    930 04244
    930 04244
    930 04244
    930 06418
    930 06418
    930 06418
    930 06418
    930 06418
    930 06418.1
    930 07599
    931 05181
    931 05181
    932 08352
    932 08352
    932 08352
    933 04537
    933 04539
    933 04539
    933 04539
    933 04541
    933 04541
    933 04541
    933 05616
    933 05616
    933 05617
    933 05617
    933 05617.1
    933 05618
    933 05618
    933 05619
    933 05619
    933 05620
    933 05621
    933 05621
    933 06996
    933 07348
    933 07350
    933 07350
    933 07351
    933 07352
    933 07353
    934 06861
    934 06861
    934 06861
    935 03892.1
    935 03896.1
    935 03896.1
    935 03896.1
    935 03896.1
    935 03897.1

    2
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1 EYE DISORDER
    1
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERTENSION
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 SINUSITIS
    1
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    1
    2
    3
    4
    1 VISION CARE

    935 04073
    935 04073
    935 04073
    935 04073.1
    935 04073.2
    935 04968
    935 04969
    935 04969
    935 04969
    935 04971
    935 04971
    935 04971
    935 04971
    935 04971.1
    935 04972
    935 04975
    935 04975
    935 04975
    935 04975
    935 04975
    935 04976
    935 04976
    935 04976
    935 04976
    935 04977
    935 04977
    935 06251
    935 06251
    935 06251
    935 06251
    935 06251
    935 06251.1
    935 06252
    935 06598
    935 06598
    935 06599
    935 06599
    935 06607
    935 06607
    935 06607
    935 06749
    935 06749
    935 06749
    935 07044
    935 07408
    935 07408
    935 07409
    935 07409
    935 07409
    935 07410
    935 07524
    935 07524
    935 08096

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 HEADACHE- MIGRAINE TENSION
    1 ALLERGY
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 HEADACHE- MIGRAINE TENSION
    1 DENTAL CARE
    1 EPIDIDMYITIS
    2 EPIDIDMYITIS
    3 EPIDIDMYITIS
    4 EPIDIDMYITIS
    5 EPIDIDMYITIS
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1 RECTAL BLEEDING
    2 RECTAL BLEEDING
    3 RECTAL BLEEDING
    4 RECTAL BLEEDING
    5 RECTAL BLEEDING
    1 OTITIS - EAR
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 ALLERGIC RHINITIS

    935 08096
    935 08096
    935 08181
    936 06464
    936 06465
    936 06465
    936 06465
    936 06467
    936 06467
    936 06470
    936 06470
    936 06470
    936 06471
    936 06471
    936 06471
    936 08093
    936 08093
    936 08094
    936 08095
    936 08095
    937 03837
    937 03837
    937 03837
    937 05628
    937 05628
    937 08650
    937 08651
    937 08651
    937 08651
    937 08651
    938 04953
    938 04953
    938 04953
    938 04953
    938 06441
    938 06441
    938 06441
    939 07949
    939 07949
    940 03842
    940 03842
    940 03842
    940 05389
    940 05389
    940 05389
    940 06672
    940 06672
    940 06672
    940 07000
    940 07000
    940 07000
    940 07000
    940 07104

    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 PAIN-BACK/SHOULDER
    1 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    1 HYPERTENSION
    1 BURSITIS
    2 BURSITIS
    1 ENDOMETROSIS
    2 ENDOMETROSIS
    3 ENDOMETROSIS
    1 SKIN - LESION
    2 SKIN - LESION
    1 DENTAL CARE
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    4 CIRCULATORY DISORDER
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 VISION CARE

    940 07104
    940 07104
    940 07105
    940 07105
    940 07106
    940 07106.1
    940 07106.1
    940 07106.1
    940 07367
    940 08283
    940 08283
    941 04949
    941 04949
    941 04949
    941 06667
    941 06667
    942 03821
    942 03821
    942 03821
    942 05742
    942 05742
    943 08108.1
    943 08108.1
    943 05756
    943 05756
    943 05756
    943 05756
    943 05756.1
    943 05756.1
    943 06474
    944 04187
    944 04187
    944 06446
    944 06446
    944 06446
    944 06446
    945 06854
    946 04249
    946 04249
    946 04249
    946 04249
    946 04249
    946 05186
    946 05186
    946 05186
    946 05186
    946 05441
    946 05441
    946 05441
    946 06673
    946 06673
    946 06674
    946 06674

    2 VISION CARE
    3 VISION CARE
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 DEVIATED NASAL SEPTUM
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 VISION CARE
    1
    2
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1
    2
    3
    4
    1
    2
    1 ANAEMIA
    1 THYROID
    2 THYROID
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE

    946 07936
    946 07936
    946 07937
    946 07937
    946 07937
    946 08073
    946 08073
    946 08073
    946 08073
    946 08073
    946 08074
    946 08075
    946 08075
    946 08075
    946 08076
    946 08076
    946 08076
    947 03829
    947 04545
    947 04546
    947 05625
    947 06430
    947 07602.1
    947 07932
    948 03678
    948 03679
    948 03679
    948 03679
    948 03679
    948 04765
    948 06812
    948 07485
    948 07486
    949 03850
    949 03850
    949 03850
    949 07615
    949 07615
    949 07615
    949 08290
    949 08290
    949 08290
    950 05318
    951 04196
    951 04196
    951 04196
    951 04197
    951 04197
    951 04198
    951 04198
    951 04199
    951 04199
    951 04280

    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    1 VISION CARE
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 HYPERTENSION
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 FATIGUE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 THYROID
    2 THYROID
    3 THYROID
    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    1
    1
    2
    3
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 MISCARRIAGE

    951 04280
    951 04280
    951 04280
    951 04961
    951 04961
    951 05437
    951 05437
    951 05437
    951 05751
    951 05751
    951 05752
    951 05752
    951 05752
    951 06459
    951 06459
    951 08085
    951 08086
    951 08656
    951 08656
    952 06437
    952 06437
    952 06437
    952 06437
    952 06437
    952 06437
    953 03828
    953 06428
    953 06428
    954 04179
    954 04179
    954 04860
    954 04860.1
    954 04860.1
    954 05741
    954 05741
    954 07347
    954 07597
    954 07597
    954 07702
    954 07702
    954 07702
    955 03841
    955 03841
    955 05442
    955 05442
    955 07604
    955 07604
    955 07605
    955 07605
    955 07605
    955 07938
    955 07938
    955 08285

    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 SKIN - LESION
    2 SKIN - LESION
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1
    2
    1
    2
    3
    1 EYE DISORDER
    2 EYE DISORDER
    1 SKIN - ATOPIC DERMATITIS
    1 ALLERGIC RHINITIS
    1 EYE DISORDER
    2 EYE DISORDER
    1 PSORIASIS
    1 PSORIASIS
    2 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    3 PSORIASIS
    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1
    1 CERVICITIS
    2 CERVICITIS
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    1

    955 08286
    956 04617
    956 04617
    956 04618
    956 04618
    956 04618
    956 05107
    956 05107
    956 05107
    956 05748
    956 05748
    956 05748
    956 05749
    956 05749
    956 05749
    956 05749
    956 05749
    956 05750
    956 05750
    956 05750
    956 05750
    956 05750
    956 06458
    956 06458
    956 07014
    956 07014
    956 07014
    957 05636
    958 05326
    958 05326
    958 05326
    959 04544
    959 04544
    959 04544
    960 08652
    960 08652
    961 04557
    961 04557
    961 04557
    961 04557
    962 04542
    962 04542
    962 04542
    962 04543
    962 04543
    962 04543
    962 04543
    962 04543
    962 04543.1
    962 04543.1
    962 06416
    962 06416
    962 06417

    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    4 INGROWING TOE NAIL
    5 INGROWING TOE NAIL
    1 FEVER
    2 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    3 FRACTURE - HAND BONES
    4 FRACTURE - HAND BONES
    5 FRACTURE - HAND BONES
    1 FRACTURE - HAND BONES
    2 FRACTURE - HAND BONES
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 FRACTURE - HAND BONES

    962 06417
    962 06417
    963 08644
    963 08644
    963 08644
    964 04189
    964 04189
    964 04190
    964 04190
    964 04190
    964 06450
    964 06450
    964 06450
    964 06451
    965 03831
    965 03831
    965 03831
    965 03831
    965 03832
    965 04547
    965 04547
    965 04547
    965 04547
    965 04547
    965 04547.1
    965 04547.1
    965 04547.1
    965 04614
    965 04614
    965 06433
    965 06433
    965 06433
    965 06433
    965 06433
    965 07933
    965 07933
    965 07933
    965 07933
    965 07933
    966 06448
    967 03834
    967 03834
    967 03834
    968 06664
    968 06664
    968 06664
    969 07954
    969 07954
    969 07954
    970 08287
    971 06668
    971 06668
    971 06668

    2 FRACTURE - HAND BONES


    3 FRACTURE - HAND BONES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 INTESTINAL COLIC
    1
    2
    3
    4
    1 LIVER CIRRHOSIS
    1
    2
    3
    4
    5
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    3
    4
    5
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    971 08072
    971 08072
    971 08072
    971 08072
    972 06435
    972 06435
    972 06435
    972 06998.1
    972 06998.3
    972 06998.3
    972 06998.3
    972 06998.3
    972 07934
    972 07934
    973 08097
    973 08097
    973 08185
    973 08185
    973 08185
    974 08084
    974 08084
    975 04001
    975 04001
    975 04001
    975 06971
    975 06971
    975 06971
    975 06971.1
    975 06971.1
    975 06971.1
    976 03995
    976 04718
    976 04718
    976 04719
    976 05919
    976 06642
    976 06643
    976 06643
    976 06643
    976 06643
    976 07147
    976 08147
    977 04243
    977 04243
    978 04896
    978 04896.1
    978 04896.1
    978 05045
    978 05045
    978 05325
    978 05325
    978 05325
    978 05679

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    1 CONSTIPATION
    2 CONSTIPATION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 DIAB'ETES
    1 ARTHRITIS
    2 ARTHRITIS
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM

    978 05679
    978 07327
    978 07327
    978 07327
    978 07327.1
    978 07560
    978 07560
    979 04615
    979 04615
    980 05443
    980 05443
    980 05443
    980 05443
    981 03891
    981 03891
    981 03891
    981 07459
    982 03552
    982 04897
    982 06970
    982 06970
    982 06970
    983 07015
    983 07015
    983 07015.1
    983 07015.1
    983 07015.1
    983 07015.2
    983 07015.2
    983 07015.2
    984 05447
    985 05184
    985 05184
    985 06852
    985 06852
    985 06852
    985 06852
    985 06852
    986 04250
    986 04250
    986 04250
    986 04616
    986 04616
    987 07368
    987 07368
    988 03847
    988 03847
    988 03848
    988 03848
    988 03849
    988 03849
    988 03849
    988 04963

    2 DEVIATED NASAL SEPTUM


    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1
    2
    3
    4
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 BACK PAIN
    1 ARTHRITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BLOOD DISORDER
    2 BLOOD DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS
    4 ABSCESS
    5 ABSCESS
    1 HEART
    2 HEART
    3 HEART
    1 HEART
    2 HEART
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION

    988 04963
    988 04964
    988 04964
    988 05327
    988 05327
    988 05327
    988 07613
    988 07613
    988 07614
    988 07614
    988 07614
    988 07614.1
    988 07614.1
    989 04253
    989 04253
    989 04253
    989 04253
    989 04966
    989 04966
    989 05328
    989 06463
    989 07370
    989 07370
    989 07371
    989 07371
    989 07371
    989 07371
    990 04191
    990 04191
    990 04191
    990 04553
    990 04553
    990 05191
    990 05745
    990 05746
    990 05746
    990 05746
    990 05746
    990 05746
    990 07010
    990 07010
    990 07010.1
    991 03823
    991 03823
    991 03823
    991 04183
    991 04183.1
    991 05432
    991 05433
    991 05433
    992 03844
    992 03845
    992 04201

    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 VISION CARE
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 PAIN-BACK/SHOULDER
    1 BARTHOLIN'S CYST
    1 THYROID
    1 FATIGUE
    2 FATIGUE
    1 DENTAL CARE
    1 DENTAL CARE
    1 SKIN - LESION

    992 04201
    992 04201
    992 04201.1
    992 06865
    992 06865.1
    992 08088
    992 08088
    992 08088
    992 08088
    993 04965
    994 04535
    994 04535
    994 04535
    994 04535
    994 04535
    995 06662
    995 06662
    995 06662
    995 06662
    995 06662.1
    995 06663
    995 06663
    995 06663
    995 07598
    996 03846
    996 03846
    996 04202
    996 04202
    996 04202.1
    996 06461
    996 06461
    996 06461
    996 06461
    997 04182
    997 04182
    997 04182
    998 03825
    998 03825
    998 03826
    998 03826
    998 04613
    998 04613
    998 06427
    998 06666
    998 06666
    998 06666
    998 06666
    999 04195
    1000 06855
    1000 06855
    1000 06855
    1000 06855.1
    1000 06855.1

    2 SKIN - LESION
    3 SKIN - LESION
    1
    1 DIAB'ETES
    1 AMMENORRHOEA
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    4 SKIN - ECZEMA
    1 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART
    1 ALOPECIA
    1 DIAB'ETES
    2 DIAB'ETES
    1 HEMORRHOIDS
    2 HEMORRHOIDS
    1 INTESTINAL COLIC
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1
    2
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    1 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 FEVER
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    1000 06855.1
    1001 07595
    1002 06679
    1002 06679
    1003 06676
    1003 06676
    1003 06677
    1004 04181
    1004 04181
    1004 04181
    1004 04181
    1005 05631
    1005 05631
    1005 05631
    1005 05631.1
    1005 05631.2
    1005 05631.2
    1005 05631.2
    1006 05626
    1007 05678
    1007 05678
    1007 06669
    1007 06669
    1008 05324
    1008 05324
    1009 05319
    1009 05319
    1009 05319
    1009 05321
    1009 06411
    1009 06411
    1009 06411
    1009 07346
    1009 07346
    1009 07346
    1009 07592
    1010 07369
    1011 03890
    1011 03890
    1011 03890
    1011 04444
    1011 04444
    1011 04444
    1011 04444
    1011 07404
    1011 07404
    1011 07404
    1011 07404
    1012 08468
    1012 08468
    1012 08468
    1012 08468
    1012 08468

    3 DEVIATED NASAL SEPTUM


    1 ALLERGIC REACTION
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    4 ALLERGIC RHINITIS
    1
    2
    3
    1 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 MISCARRIAGE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DENTAL CARE
    1
    2
    3
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DENTAL CARE
    1
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    4 GLAUCOMA
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION

    1013 04549
    1013 04549
    1013 04549.1
    1013 06860
    1013 06860
    1013 06860.1
    1013 06860.1
    1013 06860.2
    1013 07606
    1013 07606
    1013 07607
    1013 07607
    1014 03534
    1014 03534
    1014 03534
    1014 04941
    1014 04941
    1014 04941
    1014 06519
    1014 06519
    1014 06520
    1014 06520
    1014 06521
    1014 06521
    1014 06521.1
    1014 08070
    1014 08070
    1015 03640
    1015 04251.1
    1015 04251.1
    1015 04251.1
    1015 04251.1
    1015 04252.1
    1015 04252.1
    1015 04252.1
    1015 05390
    1015 05390
    1015 05754
    1015 05754
    1015 05754
    1015 05754
    1015 05755
    1016 03494
    1016 03494
    1016 03494
    1016 03494
    1016 03494.1
    1016 03494.1
    1016 03494.1
    1016 03494.1
    1016 03494.2
    1016 03494.2
    1016 03494.3

    1
    2
    1 PROSTATE
    1 VISION CARE
    2 VISION CARE
    1
    2
    1 EYE DISORDER
    1
    2
    1 HYPERTENSION
    2 HYPERTENSION
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 HEARING LOSS
    2 HEARING LOSS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 HEADACHE- MIGRAINE TENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 PAIN-BACK/SHOULDER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    4 SKIN - LESION
    1 DIAB'ETES
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 DIAB'ETES
    2 DIAB'ETES
    1 INTESTINAL COLIC

    1016 03494.3
    1016 03494.3
    1016 04093
    1016 04093.1
    1016 04093.1
    1016 04093.1
    1016 05020
    1016 05020
    1016 05020
    1016 05020
    1016 05020
    1016 05020.1
    1016 05020.1
    1016 06176
    1016 07001
    1016 08077
    1016 08077
    1016 08077
    1016 08078
    1016 08078
    1016 08078
    1016 08079
    1016 08079.1
    1016 08079.1
    1017 06109
    1017 06109
    1017 06109.1
    1017 06109.1
    1017 06109.2
    1017 06109.2
    1017 06109.3
    1017 06109.3
    1017 08146
    1017 08146.1
    1017 08146.1
    1018 04241
    1018 04241
    1018 04241
    1018 04241
    1018 04241
    1018 04241.1
    1018 04241.1
    1018 04241.1
    1018 04241.1
    1018 04942
    1018 04942
    1018 04942
    1018 04942
    1019 07723
    1019 07723
    1020 07717
    1020 07717
    1020 07717

    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    5 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 DIAB'ETES
    1 CERVICAL STRAIN
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1
    2
    3
    1 ACUTE ENTERITIS
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 THYROID
    2 THYROID
    1
    2
    3
    4
    5
    1
    2
    3
    4
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS

    1021 03549
    1022 04676
    1023 06224
    1023 06224
    1023 07714
    1023 07715
    1024 03961
    1024 03961
    1024 03961
    1025 05185
    1025 05185
    1025 05185
    1025 06220
    1025 06220
    1025 06221
    1025 06221
    1025 06222
    1025 06222
    1025 06222
    1026 05194
    1026 05194
    1026 05194
    1027 08071
    1027 08071
    1027 08071
    1028 05438
    1029 07593
    1029 07593
    1029 07593
    1029 07594
    1029 07594.1
    1029 07594.1
    1029 07594.1
    1029 07594.1
    1030 04256
    1030 04257
    1030 06236
    1030 06236
    1030 06525
    1030 06969
    1030 06969
    1030 06969
    1030 08289
    1031 03962
    1031 03962
    1031 04960
    1031 04960
    1031 04960.1
    1031 07164
    1031 07164
    1031 07164.1
    1032 04675
    1032 06233

    1 DENTAL CARE
    1 ACUTE ENTERITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 MUSCULAR PAIN
    1 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 FEVER
    2 FEVER
    3 FEVER
    1 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    1 DIAB'ETES
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 EYE DISORDER
    1 HYPERTENSION
    1 EYE DISORDER
    2 EYE DISORDER
    1 EYE DISORDER
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1
    1
    2
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 GASTRIC - PEPTIC ULCER/GERD
    1 FATIGUE
    2 FATIGUE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 DIAB'ETES
    1 VISION CARE

    1032 06233
    1032 06233
    1032 07720
    1032 07720
    1032 07720
    1033 03957
    1033 03957
    1033 03957
    1033 03957
    1033 03957
    1033 03957.1
    1033 03957.1
    1034 03547
    1034 03547
    1034 03547
    1034 07160
    1034 07161
    1034 07161
    1034 07161
    1035 04717
    1035 05820
    1035 06856
    1035 06856
    1035 06856
    1036 03952
    1036 03952
    1036 03953
    1036 03953
    1037 04670
    1037 04670
    1037 04670.1
    1037 04670.2
    1037 04945
    1038 03538
    1038 03538
    1038 03538
    1038 03955
    1038 03955
    1038 03955
    1038 03956
    1038 03956
    1038 03956
    1038 04247
    1038 04247
    1038 05183
    1038 05183
    1038 05183
    1038 05183.1
    1038 06522
    1038 06522
    1038 06523
    1038 06523
    1038 06523

    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1
    2
    3
    4
    5
    1
    2
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    3 SOFT TISSUE DISORDERS/DISEASE
    1 BARTHOLIN'S CYST
    1 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 INTESTINAL COLIC
    1 ABDOMINAL PAINS
    1 GASTRIC - PEPTIC ULCER/GERD
    1 RADICULOPATHY INFLAME NERVE ROOT
    2 RADICULOPATHY INFLAME NERVE ROOT
    3 RADICULOPATHY INFLAME NERVE ROOT
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 TONSILLITIS
    2 TONSILLITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    2
    3

    1038 07706
    1038 07706
    1038 07706
    1038 07707
    1038 07707
    1038 07707
    1039 03965
    1039 03965
    1039 03965
    1040 04200
    1040 04200
    1040 04245
    1040 04245
    1040 06034
    1040 06034
    1040 06034
    1040 06034
    1040 06175
    1040 06175
    1040 06175.1
    1040 06175.1
    1040 06175.1
    1040 06175.2
    1040 06175.2
    1040 06175.3
    1040 06175.3
    1040 06175.3
    1040 06175.3
    1040 06175.3
    1040 06175.4
    1040 06219
    1040 07362
    1040 07362
    1040 07704
    1040 07704
    1041 04248
    1041 04248
    1041 04248
    1042 06217
    1043 07716
    1044 03551
    1044 03551
    1044 03551
    1045 04672
    1045 04673
    1045 05188
    1045 05188
    1045 05188
    1045 05188
    1045 05188
    1046 03991
    1046 03991
    1046 03991

    1 DEVIATED NASAL SEPTUM


    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1
    2
    3
    1
    2
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    3 EAR DYSFUNCTION
    4 EAR DYSFUNCTION
    5 EAR DYSFUNCTION
    1 EAR DYSFUNCTION
    1 DEVIATED NASAL SEPTUM
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 INJURY - UNSPECIFIED
    2 INJURY - UNSPECIFIED
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 MISCARRIAGE
    1 DIAB'ETES
    1 CHlCKEN POX
    2 CHlCKEN POX
    3 CHlCKEN POX
    1 DIAB'ETES
    1 ACUTE ENTERITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    1047 05174
    1047 05174
    1047 05174
    1048 04254
    1048 04254
    1048 04254
    1048 04254
    1048 04254
    1048 04255
    1048 04255
    1048 06235
    1048 06235
    1048 06235
    1048 06235
    1048 06235
    1048 06235.1
    1049 07158
    1049 07158
    1049 07700
    1050 05187
    1050 06223
    1050 06524
    1050 06524
    1050 06524
    1050 07709
    1050 07709
    1050 07709
    1050 07709
    1051 06234
    1051 06234
    1051 06234
    1052 03954
    1052 03954
    1052 03954
    1052 04671
    1053 05175
    1053 05175
    1053 05176
    1053 05176
    1053 06215
    1053 06215
    1053 06215
    1053 06215
    1053 06216
    1053 07701
    1054 04895.1
    1054 04895.1
    1054 04895.1
    1054 04895.1
    1055 03963
    1055 03963
    1055 03964
    1055 03964

    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1 EYE DISORDER
    1 STROKE
    2 STROKE
    1 STROKE
    1
    1 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 EYE DISORDER
    2 EYE DISORDER
    1 CONJUNCTIVITIS - EYE
    2 CONJUNCTIVITIS - EYE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1
    1 INJURY - UNSPECIFIED
    1 THYROID
    2 THYROID
    3 THYROID
    4 THYROID
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE

    1055 03964
    1055 03964
    1055 03964
    1055 07721
    1055 07721
    1055 07721
    1055 08090
    1055 08091
    1055 08091
    1056 06357
    1056 06357
    1056 07935
    1056 07935
    1057 03959
    1057 03959
    1057 03960
    1057 03960
    1057 04957
    1057 04957
    1057 04958
    1057 04959
    1057 04959
    1057 04959
    1057 06229
    1057 06229
    1057 06230
    1057 06230
    1057 07162
    1057 07162
    1057 07163
    1057 07163
    1057 08080
    1057 08080
    1057 08081
    1057 08081
    1058 02813.4
    1058 02813.5
    1058 02813.5
    1058 06225
    1058 06225
    1058 06225
    1058 06225
    1059 03545.1
    1059 03545.1
    1059 08284
    1059 08284
    1059 08284
    1060 04946
    1060 04946
    1060 04946
    1061 04072
    1061 04072
    1061 04072

    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    2 FEVER
    1 VISION CARE
    2 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEART
    2 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEART
    1 HEART
    1 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    1061 06226
    1061 06226
    1061 06226
    1061 06226
    1062 03535
    1062 03535
    1062 03535
    1063 07703
    1063 07703
    1064 07159
    1065 06231
    1065 06231
    1065 06231
    1065 07719
    1065 07719.1
    1065 07719.1
    1066 05190
    1066 05190
    1067 04950.1
    1067 04951
    1067 04951
    1067 04951
    1067 07454
    1067 07454
    1067 07454
    1067 07455
    1067 07455
    1067 07455
    1067 07455
    1067 07455
    1067 07455.1
    1068 03863
    1068 03863
    1068 03863
    1068 03863
    1068 03863
    1068 03863.1
    1068 04901
    1068 04901
    1068 05451
    1068 05451
    1068 06613
    1068 06613
    1069 03641.1
    1069 03641.1
    1070 04388
    1070 04388
    1070 04388
    1070 04388
    1070 04388
    1070 05640
    1070 05640
    1070 08149

    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 MISCARRIAGE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 HYPERTENSION
    2 HYPERTENSION
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    3 SKIN - LOCAL INFECTION
    4 SKIN - LOCAL INFECTION
    5 SKIN - LOCAL INFECTION
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES

    1070 08149
    1070 08149
    1071 08005
    1071 08005
    1072 06255
    1072 06255
    1073 05216
    1073 05216
    1073 05216
    1073 05216
    1073 05216
    1073 05216.1
    1073 06076
    1073 06076
    1073 06738
    1073 06738
    1073 06975
    1073 06975
    1073 06975
    1073 06975
    1073 06975
    1073 06975.1
    1073 06975.1
    1074 05706
    1074 05706
    1074 05706
    1074 07377
    1074 07377
    1074 07377
    1074 08156
    1074 08156
    1074 08156
    1074 08156.1
    1074 08156.1
    1075 05826
    1075 05826
    1075 05826
    1076 04391
    1077 04558
    1077 06904
    1077 06905
    1078 04623
    1079 05891
    1079 05891
    1079 05891
    1079 05891
    1079 06239
    1079 06239
    1079 06239
    1079 06239
    1079 06483
    1079 06483
    1079 06483

    2 DIAB'ETES
    3 DIAB'ETES
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 ARTHRITIS
    2 ARTHRITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    4 HORMONE REPLACMENT THERAPY
    5 HORMONE REPLACMENT THERAPY
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 BACK PAIN
    2 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 GLAUCOMA
    1 HYPERTENSION
    1 EYE DISORDER
    1 EYE DISORDER
    1 HEART
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    4 SKIN - ECZEMA
    1 INFECTION THUMB
    2 INFECTION THUMB
    3 INFECTION THUMB
    4 INFECTION THUMB
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    1079 07025
    1079 07240
    1079 07240
    1079 07240
    1079 07240
    1079 07240
    1080 03554
    1080 03554
    1080 06477
    1080 06477
    1080 06732
    1080 06732
    1080 06732
    1080 06732
    1080 06732
    1080 06732.1
    1081 06737
    1081 06737
    1082 04115
    1082 04115.1
    1082 05197
    1082 05197
    1082 05637
    1082 05638
    1082 05701
    1082 05702
    1082 05702
    1082 05821
    1082 05821.1
    1082 06475
    1082 06608
    1082 06608
    1082 08580
    1083 03555
    1083 03555
    1083 03555
    1083 04120
    1083 04120
    1083 04625
    1083 05641
    1083 05641
    1083 05641
    1083 05641
    1083 05641
    1083 05642
    1083 05642
    1083 05642
    1083 06072
    1083 06072
    1083 06073
    1083 06073
    1083 06569
    1083 06569

    1 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    5 SKIN - ATOPIC DERMATITIS
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 BURSITIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DIAB'ETES
    1 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 PROSTATE
    1 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 DEPRESSION
    1 EYE DISORDER
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 EPILEPSY
    2 EPILEPSY
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC

    1083 06569
    1083 06569
    1083 06569.1
    1083 06569.2
    1083 07866
    1083 07866
    1084 04112
    1084 04112
    1084 04112
    1084 04112
    1084 04113
    1084 04113.1
    1084 04114
    1084 05448
    1084 05448
    1084 05449
    1084 05449
    1084 05884
    1084 05884
    1084 05884
    1084 05884
    1084 05884
    1084 05884.1
    1084 05889
    1084 05889
    1084 07019
    1084 07019
    1085 06238
    1086 04622
    1087 03851
    1087 03851
    1087 03851
    1087 03851
    1087 03852
    1087 03852
    1087 03853
    1087 03853
    1087 03853
    1087 05703
    1087 05703
    1087 05703
    1087 07628
    1087 07628
    1087 07629
    1087 07629
    1088 07376
    1088 07376
    1088 07376
    1088 07646
    1088 07646
    1089 05452
    1089 05452
    1089 05452

    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 EPILEPSY
    1 HEART
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    1 HYPERTENSION
    1 RENAL DYSFUNCTION
    1 ANXIETY
    2 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    4 ANXIETY
    5 ANXIETY
    1 ANXIETY
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 BARTHOLIN'S CYST
    1 BONE & CARTILAGE DISORDER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 HERPES ZOSTER
    2 HERPES ZOSTER
    3 HERPES ZOSTER
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    1089 05823
    1089 06237
    1089 06735
    1089 06735
    1089 06735
    1089 06735
    1090 06556
    1090 06730
    1090 06731
    1090 07814
    1090 07814
    1090 07815
    1090 07816
    1090 08354
    1091 03854
    1091 03854
    1091 03854
    1091 03856
    1091 03856
    1091 04624
    1091 04624
    1091 07462
    1091 07462
    1091 07463
    1091 07463
    1091 08001
    1091 08001
    1091 08001.1
    1091 08002
    1092 05822
    1093 04390
    1093 04390
    1093 04900
    1093 04900
    1093 04900.1
    1093 04900.2
    1093 06074
    1093 06074
    1093 06074.1
    1093 06479
    1093 06479
    1093 06479.1
    1093 06479.1
    1093 07374
    1093 07374.1
    1094 08003
    1094 08003
    1094 08004
    1095 03557
    1095 03557
    1095 03557
    1095 03557
    1096 04121

    1 INTESTINAL COLIC
    1 GASTRIC - PEPTIC ULCER/GERD
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 CHEST PAIN
    1 DENTAL CARE
    1 DENTAL CARE
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1
    2
    1 ARTHRITIS
    2 ARTHRITIS
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 HEART
    2 HEART
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    1
    1 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 SINUSITIS
    2 SINUSITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ARTHRITIS
    1 BACK PAIN
    2 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    2 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 URTICARIA
    2 URTICARIA
    1 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE

    1096 04121
    1096 04121
    1096 04121
    1096 04121
    1096 04121.1
    1097 04395
    1097 04395
    1097 04395
    1098 05453
    1098 05453
    1098 05453
    1098 05453
    1098 05454
    1098 05454
    1098 05890
    1098 05890
    1098 05890
    1098 08153
    1098 08153
    1098 08153
    1098 08153
    1098 08153
    1099 04385
    1099 04385
    1099 04385
    1099 05825
    1099 05825
    1099 05825
    1099 05825
    1099 05825
    1099 05825.1
    1099 05825.1
    1099 05825.1
    1099 05825.1
    1100 03860
    1100 03860
    1100 03860
    1100 03860
    1100 03861
    1100 03861
    1100 03861
    1100 03861
    1100 03861
    1100 04389
    1100 05704
    1100 05704
    1100 05704.1
    1100 05704.1
    1100 05704.1
    1100 05704.1
    1100 06071
    1100 06071
    1100 07021

    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    1 BACK PAIN
    2 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    5 PAIN-BACK/SHOULDER
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 EPILEPSY
    2 EPILEPSY
    3 EPILEPSY
    4 EPILEPSY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 REMOVAL OF MOLE
    1
    2
    1
    2
    3
    4
    1 EPILEPSY
    2 EPILEPSY
    1 EPILEPSY

    1100 07021
    1100 07504
    1100 07865
    1100 07865
    1100 07865.1
    1100 08148
    1100 08148
    1100 08148
    1100 08148
    1100 08148.1
    1100 08148.1
    1100 08585
    1101 04384
    1101 04384
    1101 04384
    1101 04384
    1101 04384
    1101 04384.1
    1101 04384.1
    1101 04384.1
    1101 07460
    1101 07460
    1101 08000
    1102 03857
    1102 03857
    1102 03857
    1102 06973
    1102 06973
    1102 06973
    1102 06973
    1103 05450
    1103 05450
    1104 06549
    1104 06550
    1105 04904
    1106 04392
    1106 04393
    1106 04393
    1106 04393
    1106 04393.1
    1106 04559
    1107 04394
    1107 04394
    1108 05207
    1108 05207
    1108 07022
    1108 07022
    1108 07023
    1108 08586
    1108 08586
    1108 08587
    1108 08587
    1108 08587

    2 EPILEPSY
    1 HEART
    1 EPILEPSY
    2 EPILEPSY
    1 DEVIATED NASAL SEPTUM
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 RETINOPATY
    2 RETINOPATY
    1 BONE & CARTILAGE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    4 URTICARIA
    1 VISION CARE
    2 VISION CARE
    1 ABDOMINAL PAINS
    1 OVARIAN CYST
    1 DEVIATED NASAL SEPTUM
    1 OTITIS - EAR
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    1 OTITIS - EAR
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 SKIN - LOCAL INFECTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    1109 04129
    1109 04129.1
    1110 06481
    1110 06481
    1110 06481
    1110 06570
    1110 06570
    1110 06570
    1110 06570
    1110 06570
    1110 06736
    1111 03556
    1111 03556
    1111 07375
    1111 07375
    1111 07375
    1111 08152
    1111 08152
    1112 07372
    1112 07372
    1112 07372
    1112 07372
    1112 07372
    1113 04620
    1113 04620
    1113 04621
    1114 08155
    1115 07373
    1115 07373
    1115 07373
    1116 06069
    1116 06069
    1116 06069
    1116 06478
    1116 06478
    1117 03754
    1117 03754
    1117 03754
    1117 05771
    1117 05771
    1117 07824
    1117 07824
    1118 03747
    1118 03747
    1118 03747
    1118 03747
    1119 06291
    1119 06291
    1119 06291
    1119 06291
    1119 06292
    1119 06292
    1119 06292

    1 HYPERTENSION
    1 THYROID
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 FEVER
    2 FEVER
    1 SKIN - LOCAL INFECTION
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST

    1119 06293
    1120 08364
    1120 08364
    1120 08364
    1120 08364
    1120 08364
    1120 08364.1
    1120 08364.1
    1120 08364.1
    1121 04006
    1121 04006
    1121 05705
    1122 07527
    1122 07527
    1122 07527
    1122 07527
    1122 07527
    1122 07527.1
    1123 08355
    1123 08355
    1123 08355.1
    1124 07020
    1124 07020
    1124 07020.1
    1124 07020.1
    1125 07641
    1125 07641
    1125 07641
    1125 07642
    1125 07642
    1125 07642
    1125 07643
    1126 06294
    1126 06294
    1126 06294
    1127 05770
    1127 05770
    1127 05770
    1128 07653
    1129 07631
    1129 07631
    1129 07631
    1129 08360
    1129 08360
    1129 08360
    1130 05046
    1130 05639
    1130 05680
    1130 06476.1
    1130 06821
    1130 06821.1
    1130 07116
    1131 07076

    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    5 AMMENORRHOEA
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 HYPERTENSION
    2 HYPERTENSION
    1 BEHAVIOURIAL PROBLEMS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 VISION CARE
    1 HEART
    2 HEART
    1
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 HEADACHE- MIGRAINE TENSION
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BLOOD DISORDER
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 DEPRESSION
    1 OVARIAN CYST
    1 DEPRESSION
    1 BARTHOLIN'S CYST
    1 BARTHOLIN'S CYST
    1
    1 ANAEMIA
    1

    1132 04009
    1132 04009
    1132 04009.1
    1133 07645
    1133 07645
    1134 08362
    1134 08363
    1134 08363
    1134 08363
    1134 08363
    1135 04204
    1135 04204
    1135 04204
    1135 04204
    1135 04204
    1135 04898
    1135 04898
    1135 06359
    1135 06359
    1135 06359
    1135 06359
    1135 07525
    1135 07525
    1135 07525
    1136 04796
    1136 04796
    1136 04796
    1137 03755
    1137 03755
    1137 03756
    1137 07072
    1137 07072
    1138 04772
    1138 04772
    1138 04772
    1138 05760
    1138 05760
    1138 06557
    1138 06557
    1138 06557
    1138 06557.1
    1138 06557.1
    1138 06557.1
    1138 06557.2
    1138 06557.3
    1138 06557.3
    1138 06557.3
    1138 06557.3
    1138 06557.3
    1138 06557.4
    1138 07617
    1138 07617
    1138 07617

    1 DIAB'ETES
    2 DIAB'ETES
    1 PROSTATE
    1 VISION CARE
    2 VISION CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HEART
    2 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ENDOCRINE DISORDERS
    2 ENDOCRINE DISORDERS
    1 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    1 GASTRIC - PEPTIC ULCER/GERD
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    5 ANAEMIA
    1 ANAEMIA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    1138 07618
    1138 07618
    1138 07618
    1138 07619
    1138 07619
    1138 07619
    1138 08476
    1138 08476
    1138 08476
    1138 08476
    1138 08476
    1139 07616
    1139 07616
    1139 07616
    1139 08474
    1139 08474
    1139 08474
    1140 04314
    1140 04314
    1140 04314
    1140 04315
    1140 04315
    1140 04315
    1141 07640
    1141 07640
    1141 07640
    1141 07640
    1142 03745
    1142 03745
    1142 05763
    1142 05763
    1142 05763
    1142 06563
    1142 06564
    1142 06564
    1142 06564
    1142 08359
    1142 08359
    1143 04010
    1143 04010
    1143 04010
    1143 04788
    1143 04788
    1143 05772
    1143 05772
    1143 07648
    1143 07648
    1143 08367
    1144 05933
    1145 05206
    1145 05206
    1145 07637
    1146 08361

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 ANXIETY
    2 ANXIETY
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    1 HEART
    2 HEART
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    1 OTITIS - EAR
    1
    1 VISION CARE
    2 VISION CARE
    1 SKIN - LESION
    1 ABSCESS

    1146 08361
    1147 03746
    1147 07820
    1148 04303
    1148 04303
    1148 04303
    1148 04303
    1148 04304
    1148 04304
    1148 05209
    1148 05209
    1148 05209
    1148 06124
    1148 06124
    1148 06124
    1148 06124
    1149 05215
    1149 05215
    1149 05215
    1150 04720
    1150 04720
    1150 04720
    1150 04720
    1150 04720
    1151 07111
    1151 07111
    1151 07111
    1151 07111
    1151 07111
    1151 07112
    1151 07112.1
    1151 07112.1
    1151 07112.1
    1151 07113
    1151 07113.1
    1151 07113.1
    1151 07113.1
    1151 07114
    1152 04005
    1153 08486
    1153 08487
    1153 08487
    1153 08487
    1154 05926
    1154 05926
    1154 05926
    1154 06560
    1154 06560
    1155 04117
    1155 04117
    1155 07620
    1155 08581
    1155 08581

    2 ABSCESS
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1
    2
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    3 PAINFUL LEGS
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    3 PAINFUL LEGS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 INSECT STING
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 SKIN - LESION
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    1 FEVER
    1 DIAB'ETES
    1 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HEART
    2 HEART
    3 HEART
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    1156 07819
    1156 07819
    1156 07819
    1157 06568
    1158 03617
    1158 03617
    1158 03617
    1158 03617
    1158 03617
    1159 07639
    1159 07639
    1159 07639
    1160 05212
    1160 05213
    1160 05213
    1160 05213
    1160 05213.1
    1160 05213.1
    1160 05769
    1160 05769
    1160 06125
    1160 06125
    1160 07644
    1161 06562
    1161 06562.1
    1161 06562.2
    1161 07772
    1161 07772
    1162 04125
    1162 04125
    1162 05932
    1162 05932
    1162 05932
    1162 06290
    1162 06290
    1162 06290
    1162 06290
    1162 06290.1
    1162 06290.1
    1162 06290.1
    1163 03862
    1163 03862
    1163 04003
    1163 04004
    1163 04004
    1163 04118
    1163 04899
    1163 04899
    1163 04899
    1163 04899
    1163 04899
    1163 06118
    1163 06118

    1 HEART
    2 HEART
    3 HEART
    1 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 GLAUCOMA
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 GLAUCOMA
    2 GLAUCOMA
    1 HYPERTENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 PROSTATE
    1 CHOSTOCHRONDITIS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1
    2
    1 HEART
    2 HEART
    3 HEART
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 CATARACT
    2 CATARACT
    1
    1 GLAUCOMA
    2 GLAUCOMA
    1 HYPERTENSION
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 HYPERTENSION
    2 HYPERTENSION

    1163 06119
    1163 06119
    1163 06120
    1163 06120
    1163 06178
    1163 06178
    1163 06178.1
    1163 06178.1
    1163 06178.1
    1163 06178.1
    1163 06178.1
    1163 06178.2
    1163 06178.2
    1163 06974
    1163 06974
    1163 06974
    1163 06974
    1163 06974
    1163 06974.1
    1163 06974.1
    1163 06974.1
    1163 07528
    1163 07528
    1163 07528
    1163 07528
    1163 07528
    1164 04312
    1164 05217
    1164 05217
    1164 05217
    1164 07071
    1164 07071
    1164 07071
    1165 07062
    1166 03904
    1166 03904
    1166 03904
    1166 04778
    1166 06123
    1166 06123
    1166 07065
    1166 07065
    1166 07635
    1166 07636
    1166 07636
    1166 08480
    1166 08481
    1166 08481
    1166 08482
    1166 08482
    1167 02057.1
    1167 03741
    1167 03741

    1 VISION CARE
    2 VISION CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 DIAB'ETES
    2 DIAB'ETES
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    5 DEPRESSION
    1 DEPRESSION
    2 DEPRESSION
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    3 HEART
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    4 DEPRESSION
    5 DEPRESSION
    1 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INTESTINAL COLIC
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 ABDOMINAL PAINS
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    1 VISION CARE
    2 VISION CARE
    1 DEPRESSION
    1 EYE DISORDER
    2 EYE DISORDER
    1 ENDOMETROSIS
    2 ENDOMETROSIS
    1
    1 VISION CARE
    2 VISION CARE

    1167 03741
    1167 04774
    1167 07622
    1167 07623
    1167 07623
    1167 07624
    1168 03740
    1168 03740
    1168 03740
    1168 03740
    1168 03740
    1168 04300
    1168 06558
    1168 06558
    1168 06558
    1168 06612
    1168 07049
    1168 07049
    1169 04116
    1169 04116
    1169 04116
    1170 07634
    1170 07634
    1171 06117
    1171 06117
    1172 05766
    1172 05766
    1172 05766
    1172 07066
    1172 07066
    1173 03764
    1173 06680
    1173 06680
    1174 04776
    1174 04777
    1174 04777
    1174 06295
    1175 06554
    1175 06554
    1176 04780
    1176 04780
    1177 04313
    1178 06113
    1178 06113
    1178 06113
    1178 06116
    1178 06116
    1179 05018
    1179 05214
    1179 05214
    1179 06614
    1179 06614
    1179 06614

    3 VISION CARE
    1
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 BRONCHITIS - ACUTE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 DEPRESSION
    2 DEPRESSION
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    1 VISION CARE
    2 VISION CARE
    1 FEVER
    2 FEVER
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 ABDOMINAL PAINS
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HORMONE REPLACMENT THERAPY
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART
    1
    2
    1 HYPERTENSION
    1 SINUSITIS
    2 SINUSITIS
    1 ABSCESS
    2 ABSCESS
    3 ABSCESS

    1179 06614
    1179 06614
    1180 06112
    1180 06112
    1180 06112
    1181 05297
    1181 05297
    1181 05297
    1181 07868
    1181 07868
    1182 03757
    1182 03757
    1182 03757
    1183 03750
    1183 03750
    1183 03751
    1183 03751
    1183 05203
    1183 05927
    1183 05927
    1183 05927
    1183 05928
    1184 04305
    1184 04305
    1184 04305
    1184 04305
    1184 04306
    1184 04306
    1184 04306
    1184 04306
    1184 04306
    1184 04306.1
    1184 04308
    1184 04308
    1184 04308
    1184 04308
    1184 04309
    1184 05768
    1184 05768
    1184 05768
    1184 07067
    1185 08472
    1185 08472
    1186 03742
    1186 03742
    1186 03901
    1186 04775
    1187 04119
    1187 04119
    1187 04119
    1188 03905
    1188 03905
    1188 04781

    4 ABSCESS
    5 ABSCESS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    1 BEHAVIOURIAL PROBLEMS
    2 BEHAVIOURIAL PROBLEMS
    3 BEHAVIOURIAL PROBLEMS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    1
    2
    1
    1
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE

    1188 04781
    1188 05765
    1188 08484
    1188 08484
    1189 05221
    1189 05221
    1189 07649
    1189 07649
    1189 07649
    1189 08368
    1189 08369
    1190 03752
    1190 03752
    1190 08493
    1190 08493
    1191 05195
    1191 05757
    1191 05757
    1192 06565
    1192 06565
    1192 06565
    1193 04316
    1194 07632
    1194 07632
    1194 07632
    1195 07817
    1195 07817
    1195 07817
    1196 03739
    1196 03739
    1196 06551
    1196 06551
    1196 06551
    1196 06551
    1196 06551
    1196 06552
    1196 06552
    1196 06552
    1196 06552
    1197 04768
    1197 04768
    1197 04768
    1197 04768
    1197 04768
    1197 04769.1
    1197 04769.1
    1197 08470
    1197 08470
    1198 06566
    1198 06567
    1198 06567
    1198 06567
    1199 05924

    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1 DENTAL CARE
    1 THYROID
    2 THYROID
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 MISCARRIAGE
    1 ANAEMIA
    2 ANAEMIA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL STRAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    1 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER

    1199 05924
    1200 07823
    1200 07823
    1200 07823
    1200 07823
    1201 05196
    1201 05196.1
    1201 05196.1
    1202 06111
    1202 07047
    1203 03759
    1203 03760
    1203 03760
    1203 03761
    1203 05774
    1203 05775
    1203 05775
    1203 05775
    1204 04773
    1204 04773
    1204 05925
    1204 05925
    1205 05147
    1205 05147
    1205 05147
    1205 08588
    1205 08588
    1205 08589
    1206 04383
    1206 04383
    1206 04383
    1206 07265
    1206 07265
    1206 07265
    1206 07265
    1206 07266
    1206 07267
    1206 07267
    1206 07267
    1206 07267
    1206 07268
    1206 07268
    1207 07269
    1208 04386
    1209 05145
    1209 05145
    1209 05145
    1209 05145
    1209 05146
    1209 05146
    1209 05146
    1210 04094
    1211 06572

    2 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 CERVICAL STRAIN
    1 BACK PAIN
    1 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    1 BONE & CARTILAGE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 THYROID
    2 THYROID
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 ASTHMA
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 ASTHMA
    2 ASTHMA
    1 BACK PAIN
    1 FATIGUE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    3
    1 HYPERTENSION
    1 DENTAL CARE

    1211 06572
    1212 04096
    1213 07272
    1213 07272
    1213 07272
    1213 07272
    1214 03899
    1214 03899
    1214 04770
    1214 04770
    1214 04771
    1214 04771
    1215 07050
    1215 08357
    1215 08357
    1215 08357
    1216 06289
    1216 06289
    1217 08483
    1217 08483
    1217 08483
    1218 09860.1
    1218 09860.1
    1218 09860.1
    1218 09860.1
    1218 09860.1
    1218 09860.2
    1218 06131
    1218 06131
    1218 06575
    1218 06575
    1218 07073
    1218 07073
    1218 07073
    1219 04310
    1219 04310
    1219 04310
    1219 04310
    1219 04310
    1219 06126
    1219 06126
    1220 07627
    1220 07627
    1221 06571
    1221 06571
    1221 06571
    1221 06571
    1221 06571
    1221 07638
    1221 07638
    1221 07638
    1221 07638
    1221 08485

    2 DENTAL CARE
    1 MISCARRIAGE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 HORMONE REPLACMENT THERAPY
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    5 DILATION & CURRETAGE
    1 DILATION & CURRETAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CANCER-BREAST
    2 CANCER-BREAST
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE

    1221 08485
    1222 05761
    1222 05761
    1222 05761
    1222 05761
    1222 05762
    1222 05762
    1222 08353
    1222 08353
    1223 08475
    1223 08475
    1223 08475
    1224 05201
    1224 05201
    1224 05201
    1224 05201
    1224 06297
    1224 06297
    1224 06561
    1224 06561
    1224 06561
    1224 06561
    1224 07055
    1224 07055
    1224 07055
    1224 07055
    1224 07055.1
    1224 07625
    1224 08479
    1224 08479
    1224 08479
    1225 04122
    1225 04122
    1225 04122
    1225 04122
    1225 04122
    1225 04783
    1225 04783
    1225 04783
    1225 04783
    1225 04783
    1225 04784
    1225 04784
    1225 05021
    1225 05021
    1225 05021
    1225 05021
    1225 05021
    1225 05021.1
    1225 05021.1
    1225 05022
    1225 05022
    1225 05022

    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    4 PHARYNGITIS
    1 RETINOPATY
    2 RETINOPATY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 THYROID
    1 THYROID
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HEART
    2 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM

    1225 06482
    1225 06482
    1225 06482
    1225 06482
    1225 07068
    1225 07068
    1225 07068
    1225 07068
    1225 07068
    1226 04795
    1226 04795
    1227 06574
    1227 06574
    1228 03907
    1228 03907
    1228 03907
    1228 05931
    1228 05931
    1228 05931
    1228 05931
    1228 05931
    1228 06128
    1228 06128
    1228 06128
    1228 06128
    1228 06128
    1228 06128.1
    1228 06129
    1228 06129
    1228 06129
    1228 06130
    1228 06130
    1228 06130
    1228 06130
    1229 05200
    1229 05200
    1230 04317
    1230 04317
    1231 07654
    1231 07654
    1231 07654
    1231 08371
    1231 08371
    1231 08371
    1231 08371
    1231 08371.1
    1231 08371.2
    1232 04782
    1232 06075
    1232 06075
    1232 06075
    1233 07822
    1233 07822

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    5 CHEST PAIN
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 THYROID
    2 THYROID
    3 THYROID
    4 THYROID
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 DENTAL CARE
    2 DENTAL CARE
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 RENAL DYSFUNCTION
    1 THYROID
    1 URTICARIA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2

    1233 08591
    1234 03900
    1234 03900
    1234 03900
    1235 07053
    1235 07053.1
    1235 07053.1
    1235 07053.1
    1235 07053.1
    1235 07053.2
    1235 07053.2
    1235 07053.2
    1235 07053.2
    1235 07053.2
    1235 07053.3
    1235 07053.4
    1235 07053.4
    1235 07053.5
    1235 07053.6
    1235 07053.6
    1236 04792
    1236 04792
    1236 04794
    1236 04794
    1237 04785
    1237 04785
    1237 04785
    1237 04785
    1238 03758
    1238 03758
    1238 08291
    1238 08291
    1238 08291
    1238 08291
    1238 08291
    1238 08291.1
    1238 08291.1
    1238 08291.1
    1238 08291.1
    1238 08291.1
    1239 06121
    1239 06121
    1240 03738
    1240 03738
    1240 03738
    1240 07810
    1240 07810
    1240 07810
    1240 07810
    1240 07810
    1240 07812
    1240 07812
    1241 07821

    1 DEVIATED NASAL SEPTUM


    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 BONE & CARTILAGE DISORDER
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    4 HYPERLIPIDERMIA - CHOLESTEROL
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 INTESTINAL COLIC
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1
    2
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE

    1241 07821
    1241 07821
    1242 03748
    1242 03748
    1242 03748.1
    1242 03749
    1242 07064
    1243 03908
    1243 03908
    1243 03908
    1244 04311
    1244 04786
    1244 04786
    1244 04786
    1244 04787
    1244 04787
    1244 04787
    1245 05218
    1245 05218
    1245 05218.1
    1245 05219
    1245 05219
    1245 05219
    1245 05220
    1245 05220
    1245 05220
    1245 05220
    1245 06573
    1245 06573
    1245 06573
    1245 06573
    1246 07110
    1246 07110
    1247 07626
    1247 07626
    1247 07626
    1247 07626
    1247 07818
    1247 07818
    1248 06288
    1248 07048
    1248 07048
    1248 07048
    1248 07048
    1249 05929
    1249 05929
    1249 05929
    1249 05929
    1249 08492
    1249 08492
    1250 05210
    1250 05210
    1250 05210

    2 VISION CARE
    3 VISION CARE
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    1 THYROID
    1 BREAST DISORDERS
    1 FATIGUE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1
    2
    3
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 GASTRIC - PEPTIC ULCER/GERD
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    1250 05210
    1250 05211
    1250 05211
    1250 05211
    1250 05211
    1250 05211
    1250 05211.1
    1251 04128
    1251 04128
    1251 04128
    1251 04128.1
    1251 04128.1
    1251 07074
    1251 07074
    1251 07650
    1251 07650
    1251 07651
    1251 07825
    1252 04302
    1252 04302
    1252 04302
    1252 04302
    1252 04302
    1252 04302.1
    1253 05773
    1253 05773
    1253 05773
    1253 07652
    1253 07652
    1253 07652
    1254 07061
    1255 05202
    1255 05202
    1256 05198
    1256 05198
    1256 05198
    1256 05198
    1257 06559
    1257 07621
    1257 07621
    1258 03763
    1258 03763
    1258 05222
    1258 06132
    1258 06132
    1258 06287
    1258 06287
    1258 06287
    1259 07075
    1259 07075
    1259 07075
    1260 08370
    1260 08370

    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1
    2
    3
    1
    2
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    1 VISION CARE
    2 VISION CARE
    1 HEADACHE- MIGRAINE TENSION
    1 HEADACHE- MIGRAINE TENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 OTITIS - EAR
    1 ENDOMETROSIS
    2 ENDOMETROSIS
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA
    1 PROSTATE
    2 PROSTATE

    1261 07063
    1261 07063
    1262 05758
    1262 05758
    1262 05758.1
    1262 07813
    1263 05759
    1263 05759
    1263 05759
    1263 06555
    1263 06555
    1263 06555
    1263 06611
    1264 08473
    1265 05767
    1265 05767
    1266 04126
    1266 04126
    1266 04126
    1266 04127
    1266 04127
    1267 04007
    1267 04007
    1267 04008
    1267 04008
    1267 04008
    1267 07070
    1267 07070
    1267 07070
    1267 07070
    1267 08366
    1267 08366
    1267 08366
    1267 08366.1
    1268 03903
    1268 03903
    1268 04002
    1268 04002
    1268 04002
    1269 06296
    1269 06296
    1269 06296
    1269 07633
    1269 07633
    1269 07633
    1269 07633
    1270 04560
    1270 04561
    1270 04561
    1270 04561
    1270 05263
    1270 05263
    1270 05263

    1 VISION CARE
    2 VISION CARE
    1 INGROWING TOE NAIL
    1 INGROWING TOE NAIL
    1 OVARIAN CYST
    1 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 FEVER
    2 FEVER
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 HEMORRHOIDS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC

    1270 05263
    1270 05263
    1270 05263.1
    1270 05263.1
    1270 05263.1
    1270 05264
    1270 05264
    1270 05475
    1270 05475
    1270 07117
    1270 07117
    1270 07117
    1271 06906
    1271 06906
    1271 06906
    1272 04564
    1272 04564
    1272 04564
    1273 03646
    1273 03646
    1273 03646
    1273 03647
    1273 03647
    1273 03647
    1274 04397
    1274 04397
    1274 04397
    1274 07873
    1274 07873
    1274 07873
    1275 04398
    1275 04398
    1275 04398
    1275 04399
    1275 05996
    1275 05996
    1275 05996
    1275 05996
    1275 05996
    1275 08105
    1275 08105
    1276 03618
    1276 03618
    1276 03618
    1276 03618
    1276 03618
    1276 03618.1
    1276 03618.1
    1276 03618.1
    1276 03618.1
    1277 04563
    1277 04563
    1277 04563

    4 INTESTINAL COLIC
    5 INTESTINAL COLIC
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 TENDONITIS
    2 TENDONITIS
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 CANCER-BREAST
    2 CANCER-BREAST
    3 CANCER-BREAST
    1
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    4 PROSTATE
    5 PROSTATE
    1
    2
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    4 KNEE INTERNAL DERANGEMENT
    5 KNEE INTERNAL DERANGEMENT
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    4 KNEE INTERNAL DERANGEMENT
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS

    1277 04563
    1277 05477
    1277 05477
    1277 05477
    1277 05478
    1277 05478
    1277 05478
    1277 05478
    1277 05478
    1277 07329
    1277 07329
    1277 07329
    1277 07329
    1277 07869
    1277 07869
    1277 07869
    1278 05994
    1278 05994
    1278 05994
    1278 05994
    1278 05994
    1279 06753
    1279 06753
    1280 04562
    1280 04562
    1280 04562
    1280 04562
    1280 04562
    1280 04562.1
    1280 04562.1
    1280 05476
    1280 05476
    1281 03648
    1281 03648
    1281 04396
    1281 04396
    1281 04396
    1282 03558
    1282 03558
    1282 03558
    1282 03558.1
    1282 03558.1
    1282 03558.1
    1282 03558.1
    1282 04626
    1282 04626
    1282 04626
    1282 04626
    1282 07870
    1282 07870
    1282 07870
    1282 07870.1
    1283 04677

    4 SKIN - ATOPIC DERMATITIS


    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    5 BRONCHITIS - ACUTE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    4 PROSTATE
    5 PROSTATE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 FEVER
    2 FEVER
    3 FEVER
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    4 KNEE INTERNAL DERANGEMENT
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    4 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    1 DEVIATED NASAL SEPTUM

    1283 04677
    1283 04677
    1283 04677
    1283 04677
    1283 04677.1
    1283 04678
    1283 04678
    1283 04679
    1283 04679
    1283 05266
    1283 05266
    1283 07119
    1283 07119
    1283 07119
    1283 07119
    1283 07120
    1283 07120
    1284 05298
    1284 05298
    1284 05298
    1284 05298.1
    1284 05298.1
    1284 05298.1
    1285 06866
    1285 06866
    1286 04680
    1286 04680
    1287 06010
    1287 06257
    1287 06257
    1287 07330
    1287 07330
    1288 06484
    1288 06484
    1289 08321.1
    1289 08321.1
    1289 08321.1
    1289 08321.1
    1290 03911
    1291 08102
    1291 08102
    1291 08102
    1292 08098
    1292 08098
    1292 08099
    1292 08099
    1292 08099
    1292 08099
    1293 07871
    1293 07872
    1293 07872
    1294 05480
    1294 05480

    2 DEVIATED NASAL SEPTUM


    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1
    2
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 ALOPECIA
    2 ALOPECIA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    2 HEART
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DEPRESSION
    2 DEPRESSION
    1
    1 VISION CARE
    2 VISION CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 BACK PAIN
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    1 VISION CARE
    2 VISION CARE

    1294 05480
    1294 05995
    1294 05995
    1294 05995
    1295 05268
    1295 05268
    1295 05268
    1296 03559
    1296 03559
    1296 04565
    1296 04565
    1296 04565
    1296 04566
    1296 04566
    1296 04566
    1296 05479
    1296 08103
    1296 08103
    1296 08103
    1296 08104
    1296 08104
    1296 08104
    1297 05993
    1297 05993
    1298 06009
    1299 03910
    1299 03910
    1299 03910
    1299 03910
    1299 03910
    1299 05269
    1299 05269
    1300 04906
    1300 04906
    1300 04906
    1300 04906
    1300 07414
    1300 07414
    1301 03912
    1301 05682
    1302 05023
    1302 07529
    1302 08006
    1302 08006
    1302 08006.1
    1302 08006.1
    1303 03495
    1303 03495
    1303 03495
    1303 03909
    1303 03909
    1303 03909
    1303 06752

    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALOPECIA
    2 ALOPECIA
    3 ALOPECIA
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 BONE & CARTILAGE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 EYE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1
    2
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1
    1 SKIN - ATOPIC DERMATITIS
    1 ARTHRITIS
    1 BACK PAIN
    1 CERVICAL STRAIN
    2 CERVICAL STRAIN
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 RECTAL ABCESS

    1303 06752
    1303 06752
    1304 04318
    1304 04907
    1304 07077
    1304 07077
    1304 07077
    1305 06867
    1305 06867.1
    1305 06867.2
    1305 06867.2
    1306 04447
    1306 04447
    1306 04447
    1306 06750
    1306 06751
    1306 06751
    1307 08374
    1307 08374
    1307 08374
    1308 08008
    1309 05299
    1309 05299
    1309 05299
    1309 05299.1
    1309 05299.1
    1310 04097
    1311 05827
    1311 05827
    1311 05827
    1311 05828
    1311 05829
    1311 05829
    1311 05829
    1311 05829
    1312 05267
    1312 05681
    1312 06526
    1312 06527
    1312 06527
    1312 06527
    1312 06527
    1312 06527.1
    1312 06527.1
    1312 07562
    1312 07563
    1313 06528
    1313 06528
    1313 06528
    1313 06528
    1313 06528
    1314 05997
    1314 05997

    2 RECTAL ABCESS
    3 RECTAL ABCESS
    1
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 DIAB'ETES
    1 CANDIDIASIS
    1 ANXIETY
    2 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1
    2
    3
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    1
    2
    3
    4
    1 INTESTINAL COLIC
    1 INTESTINAL COLIC
    1 GASTRIC - PEPTIC ULCER/GERD
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 DIAB'ETES
    2 DIAB'ETES
    1 MISCARRIAGE
    1 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE

    1314 05997
    1315 08158
    1315 08158
    1316 03561
    1316 06241
    1317 06242
    1317 06242
    1317 06242
    1318 04681
    1318 04681
    1319 03560
    1319 03560
    1319 03560
    1319 03560
    1319 04682
    1319 04682
    1319 04682
    1319 04991
    1319 04991
    1319 04991
    1319 08292
    1319 08292
    1319 08292
    1320 03563
    1320 03563
    1320 03563.1
    1320 03564
    1320 03564
    1320 03564
    1320 03564.1
    1320 03564.1
    1320 03564.1
    1320 03564.1
    1320 03564.2
    1321 04801
    1321 04802
    1321 04802
    1321 04802
    1321 07128
    1321 07128
    1321 07128
    1322 05645
    1322 05645
    1322 05645
    1322 05645
    1322 05645
    1322 05645.1
    1322 05645.1
    1322 05645.1
    1322 05645.1
    1322 05645.1
    1322 07122
    1322 07122

    3 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 SKIN - ATOPIC DERMATITIS
    1
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 CHOSTOCHRONDITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 PAIN-BACK/SHOULDER
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE

    1322 07123
    1322 07123
    1322 07123
    1322 05645,2
    1322 05645,2
    1323 03967
    1323 07124
    1323 07124
    1323 07124
    1323 07125
    1324 05393
    1324 05393
    1324 05393
    1324 05393.1
    1324 05393.1
    1324 05393.2
    1324 05393.2
    1324 05393.2
    1324 05393.2
    1324 05393.23
    1324 05393.23
    1325 05392
    1325 05392
    1325 05392
    1325 08108
    1325 08108
    1326 03562
    1326 03562
    1326 04797
    1326 04798
    1326 04798
    1326 04798
    1326 08106
    1326 08106
    1326 08106
    1326 08106
    1326 08107
    1326 08107
    1326 08107
    1327 03567
    1327 03567
    1328 07126
    1328 07126
    1328 07126
    1329 08113
    1329 08113
    1329 08113
    1330 04076
    1330 04076
    1330 04076
    1331 03620
    1331 03620
    1331 04074

    1 INFECTION THUMB
    2 INFECTION THUMB
    3 INFECTION THUMB
    1 DIAB'ETES
    2 DIAB'ETES
    1 GLAUCOMA
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 GLAUCOMA
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    1 HYPERTENSION
    2 HYPERTENSION
    1 ANXIETY
    2 ANXIETY
    3 ANXIETY
    4 ANXIETY
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FATIGUE
    2 FATIGUE
    1 HYPERTENSION
    2 HYPERTENSION
    1
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 HEART
    2 HEART
    3 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 OVARIAN CYST

    1331 04074
    1331 04800
    1331 04800
    1331 07127
    1331 07276
    1331 07276
    1331 07276
    1332 03568
    1332 03569
    1332 03569
    1332 03569
    1332 03569
    1333 04075
    1333 04075
    1333 04075.1
    1333 04804
    1333 04804
    1333 04804
    1333 05650
    1333 05650
    1333 05651
    1333 05651
    1333 07279
    1333 07279
    1333 08117
    1333 08117
    1333 08118
    1333 08119
    1334 05395
    1334 05395
    1335 08120
    1335 08120
    1335 08120
    1336 05401
    1336 05401
    1336 05401
    1337 03566
    1337 03566
    1337 03566
    1337 03566
    1338 08299
    1339 03968
    1339 03968
    1339 03968
    1339 03968
    1340 06485
    1340 06485
    1340 06485
    1340 06485
    1340 06485
    1341 03970
    1341 03970
    1341 05396

    2 OVARIAN CYST
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 OVARIAN CYST
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1
    2
    1 HEARING LOSS
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 FEVER
    2 FEVER
    1 CANDIDIASIS
    2 CANDIDIASIS
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 SKIN - LOCAL INFECTION
    1 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    4 HEADACHE- MIGRAINE TENSION
    1 CANDIDIASIS
    2 CANDIDIASIS
    3 CANDIDIASIS
    4 CANDIDIASIS
    5 CANDIDIASIS
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    1 PAIN-BACK/SHOULDER

    1341 05396
    1341 05396
    1341 05396
    1341 05396.1
    1341 05396.1
    1341 08494
    1341 08494
    1341 08494
    1342 03570
    1342 03570
    1343 05648
    1343 05648
    1343 05648
    1343 05648
    1343 05648
    1343 05648.1
    1343 08293
    1343 08293
    1343 08293
    1343 08293
    1343 08294
    1343 08294
    1343 08295
    1343 08295
    1343 08295
    1343 08295
    1343 08295.1
    1343 08295.1
    1344 03573
    1344 08112
    1344 08112
    1344 08112
    1345 07121
    1345 07121
    1346 03966
    1346 03966
    1346 03966
    1346 03966
    1347 03976
    1347 03977
    1347 03977
    1347 03977
    1347 03977.1
    1347 03977.1
    1347 05402
    1347 08300
    1347 08300
    1347 08300
    1348 05643
    1348 05643
    1348 05643
    1349 03571
    1349 03571

    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    1 HYPERTENSION
    2 HYPERTENSION
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 HERPES ZOSTER
    2 HERPES ZOSTER
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    3 SOFT TISSUE DISORDERS/DISEASE
    4 SOFT TISSUE DISORDERS/DISEASE
    5 SOFT TISSUE DISORDERS/DISEASE
    1 SOFT TISSUE DISORDERS/DISEASE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 ASTHMA
    2 ASTHMA
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    3 ACUTE ENTERITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER

    1349 03571
    1349 03571
    1350 03574
    1350 03575
    1350 03575
    1350 03971
    1350 03971
    1350 03971.1
    1350 03973
    1350 03974
    1350 03975
    1350 03975
    1350 04803
    1350 04803
    1350 04803
    1350 05397
    1350 05397
    1350 05397
    1350 05397.1
    1350 05397.1
    1350 05649
    1350 05649
    1350 07129
    1350 07129
    1350 08114
    1350 08115
    1350 08115
    1350 08115.1
    1351 05391
    1352 04799
    1352 04799
    1352 04799
    1353 08109
    1354 05047
    1354 05047
    1354 05509
    1354 05509
    1354 05509
    1354 05509
    1354 07278
    1354 07379
    1354 08116
    1354 08116
    1355 06079
    1356 04319
    1356 04319
    1356 04319
    1356 04319
    1356 04319
    1356 04319.1
    1356 07416
    1356 07416
    1356 07416

    3 FEVER
    4 FEVER
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    1 THYROID
    2 THYROID
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BREAST DISORDERS
    1 SKIN - LOCAL INFECTION
    1 FEVER
    2 FEVER
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 THYROID
    2 THYROID
    1 THYROID
    2 THYROID
    1 THYROID
    2 THYROID
    1 THYROID
    1 FEVER
    2 FEVER
    1 DEVIATED NASAL SEPTUM
    1 CHOSTOCHRONDITIS
    1 FEVER
    2 FEVER
    3 FEVER
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEADACHE- MIGRAINE TENSION
    2 HEADACHE- MIGRAINE TENSION
    3 HEADACHE- MIGRAINE TENSION
    4 HEADACHE- MIGRAINE TENSION
    1 DENTAL CARE
    1 LARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    1 GLAUCOMA
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    1356 07416
    1356 07416
    1357 03765
    1357 03765
    1357 03766
    1357 03766
    1357 04320
    1357 04805
    1357 07883
    1358 04993
    1358 04993
    1358 04993
    1358 04993
    1358 04994
    1358 04994
    1358 04994
    1358 04994
    1358 04994
    1359 03916
    1359 03916
    1359 03916
    1359 03917
    1359 03917
    1359 03917
    1360 05024
    1360 05024
    1360 05024
    1360 05024
    1360 05024
    1360 05025
    1360 05025
    1360 05025
    1360 05025
    1360 05025
    1360 05025.1
    1360 05125
    1360 05125
    1360 05125
    1360 05125
    1361 03913.1
    1361 03913.1
    1362 03914
    1362 03914
    1362 03914
    1362 03915
    1362 03915
    1362 04321
    1362 04321
    1362 06341
    1362 06341
    1362 06907
    1362 06907
    1362 06907

    4 DENTAL CARE
    5 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1
    2
    1 SKIN - LOCAL INFECTION
    1 DIAB'ETES
    1 DIAB'ETES
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 LARYNGITIS
    2 LARYNGITIS
    3 LARYNGITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1
    2
    3
    4
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES

    1363 03767
    1363 03767
    1363 03767
    1364 07419
    1365 03501
    1365 03501
    1365 03501
    1365 03501
    1365 03502
    1365 03502
    1365 03502
    1365 03502
    1365 03502
    1365 06913
    1365 06913.1
    1365 06913.2
    1366 04590
    1366 04590
    1366 04590.1
    1366 04590.1
    1366 06179
    1366 06179
    1366 06179
    1366 06179
    1366 07995
    1366 07995
    1367 06868
    1368 08536
    1369 03505
    1369 03505
    1369 03505
    1369 06488
    1369 06488.2
    1369 06488.2
    1369 06488.3
    1370 04571
    1370 04571
    1370 04571
    1371 05964
    1371 05964
    1371 05964
    1372 07787
    1372 07787
    1373 04922
    1373 04922
    1373 05967
    1373 05967
    1373 05967
    1373 05967
    1374 04012
    1374 04012
    1374 04012
    1374 04012.1

    1
    2
    3
    1 RENAL DYSFUNCTION
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HYPERTENSION
    1 HYPERTENSION
    1 ARTHRITIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ANAEMIA
    1
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    3 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1
    1 ENDOCRINE DISORDERS
    2 ENDOCRINE DISORDERS
    3 ENDOCRINE DISORDERS
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 HYPERTENSION

    1374 04012.2
    1374 04012.3
    1374 07418
    1374 07418
    1374 07418
    1374 07418
    1375 04913
    1375 04913
    1375 04913
    1375 05543
    1375 05543
    1375 06979
    1375 06979
    1375 07421
    1375 07421
    1375 07421
    1375 07422
    1375 07422
    1375 07779
    1376 04017
    1376 04017
    1376 04017.1
    1376 04017.1
    1376 04914
    1376 04914
    1376 04914
    1376 04914
    1376 04914
    1376 06921.1
    1376 06921.1
    1376 06921.1
    1376 06922.1
    1376 06922.1
    1377 05835
    1377 05836
    1377 05836
    1377 05836
    1377 05837
    1377 05837
    1378 07796
    1378 07796
    1378 07796
    1378 07796
    1379 03497
    1379 03497
    1379 03497
    1379 03497
    1379 05707
    1379 05707
    1379 05707
    1379 05707
    1379 05707
    1379 06038

    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 KIDNEY DISEASE
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    3 KIDNEY DISEASE
    4 KIDNEY DISEASE
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 CHEST PAIN
    2 CHEST PAIN
    1 ARTHRITIS
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1
    2
    1 THROMBOSIS
    2 THROMBOSIS
    3 THROMBOSIS
    4 THROMBOSIS
    5 THROMBOSIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 LARYNGITIS
    2 LARYNGITIS
    1 EYE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    3 DILATION & CURRETAGE
    4 DILATION & CURRETAGE
    1 SKIN - ECZEMA
    2 SKIN - ECZEMA
    3 SKIN - ECZEMA
    4 SKIN - ECZEMA
    5 SKIN - ECZEMA
    1 DEVIATED NASAL SEPTUM

    1379 06038
    1379 06038.1
    1379 06038.1
    1379 06038.2
    1379 06038.2
    1379 06908
    1379 06908
    1379 07776
    1379 07776
    1379 07776
    1379 08031
    1379 08031
    1379 08031
    1379 08031.1
    1379 08031.1
    1379 08597
    1379 08597
    1379 08597
    1379 08597
    1379 08597.1
    1380 04011
    1380 04011
    1380 04011
    1381 07788.2
    1381 07788.2
    1381 07788.2
    1381 07788.3
    1381 07788.3
    1382 05965
    1382 08301
    1383 04568
    1383 04568
    1384 04567
    1384 04567
    1384 05403
    1384 05403
    1384 05403
    1384 06909
    1384 06909
    1384 06909
    1384 07417
    1384 07417
    1384 07417.1
    1384 07955
    1384 08566
    1384 08566
    1385 05407
    1385 05407
    1385 05407
    1385 05407
    1386 04572
    1386 04572
    1386 04572

    2 DEVIATED NASAL SEPTUM


    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    1 HYPERTENSION
    2 HYPERTENSION
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    1 SKIN - ATOPIC DERMATITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 CATARACT
    2 CATARACT
    3 CATARACT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER
    2 EYE DISORDER
    2 EYE DISORDER
    1 ANAEMIA
    2 ANAEMIA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    1386 04572
    1386 04572
    1386 05415
    1386 07425
    1386 07425
    1387 05417
    1388 04020
    1388 04020
    1388 04020
    1389 04919
    1389 04919
    1390 04019
    1390 04019
    1390 04019
    1391 03082
    1391 03082
    1391 03082
    1391 03082
    1391 03082
    1391 03082.1
    1391 06893
    1391 06893.1
    1392 06925
    1392 06925
    1392 06926
    1392 06926
    1393 03500
    1393 03500
    1393 04013
    1393 04014
    1393 04912
    1393 06260
    1393 06911
    1393 07420
    1393 07778
    1393 07778
    1394 07828
    1394 07828
    1394 07828
    1394 07828.1
    1394 07828.1
    1394 07828.1
    1394 07828.1
    1395 07429
    1395 07430
    1395 07430
    1395 07430
    1395 08537
    1396 05419
    1396 05419
    1396 05419
    1396 05419
    1396 05419

    4 DENTAL CARE
    5 DENTAL CARE
    1 DIAB'ETES
    1 CATARACT
    2 CATARACT
    1 VISION CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    3
    4
    5
    1
    2 SKIN - ECZEMA
    2 SKIN - ECZEMA
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    1 GLAUCOMA
    2 GLAUCOMA
    1 GLAUCOMA
    1 VISION CARE
    1 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    1 GLAUCOMA
    2 GLAUCOMA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    4 CONSTIPATION
    1 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    4 CIRCULATORY DISORDER
    5 CIRCULATORY DISORDER

    1396 05419.1
    1396 05419.1
    1396 05419.1
    1396 05419.1
    1396 05844
    1396 05844
    1396 05844
    1396 05844
    1396 05844
    1396 05844.1
    1396 05844.1
    1396 05844.1
    1396 05844.1
    1396 05844.1
    1397 03504
    1398 04918
    1398 04918
    1398 04918
    1398 04918
    1398 04918
    1398 04918.1
    1398 05839
    1398 05839
    1398 05839
    1398 05839
    1398 05839.1
    1398 06263
    1398 06263
    1398 06263
    1398 07830
    1398 07830.1
    1398 07830.2
    1398 07830.2
    1399 05410
    1399 05411
    1399 06261
    1399 06261
    1399 07884
    1399 07884
    1399 07884
    1399 07884
    1399 07884
    1399 07884.1
    1400 04910
    1400 04910
    1400 04910
    1400 04910
    1400 05405
    1400 06259
    1400 06259
    1401 06927
    1401 06927
    1401 06927

    1 CIRCULATORY DISORDER
    2 CIRCULATORY DISORDER
    3 CIRCULATORY DISORDER
    4 CIRCULATORY DISORDER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 OTITIS - EAR
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 DIAB'ETES
    1
    2
    3
    4
    1 DIAB'ETES
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    1 MUSCULAR PAIN
    1 BURSITIS
    1 DIAB'ETES
    2 DIAB'ETES
    1 DILATION & CURRETAGE
    1 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    5 RENAL DYSFUNCTION
    1 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER

    1401 06927
    1402 04016
    1403 05414
    1403 05414
    1403 05414
    1403 06264
    1403 06264
    1404 05830
    1405 05833
    1405 05833
    1405 05833
    1406 03498
    1406 03499
    1406 03499
    1406 03499
    1407 05843
    1408 04921
    1408 04921
    1409 04569
    1409 04569
    1410 04025
    1410 04025
    1410 04025
    1410 06928
    1411 04015
    1411 04015
    1412 07423
    1412 07423
    1412 07423
    1413 05404
    1413 05404
    1413 07775
    1414 04576
    1414 04576
    1415 07780
    1415 07780
    1416 06269
    1417 06919
    1417 06919
    1417 06919
    1417 06919
    1417 06919
    1418 05832
    1419 04023
    1419 05416
    1419 05416
    1419 07786
    1419 07786
    1420 04920
    1420 04920
    1420 07785
    1421 07795
    1421 07795

    4 FEVER
    1 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 ARTHRITIS
    2 ARTHRITIS
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 MISCARRIAGE
    1 BACK PAIN
    2 BACK PAIN
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 HEART
    2 HEART
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OTITIS - EAR
    2 OTITIS - EAR
    1 VISION CARE
    1 BREAST DISORDERS
    2 BREAST DISORDERS
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1
    1 EYE DISORDER
    1
    2
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    1422 05418
    1422 05418
    1423 06258
    1423 06258
    1423 06258
    1424 06918
    1424 06918
    1424 06918
    1425 03506
    1425 04209
    1425 04209
    1425 04209
    1425 04209
    1425 04209.1
    1425 04209.1
    1425 04209.1
    1425 04401
    1425 04401
    1425 04401
    1425 04401
    1425 04402
    1425 04402
    1425 04402
    1425 04402
    1425 05482
    1425 05482
    1425 05483
    1425 05484
    1425 06267
    1425 06268
    1425 06298
    1425 06298
    1425 07532
    1425 07532
    1425 07532
    1425 07532.1
    1425 07791
    1425 07791
    1425 07791.1
    1425 07791.1
    1425 07791.2
    1425 07793
    1425 07794
    1425 08303
    1426 03768
    1426 03768
    1426 03768
    1427 05225
    1427 05225
    1428 05840
    1428 05840
    1429 04573
    1429 04573

    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BEHAVIOURIAL PROBLEMS
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DILATION & CURRETAGE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 PROSTATE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEART
    2 HEART

    1429 04573
    1429 04574
    1429 04755
    1429 04755
    1429 07426
    1429 07426
    1429 07426
    1429 07426
    1429 07426
    1429 07426.1
    1429 07426.1
    1429 07427
    1429 07427
    1429 07427
    1430 06923
    1430 06923
    1430 06923
    1431 06910
    1431 06910
    1432 07424
    1433 04911
    1434 04018
    1434 04018
    1434 04018
    1434 04018
    1435 04862
    1435 04862
    1435 04862.1
    1435 05412
    1435 05412
    1435 05412.1
    1436 06912
    1436 06912
    1437 05831
    1437 05831
    1437 05831
    1437 05831
    1438 04024
    1438 04024
    1438 04630
    1438 04630
    1438 04630
    1438 05841
    1438 05841
    1438 05841.1
    1438 05841.1
    1438 05842
    1438 05842
    1438 06688
    1439 07783
    1439 07783
    1440 05966
    1440 05966

    3 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 HEART
    2 HEART
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    5 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE
    1 ABSCESS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEPRESSION
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ANXIETY
    2 ANXIETY
    1 DIAB'ETES
    2 DIAB'ETES
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    1 EYE DISORDER
    2 EYE DISORDER

    1440 06487
    1440 06487
    1440 06487
    1440 06487
    1441 07826
    1441 07826
    1441 08030
    1441 08030
    1441 08030
    1441 08030
    1441 08030
    1441 08030.1
    1442 06686
    1442 06686
    1442 06686
    1443 06924
    1443 07957
    1443 07957
    1444 04864
    1444 04864
    1444 04864
    1445 05406
    1445 05406
    1445 05406
    1446 05224
    1446 05224
    1447 06687
    1447 07781
    1448 03769
    1448 04570
    1448 04570
    1448 04683
    1448 04683
    1448 04683
    1448 04684
    1448 04684
    1448 04684
    1448 04861
    1448 05408
    1448 05408
    1448 06917
    1449 03770
    1449 03770
    1449 03770
    1449 03770
    1449 03770
    1449 03770.1
    1449 04400
    1449 04400
    1449 04400
    1449 04400
    1450 04629
    1450 04629

    1 GLAUCOMA
    2 GLAUCOMA
    3 GLAUCOMA
    4 GLAUCOMA
    1 PHARYNGITIS
    2 PHARYNGITIS
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    5 BRONCHITIS - ACUTE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    1 HYPERTENSION
    1 DEPRESSION
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEPRESSION
    1 DEPRESSION
    2 DEPRESSION
    1 DEPRESSION
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1
    2
    3
    4
    1 TONSILLITIS
    2 TONSILLITIS

    1450 04629
    1451 06266
    1451 06266
    1451 06266
    1452 04130
    1452 04130
    1452 04130
    1452 04130
    1453 07784
    1453 08538
    1454 05413
    1454 05413
    1455 04863
    1456 04636
    1456 04636
    1456 04636
    1456 04636
    1456 04637
    1456 04637
    1456 06932
    1456 06932
    1456 06932
    1456 06933
    1456 06933
    1456 06933
    1456 06933
    1457 04806
    1457 04806
    1457 05066
    1457 07658
    1457 07996
    1457 07996
    1457 08160
    1457 08160
    1458 04807
    1458 04807
    1458 04807
    1458 04807
    1458 07489
    1459 04635
    1459 04635
    1459 04635
    1459 05164
    1459 05164
    1459 05164
    1459 05164
    1459 05849
    1459 05849
    1459 06014
    1459 06014
    1459 06014
    1459 06014
    1459 06014

    3 TONSILLITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 MISCARRIAGE
    1 MISCARRIAGE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    1 INGROWING TOE NAIL
    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    4 BACK PAIN
    1 DENTAL CARE
    1
    2
    3
    1 INFECTION - MALE GENITAL
    2 INFECTION - MALE GENITAL
    3 INFECTION - MALE GENITAL
    4 INFECTION - MALE GENITAL
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1
    2
    3
    4
    5

    1459 06689
    1459 06689
    1459 06689
    1459 06691
    1459 06691
    1459 06691
    1459 06691
    1459 06934
    1459 06934
    1459 06934
    1459 06934
    1459 07660
    1459 07660
    1459 07660
    1459 07833
    1459 07833
    1459 07997
    1459 07997
    1459 08601
    1459 08601
    1460 05067
    1460 05067
    1460 05067
    1460 05067
    1461 05345
    1461 05345
    1461 05345
    1461 05345
    1462 05343
    1462 05343
    1462 05343
    1462 05344
    1462 05344
    1462 05344
    1463 04026
    1463 04026
    1463 04027
    1463 04027
    1463 04027
    1463 04029
    1463 04029
    1463 04029
    1463 04029
    1463 04631
    1463 04631
    1463 04631
    1463 04631.1
    1463 04631.1
    1463 04631.1
    1463 04631.2
    1463 04631.2
    1463 04631.2
    1463 04724

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 KIDNEY DISEASE
    2 KIDNEY DISEASE
    1 GENERAL PAIN
    2 GENERAL PAIN
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    1 MUSCULAR PAIN
    2 MUSCULAR PAIN
    3 MUSCULAR PAIN
    4 MUSCULAR PAIN
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 TONSILLITIS

    1463 04724
    1463 04724
    1463 04724
    1463 04724
    1463 04724.1
    1463 04724.1
    1463 05458
    1463 05458
    1463 05458
    1463 05458
    1464 04865
    1464 04865
    1464 04865
    1464 04865
    1464 04865
    1464 05026
    1464 05026
    1464 05026
    1464 05026
    1464 05026
    1464 05457
    1464 05457
    1464 06301
    1464 06301
    1464 06301
    1464 06301
    1464 06931
    1464 07381
    1464 08272
    1465 03773
    1465 03773
    1465 03773
    1465 03773
    1465 06013
    1465 06013
    1465 06013
    1465 06739
    1465 06739
    1465 06739
    1465 06739
    1465 06739
    1466 04322
    1466 04324
    1466 04324
    1466 06302
    1466 06302
    1466 06302
    1466 07130
    1466 07130
    1466 07130
    1466 07130
    1466 07131
    1466 07131

    2 TONSILLITIS
    3 TONSILLITIS
    4 TONSILLITIS
    5 TONSILLITIS
    1 SINUSITIS
    2 SINUSITIS
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    5 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 DENTAL CARE
    1 DENTAL CARE
    1 DIAB'ETES
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 OBESITY
    1 HEMATURIA
    2 HEMATURIA
    1 CONSTIPATION
    2 CONSTIPATION
    3 CONSTIPATION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 OBESITY
    2 OBESITY

    1466 07131
    1466 07131
    1467 05346
    1467 05346
    1467 05346
    1467 05346
    1467 05346
    1467 05346.1
    1467 05346.2
    1467 07132
    1467 07659
    1468 04995
    1468 04995
    1468 05274
    1468 05274
    1468 05274
    1468 07832
    1468 07832
    1468 07832
    1468 07832
    1468 07832
    1468 07832.1
    1469 04632
    1469 04632
    1469 04632
    1469 04632
    1469 04633
    1469 04633
    1469 04633
    1469 04634
    1469 04634
    1469 04634
    1469 05848
    1469 05848
    1469 05848
    1469 08161
    1469 08162
    1470 04030
    1470 04030
    1470 04030
    1470 04030
    1470 06741
    1470 06741
    1470 06741
    1471 05068
    1471 05068
    1471 05068
    1472 05064
    1472 05064
    1472 05064
    1473 05065
    1473 05065
    1473 05065

    3 OBESITY
    4 OBESITY
    1
    2
    3
    4
    5
    1
    1 DIAB'ETES
    1
    1 HYPERTENSION
    1 HERPES ZOSTER
    2 HERPES ZOSTER
    1 PNEUMONIA
    2 PNEUMONIA
    3 PNEUMONIA
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ASTHMA
    1 SINUSITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE

    1473 05456
    1473 05456
    1473 05456
    1474 06299
    1474 06299
    1474 06299
    1474 06299
    1474 06935
    1474 06935
    1474 06935
    1475 07657
    1475 07657
    1475 07657
    1475 07657
    1476 05846
    1476 05846
    1476 05846
    1477 08600
    1477 08600
    1477 08600
    1478 07488
    1478 07488
    1479 07831
    1479 07831
    1479 07831
    1479 07831
    1480 03771
    1481 07331
    1481 07331
    1481 07331
    1482 03599
    1482 03599
    1482 03599
    1483 05354
    1483 05354
    1483 07336
    1483 07336
    1483 08391
    1483 08391
    1484 05352
    1484 05352
    1484 05352
    1485 04651
    1485 04651
    1486 04325
    1486 04325
    1486 04325
    1486 05351
    1486 05351
    1486 05351
    1486 05351
    1487 08033
    1487 08033

    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    3
    4
    1 NASAL POLYP
    2 NASAL POLYP
    3 NASAL POLYP
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 FEVER
    2 FEVER
    3 FEVER
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 PHARYNGITIS
    2 PHARYNGITIS
    3 PHARYNGITIS
    1 VISION CARE
    2 VISION CARE
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    1487 08033
    1487 08033
    1488 04144
    1488 04144
    1488 04144
    1488 06826
    1488 06827
    1488 06827
    1488 06827
    1488 08390
    1489 05353
    1490 06082
    1490 06082
    1491 04146
    1491 04146
    1491 04146
    1491 04146
    1492 03601
    1492 03601
    1492 03601
    1492 07247
    1492 07247
    1492 07248
    1492 07248
    1492 07248
    1492 07248
    1492 07334
    1492 07334
    1492 07334
    1492 07334
    1492 07334.1
    1492 07334.1
    1492 07334.1
    1493 04326
    1493 04326
    1493 04326
    1493 07332
    1493 07332
    1493 07333
    1493 07333
    1493 07333
    1493 07333
    1494 06830
    1494 06830
    1494 06830
    1495 04650
    1495 04650
    1495 04650
    1496 05349
    1496 05349
    1496 05350
    1496 05350
    1496 05350

    3 DENTAL CARE
    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 HORMONE REPLACMENT THERAPY
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    1 MISCARRIAGE
    1
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 TONSILLITIS
    2 TONSILLITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    1496 05350
    1497 03602
    1498 03603
    1498 03603
    1498 03603
    1498 03603
    1498 06083
    1499 04147
    1499 04147
    1499 04147
    1499 04147
    1499 04147
    1499 07337
    1499 07337
    1500 03597
    1500 03597
    1500 03597
    1500 03598
    1500 03598
    1500 06489
    1500 06489
    1500 06489
    1500 06490
    1500 06490
    1500 06490
    1501 03595
    1501 03595
    1501 03596
    1501 03596
    1501 03596
    1502 05485
    1502 05485
    1502 05485
    1502 05485
    1503 04926
    1503 04926
    1503 04926
    1503 04926
    1503 04926.1
    1503 04926.1
    1504 04832
    1504 04832
    1504 04832
    1505 03926
    1505 03926
    1505 06309
    1505 06309
    1505 06310
    1505 06310
    1505 06310
    1505 06310
    1505 06310
    1505 07302

    4 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1
    2
    1 CYSTITIS
    2 CYSTITIS
    3 CYSTITIS
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1
    2
    3
    4
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 FEVER
    2 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 HEART
    2 HEART
    1 CHEST PAIN
    2 CHEST PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    5 CHEST PAIN
    1 DIAB'ETES

    1505 07303
    1505 07303
    1505 07303
    1506 07304
    1506 07304
    1506 07304
    1506 07304
    1506 08015
    1506 08015
    1507 05333
    1507 05333
    1508 03660
    1508 03660
    1508 03660
    1508 03660
    1508 03661
    1508 03661
    1508 03662
    1508 03662
    1509 06585
    1509 06585
    1509 06585
    1509 06585
    1509 06588
    1509 06588
    1509 06588
    1509 06588
    1509 07564
    1509 07564
    1509 07564
    1509 07564
    1509 07564
    1509 07564.1
    1509 07564.1
    1509 07564.1
    1509 07564.1
    1510 08011
    1510 08012
    1510 08012
    1510 08012
    1510 08012
    1510 08012.1
    1510 08012.1
    1511 05030
    1511 05031
    1511 05031
    1512 06590
    1512 06590
    1512 06590
    1512 06590
    1512 06590
    1512 06590.1
    1512 08014

    1 HEART
    2 HEART
    3 HEART
    1 SKIN - LESION
    2 SKIN - LESION
    3 SKIN - LESION
    4 SKIN - LESION
    1 EYE DISORDER
    2 EYE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 KNEE INTERNAL DERANGEMENT
    2 KNEE INTERNAL DERANGEMENT
    3 KNEE INTERNAL DERANGEMENT
    4 KNEE INTERNAL DERANGEMENT
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    4 INTESTINAL COLIC
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    3 PAINFUL LEGS
    4 PAINFUL LEGS
    5 PAINFUL LEGS
    1 PAINFUL LEGS
    2 PAINFUL LEGS
    3 PAINFUL LEGS
    4 PAINFUL LEGS
    1 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 BASAL CELL CARCINOMA
    2 BASAL CELL CARCINOMA
    1 CONJUNCTIVITIS - EYE
    1 VISION CARE
    2 VISION CARE
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    3 BONE & CARTILAGE DISORDER
    4 BONE & CARTILAGE DISORDER
    5 BONE & CARTILAGE DISORDER
    1 BONE & CARTILAGE DISORDER
    1 VISION CARE

    1512 08014
    1512 08014
    1513 03663
    1513 04834
    1513 04834
    1513 04834
    1513 06308
    1513 07799
    1514 04078
    1514 04078
    1514 07305
    1515 07288
    1515 07288
    1515 07288.1
    1515 07288.1
    1516 03664
    1516 03664
    1516 03664
    1517 06002
    1517 06002
    1517 06002
    1517 06002
    1517 06002
    1518 03509
    1518 03509
    1518 03927
    1518 03927
    1518 03927
    1518 03927
    1518 03927
    1518 03928
    1518 03928
    1518 03928
    1518 03928
    1518 05332
    1518 05332
    1518 05332
    1519 03930
    1519 04833
    1519 06311
    1519 07798
    1520 05029
    1520 05029
    1521 04426
    1522 06801
    1523 06001
    1523 06001
    1523 06001
    1523 06800
    1523 06800
    1523 06800
    1523 06800
    1524 03508

    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DIAB'ETES
    1 DIAB'ETES
    1 DIAB'ETES
    2 DIAB'ETES
    1 DIAB'ETES
    1 DENTAL CARE
    2 DENTAL CARE
    1
    2
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 DEVIATED NASAL
    2 DEVIATED NASAL
    3 DEVIATED NASAL
    4 DEVIATED NASAL
    5 DEVIATED NASAL
    1 PROSTATE
    2 PROSTATE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 DENTAL CARE

    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM
    SEPTUM

    1524 04425
    1525 04333
    1525 04333
    1525 04334
    1525 04334
    1525 04334
    1525 04334
    1526 05355
    1526 06086
    1527 05669
    1527 05669
    1528 05907
    1528 05907
    1529 03794
    1529 04331
    1529 04331
    1529 05667
    1529 05668
    1529 05668
    1529 05668
    1529 05668
    1530 05902
    1530 05902
    1531 06192
    1531 06192
    1532 05085
    1532 05085
    1533 05309
    1533 05309
    1534 07567
    1534 07567
    1534 07567
    1534 07567
    1534 07568
    1534 07568
    1534 07568
    1534 07568
    1534 07568
    1534 07568.1
    1534 07568.1
    1534 07568.1
    1534 07568.1
    1534 07568.1
    1534 07568.2
    1535 03932
    1535 03932
    1535 03932
    1535 06091
    1535 06091
    1535 06091
    1536 03801
    1536 03801
    1536 03801

    1 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    1 CANCER-BREAST
    1 CANCER-BREAST
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 VISION CARE
    2 VISION CARE
    1 STONE - URETER
    1
    2
    1 STONE - URETER
    1 CATARACT
    2 CATARACT
    3 CATARACT
    4 CATARACT
    1 HYPERTENSION
    2 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    4 GASTRIC - PEPTIC ULCER/GERD
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    5 HEART
    1 HEART
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    1 FEVER
    2 FEVER
    3 FEVER

    1536 03801
    1536 03801
    1537 07904
    1537 07904
    1538 05356
    1539 03931
    1539 03931
    1539 03931
    1539 04335
    1539 04335
    1539 04335
    1539 04335
    1540 05670
    1540 05670.1
    1540 05670.1
    1540 05670.1
    1540 07249
    1540 07249
    1540 07249
    1540 07250
    1540 07250
    1540 07250
    1540 07250
    1540 07250
    1540 07250.1
    1540 07250.1
    1541 04837
    1541 06942
    1542 05909
    1543 05359
    1543 05359
    1543 05359
    1544 07572
    1544 07572
    1545 03798
    1545 03798
    1545 03798
    1545 03798
    1545 03798
    1545 03800
    1545 03980
    1545 03980
    1545 04835
    1545 04836
    1545 05903
    1545 05903
    1545 06938
    1545 06938
    1545 06938
    1545 06938
    1545 06938
    1545 06939
    1545 06939

    4 FEVER
    5 FEVER
    1 HEART
    2 HEART
    1 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 COUGH - AIRWAY OBSTRUCTION
    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    4 COUGH - AIRWAY OBSTRUCTION
    1 CATARACT
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CYSTITIS
    2 CYSTITIS
    3 CYSTITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1
    1 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    4 DIAB'ETES
    5 DIAB'ETES
    1
    1 HEART
    2 HEART
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 DIAB'ETES
    1 HEART
    2 HEART
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 HEART
    2 HEART

    1545 07843
    1545 07843
    1546 06088
    1547 03796
    1547 03796
    1547 03796
    1547 06343
    1547 06343
    1547 06343
    1547 07905
    1547 07905
    1547 07905
    1547 07905
    1547 07905
    1547 07905.1
    1548 07844
    1548 07844
    1548 07844
    1548 07844
    1549 08618
    1549 08618
    1549 08618
    1550 04344
    1550 04344
    1550 04345
    1550 04345
    1550 04345
    1550 04345
    1550 04345
    1550 04345.1
    1550 05360
    1550 05360
    1550 05361
    1550 05361
    1550 07575
    1550 07575
    1551 04659
    1551 04659
    1551 04659
    1551 04659
    1551 04659
    1551 04659.1
    1552 06090
    1552 06090
    1552 06090
    1552 06090
    1553 03978
    1553 03978
    1553 03979
    1554 07573
    1554 07573
    1554 07573
    1554 07573

    1 DIAB'ETES
    2 DIAB'ETES
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    5 CERVICAL SPONDYLOSIS
    1 CERVICAL SPONDYLOSIS
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    1
    2
    3
    1 HEART
    2 HEART
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HEART
    2 HEART
    1
    2
    3
    4
    5
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 ALLERGIC RHINITIS
    1 VARICOSE
    2 VARICOSE
    3 VARICOSE
    4 VARICOSE

    1554 07573
    1555 03983
    1555 03983
    1555 03983.1
    1555 03983.1
    1555 05908
    1555 05908
    1555 05908.1
    1556 03982
    1556 03982
    1557 07571
    1557 07571
    1557 07571
    1558 03795
    1558 03795
    1558 03795
    1558 03795
    1558 03795
    1558 03795.1
    1558 05899
    1558 05899
    1558 05899
    1558 05899
    1558 05899
    1558 05899.1
    1558 05899.1
    1558 05900
    1558 05900
    1558 05900
    1558 05901
    1558 05901
    1558 05901
    1558 05901
    1559 03803
    1559 03803
    1559 03803
    1559 03804
    1559 03804
    1559 03804
    1559 04348
    1559 04348
    1559 04348
    1559 04348
    1559 04349
    1559 04349
    1559 04349
    1559 04349
    1559 04350
    1559 04350
    1559 04350
    1559 04351
    1559 04351
    1559 04351

    5 VARICOSE
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERTENSION
    2 HYPERTENSION
    1 OTITIS - EAR
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 PSORIASIS
    2 PSORIASIS
    3 PSORIASIS
    4 PSORIASIS
    5 PSORIASIS
    1 PSORIASIS
    1 ANAEMIA
    2 ANAEMIA
    3 ANAEMIA
    4 ANAEMIA
    5 ANAEMIA
    1 DEPRESSION
    2 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN

    1559 04351
    1559 04352
    1559 04352
    1559 04352
    1559 04838
    1559 04838
    1559 04838
    1559 05086
    1559 05086
    1559 05086
    1559 06543
    1559 06543
    1559 06543
    1560 03797
    1561 04685
    1561 04685
    1561 07515
    1561 07515
    1562 07912
    1562 07912
    1562 07912.1
    1563 04336
    1563 04336
    1563 04336
    1563 04336
    1563 04337
    1563 04337
    1563 04337
    1563 04337
    1563 07306
    1563 07306
    1563 07306
    1563 07306
    1563 07306.1
    1563 07306.2
    1563 07306.2
    1563 07306.2
    1564 03510
    1564 03510
    1564 03510
    1564 03510
    1564 04427
    1564 04427
    1564 04427
    1564 04427
    1564 06400
    1564 06400
    1564 06400
    1564 07448
    1564 07448
    1564 07448
    1564 07448
    1565 06087

    4 BACK PAIN
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 VISION CARE
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DIAB'ETES
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 CHEST PAIN
    1 FATIGUE
    2 FATIGUE
    3 FATIGUE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    3 BRONCHITIS - ACUTE
    4 BRONCHITIS - ACUTE
    1 TONSILLITIS
    2 TONSILLITIS
    3 TONSILLITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    1 SINUSITIS

    1565 06087
    1566 07574
    1566 07574
    1566 07574
    1567 05898
    1567 05898
    1567 05898
    1568 04339
    1568 04339
    1568 06089
    1568 06089
    1569 05906
    1569 05906.1
    1569 05906.1
    1569 05906.1
    1569 05906.1
    1569 07447
    1569 07447
    1569 07447
    1569 07447
    1569 07447
    1570 05357
    1570 05357
    1570 05357
    1570 05357
    1570 05357
    1570 05604
    1570 05604
    1570 05604
    1570 05604
    1571 04343
    1572 04341
    1573 03802
    1573 03802
    1573 03802
    1573 04342
    1573 04342
    1573 04342
    1573 04342
    1573 04342
    1574 04927
    1575 03511
    1575 03511
    1575 03511.1
    1575 04729
    1575 04730
    1575 05490
    1575 05490
    1575 05491
    1575 05491
    1575 05491
    1575 05491.1
    1575 06492

    2 SINUSITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    1 HEART
    2 HEART
    1 VISION CARE
    1 RETINOPATY
    2 RETINOPATY
    3 RETINOPATY
    4 RETINOPATY
    1 EYE DISORDER
    2 EYE DISORDER
    3 EYE DISORDER
    4 EYE DISORDER
    5 EYE DISORDER
    1
    2
    3
    4
    5
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    4 AMMENORRHOEA
    1 BACK PAIN
    1 VISION CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    5 STONE - URETER
    1 DENTAL CARE
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 EAR DYSFUNCTION
    1 GLAUCOMA
    1 BONE & CARTILAGE DISORDER
    1 GLAUCOMA
    2 GLAUCOMA
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 DIAB'ETES
    1 GLAUCOMA

    1575 06947
    1575 06947
    1575 07916
    1575 07916
    1576 04428
    1577 06003
    1577 06003
    1577 06003
    1577 06003
    1578 08621
    1578 08621
    1578 08621
    1578 08621
    1578 08621
    1578 08621.1
    1579 05285
    1579 05285
    1580 06869
    1580 06869
    1580 06869
    1580 06869
    1580 06870
    1580 06870
    1580 06870
    1580 06870
    1580 06870
    1580 06870.1
    1580 06870.1
    1581 05286
    1581 05286
    1582 07140
    1582 07140
    1583 03665
    1583 03665
    1583 03665
    1583 03665
    1583 03665
    1583 04583
    1583 04583
    1583 04583
    1583 04583
    1583 04584
    1583 04584
    1583 04584
    1583 04584
    1583 05034
    1583 05034
    1583 05034
    1583 05034
    1583 05034
    1583 05034.1
    1583 05034.1
    1583 05034.1

    1 HYPERTENSION
    2 HYPERTENSION
    1 GLAUCOMA
    2 GLAUCOMA
    1 GASTRIC - PEPTIC ULCER/GERD
    1
    2
    3
    4
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    5 HYPERTENSION
    1 ANAEMIA
    1 HYPERTENSION
    2 HYPERTENSION
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    4 OVARIAN CYST
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    3 ALLERGIC REACTION
    4 ALLERGIC REACTION
    5 ALLERGIC REACTION
    1 ALLERGIC REACTION
    2 ALLERGIC REACTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    4 ALLERGIC RHINITIS
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE

    1583 05034.1
    1583 05034.1
    1583 05034.2
    1583 05034.2
    1583 05034.2
    1583 05034.2
    1583 05034.2
    1583 05034.3
    1583 05487
    1583 05487
    1583 05487
    1583 06271
    1583 06271.1
    1583 06493
    1583 06493
    1583 07917
    1583 07917
    1584 05239
    1584 07845
    1585 05807
    1585 05807
    1585 05807
    1585 05807
    1586 05237
    1586 05237
    1586 05237.1
    1586 05237.1
    1586 05237.1
    1586 06494
    1586 06494.1
    1586 06494.1
    1586 08549
    1586 08549
    1586 08549.1
    1587 07289
    1587 07289
    1587 07289
    1588 04690
    1588 06701
    1588 06701
    1588 06701
    1589 04267
    1589 04267.1
    1590 04734
    1590 04734
    1590 04734
    1590 04734
    1590 04734
    1590 04734.1
    1590 06194
    1590 06194.1
    1590 06194.1
    1590 06495

    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    5 MISCARRIAGE
    1 MISCARRIAGE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    1 VISION CARE
    2 VISION CARE
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 DIAB'ETES
    1 DIAB'ETES
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    4 HYPERTENSION
    1 ASTHMA
    2 ASTHMA
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 ASTHMA
    2 ASTHMA
    1 ASTHMA
    2 ASTHMA
    1 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 GLAUCOMA
    1 VISION CARE
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    5 ABDOMINAL PAINS
    1 ABDOMINAL PAINS
    1 DIAB'ETES
    1 ARTHRITIS
    2 ARTHRITIS
    1 VISION CARE

    1590 06495
    1591 03667
    1591 03667
    1591 03667
    1591 03668
    1591 03668
    1591 03668
    1591 03668
    1591 04268
    1591 04268
    1591 04268
    1591 04268
    1591 04268
    1591 04268.1
    1591 04353
    1591 04353
    1591 04353
    1591 04353.1
    1591 04354
    1591 04354
    1591 04354.1
    1591 04354.2
    1591 04518
    1591 04518
    1591 05240
    1591 05240
    1591 05240.1
    1591 05241
    1591 05241
    1591 05461
    1591 05461
    1591 05461.1
    1591 05461.2
    1591 05462
    1591 05462
    1591 06835
    1591 06835
    1591 06835
    1591 06835.1
    1591 06835.1
    1591 06835.1
    1592 05242
    1592 07846
    1592 07846
    1592 07846
    1593 07692
    1593 07692
    1593 07692
    1593 08552
    1593 08552
    1593 08552
    1593 08552
    1593 08552

    2 VISION CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 HEART- ISCHEMIC HEART
    2 HEART- ISCHEMIC HEART
    3 HEART- ISCHEMIC HEART
    4 HEART- ISCHEMIC HEART
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 FEVER
    1 FEVER
    2 FEVER
    3 FEVER
    1 DEPRESSION
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 HYPERTENSION
    1 DEPRESSION
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 DIAB'ETES
    2 DIAB'ETES
    1 ASTHMA
    1 HYPERTENSION
    2 HYPERTENSION
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 ALLERGIC RHINITIS
    1 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 ASTHMA
    2 ASTHMA
    3 ASTHMA
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE

    DISEASE
    DISEASE
    DISEASE
    DISEASE

    1593 08552.1
    1594 04693
    1594 04693
    1594 06496
    1594 06496
    1594 06496
    1594 06496
    1594 06496
    1594 08034
    1594 08034
    1594 08034
    1594 08034
    1594 08034
    1594 08034.1
    1595 04736
    1595 04736
    1595 04736
    1595 04736
    1595 04736
    1596 08965
    1596 08965
    1596 08965
    1597 06198
    1598 05554
    1598 05554
    1599 04519
    1599 04519
    1599 04519
    1599 04520
    1599 04520
    1599 04520
    1599 05555
    1600 05464
    1600 05464
    1601 03669
    1602 06195
    1602 06195
    1603 04040
    1603 04040
    1603 04040
    1603 04040
    1603 04040
    1603 04040.1
    1603 04040.1
    1603 04040.1
    1603 04040.1
    1603 06834
    1603 07096
    1603 07096
    1603 07096
    1603 08964
    1603 08964
    1604 04036

    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HYPERTENSION
    1 VISION CARE
    2 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 LUNG DISEASE
    2 LUNG DISEASE
    3 LUNG DISEASE
    1 HEART
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 VISION CARE
    1 ANXIETY
    2 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HEART
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 BACK PAIN

    1604 04735
    1604 05463
    1604 05551
    1604 05552
    1604 05552
    1604 05808
    1604 05808
    1604 05809
    1604 06049
    1604 06050
    1605 05465
    1605 05465
    1605 05465
    1606 04270
    1606 04271
    1606 04271
    1606 05546
    1606 05546
    1606 05546.1
    1607 06703
    1607 06703
    1607 06703
    1607 06704
    1607 06704
    1607 06704
    1607 07094
    1607 07095
    1607 07095
    1607 08963
    1608 04516
    1608 04516
    1608 04517
    1608 04517
    1609 03875
    1609 03875
    1609 03935
    1609 03935
    1609 03935
    1609 03935
    1609 03935
    1609 04695
    1609 04695
    1609 04695
    1609 04695
    1609 04928
    1609 04928
    1609 04928
    1609 04928
    1610 02539.1
    1611 03512
    1611 03512
    1611 03512
    1611 03512

    1 PAINFUL LEGS
    1 VARICOSE
    1 BARTHOLIN'S CYST
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    1
    2
    3
    1 CERVICAL SPONDYLOSIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 BACK PAIN
    2 BACK PAIN
    1 RENAL DYSFUNCTION
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 AMMENORRHOEA
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ENDOCRINE DISORDERS
    2 ENDOCRINE DISORDERS
    1 GLAUCOMA
    2 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    5 VISION CARE
    1 HEART
    2 HEART
    3 HEART
    4 HEART
    1 CYST
    2 CYST
    3 CYST
    4 CYST
    1 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM

    1611 03512
    1611 04038
    1611 04038
    1611 04038
    1611 04880
    1611 04880
    1611 04880
    1611 04880
    1611 04880
    1611 04880.1
    1611 04880.1
    1611 05035
    1611 05035
    1611 05035
    1611 05035
    1611 05035
    1611 05035.1
    1611 06047
    1611 06093
    1611 06094
    1611 06095
    1611 06193
    1611 06833
    1611 06833
    1611 06833
    1612 04731
    1612 04731
    1612 04731
    1613 04355
    1614 04691
    1614 04691
    1614 04691
    1615 05243
    1615 05243
    1616 03623
    1616 03623
    1616 07693
    1616 07693
    1617 06197
    1617 06197
    1617 06197
    1618 05861
    1618 05861
    1618 05861
    1618 08961
    1618 08961
    1618 08962
    1618 08962
    1618 08962
    1618 08962
    1619 05549
    1619 05549
    1619 06702

    5 DEVIATED NASAL SEPTUM


    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    4 DEVIATED NASAL SEPTUM
    5 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    1 PAINFUL LEGS
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 PAINFUL LEGS
    1 BRONCHITIS
    2 BRONCHITIS
    3 BRONCHITIS
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    1 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 SKIN - ATOPIC DERMATITIS
    2 SKIN - ATOPIC DERMATITIS
    3 SKIN - ATOPIC DERMATITIS
    4 SKIN - ATOPIC DERMATITIS
    1 TONSILLITIS
    2 TONSILLITIS
    1 TONSILLITIS

    1619 06702
    1620 07847
    1620 07847
    1620 07847
    1621 05860
    1621 05860
    1622 04732
    1622 04732
    1622 04732
    1622 04732
    1624 05003
    1624 05004
    1624 05004
    1624 08550
    1624 08550
    1625 06832
    1625 06832
    1626 06051
    1626 06051
    1626 06051
    1626 06051
    1627 04692
    1627 04692
    1628 06943
    1628 06943
    1629 08966
    1629 08966
    1630 04515
    1630 04515
    1631 07290
    1631 07290
    1631 07290
    1631 07290
    1632 04039
    1632 04039
    1632 04039
    1632 07688
    1632 07688
    1632 07688
    1633 06048
    1633 06048
    1633 06048
    1633 07689
    1633 07689
    1633 07689
    1633 07689
    1633 07689
    1633 07690
    1633 07690
    1633 07690
    1633 07690.1
    1633 07690.1
    1634 07691

    2 TONSILLITIS
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BONE & CARTILAGE DISORDER
    2 BONE & CARTILAGE DISORDER
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 RENAL DYSFUNCTION
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DILATION & CURRETAGE
    2 DILATION & CURRETAGE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 VISION CARE
    2 VISION CARE
    1
    2
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    3
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    5 FEVER
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 VISION CARE

    1634 07691
    1634 07691
    1635 05553
    1635 05553
    1635 05553
    1636 05238
    1636 05238
    1636 05238
    1636 05550
    1636 05550
    1637 04689
    1637 04689
    1637 04689
    1637 05547
    1637 05547
    1637 05547
    1637 05548
    1637 05548
    1637 05548
    1638 03625
    1638 03625
    1638 03625
    1638 03626
    1638 03626
    1638 03626
    1638 03626
    1638 03626
    1638 03626.1
    1638 03626.1
    1638 03626.1
    1638 03626.1
    1638 03626.2
    1638 03626.2
    1638 03628
    1638 03628
    1638 03628
    1639 05165
    1639 05165
    1639 05165
    1639 05427
    1639 05427
    1640 06497
    1640 06497
    1640 06497
    1641 03624
    1641 03624
    1641 03624
    1642 05166
    1642 05166
    1642 05166
    1642 05166
    1643 03632
    1643 03632

    2 VISION CARE
    3 VISION CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 FEVER
    2 FEVER
    3 FEVER
    1 OVARIAN CYST
    2 OVARIAN CYST
    1 FEVER
    2 FEVER
    3 FEVER
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    3 INTESTINAL COLIC
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    5 STONE - URETER
    1 STONE - URETER
    2 STONE - URETER
    3 STONE - URETER
    4 STONE - URETER
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    1 OTITIS - EAR
    2 OTITIS - EAR
    3 OTITIS - EAR
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 ALLERGY
    2 ALLERGY
    1 HORMONE REPLACMENT THERAPY
    2 HORMONE REPLACMENT THERAPY
    3 HORMONE REPLACMENT THERAPY
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE

    1643 03632
    1643 03632
    1643 03632
    1643 06053
    1643 06499
    1643 08124
    1643 08124
    1643 08124
    1644 03631
    1644 04041
    1644 04041.1
    1644 04041.1
    1644 04041.1
    1644 04041.1
    1644 04042
    1644 04154
    1644 04155
    1644 04155
    1644 05167
    1644 05862
    1644 05863
    1644 06498
    1644 07546
    1644 07546
    1644 07547
    1644 07547
    1644 07547
    1644 07547
    1644 07548
    1644 07548
    1644 07549
    1644 07694
    1644 07695
    1644 07695
    1644 07695
    1644 07696
    1644 07696
    1645 08123
    1645 08123
    1646 06052
    1646 06052
    1647 04585
    1647 04585
    1647 04585.1
    1648 03984
    1649 05428
    1649 05864
    1650 05488
    1650 05488
    1650 05488
    1650 05488
    1650 07031
    1650 07031

    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 DEPRESSION
    1 GLAUCOMA
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    4 VISION CARE
    1 DENTAL CARE
    1 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    1 DEPRESSION
    1 DENTAL CARE
    1 DEPRESSION
    1 DENTAL CARE
    2 DENTAL CARE
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    3 RENAL DYSFUNCTION
    4 RENAL DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    1 DEPRESSION
    1
    2
    3
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    1 BACK PAIN
    2 BACK PAIN
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 BACK PAIN
    1 ALLERGIC REACTION
    1 ANXIETY
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 CYST
    2 CYST

    1651 06981
    1651 06981
    1651 06981
    1651 06981
    1652 07919
    1652 07919
    1652 07919
    1653 04523
    1653 04523
    1653 04523
    1653 05363
    1653 05363
    1653 05363
    1653 07960
    1653 07960
    1653 07960
    1653 07960
    1654 03940
    1654 03940
    1654 03940
    1655 06635
    1655 06635
    1656 08724
    1656 08724
    1656 08724
    1656 08725
    1656 08725
    1656 08725.1
    1657 04283
    1657 04283
    1658 04524
    1658 04524
    1658 04524
    1658 04525
    1658 04525
    1658 08052
    1658 08052
    1658 08052
    1658 08052
    1659 06278
    1659 06278
    1660 03941
    1660 03941
    1660 03941
    1661 08564
    1661 08564.1
    1662 07962
    1662 07962
    1663 03634
    1663 03634
    1663 03634
    1663 03634
    1663 03634

    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 HEMATURIA
    2 HEMATURIA
    3 HEMATURIA
    4 HEMATURIA
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 VISION CARE
    2 VISION CARE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    3 DEVIATED NASAL SEPTUM
    1 SKIN - LOCAL INFECTION
    2 SKIN - LOCAL INFECTION
    1 PAIN-BACK/SHOULDER
    1 GLAUCOMA
    2 GLAUCOMA
    1
    2
    3
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 CHOSTOCHRONDITIS
    1 THYROID
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    4 CHOSTOCHRONDITIS
    5 CHOSTOCHRONDITIS

    1663 03635
    1663 03635
    1663 03635
    1663 03635
    1663 07238
    1663 07238
    1663 07238
    1663 08521
    1663 08521
    1663 08521
    1663 08522
    1663 08522
    1663 08522
    1664 08726
    1664 08726
    1664 08726
    1664 08726
    1665 03636
    1665 05012
    1665 05012
    1665 05012
    1665 05602
    1665 05602
    1665 07398
    1665 07398
    1666 03637
    1667 07965
    1667 07965
    1667 07965
    1667 07965
    1667 07965
    1667 07965.1
    1667 07965.1
    1667 08053
    1667 08053
    1667 08053
    1668 04285
    1668 04285
    1668 07097
    1668 08054
    1668 08054
    1668 08054.1
    1668 08054.1
    1668 08054.1
    1668 08054.1
    1669 03943
    1669 03943
    1669 07968
    1669 07968
    1669 07968
    1669 07968
    1670 07969
    1670 07969

    1 COUGH - AIRWAY OBSTRUCTION


    2 COUGH - AIRWAY OBSTRUCTION
    3 COUGH - AIRWAY OBSTRUCTION
    4 COUGH - AIRWAY OBSTRUCTION
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    3 AMMENORRHOEA
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    3 ALLERGIC RHINITIS
    1 PAIN-BACK/SHOULDER
    2 PAIN-BACK/SHOULDER
    3 PAIN-BACK/SHOULDER
    4 PAIN-BACK/SHOULDER
    1 AMMENORRHOEA
    1 SOFT TISSUE DISORDERS/DISEASE
    2 SOFT TISSUE DISORDERS/DISEASE
    3 SOFT TISSUE DISORDERS/DISEASE
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 AMMENORRHOEA
    2 AMMENORRHOEA
    1 VISION CARE
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    5 ARTHRITIS
    1 ARTHRITIS
    2 ARTHRITIS
    1 CHOSTOCHRONDITIS
    2 CHOSTOCHRONDITIS
    3 CHOSTOCHRONDITIS
    1
    2
    1 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 ABDOMINAL PAINS
    2 ABDOMINAL PAINS
    3 ABDOMINAL PAINS
    4 ABDOMINAL PAINS
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM

    1670 07969.1
    1670 07969.1
    1670 07970
    1670 07970
    1670 07971
    1670 07971
    1670 08565
    1670 08565
    1670 08565
    1671 03522
    1671 03522
    1671 05036
    1671 05036
    1671 05036
    1672 05364
    1672 06807
    1672 06807
    1673 06015
    1673 06015
    1673 06016
    1673 06016
    1674 04284
    1674 04284
    1674 04284
    1674 04284
    1674 04284
    1675 07963
    1675 07964
    1675 07964
    1676 04989
    1676 04989
    1677 08324
    1677 08594
    1677 08594
    1678 06576
    1678 06576
    1678 08323
    1678 08323
    1678 08323
    1679 04205
    1679 04206
    1679 04206.1
    1679 07773
    1679 07773
    1680 04207
    1680 07774
    1680 07774
    1680 08534
    1681 05683
    1681 05683
    1681 06240
    1681 06240
    1681 06240

    1 HYPERTENSION
    2 HYPERTENSION
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1
    2
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BREAST DISORDERS
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HEART
    1 SINUSITIS
    2 SINUSITIS
    1 MISCARRIAGE
    2 MISCARRIAGE
    1 MISCARRIAGE
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 INFECTION THUMB
    2 INFECTION THUMB
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 REMOVAL OF MOLE
    1 DEVIATED NASAL SEPTUM
    1
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 ALLERGIC RHINITIS
    1 DEVIATED NASAL SEPTUM
    2 DEVIATED NASAL SEPTUM
    1 INTESTINAL COLIC
    1
    2
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND

    1681 06340
    1682 05935
    1682 05936
    1682 05936
    1683 03605
    1683 03605
    1683 03605
    1683 03606
    1684 03723
    1684 03723
    1684 03723
    1684 03724
    1684 05729
    1684 05729
    1684 05729
    1684 07089
    1684 07089
    1684 07089
    1684 07089
    1685 03725
    1685 03726
    1685 06624
    1685 06624
    1685 06625
    1685 08233
    1686 05032
    1686 05730
    1686 05730
    1686 05730
    1687 06092
    1687 06092
    1687 06092
    1687 06092
    1687 06626
    1687 06626
    1687 06626
    1687 08518
    1687 08518
    1687 08518
    1687 08518
    1688 04687
    1688 04687
    1688 04687
    1688 04687
    1688 04687
    1688 04687.1
    1688 04687.1
    1688 04687.1
    1688 04687.2
    1688 04687.2
    1688 04688
    1688 04688
    1688 05671

    1 INJURY - OPEN WOUND


    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DEVIATED NASAL SEPTUM
    1 LUPUS
    2 LUPUS
    3 LUPUS
    1 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 ARTHRITIS
    2 ARTHRITIS
    3 ARTHRITIS
    4 ARTHRITIS
    1 HYPERTENSION
    1 PAIN-BACK/SHOULDER
    1
    2
    1 HYPERTENSION
    1 HYPERTENSION
    1
    1
    2
    3
    1 INJURY - OPEN WOUND
    2 INJURY - OPEN WOUND
    3 INJURY - OPEN WOUND
    4 INJURY - OPEN WOUND
    1 HEART
    2 HEART
    3 HEART
    1 FEVER
    2 FEVER
    3 FEVER
    4 FEVER
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    4 BURSITIS
    5 BURSITIS
    1 BURSITIS
    2 BURSITIS
    3 BURSITIS
    1
    2
    1 RENAL DYSFUNCTION
    2 RENAL DYSFUNCTION
    1 PAINFUL LEGS

    1688 05671
    1688 07093
    1689 03933
    1689 03933
    1689 03933
    1689 07090
    1689 07090
    1689 07090
    1689 08305
    1689 08305
    1690 04686
    1690 04686.1
    1690 04686.2
    1690 07091
    1690 07091
    1690 07092
    1690 07092
    1690 07092
    1690 07092
    1691 03934
    1691 03934
    1691 03934
    1692 06591
    1692 07030
    1692 07030
    1693 06096
    1693 06096
    1693 06096
    1693 06872
    1693 06872
    1694 06873
    1694 06873
    1695 03876
    1695 03876
    1695 03876
    1695 03876
    1695 07918
    1696 04881
    1696 04881
    1697 04882
    1697 04882
    1697 04882
    1698 04212
    1698 04213
    1698 04213
    1698 04213
    1699 06944
    1699 06944
    1699 06944
    1700 07032
    1701 04157
    1701 04157
    1701 04157

    2 PAINFUL LEGS
    1 EYE DISORDER
    1 EAR DYSFUNCTION
    2 EAR DYSFUNCTION
    3 EAR DYSFUNCTION
    1 PAINFUL HEEL
    2 PAINFUL HEEL
    3 PAINFUL HEEL
    1 DENTAL CARE
    2 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    1 FEVER
    2 HYPERLIPIDERMIA - CHOLESTEROL
    1 DENTAL CARE
    2 DENTAL CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    4 BARTHOLIN'S CYST
    1 FEVER
    2 FEVER
    3 FEVER
    1 FEVER
    1 BURSITIS
    2 BURSITIS
    1 INGROWING TOE NAIL
    2 INGROWING TOE NAIL
    3 INGROWING TOE NAIL
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    1 EYE DISORDER
    2 EYE DISORDER
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 ALLERGIC RHINITIS
    1 ACUTE ENTERITIS
    2 ACUTE ENTERITIS
    1 FEVER
    2 FEVER
    3 FEVER
    1 DENTAL CARE
    1 CYST
    2 CYST
    3 CYST
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    1701 04157
    1701 04157
    1701 06097
    1702 07213
    1702 07213
    1703 06274
    1704 05731
    1704 05731
    1704 06275
    1704 06277
    1704 06277
    1704 06277.1
    1704 06277.1
    1704 06804
    1704 06805
    1704 06805
    1704 06805
    1705 07450
    1705 07450
    1705 07450
    1706 07214
    1706 07214
    1706 07214
    1707 05334
    1708 05732
    1708 05732
    1708 05732
    1709 07958
    1709 07958
    1709 07958
    1710 05128
    1710 05128
    1710 05129
    1710 05129
    1710 05129
    1710 07496
    1711 03514
    1711 03514
    1711 03514
    1711 03514
    1712 06595
    1712 06595
    1712 06595
    1712 08036
    1712 08036
    1712 08036
    1713 03515
    1713 03515
    1713 03515
    1713 03515
    1713 05007
    1713 05008
    1713 05008

    4 DENTAL CARE
    5 DENTAL CARE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    1 DENTAL CARE
    1 DEPRESSION
    2 DEPRESSION
    1 DENTAL CARE
    1 CHEST PAIN
    2 CHEST PAIN
    1 DIAB'ETES
    2 DIAB'ETES
    1
    1 PROSTATE
    2 PROSTATE
    3 PROSTATE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 OVARIAN CYST
    2 OVARIAN CYST
    3 OVARIAN CYST
    1 DENTAL CARE
    1 DEPRESSION
    2 DEPRESSION
    3 DEPRESSION
    1 DENGUE
    2 DENGUE
    3 DENGUE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    2 DIAB'ETES
    3 DIAB'ETES
    1 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1
    2
    3
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS
    3 CERVICAL SPONDYLOSIS
    4 CERVICAL SPONDYLOSIS
    1 OVARIAN CYST
    1 CERVICAL SPONDYLOSIS
    2 CERVICAL SPONDYLOSIS

    1713 05016
    1713 05016
    1713 06332
    1713 07551
    1713 07551
    1714 08035
    1715 07495
    1715 07495
    1715 07495
    1715 07495
    1716 06345
    1716 06345
    1716 06345
    1716 06345
    1717 06501
    1717 07395
    1717 07396
    1718 07392
    1718 08235
    1718 08235
    1718 08236
    1718 08236
    1718 08236
    1718 08236
    1719 06500
    1719 06500
    1719 06500
    1719 06500.1
    1720 08234
    1720 08234
    1721 07394
    1721 07394
    1721 07394
    1722 08040
    1723 04100
    1723 04100
    1723 04100
    1724 07218
    1724 07218
    1724 07218
    1725 04102
    1725 04102
    1725 04102
    1725 04102
    1725 04102
    1725 07220
    1725 07220
    1725 07220
    1725 07220.1
    1725 07220.1
    1725 07220.1
    1726 04839
    1726 04839

    1 BACK PAIN
    2 BACK PAIN
    1 MUSCULAR PAIN
    1 BACK PAIN
    2 BACK PAIN
    1
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 DEVIATED NASAL SEPTUM
    1 EYE DISORDER
    1 ALLERGIC RHINITIS
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 HYPERTENSION
    2 HYPERTENSION
    3 HYPERTENSION
    1
    1 DENTAL CARE
    2 DENTAL CARE
    1 SINUSITIS
    2 SINUSITIS
    3 SINUSITIS
    1 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    5 DENTAL CARE
    1 HYPERLIPIDERMIA - CHOLESTEROL
    2 HYPERLIPIDERMIA - CHOLESTEROL
    3 HYPERLIPIDERMIA - CHOLESTEROL
    1 TENDONITIS
    2 TENDONITIS
    3 TENDONITIS
    1 VISION CARE
    2 VISION CARE

    1726 04839
    1727 07497
    1727 07497
    1727 07497
    1728 04429
    1728 04429
    1728 04430
    1728 04430
    1728 04430.1
    1728 04431
    1728 05095
    1728 05095
    1728 05095
    1728 05095
    1728 05096
    1728 08626
    1729 03520
    1729 03520
    1729 06630
    1729 06630
    1729 06630
    1729 06631
    1729 06631
    1729 06631
    1730 03939
    1730 03939
    1730 03939
    1730 05097
    1730 05097
    1730 05097
    1730 05097
    1730 05098
    1730 05098
    1730 05100
    1730 05100
    1730 05100
    1730 05100
    1730 05737
    1730 05737
    1730 06836
    1730 06836
    1730 08627
    1730 08627.1
    1730 08627.1
    1731 04929
    1731 04929
    1731 04929
    1731 08625
    1732 08720
    1732 08720
    1733 06512
    1733 06512
    1733 06512

    3 VISION CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    1 BRONCHITIS - ACUTE
    2 BRONCHITIS - ACUTE
    1 INTESTINAL COLIC
    2 INTESTINAL COLIC
    1 DEVIATED NASAL SEPTUM
    1 ALLERGIC REACTION
    1
    2
    3
    4
    1 DEPRESSION
    1 DEPRESSION
    1 VISION CARE
    2 VISION CARE
    1 URTICARIA
    2 URTICARIA
    3 URTICARIA
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 BACK PAIN
    2 BACK PAIN
    3 BACK PAIN
    1 CHEST PAIN
    2 CHEST PAIN
    3 CHEST PAIN
    4 CHEST PAIN
    1 ALLERGIC RHINITIS
    2 ALLERGIC RHINITIS
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE
    4 DENTAL CARE
    1 TONSILLITIS
    2 TONSILLITIS
    1 EYE DISORDER
    2 EYE DISORDER
    1 EYE DISORDER
    1 VISION CARE
    2 VISION CARE
    1 BARTHOLIN'S CYST
    2 BARTHOLIN'S CYST
    3 BARTHOLIN'S CYST
    1 ALLERGIC REACTION
    1 DENTAL CARE
    2 DENTAL CARE
    1 DENTAL CARE
    2 DENTAL CARE
    3 DENTAL CARE

    1733 06512
    1733 06512
    1734 05911
    1735 06401
    1735 06401
    1736 05006.1
    1736 05006.1
    1736 05006.1
    1736 05006.1
    1737 04098
    1737 05865
    1737 05865
    1737 05865
    1738 05733.1
    1739 04099
    1739 04099
    1739 04099
    1739 05011
    1739 05011
    1740 06346
    1741 05287
    1742 06842
    1742 06842

    4 DENTAL CARE
    5 DENTAL CARE
    1 FEVER
    1 DENTAL CARE
    2 DENTAL CARE
    1 MISCARRIAGE
    2 MISCARRIAGE
    3 MISCARRIAGE
    4 MISCARRIAGE
    1 DENTAL CARE
    1 VISION CARE
    2 VISION CARE
    3 VISION CARE
    1 BACK PAIN
    1 GASTRIC - PEPTIC ULCER/GERD
    2 GASTRIC - PEPTIC ULCER/GERD
    3 GASTRIC - PEPTIC ULCER/GERD
    1 DENTAL CARE
    2 DENTAL CARE
    1 DIAB'ETES
    1 HEART- ISCHEMIC HEART DISEASE
    1 DIAB'ETES
    2 DIAB'ETES

    SERVICE DESCRIPTION
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-INJECTABLES


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE

    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    OTHER
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    OTHER
    OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    OTHER

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSIOTHERAPY
    OTHER
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSIOTHERAPY
    OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-INJECTABLES


    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSIOTHERAPY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL INTENSIVE CARE
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    HOSPITAL LOCAL ROOM


    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    SURGICAL INPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    OTHER
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-INJECTABLES


    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT

    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    EMERGENCY ACCIDENT
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PREVENTATIVE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-NORMAL DELIVERY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    SURGICAL OUTPATIENT
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-NORMAL DELIVERY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    MATERNITY-NORMAL DELIVERY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT

    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL INPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    OTHER
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    DIAGNOSTIC LABORATORY
    VISION CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-HOSPITAL

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-NORMAL DELIVERY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    MATERNITY-PRENATAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    SURGICAL INPATIENT
    HOSPITAL MISC-LOCAL
    OTHER
    SPECIALIST CNSLT-HOSPITAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SURGICAL OUTPATIENT

    MISC OUT HOSP-ORAL DRUGS


    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    OTHER
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE

    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    OTHER
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    PHYSIOTHERAPY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    MISC OUT HOSP-OTHER
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE

    MISC OUT HOSP-OTHER


    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE

    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    MATERNITY-CAESAR/EXTRA UT

    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-INJECTABLES


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE

    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    OTHER
    DENTAL CARE
    DENTAL CARE
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER

    MISC OUT HOSP-OTHER


    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    HOSPITAL MISC-LOCAL
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOME
    HOSPITAL LOCAL ROOM
    PHYSICIAN VISIT-HOSPITAL
    PRIVATE DUTY NURSING CARE
    HOSPITAL MISC-LOCAL

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    SURGICAL OUTPATIENT
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS

    DENTAL CARE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    VISION CARE
    VISION CARE
    VISION CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE

    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    OTHER
    HOSPITAL MISC-LOCAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT

    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT

    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSIOTHERAPY
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSIOTHERAPY
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE

    DENTAL CARE
    MATERNITY-PRENATAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    SURGICAL ANAESTHESIA
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE

    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PREVENTATIVE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-OTHER


    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    HOSPITAL LOCAL ROOM
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    SPECIALIST CNSLT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SURGICAL OUTPATIENT

    MISC OUT HOSP-OTHER


    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE

    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    OTHER
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE

    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY

    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL MISC-LOCAL
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-NORMAL DELIVERY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    MISC OUT HOSP-ORAL DRUGS

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL

    SURGICAL ANAESTHESIA
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-HOSPITAL
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    PHYSIOTHERAPY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    DIAGNOSTIC X-RAY
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    VISION CARE

    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE

    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    HOSPITAL MISC-LOCAL
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-HOSPITAL
    DIAGNOSTIC LABORATORY
    SURGICAL OUTPATIENT
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    EMERGENCY ACCIDENT
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    HOSPITAL MISC-LOCAL
    SURGICAL INPATIENT
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-HOSPITAL
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-INJECTABLES


    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PREVENTATIVE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    OTHER

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SURGICAL ANAESTHESIA
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    SURGICAL ANAESTHESIA
    SURGICAL INPATIENT
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT

    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    MATERNITY-CAESAR/EXTRA UT
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    SURGICAL OUTPATIENT
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE

    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL OUTPATIENT
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE

    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-OTHER
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MATERNITY-MISCARRIAGE
    MATERNITY-MISCARRIAGE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    VISION CARE

    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    SURGICAL INPATIENT
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-OTHER
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    SURGICAL OUTPATIENT
    SURGICAL OUTPATIENT
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC X-RAY

    MISC OUT HOSP-ORAL DRUGS


    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    HOSPITAL LOCAL ROOM
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC X-RAY
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    PREVENTATIVE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE

    MISC OUT HOSP-ORAL DRUGS


    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PREVENTATIVE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    SURGICAL OUTPATIENT
    MISC OUT HOSP-INJECTABLES
    MISC OUT HOSP-ORAL DRUGS
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    MATERNITY-NORMAL DELIVERY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    VISION CARE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-HOSPITAL
    MISC OUT HOSP-OTHER
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES

    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    PHYSIOTHERAPY
    PHYSIOTHERAPY
    PHYSICIAN VISIT-OFFICE
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    PREVENTATIVE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC X-RAY
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE

    VISION CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    SURGICAL INPATIENT
    SURGICAL ANAESTHESIA
    HOSPITAL LOCAL ROOM
    HOSPITAL MISC-LOCAL
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-INJECTABLES
    DIAGNOSTIC LABORATORY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-INJECTABLES
    PHYSICIAN VISIT-OFFICE
    SPECIALIST CNSLT-OFFICE
    DIAGNOSTIC LABORATORY
    DIAGNOSTIC LABORATORY
    SPECIALIST CNSLT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    PHYSICIAN VISIT-OFFICE
    SURGICAL OUTPATIENT
    SPECIALIST CNSLT-OFFICE
    VISION CARE
    VISION CARE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE
    DENTAL CARE

    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    DENTAL CARE
    DENTAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    MATERNITY-PRENATAL CARE
    DENTAL CARE
    VISION CARE
    VISION CARE
    VISION CARE
    DIAGNOSTIC X-RAY
    PHYSICIAN VISIT-OFFICE
    MISC OUT HOSP-ORAL DRUGS
    MISC OUT HOSP-OTHER
    DENTAL CARE
    DENTAL CARE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    PHYSICIAN VISIT-OFFICE
    DIAGNOSTIC X-RAY

    PROCEDURE DESCRIPTION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    PROSTATE: TRANSURETHRAL RESECTION

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-BI-FOCAL


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    PREVENTIVE: DENTAL PROPHYLAXIS

    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN

    COMPLETE EXAMINATION

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    MATERIALS: FRAMES

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABDOMEN: GASTROSCOPY, OPERATIVE

    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OPER


    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OPER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/PHYS)


    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/PHYS)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PROSTATE: TRANSURETHRAL RESECTION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES

    COMPLETE EXAMINATION

    ABDOMEN: CUTTING ABDOMINAL CAVITY EXCEPT AS OTHERWISE SPECIFIED

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OTHER
    OTHER
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)

    OTHER
    OTHER
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    PROSTATE: TRANSURETHRAL RESECTION


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/PHYS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    JOINT: INCISION FOR DIAG OR TREATMNT-INTRA-ARTICULAR STRUCTURES

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OTHER
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    OTHER
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: COMPLETE INTRAORAL SERIES OF PERIAPICAL X-RAYS


    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/PHYS)

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION

    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:

    FRAMES
    FRAMES
    LENS, EACH-SINGLE VISION
    LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    MATERIALS: LENS, EACH-TRI-FOCAL


    MATERIALS: FRAMES

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL STANNOUS FLUORIDE, ONE (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    MATERIALS: LENS, EACH-SINGLE VISION


    MATERIALS: FRAMES

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:

    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM

    FILL
    FILL
    FILL
    FILL

    1
    1
    2
    3

    SURFACE CAVITY
    SURFACE CAVITY
    SURFACE CAVITY
    OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    SUTURING SURFACE WOUNDS: ONE OR MORE W 5 OR FEWER STITCHES

    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER DENTISTS/PHYS)
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    ABSCESSES, BOILS & CARBUNCLES: CUTTING OPERATION, HOSPITALIZATION


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    MATERIALS: FRAMES

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    PROSTHETICS: ADD TOOTH TO PRT DENT REPL EXTR TOOTH W/O CLSP
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    PREVENTIVE: DENTAL PROPHYLAXIS

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CLASP

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: CUTTING OPERATION, HOSPITALIZATION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    PREVENTIVE: DENTAL PROPHYLAXIS


    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)


    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OPER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PROSTATE: TRANSURETHRAL RESECTION

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    EYE: OTHER CUTTING OPERATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OTHER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION

    MATERIALS: LENS, EACH-SINGLE


    MATERIALS: LENS, EACH-SINGLE
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE
    MATERIALS: LENS, EACH-SINGLE
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE

    VISION
    VISION

    VISION
    VISION

    VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:

    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM

    FILL
    FILL
    FILL
    FILL
    FILL

    2
    2
    2
    1
    1

    SURFACE
    SURFACE
    SURFACE
    SURFACE
    SURFACE

    CAVITY
    CAVITY
    CAVITY
    CAVITY
    CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-SINGLE VISION


    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-SINGLE VISION


    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: TREAT SIMPLE FRACTURE OF MANDIBLE, OPEN REDUCTION
    ORAL SURGERY: TREAT SIMPLE FRACTURE OF MANDIBLE, OPEN REDUCTION
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:

    DENTAL PROPHYLAXIS
    DENTAL PROPHYLAXIS
    TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)


    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)

    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    ABDOMEN: GASTROSCOPY, TAPPING

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CLASP

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OTHER
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: ALVEOLECTOMY, SURG PREP OF RIDGE FOR DENTURES/QUAD

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE
    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)

    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:

    DENTAL
    DENTAL
    DENTAL
    DENTAL

    PROPHYLAXIS
    PROPHYLAXIS
    PROPHYLAXIS
    PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    MATERIALS: LENS, EACH-SINGLE VISION


    COMPLETE EXAMINATION
    PROSTHETICS: COMPLETE LOWER ACRYLIC BASE DENTURE
    PROSTHETICS: COMPLETE LOWER ACRYLIC BASE DENTURE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OTHER
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    MATERIALS: LENS, EACH-SINGLE VISION


    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    EYE: OTHER CUTTING OPERATION
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    STONE OR TUMOR: REMOVAL OF FROM KIDNEY OR BLADDER (OPEN SURGICAL)

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: PULP VITALITY TEST
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    UTERUS: DILATION & CURRETTAGE, OR OTHER SURGERY ON EXT GENITALIA

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    EYE: OPERATION ON EYE, EYE MUSCLE, OR THROUGH SCLERA OR CORNEA

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ABDOMEN: CUTTING ABDOMINAL CAVITY EXCEPT AS OTHERWISE SPECIFIED

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-BI-FOCAL


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CLASP


    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CLASP

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OTHER
    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    OTHER
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS


    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA
    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    CROWN & BRIDGE: BRIDGE, 3 UNITS (UNIT=EACH)


    CROWN & BRIDGE: BRIDGE, 3 UNITS (UNIT=EACH)
    CROWN & BRIDGE: BRIDGE, 3 UNITS (UNIT=EACH)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION


    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ORAL SURGERY: REDUCE DISLOC TEMPOROMANDIBULAR JOINT, CLOSED
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OTHER
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    PREVENTIVE: DENTAL PROPHYLAXIS
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    OTHER
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OTHER

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENT 2 CLASP W REST

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    EYE: REMOVAL OF CATARACT

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    OTHER

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    UTERUS: DILATION & CURRETTAGE, OR OTHER SURGERY ON EXT GENITALIA

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    OTHER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-TRI-FOCAL

    ORTHODONTICS:
    ORTHODONTICS:
    ORTHODONTICS:
    ORTHODONTICS:
    ORTHODONTICS:

    EACH
    EACH
    EACH
    EACH
    EACH

    ADDED
    ADDED
    ADDED
    ADDED
    ADDED

    ORTHODONTIC
    ORTHODONTIC
    ORTHODONTIC
    ORTHODONTIC
    ORTHODONTIC

    TREATMENT
    TREATMENT
    TREATMENT
    TREATMENT
    TREATMENT

    AFTER
    AFTER
    AFTER
    AFTER
    AFTER

    1ST
    1ST
    1ST
    1ST
    1ST

    6
    6
    6
    6
    6

    MONTHS
    MONTHS
    MONTHS
    MONTHS
    MONTHS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    ABDOMEN: CUTTING ABDOMINAL CAVITY EXCEPT AS OTHERWISE SPECIFIED

    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    CROWN & BRIDGE: PORCELAIN JACKET CROWN W METAL THIMBLE
    CROWN & BRIDGE: PORCELAIN JACKET CROWN W METAL THIMBLE
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PROPHYLAXIS)

    PROPHYLAXIS)

    PROPHYLAXIS)

    PROPHYLAXIS)
    PROPHYLAXIS)

    PROPHYLAXIS)
    PROPHYLAXIS)

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    CROWN & BRIDGE: ACRYLIC JACKET CROWN


    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS

    MATERIALS: LENS, EACH-SINGLE VISION


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    ABDOMEN: APPENDECTOMY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    PROSTATE: TRANSURETHRAL RESECTION

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    OTHER

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W PARTIAL BONE IMPACTION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    STONE OR TUMOR: REMOVAL OF FROM KIDNEY OR BLADDER (OPEN SURGICAL)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: GOLD FOIL FILLING 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    OTHER
    DIAGNOSTIC: CEPHALOMETRIC X-RAY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)


    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OTHER
    OTHER
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    ORTHODONTICS: FIXED SPACE MAINTAINER, BAND TYPE
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OTHER
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    EYE: OTHER CUTTING OPERATION


    EYE: OTHER CUTTING OPERATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    OTHER

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    URETHRA: CIRCUMCISION
    URETHRA: CIRCUMCISION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS

    PREVENTIVE: DENTAL PROPHYLAXIS


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION

    ORTHODONTICS: FIXED/CEMENTED APPLIANCE FOR TOOTH GUIDANCE


    ORTHODONTICS: FIXED/CEMENTED APPLIANCE FOR TOOTH GUIDANCE
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    PROSTHETICS: ADD TOOTH TO PRT DENT REPL EXTR TOOTH W/O CLSP
    OTHER
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: PULP VITALITY TEST
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    COMPLETE EXAMINATION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W PARTIAL BONE IMPACTION

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)


    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)
    CROWN & BRIDGE: PORCELAIN JACKET CROWN W METAL THIMBLE
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    ORTHODONTICS: EACH ADDED ORTHODONTIC
    ORTHODONTICS: EACH ADDED ORTHODONTIC

    TREATMENT
    TREATMENT
    TREATMENT
    TREATMENT

    AFTER
    AFTER
    AFTER
    AFTER

    1ST
    1ST
    1ST
    1ST

    6
    6
    6
    6

    MONTHS
    MONTHS
    MONTHS
    MONTHS

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CLASP
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CLASP

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL


    COMPLETE EXAMINATION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH


    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: CUTTING OPERATION, HOSPITALIZATION

    BIOPSY, SUPERFICIAL
    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)


    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    EYE: REMOVAL OF CATARACT

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    PROSTATE: TRANSURETHRAL RESECTION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    EYE: OTHER CUTTING OPERATION

    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-TRI-FOCAL


    COMPLETE EXAMINATION

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    OTHER
    OTHER
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PROSTATE: TRANSURETHRAL RESECTION

    EYE: OTHER CUTTING OPERATION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    COMPLETE EXAMINATION

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)
    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA
    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    PREVENTIVE: DENTAL PROPHYLAXIS


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL


    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    FRACTURE: HAND, FOOT OR STERNUM

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    MATERIALS: CONTACT, MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    COMPLETE EXAMINATION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:
    PREVENTIVE:

    DENTAL PROPHYLAXIS
    TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: DIAGNOSTIC MODEL
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    MATERIALS: LENS, EACH-BI-FOCAL


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    SPINE/SPINAL CORD: REMOVAL NUCLEUS PULPOSUS INTERVERTEBRAL DISK

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION

    MATERIALS: LENS, EACH-SINGLE VISION


    MATERIALS: FRAMES

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    DIAGNOSTIC: PULP VITALITY TEST

    PREVENTIVE: DENTAL PROPHYLAXIS


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    CROWN & BRIDGE: RECEMENTING BRIDGE


    CROWN & BRIDGE: RECEMENTING BRIDGE

    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)


    OTHER

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    CROWN & BRIDGE: REPLACE BROKEN FACING WITH STEELE'S/OTHER FACING

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: LENS, EACH-BI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    COMPLETE EXAMINATION
    EYE: OPERATION ON EYE, EYE MUSCLE, OR THROUGH SCLERA OR CORNEA

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OTHER

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION

    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OPER


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC:
    DIAGNOSTIC:
    DIAGNOSTIC:
    DIAGNOSTIC:
    DIAGNOSTIC:

    INITIAL ORAL EXAM (EXCLUDE X-RAY)


    BITEWING X-RAY, SINGLE VIEW
    BITEWING X-RAY, SINGLE VIEW
    BITEWING X-RAY, SINGLE VIEW
    BITEWING X-RAY, SINGLE VIEW

    PROSTATE: TRANSURETHRAL RESECTION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    UTERUS: OTHER OPR ON UTERUS, TUBES, OVARIES BY ABDOMINAL APPROACH

    UTERUS: DILATION & CURRETTAGE, OR OTHER SURGERY ON EXT GENITALIA

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: LENS, EACH-TRI-FOCAL


    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE


    CROWN & BRIDGE: ACRYLIC JACKET CROWN W METAL THIMBLE
    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED
    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    VARICOSE VEINS: INJECTION TREATMENT ON ONE LEG

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-SINGLE VISION


    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ORTHODONTICS: DIAGNOSIS (EX INTRAORAL OR CEPHALOMETRIC X-RAY)

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: FRAMES
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    UTERUS: COMPLETE REMOVAL W/O REMOVAL OF TUBES OR OVARIES

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    OTHER
    OTHER
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: APICOECTOMY
    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: COMPLETE INTRAORAL SERIES OF PERIAPICAL X-RAYS
    DIAGNOSTIC: COMPLETE INTRAORAL SERIES OF PERIAPICAL X-RAYS
    PREVENTIVE: DENTAL PROPHYLAXIS

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    OTHER SERVICES: ADMINISTRATION OF GENERAL ANESTHESIA
    OTHER

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:

    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM

    FILL
    FILL
    FILL
    FILL

    1
    1
    2
    2

    SURFACE
    SURFACE
    SURFACE
    SURFACE

    CAVITY
    CAVITY
    CAVITY
    CAVITY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    UTERUS: COMPLETE REMOVAL W/O REMOVAL OF TUBES OR OVARIES

    COMPLETE EXAMINATION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    OTHER
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    MATERIALS: CONTACT, MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W COMPLETE BONE IMPACTION
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    COMPLETE EXAMINATION
    PROSTHETICS: PRT UPR DENT W CHRM COBLT ALLOY PALATAL BAR 2 CL RST
    PROSTHETICS: PRT UPR DENT W CHRM COBLT ALLOY PALATAL BAR 2 CL RST

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PROSTATE: TRANSURETHRAL RESECTION

    SINUS OPERATION: TRACHEOTOMY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    CROWN & BRIDGE: RECEMENTING BRIDGE
    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    CROWN & BRIDGE: STAINLESS STEEL CROWN
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:
    MATERIALS:

    LENS, EACH-TRI-FOCAL
    FRAMES
    FRAMES
    FRAMES
    LENS, EACH-SINGLE VISION
    LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-SINGLE VISION


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ABDOMEN: CUTTING ABDOMINAL CAVITY EXCEPT AS OTHERWISE SPECIFIED

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    SUTURING SURFACE WOUNDS: ONE OR MORE W 5 OR FEWER STITCHES

    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CLASP

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC


    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OTHER

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL STANNOUS FLUORIDE, ONE (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CLASP


    PROSTHETICS: PARTIAL UPPER/LOWER ACRYLIC BASE DENTURE W/O CLASP

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    CROWN & BRIDGE: ACRYLIC JACKET CROWN


    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTHETICS: COMPLETE UPPER ACRYLIC BASE DENTURE


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    EYE: REMOVAL OF CATARACT

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OTHER
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, MEDICALLY REQUIRED
    MATERIALS: CONTACT, MEDICALLY REQUIRED

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER


    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER
    OTHER SERVICES: SPECIAL CONSULTATION (ADVISE OTHER
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    COMPLETE EXAMINATION

    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:
    OPERATIVE:

    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM
    AMALGAM

    FILL
    FILL
    FILL
    FILL
    FILL
    FILL

    1
    1
    1
    3
    3
    2

    DENTISTS/PHYS)
    DENTISTS/PHYS)

    DENTISTS/PHYS)
    DENTISTS/PHYS)

    SURFACE CAVITY
    SURFACE CAVITY
    SURFACE CAVITY
    OR MORE SURFACE CAVITY
    OR MORE SURFACE CAVITY
    SURFACE CAVITY

    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT


    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE INTRAORAL SERIES OF PERIAPICAL X-RAYS
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PROSTATE: TRANSURETHRAL RESECTION


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    PREVENTIVE: DENTAL PROPHYLAXIS

    URETHRA: INTRA-URETHRAL CUTTING OPERATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE

    PROPHYLAXIS)
    PROPHYLAXIS)
    PROPHYLAXIS)
    PROPHYLAXIS)

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: LENS, EACH-SINGLE VISION
    CROWN & BRIDGE: ACRYLIC JACKET CROWN
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ABDOMEN: GASTROSCOPY, DIAGNOSTIC

    PROSTATE: TRANSURETHRAL RESECTION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    UTERUS: DILATION & CURRETTAGE, OR OTHER SURGERY ON EXT GENITALIA

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: PULP VITALITY TEST
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    ENDODONTICS: EXTIRPATION OF PULP & FILL 2 ROOT CANAL (EX RESTOR)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    ENDODONTICS: PULP CAPPING (EXCLUDE RESTORATION)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    SUTURING SURFACE WOUNDS: ONE OR MORE W 5 OR FEWER STITCHES


    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)


    ENDODONTICS: EXTIRPATION OF PULP & FILL 3 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    EYE: REMOVAL OF CATARACT

    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED


    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    CHEST: OTHER CUTTING INTO THORACTIC CAVITY

    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER
    OTHER
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OTHER
    OTHER
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    BIOPSY, SUPERFICIAL

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    COMPLETE EXAMINATION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    COMPLETE EXAMINATION

    EYE: OTHER CUTTING OPERATION

    UTERUS: COMPLETE REMOVAL W/O REMOVAL OF TUBES OR OVARIES


    COMPLETE EXAMINATION

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW


    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    COMPLETE EXAMINATION

    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-BI-FOCAL

    CROWN & BRIDGE: ACRYLIC JACKET CROWN


    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    PREVENTIVE: DENTAL PROPHYLAXIS


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    PROSTHETICS: PART LOWER ACRYLIC DENT W LINGUAL BAR 2 CLASP W REST
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-BI-FOCAL

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    CROWN & BRIDGE: PORCELAIN JACKET CROWN
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    OTHER
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: FRAMES
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-BI-FOCAL
    MATERIALS: FRAMES

    COMPLETE EXAMINATION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    PERIODONTICS: GINGIVECTOMY, SURGICAL, PER QUADRANT W POST OPER
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    OTHER
    CROWN & BRIDGE: ACRYLIC JACKET CROWN

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    MATERIALS: LENS, EACH-TRI-FOCAL

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    MATERIALS: FRAMES

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PROSTHETICS: ADD TOOTH TO PRT DENT REPL EXTR TOOTH W/O CLSP
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    OTHER

    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION

    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH


    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)

    COMPLETE EXAMINATION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OTHER SERVICES: EMERGENCY TREATMENT OF DENTAL PAIN


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    COMPLETE EXAMINATION
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    DIAGNOSTIC: COMPLETE SERIES OF BITEWING X-RAYS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    COMPLETE EXAMINATION

    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ABDOMEN: OPERATION ON GALL BLADDER
    ABDOMEN: OPERATION ON GALL BLADDER
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 3 OR MORE SURFACE CAVITY
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    PREVENTIVE: DENTAL PROPHYLAXIS

    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER


    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    PREVENTIVE: DENTAL PROPHYLAXIS

    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    EYE: OTHER CUTTING OPERATION


    PREVENTIVE: DENTAL PROPHYLAXIS
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)
    ORTHODONTICS: EACH ADDED ORTHODONTIC TREATMENT AFTER 1ST 6 MONTHS

    PREVENTIVE: DENTAL PROPHYLAXIS


    ABSCESSES, BOILS & CARBUNCLES: INCISION FOR DRAINAGE W/O HOSPITAL

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH

    ORAL SURGERY: SURGICAL REMOVAL OF ERUPTED TOOTH


    OTHER
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS

    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    PREVENTIVE: DENTAL PROPHYLAXIS

    PREVENTIVE: DENTAL PROPHYLAXIS


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)

    ORTHODONTICS: INITIAL ORTHO APPLIANCE W 6 MONTHS TREATMENT


    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OTHER

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    DIAGNOSTIC: INTRAORAL PERIAPICAL X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    OTHER
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    COMPLETE EXAMINATION
    PREVENTIVE: DENTAL PROPHYLAXIS
    PREVENTIVE: TOPICAL SODIUM FLUORIDE,4 TIMES (EXCLUDE PROPHYLAXIS)
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION

    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)


    ENDODONTICS: EXTIRPATION OF PULP & FILL 1 ROOT CANAL (EX RESTOR)

    COMPLETE EXAMINATION
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    COMPLETE EXAMINATION
    MATERIALS: LENS, EACH-SINGLE VISION
    MATERIALS: FRAMES
    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PREVENTIVE: DENTAL PROPHYLAXIS
    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY

    COMPLETE EXAMINATION
    MATERIALS: FRAMES

    MATERIALS: LENS, EACH-SINGLE VISION


    OPERATIVE: AMALGAM FILL 1 SURFACE CAVITY
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    COMPLETE EXAMINATION
    MATERIALS: CONTACT, WHEN NOT MEDICALLY REQUIRED

    PREVENTIVE: DENTAL PROPHYLAXIS


    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW
    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    EYE: OPERATION ON EYE, EYE MUSCLE, OR THROUGH SCLERA OR CORNEA


    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-TRI-FOCAL

    DIAGNOSTIC: BITEWING X-RAY, SINGLE VIEW


    ORAL SURGERY: SURGICAL REMOVAL OF TOOTH W SOFT TISSUE IMPACTION
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    ORAL SURGERY: SIMPLE TOOTH EXTRACTION W ANESTHESIA & POST OPER
    PERIODONTICS: SUBGINGIVAL CURETTAGE, ROOT PLANING, SCALING, EACH

    PREVENTIVE: DENTAL PROPHYLAXIS


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY
    ORAL SURGERY: ALVEOLECTOMY, SURG PREP OF RIDGE FOR DENTURES/QUAD
    ORAL SURGERY: ALVEOLECTOMY, SURG PREP OF RIDGE FOR DENTURES/QUAD

    DIAGNOSTIC: INITIAL ORAL EXAM (EXCLUDE X-RAY)


    COMPLETE EXAMINATION
    MATERIALS: FRAMES
    MATERIALS: LENS, EACH-SINGLE VISION

    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY


    OPERATIVE: AMALGAM FILL 2 SURFACE CAVITY

    PROV1
    P104
    O076
    O076
    P001
    M695
    P215
    M695
    S049
    P090
    P090
    P090
    P215
    P005
    P090
    L96
    L001
    P215
    S191
    S049
    O061
    P090
    S069
    P215
    P090
    P090
    M215
    P215
    P090
    P215
    S296
    S296
    S296
    P090
    P001
    S049
    L001
    S191
    P090
    P005
    P215
    P090
    P090
    D90
    D90
    M297
    M297
    M297
    P115
    P435
    P014
    O001
    O001

    Amount
    $598.00
    $50.00
    $1,885.50
    $607.02
    $350.00
    $58.85
    $150.00
    $350.00
    $159.88
    $39.53
    $324.95
    $358.50
    $1,116.33
    $646.15
    $600.00
    $490.50
    $789.10
    $600.00
    $650.00
    $100.00
    $290.20
    $950.00
    $300.90
    $290.20
    $343.30
    $250.00
    $176.40
    $554.20
    $479.90
    $2,400.00
    $840.00
    $210.00
    $343.30
    $625.80
    $350.00
    $167.00
    $300.00
    $396.00
    $1,116.33
    $479.90
    $57.35
    $399.40
    $250.00
    $150.00
    $370.00
    $200.00
    $150.00
    $16.60
    $34.44
    $130.90
    $110.00
    $930.75

    Assignment

    List patients by subtotals in claim in a high to low spending orde


    Define how many patients spend 50% of the total claims
    Define how much money was spent by the 10% of the High spen
    Define how much was spent in Pharmacy and in Hospital
    Define which are the 3 "Cause" that spend more money

    O001
    O001
    O001
    O001
    M035
    P416
    P416
    D119
    D119
    M842
    P353
    P353
    P353
    P353
    O001
    O001
    O001
    S217
    S217
    S217
    P427
    M037
    M037
    H005
    L033
    M037
    L033
    P427
    S286
    S286
    S118
    O033
    M089
    L070
    L046
    M666
    M666
    M666
    M666
    M666
    P131
    P005
    P005
    D191
    D191
    D191
    P005
    P005
    M762
    P472
    P394
    M229
    M229

    $1,207.00
    $300.00
    $795.00
    $810.00
    $200.00
    $27.50
    $20.50
    $50.00
    $350.00
    $400.00
    $834.40
    $841.00
    $303.40
    $1,520.40
    $110.00
    $1,495.00
    $1,770.00
    $340.00
    $50.00
    $150.00
    $228.91
    $180.00
    $180.00
    $266.00
    $240.00
    $180.00
    $670.00
    $440.00
    $300.00
    $150.00
    $300.00
    $100.00
    $260.00
    $120.00
    $2,185.00
    $80.00
    $20.00
    $160.00
    $100.00
    $20.00
    $240.00
    $317.50
    $317.50
    $350.00
    $70.00
    $30.00
    $317.50
    $317.50
    $100.00
    $80.00
    $744.00
    $160.00
    $25.00

    M229
    M229
    P031
    M229
    L001
    M229
    M542
    M542
    M542
    M542
    M542
    P014
    M629
    M629
    M629
    P426
    M581
    L025
    L025
    M225
    M225
    L001
    M225
    P031
    M763
    M104
    P427
    M089
    L070
    P122
    M089
    P122
    M089
    P122
    M089
    H005
    L006
    L006
    D125
    D125
    D125
    M298
    P435
    P435
    M298
    H005
    M821
    P360
    M304
    M411
    P104
    M870
    P447

    $175.00
    $160.00
    $161.86
    $200.00
    $320.00
    $200.00
    $150.00
    $25.00
    $75.00
    $4,300.00
    $1,050.00
    $12.00
    $240.00
    $25.00
    $35.00
    $180.50
    $200.00
    $451.00
    $257.00
    $480.00
    $120.00
    $865.00
    $50.00
    $251.89
    $100.00
    $400.00
    $500.10
    $200.00
    $200.00
    $68.40
    $180.00
    $425.50
    $180.00
    $121.50
    $180.00
    $690.00
    $275.00
    $275.00
    $140.00
    $160.00
    $80.00
    $240.00
    $524.57
    $26.49
    $200.00
    $1,760.00
    $185.00
    $474.60
    $680.00
    $130.00
    $400.00
    $300.00
    $83.50

    M304
    M304
    P360
    M769
    L070
    L164
    M229
    P122
    D60
    D60
    D60
    D60
    D60
    M053
    P081
    P081
    M053
    P342
    P215
    M327
    P039
    P039
    H066
    S295
    S295
    P014
    M327
    P039
    M327
    P039
    M327
    P014
    M326
    P343
    P215
    P215
    P215
    P215
    P122
    P122
    M060
    P122
    P122
    P122
    P122
    P122
    D411
    D411
    D411
    P122
    M624
    P049
    H006

    $200.00
    $395.00
    $474.60
    $150.00
    $295.00
    $400.00
    $200.00
    $373.80
    $170.00
    $130.00
    $60.00
    $2,500.00
    $300.00
    $280.00
    $278.40
    $38.40
    $140.00
    $220.60
    $129.60
    $140.00
    $75.00
    $41.85
    $1,500.00
    $3,500.00
    $300.00
    $159.30
    $140.00
    $112.50
    $140.00
    $39.95
    $140.00
    $50.25
    $250.00
    $77.70
    $110.40
    $110.00
    $90.00
    $100.00
    $840.00
    $819.00
    $200.00
    $87.50
    $25.95
    $750.50
    $840.00
    $840.00
    $200.00
    $100.00
    $50.00
    $840.00
    $100.00
    $14.25
    $3,300.00

    H006
    S130
    P076
    D48
    D48
    D48
    D48
    D48
    D48
    D48
    D48
    D48
    D420
    S077
    P014
    P014
    M811
    M756
    M756
    M756
    M756
    P426
    P426
    P426
    M756
    L065
    M581
    P182
    M304
    P182
    M304
    P182
    O004
    O004
    O004
    M304
    M304
    D01
    D01
    M184
    M101
    P166
    P166
    P166
    P435
    P097
    P122
    P256
    P073
    P005
    P256
    P256
    P435

    $50.00
    $340.00
    $216.50
    $50.00
    $160.00
    $330.00
    $70.00
    $50.00
    $160.00
    $330.00
    $70.00
    $1,100.00
    $300.00
    $300.00
    $61.00
    $40.00
    $200.00
    $100.00
    $100.00
    $90.00
    $10.00
    $81.00
    $9.00
    $52.00
    $300.00
    $240.00
    $150.00
    $134.95
    $185.00
    $27.95
    $185.00
    $159.60
    $100.00
    $556.00
    $1,516.00
    $140.00
    $635.00
    $385.00
    $115.00
    $200.00
    $150.00
    $248.85
    $296.00
    $217.25
    $645.36
    $189.00
    $122.85
    $282.00
    $4,654.55
    $4,478.64
    ($282.00)
    $282.00
    $386.15

    P005
    P435
    P318
    P005
    P318
    P318
    P318
    P005
    P005
    P005
    P014
    P014
    S277
    P215
    H006
    P215
    P014
    S220
    P014
    UN01
    P215
    P215
    P215
    P014
    P215
    H006
    S220
    O004
    S290
    L034
    H003
    H003
    H003
    P373
    P373
    P373
    S231
    P373
    L034
    T075
    H003
    T076
    M556
    D104
    D104
    D104
    D104
    D104
    D104
    D104
    D104
    O065
    O065

    $3,104.36
    $86.14
    $1,491.55
    $5,500.68
    $424.30
    $259.90
    $212.15
    $1,052.52
    $2,315.18
    $376.04
    $451.70
    $35.00
    $200.00
    $84.00
    $327.00
    $517.60
    $201.00
    $220.00
    $117.25
    $165.00
    $61.40
    $94.10
    $55.00
    $117.25
    $423.10
    $327.00
    $220.00
    $200.00
    $400.00
    $1,700.00
    $400.00
    $265.00
    $150.00
    $145.25
    $103.80
    $11.50
    $300.00
    $148.05
    $1,093.00
    $225.00
    $200.00
    $200.00
    $120.00
    $600.00
    $80.00
    $200.00
    $400.00
    $80.00
    $70.00
    $80.00
    $280.00
    $150.00
    $1,638.00

    O065
    P256
    P094
    M087
    P094
    P094
    M229
    M229
    P011
    L001
    O004
    O004
    S136
    S089
    S301
    S301
    S275
    S136
    D104
    D104
    D104
    D104
    D104
    D104
    D104
    D104
    D04
    D04
    O001
    O001
    D04
    D04
    D04
    D04
    O007
    O007
    O007
    O004
    O004
    O002
    O002
    O002
    O015
    O015
    O015
    S296
    S296
    S296
    M692
    H005
    M056
    M056
    M056

    $765.00
    $225.90
    $352.50
    $260.00
    $11.20
    $108.75
    $200.00
    $160.00
    $65.00
    $465.00
    $200.00
    $216.00
    $200.00
    $650.00
    $300.00
    $300.00
    $300.00
    $200.00
    $80.00
    $70.00
    $60.00
    $250.00
    $2,100.00
    $340.00
    $340.00
    $600.00
    $100.00
    $190.00
    $110.00
    $200.00
    $100.00
    $190.00
    $140.00
    $285.00
    $100.00
    $1,440.00
    $2,325.00
    $200.00
    $1,408.00
    $35.00
    $1,944.00
    $1,516.00
    $120.00
    $1,980.00
    $3,805.00
    $800.00
    $400.00
    $1,500.00
    $700.00
    $1,330.00
    $150.00
    $50.00
    $70.00

    M190
    M190
    M190
    D330
    D330
    D330
    D330
    M186
    L143
    M186
    L032
    D143
    D143
    M030
    M030
    M030
    P343
    P155
    P155
    O033
    O033
    O033
    M556
    P435
    P435
    M304
    S356
    S356
    L025
    M556
    L97
    M189
    D342
    D342
    D342
    D342
    D342
    D342
    O001
    O001
    S219
    D23
    S217
    H048
    L075
    L075
    M124
    H011
    H011
    H011
    S192
    M124
    L070

    $100.00
    $25.00
    $75.00
    $780.00
    $220.00
    $450.00
    $2,800.00
    $200.00
    $150.00
    $120.00
    $350.00
    $175.00
    $25.00
    $160.00
    $50.00
    $110.00
    $321.03
    $148.59
    $152.41
    $100.00
    $1,327.50
    $1,341.00
    $120.00
    $77.10
    $46.99
    $200.00
    $300.00
    $1,400.00
    $285.00
    $120.00
    $180.00
    $140.00
    $300.00
    $840.00
    $300.00
    $120.00
    $120.00
    $8,000.00
    $110.00
    $1,258.00
    $450.00
    $100.00
    $500.00
    $232.00
    $3,182.25
    $47.75
    $250.00
    $5,500.00
    $14,307.00
    $2,850.00
    $8,500.00
    $250.00
    $80.00

    L065
    L149
    M124
    S426
    M657
    P022
    M657
    H006
    H006
    P011
    H006
    S426
    L065
    O004
    O004
    O004
    L046
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    H047
    M436
    M124
    L041
    M124
    P430
    P416
    P014
    H047
    S199
    H027
    P245
    P245
    P430
    P430
    P430
    P430
    P430
    P430
    P430
    P430
    O136
    O136

    $585.00
    $2,200.00
    $50.00
    $300.00
    $100.00
    $245.70
    $200.00
    $150.00
    $70.00
    $174.00
    $490.00
    $600.00
    $918.00
    $100.00
    $858.19
    $596.25
    $300.00
    $33,550.00
    $22,050.00
    $17,527.00
    $5,873.00
    $18,000.00
    ($3,427.00)
    $3,427.00
    ($10,983.36)
    $10,983.36
    ($1,282.00)
    $1,282.00
    $3,427.00
    $10,983.36
    $1,282.00
    $300.00
    $250.00
    $280.00
    $100.00
    $2,601.50
    $210.00
    $1,987.75
    $1,000.00
    $300.00
    $150.00
    $85.40
    $595.00
    $1,947.20
    ($1,947.20)
    $1,947.20
    $1,504.30
    ($1,504.30)
    $1,504.30
    $1,224.60
    $63.00
    $300.00
    $1,405.50

    O136
    M534
    L164
    P476
    M034
    P011
    O001
    H006
    H006
    M246
    S089
    L020
    M341
    M341
    M341
    P104
    D125
    D125
    D125
    O019
    O019
    O019
    O001
    O001
    O001
    O001
    O001
    O001
    O001
    O001
    D59
    D59
    D59
    D59
    D59
    D59
    D59
    S114
    S114
    S120
    M597
    M597
    M597
    P115
    P115
    D171
    D171
    D171
    O001
    O001
    O001
    O001
    O001

    $797.50
    $200.00
    $150.00
    $180.50
    $50.00
    $93.50
    $250.00
    $2,200.00
    $2,600.00
    $2,000.00
    $8,900.00
    $340.00
    $140.00
    $25.00
    $135.00
    $361.20
    $80.00
    $210.00
    $190.00
    $120.00
    $680.00
    $715.00
    $110.00
    $225.60
    $425.00
    $1,425.90
    $110.00
    $335.75
    $425.00
    $1,292.00
    $80.00
    $400.00
    $100.00
    $400.00
    $100.00
    $2,200.00
    $240.00
    $60.01
    $339.99
    $300.00
    $100.00
    $100.00
    $250.00
    $366.00
    $91.50
    $100.00
    $245.00
    $105.00
    $110.00
    $99.00
    $706.50
    $859.14
    $220.86

    D125
    D125
    D125
    M019
    M019
    D125
    D125
    D125
    O168
    O168
    O168
    D291
    D291
    D291
    D291
    D291
    M067
    P003
    P003
    M346
    M346
    P478
    P458
    M120
    P491
    P491
    M120
    P125
    M646
    P458
    P458
    S151
    S151
    M120
    P491
    O004
    O004
    O001
    O001
    O001
    O001
    S089
    M083
    S275
    H023
    H034
    H034
    H034
    D241
    D241
    D241
    D241
    D241

    $80.00
    $35.00
    $45.00
    $84.00
    $216.00
    $200.00
    $200.00
    $350.00
    $180.00
    $1,135.00
    $2,270.00
    $100.00
    $210.00
    $300.00
    $400.00
    $400.00
    $160.00
    $87.00
    $12.50
    $200.00
    $260.00
    $380.00
    $70.30
    $140.00
    $70.00
    $50.00
    $240.00
    $35.00
    $300.00
    $303.55
    $70.30
    $400.00
    $350.00
    $140.00
    $274.00
    $1,196.00
    $1,116.00
    $110.00
    $1,081.00
    $1,124.75
    $573.75
    $1,300.00
    $400.00
    $750.00
    $375.00
    $300.00
    $500.00
    $144.20
    $100.00
    $135.00
    $70.00
    $165.00
    $2,000.00

    P435
    P427
    UN02
    UN02
    M304
    M304
    H005
    P435
    P435
    M248
    P458
    P458
    M821
    H005
    M473
    P508
    L070
    M473
    P094
    P508
    M473
    P508
    P508
    L070
    M473
    P508
    M473
    P508
    M473
    M388
    M388
    M388
    S052
    L013
    M693
    M693
    M120
    M120
    M120
    D379
    D379
    D379
    M693
    P154
    P154
    O076
    O076
    O076
    D244
    D244
    D171
    M204
    M204

    $193.44
    $30.47
    $275.75
    $193.02
    $200.00
    $160.00
    $780.00
    $134.75
    $33.69
    $180.00
    $17.50
    $44.45
    $300.00
    $1,038.40
    $120.00
    $211.50
    $640.00
    $280.00
    $351.30
    $343.47
    $150.00
    $384.09
    $25.60
    $640.00
    $150.00
    $32.68
    $150.00
    $102.38
    $240.00
    $100.00
    $25.00
    $75.00
    $550.00
    $3,582.00
    $250.00
    $500.00
    $140.00
    $25.00
    $55.00
    $120.00
    $500.00
    $120.00
    $150.00
    $84.80
    $21.20
    $90.00
    $1,796.00
    $1,200.00
    $300.00
    $70.00
    $280.00
    $200.00
    $300.00

    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    M251
    P430
    P462
    M693
    M693
    P430
    P430
    M693
    P430
    P430
    P167
    S201
    L013
    L013
    L013
    H008
    D125
    D125
    D125
    D125
    D346
    D346
    D346
    D346
    D346
    D346
    P167
    P167
    P167
    H048
    H048
    H048
    M755
    S217
    H048
    H048
    H005
    M607
    M607
    H048
    H048
    MM06

    $200.00
    $50.00
    $150.00
    $280.00
    $200.00
    $50.00
    $150.00
    $320.00
    $400.00
    $100.00
    $700.00
    $1,215.00
    $86.10
    $125.00
    ($150.00)
    $150.00
    ($250.00)
    $250.00
    $150.00
    $202.00
    $48.00
    $1,938.60
    $300.00
    $330.00
    $800.00
    $300.00
    $2,000.00
    $80.00
    $35.00
    $45.00
    $300.00
    $150.00
    $100.00
    $400.00
    $6,500.00
    $3,000.00
    $900.00
    $1,938.60
    $2,165.85
    $2,165.85
    $900.00 $67,656.00
    $1,350.00
    $14,480.00
    $5,500.00
    $22,450.00
    $12,068.00
    $4,884.00
    $1,143.60
    $75.00
    $180.00
    $398.00
    $438.00
    $465.50

    S217
    P231
    S217
    P020
    S217
    S217
    MM07
    M483
    P020
    S217
    M607
    M607
    M607
    M607
    P073
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M607
    M795
    M795
    M795
    M795
    M795
    M795
    M754
    M754
    M754
    M795
    M795
    M795
    M795
    M795
    S115
    P011
    P011
    S292
    P351

    $340.00
    $591.90
    $340.00
    $189.00
    $340.00
    $413.00
    $530.00
    $120.00
    $120.00
    $340.00
    ($300.00)
    $300.00
    ($350.00)
    $350.00
    $1,343.64
    $300.00
    $50.00
    $300.00
    ($200.00)
    $200.00
    ($2,046.00)
    $2,046.00
    ($300.00)
    $300.00
    ($300.00)
    $300.00
    ($240.00)
    $240.00
    $200.00
    $2,046.00
    $300.00
    $300.00
    $240.00
    $250.00
    $150.00
    $120.00
    $60.00
    $150.00
    $90.00
    $410.00
    $150.00
    $100.00
    $50.00
    $470.00
    $120.00
    $150.00
    $150.00
    $100.00
    $300.00
    $201.00
    $150.00
    $400.00
    $149.00

    O004
    O004
    O004
    D90
    D90
    D90
    D90
    M120
    M120
    M120
    O004
    S060
    S060
    S060
    P019
    P435
    S060
    D89
    D89
    D89
    D89
    D89
    M072
    M693
    M693
    M693
    M693
    O004
    O004
    O004
    O004
    O004
    M205
    T060
    UN01
    M089
    M089
    P055
    S458
    M205
    P094
    M205
    P094
    M205
    P094
    D152
    D152
    D152
    M205
    M205
    M205
    P094
    L006

    $100.00
    $1,356.00
    $2,056.00
    $100.00
    $70.00
    $30.00
    $40.00
    $140.00
    $460.00
    $80.00
    $324.00
    $780.00
    $200.00
    $200.00
    $152.55
    $547.62
    $20.00
    $50.00
    $150.00
    $70.00
    $55.00
    $225.00
    $100.00
    $150.00
    $120.00
    $100.00
    $100.00
    $200.00
    $200.00
    $66.00
    $100.00
    $396.00
    $240.00
    $670.00
    $2,070.00
    $180.00
    $400.00
    $69.00
    $300.00
    $240.00
    $532.50
    $240.00
    $532.50
    $240.00
    $532.50
    $500.00
    $70.00
    $230.00
    $240.00
    $100.00
    $80.00
    $553.50
    $400.00

    M769
    M769
    P435
    M769
    M769
    T041
    UN01
    T041
    D191
    D191
    D191
    M312
    O008
    O008
    O008
    D120
    D120
    M225
    M225
    L001
    L006
    T034
    T034
    M089
    H005
    P122
    H005
    D125
    D125
    D125
    D125
    P122
    P487
    S239
    L006
    L006
    M089
    P435
    M630
    P122
    P122
    P122
    P122
    P122
    P122
    M317
    M317
    D38
    M053
    P256
    M018
    M018
    P115

    $150.00
    $400.00
    $83.27
    $150.00
    $400.00
    $1,150.00
    $790.00
    $2,825.00
    $100.00
    $35.00
    $15.00
    $100.00
    $80.00
    $1,300.00
    $750.00
    $70.00
    $300.00
    $240.00
    $60.00
    $795.00
    $400.00
    $2,050.00
    $425.00
    $200.00
    $815.00
    $37.50
    $200.00
    $80.00
    $35.00
    $35.00
    $200.00
    $173.00
    $87.30
    $200.00
    $500.00
    $120.00
    $200.00
    $81.15
    $160.00
    $183.00
    $173.00
    $173.00
    $173.00
    $153.75
    $102.50
    $120.00
    $30.00
    $85.00
    $140.00
    $124.40
    $200.00
    $300.00
    $219.80

    P031
    P215
    S114
    S114
    P106
    M422
    M422
    M422
    M422
    S114
    M630
    P093
    P066
    P066
    P005
    P005
    P011
    M473
    P435
    P435
    M473
    P435
    P435
    P435
    O033
    O033
    O033
    O033
    M473
    P435
    L001
    L046
    M030
    P115
    O001
    O001
    O001
    D343
    D343
    D343
    D343
    D343
    P094
    D343
    D343
    H005
    H005
    H005
    H005
    D143
    S452
    M473
    P256

    $59.43
    $1,312.50
    $400.00
    $50.00
    $246.75
    $320.00
    $100.00
    $80.00
    $30.00
    $1,200.00
    $180.00
    $560.00
    $487.31
    $3,271.25
    $947.94
    $631.96
    $56.00
    $120.00
    $151.78
    $108.01
    $120.00
    $285.94
    $108.41
    $285.94
    $230.00
    $625.50
    $373.50
    $1,015.00
    $120.00
    $306.36
    $640.00
    $140.00
    $160.00
    $88.80
    $110.00
    $575.00
    $1,050.00
    $200.00
    $210.00
    $70.00
    $260.00
    $80.00
    $156.75
    $290.00
    $70.00
    $455.00
    $13.95
    $300.00
    $585.31
    $250.00
    $300.00
    $140.00
    $192.50

    M473
    H005
    H025
    S278
    S361
    D31
    D31
    S220
    O156
    S220
    D31
    D31
    M019
    P049
    P049
    O007
    M019
    M019
    P049
    P049
    P049
    D31
    D31
    M638
    L143
    M638
    L006
    M638
    M638
    M638
    M638
    M638
    O001
    O001
    O001
    O001
    S255
    S255
    D125
    D125
    D125
    D125
    M123
    M123
    M123
    M123
    M144
    P427
    P195
    D264
    D264
    M693
    M693

    $160.00
    $150.00
    $475.00
    $400.00
    $300.00
    $1,140.00
    $150.00
    $600.00
    $150.00
    $150.00
    $140.00
    $430.00
    $300.00
    $25.35
    $488.45
    $100.00
    $75.00
    $225.00
    $11.16
    $10.95
    $2.79
    $540.00
    $595.00
    $140.00
    $500.00
    $280.00
    $200.00
    $140.00
    $1,240.00
    $300.00
    $280.00
    $660.00
    $775.00
    $1,515.75
    $475.00
    $987.00
    $200.00
    $200.00
    $80.00
    $70.00
    $105.00
    $600.00
    $150.00
    $40.00
    $60.00
    $150.00
    $200.00
    $149.25
    $120.00
    $600.00
    $1,140.00
    $150.00
    $25.00

    M693
    O004
    O004
    M248
    P458
    M248
    L97
    O076
    O076
    S084
    H006
    S209
    M144
    P467
    P467
    P467
    D253
    D104
    D104
    D104
    D104
    D104
    P435
    P203
    P303
    P436
    P436
    P203
    P303
    D04
    D04
    D04
    D04
    UN01
    UN01
    O001
    O001
    O001
    S302
    S302
    S137
    S137
    UN01
    M657
    L006
    P318
    P318
    M657
    P031
    S279
    L075
    P508
    S279

    $75.00
    $200.00
    $500.00
    $160.00
    $46.50
    $160.00
    $405.00
    $1,200.00
    $730.75
    $300.00
    $600.00
    $200.00
    $200.00
    $31.00
    $51.90
    $64.10
    $300.00
    $80.00
    $70.00
    $60.00
    $500.00
    $80.00
    $27.60
    $74.67
    $8.00
    $53.33
    $53.33
    $101.33
    $16.00
    $125.00
    $70.00
    $55.00
    $80.00
    $200.00
    $250.00
    $110.00
    $956.25
    $782.00
    $360.00
    $140.00
    $450.00
    $350.00
    $300.00
    $200.00
    $800.00
    $178.35
    $120.75
    $100.00
    $167.16
    $500.00
    $3,420.00
    $340.74
    $400.00

    D66
    D66
    D66
    T061
    S279
    S312
    S312
    L065
    S277
    M310
    M310
    P306
    P399
    S363
    L070
    L070
    S363
    S277
    L070
    S363
    L070
    S239
    S376
    S376
    P435
    S369
    P491
    M534
    M534
    M534
    L164
    L164
    M331
    M331
    M331
    L174
    P179
    M076
    M076
    M727
    L068
    O001
    O004
    O004
    M657
    P337
    P337
    L151
    S005
    M818
    S231
    P031
    P011

    $280.00
    $340.00
    $610.00
    $1,840.00
    $400.00
    $150.00
    $450.00
    $225.00
    $300.00
    $150.00
    $320.00
    $86.00
    $101.30
    $300.00
    $690.00
    $200.00
    $400.00
    $300.00
    $1,330.00
    $200.00
    $40.00
    $300.00
    $450.00
    $515.00
    $122.43
    $400.00
    $147.50
    $200.00
    $100.00
    $60.00
    $400.00
    $360.00
    $140.00
    $25.00
    $175.00
    $340.00
    $209.00
    $500.00
    $1,250.00
    $400.00
    $750.00
    $270.00
    $200.00
    $876.00
    $200.00
    $98.00
    $315.70
    $300.00
    $300.00
    $260.00
    $300.00
    $134.70
    $388.50

    P031
    T034
    S041
    L006
    M657
    L140
    M657
    M657
    L140
    L140
    L140
    L140
    P215
    S367
    P215
    D183
    D183
    S367
    P215
    D77
    D77
    D77
    D77
    D77
    D77
    D77
    L018
    D77
    M375
    O001
    O001
    O001
    M089
    D266
    D266
    P247
    D148
    D148
    D148
    D148
    S089
    H006
    H006
    P512
    S089
    S089
    D353
    O001
    O001
    O001
    D353
    M633
    L034

    $251.72
    $1,800.00
    $400.00
    $550.00
    $200.00
    $1,275.00
    $200.00
    $585.00
    $535.00
    $180.00
    $400.00
    $120.00
    $305.05
    $300.00
    $206.90
    $250.00
    $400.00
    $300.00
    $65.40
    $250.00
    $60.00
    $250.00
    $150.00
    $200.00
    $200.00
    $400.00
    $660.00
    $300.00
    $280.00
    $110.00
    $1,355.75
    $1,581.00
    $180.00
    $360.00
    $40.00
    $86.00
    $100.00
    $600.00
    $180.00
    $1,000.00
    $450.00
    $180.00
    $360.00
    $169.75
    $450.00
    $225.00
    $220.00
    $110.00
    $1,820.00
    $1,320.00
    $220.00
    $200.00
    $400.00

    M633
    P155
    M633
    M633
    O004
    O004
    O004
    O004
    O004
    O004
    M633
    P155
    O076
    O076
    O076
    M352
    H006
    M352
    M352
    S301
    H047
    H047
    H047
    H047
    H047
    S250
    H006
    H005
    H005
    H005
    H005
    H005
    H005
    H005
    D113
    D113
    D113
    D133
    D113
    M020
    P337
    D424
    D242
    M215
    L070
    D13
    D13
    D13
    D13
    D13
    M215
    S007
    P435

    $100.00
    $175.00
    $100.00
    $300.00
    $100.00
    $796.00
    $1,656.00
    $100.00
    $796.00
    $1,016.00
    $100.00
    $452.20
    $90.00
    $952.88
    $1,057.87
    $310.00
    $700.00
    $320.00
    $40.00
    $200.00
    $8,000.00
    $4,800.00
    $80,503.10
    $27,312.12
    $12,484.78
    $200.00
    $400.00
    $90.00
    $335.00
    $130.00
    $200.00
    $82.95
    $208.50
    $52.13
    $80.00
    $150.00
    $90.00
    $700.00
    $450.00
    $180.00
    $284.00
    $500.00
    $400.00
    $250.00
    $1,400.00
    $100.00
    $300.00
    $1,500.00
    $200.00
    $300.00
    $250.00
    $240.00
    $150.08

    S159
    S159
    S159
    S159
    S159
    D375
    D375
    D375
    D143
    O076
    O076
    M067
    M067
    P014
    H006
    S277
    S277
    M630
    M654
    P122
    P435
    P435
    M654
    S264
    S264
    S264
    L071
    O169
    O169
    D424
    D424
    D424
    D424
    M140
    L065
    M060
    M060
    D411
    D411
    D411
    M549
    P081
    M060
    M060
    M099
    P011
    O025
    O025
    M045
    P090
    L001
    M045
    P090

    $2,550.00
    $17,423.24
    $6,000.00
    $30,000.00
    $20,629.30
    $50.00
    $300.00
    $50.00
    $200.00
    $3,095.00
    $1,970.00
    $140.00
    $160.00
    $289.10
    $220.00
    $75.00
    $225.00
    $180.00
    $160.00
    $87.99
    $288.15
    $76.31
    $160.00
    $75.00
    $325.00
    $150.00
    $150.00
    $2,155.00
    $1,485.00
    $44.80
    $11.20
    $232.80
    $183.20
    $150.00
    $390.00
    $400.00
    $200.00
    $200.00
    $50.00
    $50.00
    $100.00
    $394.50
    $200.00
    $300.00
    $120.00
    $78.00
    $950.00
    $795.00
    $150.00
    $73.50
    $50.00
    $150.00
    $78.75

    M045
    M045
    O001
    M707
    M707
    M707
    S379
    M707
    M707
    D41
    D41
    D41
    D41
    D41
    S433
    D264
    O002
    O002
    O001
    O001
    O001
    L001
    L001
    M068
    M707
    M772
    P474
    O001
    O001
    O001
    H005
    H005
    H005
    S115
    P154
    S115
    M357
    H066
    H066
    M100
    P106
    P106
    D104
    D104
    D58
    D58
    D58
    D58
    M818
    O001
    D59
    D59
    D59

    $150.00
    $50.00
    $110.00
    $300.00
    $100.00
    $140.00
    $400.00
    $250.00
    $270.00
    $100.00
    $500.00
    $100.00
    $100.00
    $900.00
    $300.00
    $360.00
    $200.00
    $275.00
    $110.00
    $786.25
    $527.00
    $164.00
    $241.00
    $16.00
    $520.00
    $120.00
    $528.75
    $110.00
    $2,495.00
    $960.00
    $380.00
    $44.68
    $105.23
    $600.00
    $127.30
    $4,000.00
    $1,500.00
    $600.00
    $3,900.00
    $160.00
    $135.00
    $45.00
    $200.00
    $140.00
    $60.00
    $100.00
    $350.00
    $850.00
    $240.00
    $110.00
    $70.00
    $150.00
    $90.00

    D59
    D59
    D77
    D77
    M353
    O001
    M637
    P003
    P003
    M637
    P003
    O076
    O076
    O076
    O076
    D283
    D283
    O004
    O004
    O001
    O001
    O001
    M060
    M060
    M060
    M060
    H023
    H023
    S313
    P066
    H023
    S313
    P031
    S046
    S313
    S313
    P435
    M638
    M638
    M638
    M638
    P488
    M638
    M638
    M638
    M230
    M230
    M230
    M230
    P475
    D104
    D104
    D104

    $1,400.00
    $540.00
    $60.00
    $250.00
    $150.00
    $200.00
    $120.00
    $126.00
    $50.00
    $270.00
    $491.00
    $90.00
    $1,970.00
    $90.00
    $1,450.00
    $400.00
    $400.00
    $36.00
    $656.00
    $110.00
    $786.25
    $527.00
    $200.00
    $200.00
    $340.00
    $200.00
    $375.00
    $40.00
    $300.00
    $360.75
    $375.00
    $300.00
    $264.48
    $350.00
    $400.00
    $400.00
    $29.39
    $140.00
    $300.00
    $25.00
    $55.00
    $239.00
    $140.00
    $140.00
    $100.00
    $300.00
    $25.00
    $175.00
    $1,100.00
    $95.00
    $80.00
    $280.00
    $340.00

    O076
    O076
    O076
    O076
    M374
    P435
    P435
    D125
    D125
    D125
    D125
    D125
    O004
    O004
    O004
    D439
    D439
    D439
    D439
    D59
    D59
    M549
    P256
    P031
    M692
    S046
    S046
    L162
    P256
    D119
    D119
    D119
    D119
    D119
    D119
    M215
    M215
    P435
    M215
    O177
    O177
    O177
    S165
    P031
    S019
    S019
    M049
    P155
    D192
    D192
    D192
    D192
    D192

    $90.00
    $1,036.00
    $1,773.00
    $65.00
    $200.00
    $100.80
    $57.83
    $80.00
    $100.00
    $30.00
    $300.00
    $360.00
    $100.00
    $716.00
    $1,656.00
    $110.00
    $100.00
    $90.00
    $480.00
    $200.00
    $290.00
    $100.00
    $278.30
    $230.49
    $500.00
    $400.00
    $100.00
    $300.00
    $1,135.55
    $50.00
    $100.00
    $30.00
    $2,000.00
    $450.00
    $400.00
    $1,000.00
    $600.00
    $489.00
    $250.00
    $100.00
    $2,125.00
    $2,700.00
    $300.00
    $67.99
    $50.00
    $210.00
    $120.00
    $117.40
    $50.00
    $110.00
    $500.00
    $350.00
    $1,050.00

    D192
    D192
    O076
    O076
    O076
    M046
    L074
    P150
    M814
    M814
    M156
    M156
    P501
    M156
    P501
    M156
    M156
    H066
    P501
    S253
    S253
    M346
    M346
    P247
    D09
    D09
    D09
    M285
    M285
    P057
    M285
    M285
    M285
    M285
    P057
    M007
    P450
    M007
    P450
    M786
    P450
    P450
    S130
    M108
    M108
    P031
    P031
    M108
    L006
    P031
    M190
    M190
    M584

    $1,000.00
    $500.00
    $90.00
    $807.74
    $848.26
    $100.00
    $60.00
    $48.00
    $140.00
    $155.00
    $200.00
    $40.00
    $2,772.00
    $200.00
    $1,611.00
    $300.00
    $300.00
    $250.00
    $5,571.00
    $300.00
    $350.00
    $200.00
    $200.00
    $127.75
    $75.00
    $25.00
    $300.00
    $120.00
    $130.00
    $487.50
    $120.00
    $80.00
    $80.00
    $70.00
    $483.00
    $100.00
    $652.50
    $20.00
    $191.40
    $100.00
    $508.50
    $16.00
    $300.00
    ($150.00)
    $150.00
    ($223.44)
    $223.44
    $150.00
    $550.00
    $223.44
    $80.00
    $60.00
    $600.00

    M584
    P483
    M190
    M190
    D59
    D59
    D59
    D59
    M694
    M694
    M694
    M694
    D239
    D239
    D239
    D239
    D239
    M164
    M171
    P011
    P011
    M230
    M230
    P014
    M176
    M176
    M176
    M304
    M700
    P413
    L089
    M248
    P014
    P369
    P369
    P369
    M647
    M647
    M647
    M647
    S174
    S174
    H027
    P369
    M647
    M647
    S159
    S265
    S004
    P167
    M786
    M786
    P140

    $191.00
    $141.60
    $100.00
    $100.00
    $375.00
    $1,975.00
    $590.00
    $1,160.00
    $100.00
    $140.00
    $200.00
    $100.00
    $90.00
    $25.00
    $50.00
    $120.00
    $575.00
    $120.00
    $300.00
    $78.50
    $120.00
    $300.00
    $200.00
    $88.00
    $160.00
    $480.00
    $120.00
    $185.00
    $140.00
    $214.80
    $128.00
    $160.00
    $99.00
    $193.45
    $270.45
    $270.45
    $160.00
    $280.00
    $500.00
    $100.00
    $300.00
    $1,200.00
    $1,000.00
    $163.99
    $80.00
    $160.00
    $300.00
    $300.00
    $400.00
    $190.50
    $80.00
    $20.00
    $29.50

    M786
    D74
    D74
    D74
    D74
    D74
    D74
    D74
    M858
    M858
    H006
    M858
    M858
    S001
    L081
    L006
    L021
    L006
    P066
    S001
    P005
    S001
    P511
    P066
    M597
    P435
    D82
    D143
    D143
    S400
    D143
    S400
    S400
    D143
    D143
    D143
    D77
    D77
    D77
    D232
    D232
    M501
    M501
    M501
    M501
    M501
    M501
    S220
    S220
    M055
    P246
    P031
    P435

    $40.00
    $50.00
    $50.00
    $120.00
    $300.00
    $600.00
    $1,200.00
    $1,700.00
    $400.00
    $150.00
    $700.00
    $200.00
    $150.00
    $400.00
    $400.00
    $150.00
    $170.00
    $400.00
    $417.75
    $300.00
    $385.90
    $300.00
    $726.00
    $457.32
    $200.00
    $206.31
    $400.00
    $2,600.00
    $600.00
    $300.00
    $600.00
    $300.00
    $350.00
    $600.00
    $600.00
    $600.00
    $300.00
    $60.00
    $60.00
    $560.00
    $520.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $200.00
    $80.00
    $200.00
    $200.00
    $358.20
    $69.39
    $39.74

    M189
    P059
    M189
    P059
    L065
    P059
    L065
    M189
    P059
    M215
    P372
    P343
    D224
    D224
    D224
    D38
    D38
    D194
    D38
    M237
    M237
    M237
    D38
    M514
    P179
    S250
    P286
    P011
    S250
    P435
    S020
    P022
    L176
    S093
    S020
    S020
    S020
    P022
    S093
    S093
    S093
    S250
    S250
    P286
    M375
    M375
    P068
    M375
    L070
    L023
    M068
    L081
    M068

    $120.00
    $270.00
    $240.00
    $140.00
    $90.00
    $1,120.00
    $170.00
    $120.00
    $182.00
    $250.00
    $635.00
    $319.20
    $900.00
    $100.00
    $250.00
    $100.00
    $1,700.00
    $200.00
    $10,700.00
    $120.00
    $1,030.00
    $60.00
    $900.00
    $200.00
    $100.00
    $400.00
    $407.75
    $288.75
    $200.00
    $428.14
    $200.00
    $167.65
    $1,100.00
    $350.00
    $200.00
    $150.00
    $350.00
    $412.05
    $500.00
    $750.00
    $300.00
    $200.00
    $200.00
    $169.57
    $160.00
    $160.00
    $33.39
    $160.00
    $70.00
    $100.00
    $260.00
    $725.00
    $240.00

    M068
    L006
    M068
    L006
    M038
    M346
    M346
    P003
    M067
    M067
    H006
    H006
    M067
    H006
    M138
    M138
    P170
    M215
    P170
    M138
    L124
    P170
    M138
    P170
    M138
    P170
    Missing
    Missing
    Missing
    H066
    S133
    L151
    O001
    O001
    O001
    O001
    O076
    O076
    O076
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    P106
    M183
    M183
    P014
    O076
    O076

    $40.00
    $400.00
    $250.00
    $200.00
    $400.00
    $200.00
    $280.00
    $137.20
    ($160.00)
    $160.00
    ($1,800.00)
    $1,800.00
    $160.00
    $1,800.00
    $120.00
    $120.00
    $480.00
    $100.00
    $1,470.00
    $120.00
    $150.00
    $472.50
    $100.00
    $367.00
    $100.00
    $1,530.00
    $750.00
    $300.00
    $337.00
    $800.00
    $3,000.00
    $300.00
    $110.00
    $1,464.00
    $536.00
    $484.00
    $90.00
    $2,173.38
    $618.37
    $450.00
    $350.00
    $100.00
    $25.00
    $135.00
    $920.00
    $300.00
    $400.00
    $413.25
    $150.00
    $280.00
    $330.00
    $90.00
    $1,475.00

    O001
    M002
    M002
    M002
    M002
    M002
    M202
    H026
    M461
    M461
    L070
    M638
    M638
    M461
    M461
    L070
    P115
    M461
    M461
    O011
    O011
    O011
    M104
    P479
    M371
    M371
    M371
    P057
    D244
    D244
    S149
    M285
    M285
    M285
    S114
    S114
    S173
    S136
    H006
    M451
    M451
    M310
    M310
    M310
    D217
    D217
    M514
    H034
    O001
    O001
    O001
    D389
    D389

    $925.00
    $410.00
    $225.00
    $100.00
    $130.00
    $200.00
    $200.00
    $1,500.00
    $300.00
    $460.00
    $580.00
    $280.00
    $280.00
    $300.00
    $540.00
    $900.00
    $169.25
    $150.00
    $260.00
    $80.00
    $620.00
    $2,000.00
    $160.00
    $555.00
    $60.00
    $60.00
    $70.00
    $84.00
    $240.00
    $1,010.00
    $80.00
    $160.00
    $60.00
    $60.00
    $1,200.00
    $150.00
    $360.00
    $310.00
    $240.00
    $300.00
    $200.00
    $150.00
    $250.00
    $60.00
    $50.00
    $800.00
    $300.00
    $360.00
    $110.00
    $895.00
    $750.00
    $100.00
    $150.00

    D389
    D389
    D389
    O004
    O004
    O076
    O076
    O076
    M726
    M726
    P450
    D188
    O076
    O076
    M346
    M346
    P179
    O061
    O061
    P066
    O061
    P066
    O002
    O002
    O002
    M248
    P422
    M248
    M248
    L97
    L97
    M758
    M248
    P422
    M001
    M001
    S192
    L061
    L149
    P435
    S192
    P435
    O004
    O004
    O004
    O001
    O001
    M388
    P223
    M225
    M225
    L006
    P055

    $400.00
    $300.00
    $100.00
    $100.00
    $100.00
    $90.00
    $947.88
    $1,152.87
    $100.00
    $40.00
    $68.50
    $300.00
    $1,525.50
    $1,375.00
    $100.00
    $100.00
    $168.00
    $190.00
    $190.00
    $71.79
    $190.00
    $215.37
    $70.00
    $1,355.75
    $2,422.50
    $140.00
    $111.25
    $140.00
    $100.00
    $180.00
    $265.00
    $180.00
    $140.00
    $226.80
    $200.00
    $20.00
    $300.00
    $70.00
    $150.00
    $439.39
    $300.00
    $1,032.08
    $100.00
    $1,036.00
    $776.00
    $1,525.00
    $810.00
    $240.00
    $224.00
    $440.00
    $260.00
    $1,100.00
    $81.99

    P055
    S265
    S265
    D337
    D337
    M018
    M018
    S296
    H003
    H003
    H003
    H003
    H003
    P115
    D371
    S296
    P115
    M018
    M018
    S296
    L065
    S296
    S296
    L065
    M138
    M138
    M230
    M230
    P167
    D79
    D79
    D79
    O076
    O076
    O076
    O076
    O076
    O076
    P167
    M104
    P167
    S232
    L006
    D114
    D114
    D114
    D114
    D22
    M758
    P016
    L003
    D257
    D257

    $118.50
    $300.00
    $280.00
    $350.00
    $1,250.00
    $200.00
    $60.00
    $500.00
    $120.00
    $300.00
    $180.00
    $150.00
    $670.00
    $118.45
    $300.00
    $500.00
    $149.45
    $200.00
    $100.00
    $500.00
    $625.00
    $500.00
    $500.00
    $115.00
    $120.00
    $80.00
    $300.00
    $300.00
    $187.15
    $140.00
    $25.00
    $45.00
    $90.00
    $1,036.00
    $1,970.00
    $90.00
    $876.00
    $1,770.00
    $564.00
    $360.00
    $174.00
    $250.00
    $400.00
    $50.00
    $70.00
    $50.00
    $400.00
    $200.00
    $200.00
    $142.50
    $620.00
    $120.00
    $280.00

    D257
    M864
    M864
    M864
    P240
    O076
    O076
    O076
    O108
    O108
    O108
    P340
    M346
    M346
    M346
    M346
    P115
    P115
    M346
    M346
    P115
    M346
    M346
    P115
    S370
    M505
    L152
    P477
    O054
    S174
    M814
    M814
    M814
    P318
    P318
    M138
    M138
    P195
    L046
    M441
    M441
    P014
    H006
    H006
    H006
    L065
    P246
    M067
    M067
    L117
    P478
    S004
    M795

    $2,000.00
    $100.00
    $20.00
    $20.00
    $45.15
    $90.00
    $563.35
    $1,122.38
    $85.00
    $1,395.00
    $1,220.00
    $863.00
    $200.00
    $200.00
    $100.00
    $100.00
    $24.15
    $49.00
    $100.00
    $100.00
    $67.55
    $200.00
    $200.00
    $46.80
    $3,000.00
    $180.00
    $310.00
    $172.75
    $120.00
    $300.00
    $100.00
    $32.00
    $8.00
    $7.20
    $1.80
    $100.00
    $100.00
    $51.00
    $160.00
    $200.00
    $450.00
    $183.35
    $100.00
    $1,130.00
    $150.00
    $960.00
    $997.40
    $460.00
    $60.00
    $1,044.00
    $190.00
    $300.00
    $150.00

    M795
    M795
    M213
    M213
    P332
    M049
    P246
    M461
    M461
    M461
    L070
    M461
    M461
    M461
    P468
    H033
    M694
    M694
    M694
    M213
    M213
    M213
    M647
    M647
    S004
    L079
    L150
    L079
    L071
    M285
    M285
    M285
    M285
    M020
    M020
    M020
    M020
    M020
    P468
    S384
    S384
    M505
    M505
    O011
    O011
    O011
    D82
    D82
    S281
    S281
    P115
    M317
    M317

    $150.00
    $120.00
    $100.00
    $100.00
    $170.50
    $120.00
    $144.20
    $150.00
    $290.00
    $200.00
    $1,540.00
    $100.00
    $300.00
    $60.00
    $200.00
    $700.00
    $100.00
    $100.00
    $100.00
    $200.00
    $20.00
    $290.00
    $160.00
    $300.00
    $400.00
    $250.00
    $400.00
    $15.00
    $400.00
    $200.00
    $65.00
    $68.00
    $100.00
    $400.00
    $80.00
    $70.00
    $180.00
    $90.00
    $90.00
    $400.00
    $200.00
    $360.00
    $100.00
    $80.00
    $220.00
    $710.00
    $120.00
    $330.00
    $400.00
    $400.00
    $1,037.40
    $120.00
    $40.00

    P465
    L034
    M046
    P150
    H033
    O030
    O030
    O030
    M007
    M007
    S170
    S170
    M647
    M647
    P504
    O170
    O170
    O170
    S403
    S076
    D133
    O008
    O008
    M694
    M694
    M029
    M029
    M029
    S354
    O008
    M200
    L074
    M200
    M200
    S020
    S020
    S020
    S384
    M792
    M792
    M792
    P191
    M647
    M647
    M647
    O076
    O076
    O076
    M769
    M769
    M769
    M104
    M188

    $294.00
    $400.00
    $60.00
    $56.70
    $400.00
    $80.00
    $535.80
    $288.20
    $100.00
    $20.00
    $300.00
    $300.00
    $80.00
    $120.00
    $200.00
    $90.00
    $700.00
    $800.00
    $400.00
    $350.00
    $500.00
    $650.00
    $320.00
    $100.00
    $300.00
    $100.00
    $100.00
    $75.00
    $300.00
    $2,190.00
    $120.00
    $265.00
    $60.00
    $30.00
    $200.00
    $500.00
    $50.00
    $400.00
    $100.00
    $200.00
    $50.00
    $56.50
    $80.00
    $100.00
    $500.00
    $90.00
    $1,036.63
    $1,216.62
    $150.00
    $150.00
    $50.00
    $400.00
    $290.00

    D312
    D312
    D312
    D312
    L152
    S179
    P497
    H005
    H005
    S356
    M673
    S356
    H052
    P256
    P094
    P382
    O065
    O065
    O065
    O065
    O004
    O004
    O004
    O004
    O076
    O076
    O076
    O076
    O076
    M304
    M304
    M662
    M662
    M644
    P411
    M644
    M644
    S301
    O023
    O023
    O023
    M216
    M216
    M216
    D77
    D77
    S296
    S296
    S296
    M053
    M053
    L001
    M119

    $25.00
    $50.00
    $250.00
    $450.00
    $500.00
    $300.00
    $234.25
    $850.00
    $3,609.28
    $12,000.00
    $2,000.00
    $600.00
    $140.00
    $55.00
    $634.00
    $255.18
    $350.00
    $1,500.00
    $400.00
    $320.00
    $100.00
    $1,395.00
    $365.00
    $130.00
    $90.00
    $800.00
    $476.00
    $400.00
    $923.00
    $75.00
    $110.00
    $100.00
    $20.00
    $200.00
    $89.60
    $300.00
    $100.00
    $300.00
    $150.00
    $1,850.00
    $2,475.00
    $80.00
    $40.00
    $275.00
    $250.00
    $240.00
    $1,050.00
    $400.00
    $3,900.00
    $140.00
    $280.00
    $172.00
    $60.00

    M119
    P154
    M647
    M647
    M647
    P504
    L070
    D301
    D301
    M341
    L174
    L174
    M341
    M792
    M792
    M792
    M792
    M792
    L070
    O162
    O162
    O162
    M346
    M346
    M346
    M346
    M647
    M647
    M647
    M647
    M732
    M732
    M732
    P140
    P140
    M647
    M647
    P504
    P445
    M647
    M647
    P504
    M327
    M864
    M864
    M864
    M864
    M864
    M232
    M232
    D38
    D38
    M647

    $60.00
    $160.40
    $160.00
    $100.00
    $100.00
    $90.00
    $470.00
    $160.00
    $90.00
    $140.00
    $160.00
    $190.00
    $140.00
    $100.00
    $140.00
    $715.00
    $80.00
    $600.00
    $360.00
    $75.00
    $150.00
    $200.00
    $800.00
    $800.00
    $300.00
    $300.00
    $240.00
    $460.00
    $1,000.00
    $200.00
    $100.00
    $20.00
    $70.00
    $567.50
    $226.10
    $80.00
    $160.00
    $250.00
    $164.00
    $80.00
    $160.00
    $114.00
    $100.00
    $100.00
    $20.00
    $10.00
    $100.00
    $90.00
    $100.00
    $40.00
    $60.00
    $440.00
    $80.00

    M647
    M123
    M123
    M123
    M123
    M233
    M233
    M028
    M028
    M456
    M456
    D300
    D300
    D300
    D300
    D300
    D300
    D300
    M353
    M804
    M804
    M804
    P094
    M089
    M089
    M007
    S355
    P497
    P191
    M187
    L074
    D379
    D379
    D379
    D379
    M200
    M200
    D103
    D103
    S052
    L96
    L075
    UN01
    M167
    M167
    O076
    O076
    O076
    O131
    O131
    O131
    S071
    P497

    $160.00
    $150.00
    $60.00
    $80.00
    $150.00
    $100.00
    $20.00
    $100.00
    $10.00
    $140.00
    $60.00
    $150.00
    $262.50
    $95.00
    $17.50
    $350.00
    $150.00
    $400.00
    $150.00
    $120.00
    $360.00
    $50.00
    $154.50
    $119.00
    $441.00
    $80.00
    $300.00
    $60.00
    $63.00
    $300.00
    $200.00
    $160.00
    $50.00
    $110.00
    $1,200.00
    $60.00
    $20.00
    $140.00
    $320.00
    $400.00
    $150.00
    $3,800.00
    $450.00
    $140.00
    $60.00
    $280.00
    $846.00
    $1,345.50
    $70.00
    $2,000.00
    $850.00
    $470.00
    $230.00

    M795
    M795
    M795
    M795
    S432
    H011
    H011
    H011
    S312
    S312
    S312
    S312
    S312
    M388
    M388
    P154
    D27
    D27
    S053
    S053
    S053
    M213
    M213
    P415
    M754
    M754
    M238
    M238
    M754
    M754
    M754
    S187
    P154
    M461
    M461
    M304
    P337
    D132
    D132
    D132
    D132
    M853
    M662
    M662
    M662
    M662
    M662
    M662
    P428
    M662
    P139
    P428
    P458

    $150.00
    $230.00
    $350.00
    $1,040.00
    $2,500.00
    $900.00
    $1,800.00
    $600.00
    $3,700.00
    $250.00
    $150.00
    $20.00
    $350.00
    $100.00
    $100.00
    $228.00
    $350.00
    $1,650.00
    $300.00
    $6,000.00
    $125.00
    $100.00
    $20.00
    $165.00
    $140.00
    $100.00
    $100.00
    $75.00
    $140.00
    $98.00
    $45.00
    $50.00
    $59.99
    $150.00
    $200.00
    $125.00
    $260.00
    $60.00
    $340.00
    $100.00
    $100.00
    $400.00
    $60.00
    $40.00
    $60.00
    $40.00
    $40.00
    $100.00
    $194.90
    $100.00
    $300.00
    $295.80
    $10.00

    P428
    M662
    P011
    M662
    M662
    O001
    O001
    M662
    M002
    M002
    O004
    O004
    O004
    O004
    O004
    O004
    O004
    O004
    O076
    O076
    O076
    S152
    S152
    S152
    S152
    S152
    S152
    O077
    O077
    O077
    O163
    O163
    O163
    O076
    O076
    O076
    O076
    O136
    O047
    O047
    M514
    M189
    D90
    D90
    D90
    D90
    D90
    S400
    L065
    L006
    M310
    M310
    M310

    $36.85
    $100.00
    $41.00
    $200.00
    $200.00
    $110.00
    $110.00
    $280.00
    $130.00
    $120.00
    $1,316.00
    $379.00
    $184.00
    $465.00
    $1,236.00
    $359.00
    $264.00
    $331.00
    $80.00
    $716.00
    $1,100.00
    $300.00
    $200.00
    $400.00
    $4,000.00
    $100.00
    $100.00
    $300.00
    $1,120.00
    $1,480.00
    $70.00
    $1,100.00
    $570.00
    $90.00
    $1,500.00
    $1,095.00
    $1,935.50
    $100.00
    $995.00
    $1,050.00
    $260.00
    $140.00
    $480.00
    $100.00
    $20.00
    $640.00
    $160.00
    $300.00
    $1,500.00
    $500.00
    $150.00
    $350.00
    $528.00

    M310
    O024
    O024
    O024
    O076
    O076
    O076
    M388
    M388
    P140
    M388
    M388
    H066
    P140
    P140
    M007
    M007
    P140
    P140
    M801
    M801
    M801
    M801
    O076
    O076
    M294
    P315
    P315
    M093
    M093
    M093
    L156
    P008
    O065
    O065
    O065
    O065
    P433
    S370
    P240
    M718
    M718
    P407
    M733
    M733
    M733
    M388
    M388
    P407
    M388
    M388
    L070
    M018

    $300.00
    $100.00
    $1,276.00
    $2,056.00
    $90.00
    $2,323.25
    $768.25
    $150.00
    $150.00
    $44.00
    $150.00
    $150.00
    $300.00
    $18.00
    $25.00
    $100.00
    $20.00
    $15.00
    $15.00
    $100.00
    $100.00
    $200.00
    $400.00
    $90.00
    $90.00
    $100.00
    $405.00
    $479.55
    $120.00
    $40.00
    $24.00
    $45.00
    $146.65
    $150.00
    $990.00
    $1,764.00
    $110.00
    $144.40
    $300.00
    $65.65
    $100.00
    $100.00
    $141.35
    $100.00
    $20.00
    $80.00
    $100.00
    $100.00
    $60.00
    $100.00
    $600.00
    $350.00
    $600.00

    M018
    M028
    M028
    P140
    S210
    S210
    P433
    P145
    S210
    P145
    M156
    M156
    P433
    P145
    D125
    D125
    D125
    D125
    D125
    M156
    M156
    P433
    P145
    P145
    M061
    M061
    O049
    O049
    O049
    M061
    M061
    M061
    M061
    M061
    M061
    M061
    M061
    M061
    M083
    M083
    M232
    M232
    M232
    M553
    P073
    S170
    S170
    L070
    P140
    P140
    O001
    O001
    O001

    $150.00
    $100.00
    $15.00
    $60.00
    $300.00
    $400.00
    $129.00
    $220.00
    $200.00
    $875.00
    $100.00
    $300.00
    $191.90
    $375.00
    $70.00
    $250.00
    $75.00
    $265.00
    $320.00
    $100.00
    $300.00
    $193.50
    $345.00
    $140.00
    $100.00
    $100.00
    $60.00
    $350.00
    $490.00
    $100.00
    $40.00
    $20.00
    $100.00
    $215.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $100.00
    $30.00
    $20.00
    $140.00
    $841.20
    $600.00
    $400.00
    $24.00
    $500.00
    $194.00
    $1,479.20
    $419.80
    $2,065.50

    O001
    O001
    S354
    L070
    M159
    P158
    M159
    M159
    M159
    H023
    H006
    S302
    S302
    S302
    P031
    D252
    D252
    D252
    D252
    H003
    H003
    H003
    D263
    D263
    D263
    D263
    D263
    D263
    M055
    L174
    L021
    L065
    O001
    S096
    S096
    S201
    H008
    P462
    P462
    P462
    P435
    O004
    O004
    O004
    O004
    S160
    P435
    S265
    S265
    D35
    D35
    S201
    P435

    $1,227.80
    $356.80
    $100.00
    $250.00
    $720.00
    $83.00
    $480.00
    $60.00
    $160.00
    $652.00
    $400.00
    $120.00
    $340.00
    $540.00
    $268.98
    $500.00
    $75.00
    $75.00
    $350.00
    $600.00
    $400.00
    $250.00
    $150.00
    $350.00
    $77.00
    $23.00
    $700.00
    $300.00
    $300.00
    $740.00
    $150.00
    $1,190.00
    $110.00
    $90.00
    $210.00
    $300.00
    $154.00
    $7.25
    $507.11
    $56.34
    $199.50
    $120.00
    $80.00
    $1,380.00
    $515.00
    $240.00
    $68.56
    $300.00
    $150.00
    $120.00
    $450.00
    $300.00
    $498.85

    P435
    P435
    S160
    S160
    S128
    S128
    H006
    H006
    S277
    L025
    P478
    L174
    M857
    H025
    L018
    S277
    L025
    D266
    D259
    D259
    D259
    S149
    D388
    D388
    D388
    S179
    S179
    S149
    M857
    M857
    S296
    S296
    M473
    S103
    L013
    P430
    S103
    S103
    D376
    D376
    M194
    M194
    M194
    M847
    M847
    M847
    M847
    M847
    M194
    M194
    M194
    M194
    L061

    $49.88
    $62.05
    $400.00
    $120.00
    $400.00
    $480.00
    $437.00
    $2,100.00
    $200.00
    $125.00
    $105.00
    $340.00
    $200.00
    $60.00
    $240.00
    $200.00
    $210.00
    $400.00
    $350.00
    $70.00
    $80.00
    $260.00
    $35.00
    $15.00
    $300.00
    $260.00
    $160.00
    $240.00
    $100.00
    $725.00
    $2,400.00
    $1,050.00
    $150.00
    $800.00
    $149.00
    $288.00
    ($800.00)
    $800.00
    $910.00
    $1,590.00
    $100.00
    $70.00
    $190.00
    $300.00
    $168.00
    $42.00
    $40.00
    $120.00
    $100.00
    $25.00
    $35.00
    $60.00
    $865.00

    P019
    O004
    O004
    O004
    O004
    O004
    D90
    D90
    D90
    M194
    M194
    M194
    M194
    M194
    P019
    P014
    P014
    P019
    M694
    M694
    M694
    M694
    M694
    P019
    D31
    M124
    P435
    P435
    D31
    D31
    M437
    M437
    M437
    D341
    D341
    D341
    D341
    D341
    P286
    P286
    P286
    M668
    P435
    M300
    M300
    P081
    P155
    M300
    M053
    M053
    M053
    P081
    S214

    $113.30
    $1,084.80
    $271.20
    $915.20
    $1,140.80
    $100.00
    $475.00
    $25.00
    $2,000.00
    $100.00
    $120.00
    $30.00
    $136.00
    $34.00
    $109.50
    $26.40
    $6.60
    $448.00
    $100.00
    $320.00
    $80.00
    $112.00
    $28.00
    $447.00
    $325.00
    $250.00
    $32.42
    $168.44
    $310.00
    $310.00
    $250.00
    $25.00
    $50.00
    $100.00
    $70.00
    $170.00
    $700.00
    $500.00
    $600.00
    $705.00
    $160.00
    $220.00
    $284.45
    $320.00
    $500.00
    $67.50
    $225.55
    $1,000.00
    $280.00
    $210.00
    $60.00
    $200.00
    $1,920.00

    H005
    D125
    D125
    L001
    L075
    D31
    D31
    D31
    D31
    D181
    D181
    D181
    D181
    M720
    M720
    M119
    M119
    M119
    P479
    S200
    O047
    O047
    O047
    O047
    M872
    M872
    M872
    M872
    P479
    H008
    M060
    P031
    P022
    P022
    M375
    M060
    P031
    P122
    D97
    H029
    H029
    O053
    O053
    O053
    M215
    L128
    L070
    P231
    S286
    L128
    M847
    M847
    M847

    $1,500.00
    $80.00
    $280.00
    $1,672.00
    $3,800.00
    $325.00
    $140.00
    $460.00
    $75.00
    $100.00
    $450.00
    $100.00
    $800.00
    $200.00
    $1,700.00
    $60.00
    $25.00
    $55.00
    $289.45
    $300.00
    $2,065.50
    $1,778.50
    $625.50
    $1,539.00
    $150.00
    $70.00
    $50.00
    $105.00
    $360.00
    $440.00
    $200.00
    $65.49
    $192.00
    $192.50
    $160.00
    $200.00
    $149.48
    $184.00
    $360.00
    $100.00
    $100.00
    $100.00
    $50.00
    $60.00
    $750.00
    $150.00
    $990.00
    $8.50
    $300.00
    $1,780.00
    $180.00
    $25.00
    $75.00

    M166
    M166
    P487
    L153
    L153
    L153
    L153
    M166
    M166
    M166
    P487
    P487
    M166
    M166
    M166
    M166
    M166
    O037
    O037
    S279
    S279
    S279
    P435
    M437
    L96
    L96
    L96
    L96
    M152
    H034
    H034
    M067
    M067
    P104
    P454
    P104
    M067
    P435
    P435
    L020
    M067
    M067
    M067
    S355
    S355
    O076
    O076
    D322
    D322
    D322
    D322
    D322
    D260

    $140.00
    $110.00
    $38.61
    $360.00
    $80.00
    $20.00
    $550.00
    $160.00
    $80.00
    $20.00
    $8.98
    $2.24
    $140.00
    $112.00
    $28.00
    $80.00
    $20.00
    $1,000.00
    $1,800.00
    $500.00
    $232.00
    $200.00
    $59.06
    $300.00
    $400.00
    $700.00
    $250.00
    $500.00
    $300.00
    $260.00
    $800.00
    $160.00
    $160.00
    $16.00
    $84.00
    $129.65
    $300.00
    $147.97
    $400.48
    $720.00
    $25.00
    $15.00
    $160.00
    $300.00
    $440.00
    $90.00
    $1,395.00
    $375.00
    $70.00
    $30.00
    $375.00
    $100.00
    $700.00

    O001
    O001
    D150
    D150
    P011
    P022
    S400
    S400
    S400
    H005
    P094
    S400
    H005
    H011
    H006
    H006
    S386
    L065
    P014
    S386
    P014
    M225
    M225
    L001
    L046
    L081
    L081
    S382
    S382
    P066
    P066
    S421
    L041
    P279
    P497
    P497
    MM06
    O004
    O004
    O004
    D181
    D181
    D181
    D181
    D181
    D181
    D181
    S275
    D181
    D181
    D432
    P005
    M225

    $270.00
    $1,925.00
    $150.00
    $350.00
    $15.00
    $8.00
    $400.00
    $300.00
    $350.00
    $100.00
    $59.50
    $400.00
    $100.00
    $160.00
    $4,050.00
    $50.00
    $300.00
    $2,090.00
    $139.30
    $300.00
    $88.90
    $250.00
    $130.00
    $960.00
    $1,100.00
    $200.00
    $60.00
    $300.00
    $180.00
    $129.00
    $69.00
    $300.00
    $200.00
    $350.00
    $157.50
    $399.00
    $281.75
    $100.00
    $1,596.00
    $1,896.00
    $100.00
    $450.00
    $350.00
    $100.00
    $450.00
    $100.00
    $800.00
    $300.00
    $1,723.00
    $77.00
    $350.00
    $405.76
    $70.00

    M225
    L001
    M225
    M225
    L006
    P011
    M225
    D60
    D60
    D60
    D60
    S375
    S375
    P435
    M225
    M225
    L006
    M225
    M225
    T040
    T040
    M225
    M225
    L157
    P435
    L001
    L001
    D60
    D60
    D60
    D60
    D60
    M225
    M225
    M225
    P005
    P005
    M556
    P435
    P011
    P073
    D102
    D102
    D102
    D102
    O001
    O001
    D102
    D102
    D102
    D102
    D102
    D102

    $150.00
    $195.00
    $140.00
    $300.00
    $200.00
    $324.50
    $160.00
    $50.00
    $70.00
    $50.00
    $200.00
    $200.00
    $800.00
    $141.92
    $140.00
    $300.00
    $200.00
    $160.00
    $324.50
    $200.00
    $975.00
    $440.00
    $260.00
    $200.00
    $173.49
    $265.00
    $170.00
    $620.00
    $280.00
    $60.00
    $880.00
    $1,320.00
    $70.00
    $150.00
    $130.00
    $405.76
    $405.76
    $120.00
    $495.60
    $138.50
    $805.20
    $400.00
    $200.00
    $600.00
    $2,400.00
    $540.00
    $1,216.00
    $200.00
    $70.00
    $130.00
    $400.00
    $1,200.00
    $910.00

    D102
    D07
    D07
    D07
    D19
    D19
    D19
    M034
    L006
    P014
    D31
    D31
    D31
    D31
    T060
    T060
    M034
    P011
    D77
    D77
    D232
    D232
    L049
    O001
    M030
    P011
    L001
    H005
    M030
    P091
    P435
    M030
    M060
    H023
    H023
    L070
    S137
    S137
    M473
    P022
    L070
    H023
    H023
    S137
    P022
    P022
    S137
    M473
    P022
    M060
    P215
    M473
    P022

    $3,090.00
    $475.00
    $70.00
    $30.00
    $250.00
    $420.00
    $405.00
    $50.00
    $250.00
    $15.00
    $325.00
    $325.00
    $295.00
    $325.00
    $2,490.00
    $2,270.00
    $50.00
    $21.00
    $150.00
    $250.00
    $280.00
    $360.00
    $180.00
    $110.00
    $160.00
    $168.00
    $40.00
    $455.00
    $320.00
    $112.20
    $375.93
    $160.00
    $200.00
    $575.00
    $345.00
    $80.00
    $450.00
    $400.00
    $140.00
    $185.00
    $440.50
    $375.00
    $650.00
    $450.00
    $65.00
    $50.00
    $400.00
    $120.00
    $170.25
    $200.00
    $102.75
    $120.00
    $184.54

    L075
    L070
    M205
    P022
    S137
    S137
    M473
    S187
    D262
    D262
    D262
    D262
    D262
    S122
    S122
    S122
    M454
    L121
    L065
    S416
    D01
    D01
    D239
    D387
    D387
    M099
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    D171
    M178
    P427
    D171
    D171
    D171
    D171
    D171
    S042
    L006
    M375
    P422
    L021
    M375
    M375
    P014
    M634

    $3,800.00
    $639.00
    $240.00
    $74.90
    $450.00
    $49.00
    $240.00
    $200.00
    $135.00
    $70.00
    $35.00
    $200.00
    $400.00
    $300.00
    $300.00
    $200.00
    $260.00
    $250.00
    $586.50
    $300.00
    $85.00
    $4,515.00
    $90.00
    $85.00
    $165.00
    $120.00
    $135.00
    $45.00
    $50.00
    $390.00
    $180.00
    $135.00
    $45.00
    $135.00
    $45.00
    $135.00
    $45.00
    $400.00
    $160.65
    $300.00
    $280.00
    $200.00
    $135.00
    $45.00
    $400.00
    $300.00
    $160.00
    $581.80
    $520.00
    $160.00
    $160.00
    $134.82
    $140.00

    P022
    O001
    O019
    D291
    D291
    D291
    D291
    P011
    D232
    D411
    D411
    D411
    D411
    D411
    S293
    S293
    M861
    M861
    M861
    M230
    M230
    P426
    S257
    M861
    H003
    H003
    M312
    M312
    P256
    M312
    H003
    P256
    P256
    D224
    MM05
    MM05
    D224
    D224
    D224
    D102
    M312
    P094
    P256
    H003
    M312
    P094
    P256
    P256
    O001
    D39
    D01
    D102
    D102

    $35.00
    $528.00
    $100.00
    $1,400.00
    $1,100.00
    $133.00
    $167.00
    $181.30
    $250.00
    $100.00
    $100.00
    $100.00
    $50.00
    $100.00
    $500.00
    $100.00
    $200.00
    $200.00
    $600.00
    $300.00
    $200.00
    $364.10
    $400.00
    $200.00
    $100.00
    $175.00
    $120.00
    $60.00
    $55.85
    $100.00
    $51.50
    $8.65
    $74.30
    $350.00
    $60.00
    $60.00
    $400.00
    $230.00
    $70.00
    $400.00
    $100.00
    $109.50
    $85.50
    $1,390.00
    $100.00
    $183.50
    $43.00
    $59.55
    $496.00
    $600.00
    $300.00
    $100.00
    $400.00

    D01
    M312
    P373
    P256
    M807
    L149
    P104
    O001
    O001
    O001
    M760
    M760
    S174
    P467
    M815
    M815
    M815
    M815
    M815
    M815
    M815
    S275
    S275
    P435
    M577
    M766
    M341
    M341
    P014
    M341
    M341
    M341
    P014
    H006
    H006
    H006
    M341
    H006
    H006
    H006
    H006
    M341
    M341
    P498
    US01
    H003
    S046
    S046
    M773
    M773
    P436
    S323
    S323

    $9,700.00
    $100.00
    $26.50
    $77.35
    $400.00
    $150.00
    $14.95
    $100.00
    $1,395.00
    $660.00
    $100.00
    $100.00
    $300.00
    $457.00
    $160.00
    $140.00
    $100.00
    $35.00
    $215.00
    $160.00
    $1,200.00
    $60.01
    $239.99
    $513.38
    $200.00
    $200.00
    $140.00
    $100.00
    $418.60
    $60.00
    $140.00
    $100.00
    $418.60
    $450.00
    $1,045.00
    $355.00
    $100.00
    $450.00
    $605.00
    $805.00
    $1,310.00
    $140.00
    $100.00
    $591.25
    $28,440.00
    $350.00
    $350.00
    $100.00
    $250.00
    $15.00
    $82.74
    $350.00
    $350.00

    S323
    P435
    D414
    S165
    S375
    D414
    S375
    D217
    H034
    D41
    D41
    D41
    D41
    D41
    D41
    D41
    M202
    M202
    P461
    D327
    D327
    D327
    D327
    D327
    D327
    M818
    M687
    P435
    S437
    M818
    M818
    M818
    M388
    M388
    P450
    P140
    S450
    L149
    M833
    M833
    S083
    D232
    D232
    M577
    S404
    M577
    M454
    L065
    L149
    D169
    D169
    D169
    D169

    $160.00
    $370.26
    $600.00
    $360.00
    $200.00
    $600.00
    $1,200.00
    $2,490.00
    $700.00
    $100.00
    $35.00
    $65.00
    $1,500.00
    $150.00
    $100.00
    $500.00
    $100.00
    $160.00
    $175.00
    $150.00
    $400.00
    $133.00
    $267.00
    $1,500.00
    $1,000.00
    $260.00
    $125.00
    $79.84
    $300.00
    $300.00
    $300.00
    $260.00
    $200.00
    $200.00
    $125.50
    $311.15
    $300.00
    $900.00
    $240.00
    $60.00
    $400.00
    $50.00
    $250.00
    $200.00
    $300.00
    $240.00
    $200.00
    $235.00
    $150.00
    $160.00
    $440.00
    $105.00
    $115.00

    D169
    S191
    P154
    L041
    L041
    S437
    S437
    L061
    P154
    S421
    L041
    P060
    S052
    S151
    S151
    S151
    L157
    H005
    D232
    D232
    S112
    O001
    O001
    M580
    M580
    M580
    M580
    D336
    D336
    D336
    D336
    D336
    M029
    M029
    H008
    S296
    M750
    H023
    H003
    M473
    H023
    M473
    P373
    M297
    M297
    M297
    L116
    L116
    P404
    M297
    D78
    D323
    D323

    $300.00
    $500.00
    $1,744.50
    $400.00
    $2,400.00
    $300.00
    $250.00
    $250.00
    $108.45
    $200.00
    $150.00
    $259.95
    $300.00
    $350.00
    $350.00
    $170.00
    $450.00
    $840.00
    $495.00
    $705.00
    $300.00
    $250.00
    $904.00
    $100.00
    $400.00
    $100.00
    $200.00
    $110.00
    $70.00
    $120.00
    $940.00
    $1,770.00
    $100.00
    $20.00
    $268.00
    $7,000.00
    $2,500.00
    $3,000.00
    $275.00
    $140.00
    $375.00
    $120.00
    $214.50
    $120.00
    $120.00
    $250.00
    $230.00
    $460.00
    $163.50
    $120.00
    $400.00
    $100.00
    $400.00

    D323
    D323
    D323
    D323
    S184
    S184
    P399
    M586
    P306
    D171
    D171
    D171
    M586
    P306
    D23
    D23
    D191
    D191
    D191
    D191
    D191
    M773
    M773
    D191
    D191
    S302
    M842
    M473
    S383
    P049
    M331
    M331
    P014
    H034
    H034
    H034
    H034
    P456
    P427
    D134
    D134
    S386
    P303
    P014
    P014
    M760
    M760
    P340
    M295
    S187
    H030
    H030
    S187

    $140.00
    $180.00
    $20.00
    $750.00
    $260.00
    $100.00
    $179.00
    $550.00
    $66.00
    $100.00
    $70.00
    $180.00
    $550.00
    $90.50
    $85.00
    $315.00
    $70.00
    $450.00
    $100.00
    $70.00
    $60.00
    $250.00
    $15.00
    $350.00
    $100.00
    $700.00
    $200.00
    $180.00
    $260.00
    $51.65
    $140.00
    $200.00
    $47.25
    $525.00
    $145.00
    $500.00
    $700.00
    $42.00
    $315.40
    $360.00
    $60.00
    $300.00
    $200.95
    $180.00
    $333.12
    $100.00
    $40.00
    $129.99
    $100.00
    $200.00
    $250.00
    $2,984.95
    $2,000.00

    S187
    M864
    M864
    M864
    P158
    M864
    UN01
    L143
    S322
    H006
    H006
    H006
    S187
    P443
    S187
    M028
    M028
    M028
    M028
    M028
    M833
    M833
    D169
    M789
    L081
    P436
    M638
    M638
    M638
    M638
    P106
    D119
    D119
    D119
    D119
    D119
    M683
    M683
    M683
    M683
    M683
    M683
    S259
    S259
    S112
    S384
    M443
    M443
    M326
    H025
    M265
    M265
    P369

    $200.00
    $100.00
    $20.00
    $40.00
    $72.00
    $80.00
    $750.00
    $300.00
    $300.00
    $490.00
    $100.00
    $200.00
    $400.00
    $157.50
    $650.00
    $100.00
    $30.00
    $75.00
    $100.00
    $55.00
    $250.00
    $530.00
    $500.00
    $200.00
    $255.00
    $83.97
    $280.00
    $580.00
    $100.00
    $140.00
    $120.00
    $50.00
    $350.00
    $80.00
    $40.00
    $600.00
    $260.00
    $270.00
    $30.00
    $250.00
    $279.00
    $31.00
    $600.00
    $2,000.00
    $300.00
    $500.00
    $200.00
    $450.00
    $250.00
    $60.00
    $200.00
    $200.00
    $47.45

    L018
    S293
    S293
    S293
    M326
    P478
    L091
    P071
    P071
    O001
    O001
    O001
    M310
    S162
    P246
    P246
    S087
    P031
    P031
    P031
    P031
    S123
    S365
    S365
    M326
    S302
    S302
    S302
    D119
    D119
    D119
    D119
    M225
    M225
    T034
    T034
    P005
    P005
    P372
    O024
    O024
    O024
    D346
    D346
    D346
    D78
    D78
    M792
    M792
    M792
    P178
    O076
    O076

    $60.00
    $600.00
    $300.00
    $5,000.00
    $200.00
    $360.70
    $400.00
    $226.80
    $168.50
    $110.00
    $2,120.75
    $442.00
    $150.00
    $300.00
    $159.70
    $69.25
    $300.00
    $309.80
    $34.86
    $1,549.00
    $209.16
    $500.00
    $460.00
    $2,600.00
    $200.00
    $400.00
    $360.00
    $140.00
    $50.00
    $300.00
    $80.00
    $40.00
    $220.00
    $80.00
    $1,300.00
    $1,175.00
    $283.07
    $70.77
    $517.80
    $100.00
    $1,260.00
    $2,200.00
    $840.00
    $2,160.00
    $900.00
    $400.00
    $400.00
    $100.00
    $25.00
    $85.00
    $186.55
    $90.00
    $1,615.50

    O076
    O076
    O076
    O076
    S141
    S141
    S141
    S141
    L128
    S296
    D425
    D425
    M326
    M326
    H005
    L143
    L143
    M104
    P354
    P354
    P057
    S207
    S207
    P161
    P161
    S207
    S207
    S329
    H066
    D125
    D125
    P122
    P435
    D411
    D411
    D411
    D411
    O001
    O076
    O076
    O076
    D131
    D131
    D131
    D131
    D131
    P057
    M354
    P148
    P148
    O008
    O008
    O008

    $1,020.50
    $90.00
    $1,165.50
    $810.50
    $400.00
    $350.00
    $715.00
    $180.00
    $700.00
    $300.00
    $800.00
    $4,100.00
    $250.00
    $250.00
    $1,280.00
    $3,500.00
    $1,000.00
    $360.00
    $87.00
    $37.50
    $418.95
    $300.00
    $2,100.00
    $290.40
    $175.00
    $300.00
    $1,400.00
    $300.00
    $400.00
    $80.00
    $80.00
    $290.45
    $13.28
    $200.00
    $100.00
    $50.00
    $100.00
    $110.00
    $90.00
    $716.00
    $1,593.00
    $120.00
    $120.00
    $210.00
    $500.00
    $400.00
    $50.00
    $140.00
    $54.00
    $294.00
    $70.00
    $700.00
    $260.00

    M326
    P014
    M326
    P203
    O001
    O001
    M104
    P435
    P090
    O076
    O076
    O076
    D113
    D113
    D113
    D113
    D113
    D324
    P139
    D324
    H034
    M341
    M341
    M341
    M341
    L116
    P408
    D268
    D268
    L164
    L164
    L164
    P094
    S452
    S452
    S452
    S452
    P435
    M390
    M390
    M390
    O001
    O001
    O001
    M452
    P122
    M452
    P421
    D242
    O033
    P073
    M230
    M230

    $200.00
    $120.00
    $250.00
    $116.50
    $110.00
    $110.00
    $600.00
    $31.33
    $57.40
    $90.00
    $1,615.50
    $1,695.00
    $80.00
    $120.00
    $200.00
    $800.00
    $450.00
    $400.00
    $55.00
    $900.00
    $100.00
    $140.00
    $25.00
    $75.00
    $100.00
    $80.00
    $297.90
    $65.00
    $291.00
    $500.00
    $200.00
    $50.00
    $93.75
    $150.00
    $350.00
    $2,150.00
    $3,700.00
    $213.71
    $150.00
    $30.00
    $155.00
    $110.00
    $1,004.00
    $900.00
    $250.00
    $604.95
    $200.00
    $33.75
    $560.00
    $300.00
    $184.85
    $300.00
    $50.00

    M230
    P014
    D77
    D77
    D77
    P073
    D242
    D242
    O033
    O033
    O033
    S217
    S217
    P014
    P005
    D07
    D07
    D07
    M630
    M630
    L001
    D346
    D346
    D346
    D346
    D346
    M298
    D298
    P031
    P031
    P435
    L96
    D346
    D346
    M205
    P031
    P031
    M629
    L070
    M033
    P088
    L070
    M033
    P332
    P332
    O173
    O173
    O173
    S197
    P487
    O007
    O007
    O007

    $250.00
    $94.60
    $4,000.00
    $2,000.00
    $1,200.00
    $184.85
    $560.00
    $400.00
    $230.00
    $760.75
    $352.75
    $500.00
    $338.00
    $199.50
    $190.40
    $375.00
    $200.00
    $1,150.00
    $80.00
    $100.00
    $260.00
    $150.00
    $160.00
    $240.00
    $1,400.00
    $500.00
    $240.00
    $260.00
    $76.99
    $80.43
    $110.07
    $250.00
    $3,000.00
    $900.00
    $240.00
    $122.49
    $269.97
    $280.00
    $1,130.00
    $200.00
    $383.30
    $300.00
    $100.00
    $112.00
    $30.00
    $100.00
    $450.00
    $650.00
    $300.00
    $64.50
    $100.00
    $967.50
    $1,440.00

    S293
    S293
    L070
    S390
    H066
    S390
    L070
    S293
    S293
    S293
    S293
    H005
    H005
    D90
    D90
    D90
    D90
    D90
    D125
    D125
    D86
    D86
    D86
    D86
    D86
    D86
    D86
    D317
    D317
    D22
    D22
    D143
    D79
    D79
    D79
    D79
    D129
    D129
    D129
    D283
    D324
    D324
    D324
    D283
    P011
    O076
    O076
    O076
    D291
    D291
    D291
    D218
    M463

    $500.00
    $500.00
    $140.00
    $600.00
    $550.00
    $300.00
    $140.00
    $500.00
    $31,000.00
    $3,000.00
    $8,500.00
    $2,800.00
    $24,396.55
    $40.00
    $60.00
    $500.00
    $600.00
    $20.00
    $80.00
    $300.00
    $400.00
    $1,200.00
    $100.00
    $600.00
    $3,500.00
    $350.00
    $3,500.00
    $400.00
    $1,600.00
    $120.00
    $150.00
    $200.00
    $20.00
    $50.00
    $50.00
    $90.00
    $70.00
    $360.00
    $470.00
    $370.00
    $80.00
    $60.00
    $180.00
    $6,000.00
    $170.50
    $90.00
    $1,268.00
    $1,323.00
    $300.00
    $65.00
    $335.00
    $625.00
    $200.00

    M850
    P049
    D371
    D371
    D371
    P037
    M368
    P349
    M666
    M666
    L97
    M211
    M211
    S459
    H011
    H011
    H011
    S459
    S237
    M807
    H011
    H011
    D351
    D351
    D59
    P437
    P115
    L97
    P348
    P106
    L97
    P106
    P106
    L065
    L065
    L065
    M230
    M230
    L065
    P435
    P509
    P509
    P353
    M851
    L143
    L061
    M200
    L126
    P131
    P003
    M186
    P003
    P286

    $100.00
    $516.00
    $100.00
    $50.00
    $60.00
    $50.25
    $200.00
    $420.35
    $160.00
    $240.00
    $400.00
    $200.00
    $300.00
    $600.00
    $3,800.00
    $435.00
    $357.00
    $8,000.00
    $1,500.00
    $250.00
    $900.00
    $2,776.00
    $40.00
    $110.00
    $150.00
    $62.50
    $31.20
    $250.00
    $69.95
    $104.95
    $600.00
    $83.00
    $78.40
    $175.00
    $175.00
    $175.00
    $300.00
    $200.00
    $240.00
    $24.53
    $71.30
    $464.25
    $57.50
    $600.00
    $620.00
    $910.00
    $120.00
    $660.00
    $111.00
    $120.00
    $405.00
    $45.00
    $226.00

    L065
    L065
    S103
    D402
    D402
    D402
    M294
    M294
    M294
    M294
    M463
    P014
    O131
    O131
    O131
    H027
    H027
    S242
    P215
    S375
    M115
    M115
    M115
    M327
    M327
    M115
    M115
    M115
    M115
    M115
    D148
    D148
    D148
    D148
    D148
    P435
    P435
    S300
    P076
    P014
    L116
    P179
    L075
    P014
    S300
    P469
    T068
    T068
    M756
    M756
    P426
    M230
    M230

    $280.00
    $1,295.00
    $400.00
    $35.00
    $85.00
    $110.00
    $300.00
    $200.00
    $240.00
    $140.00
    $200.00
    $36.50
    $70.00
    $1,200.00
    $800.00
    $1,600.00
    $5,255.00
    $2,500.00
    $312.30
    $300.00
    $300.00
    $570.00
    $30.00
    $100.00
    $120.00
    $120.00
    $100.00
    $70.00
    $70.00
    $30.00
    $100.00
    $240.00
    $2,350.00
    $700.00
    $180.00
    $29.55
    $116.69
    $600.00
    $149.55
    $242.55
    $760.00
    $101.99
    $3,800.00
    $242.55
    $300.00
    $151.20
    $50.00
    $1,140.00
    $300.00
    $400.00
    $541.00
    $300.00
    $300.00

    P037
    P037
    P182
    M267
    M267
    M267
    M029
    M029
    H008
    H008
    M505
    M505
    L152
    P115
    P049
    M189
    P076
    S197
    P372
    P372
    P372
    O004
    O004
    O004
    M030
    P031
    S220
    P076
    L97
    S191
    L041
    L041
    O176
    P154
    M461
    M461
    M461
    L070
    M461
    M461
    M463
    M463
    L143
    P167
    MM06
    M176
    P039
    L161
    M176
    P014
    D113
    D113
    D113

    $58.00
    $533.50
    $125.00
    $200.00
    $60.00
    $40.00
    $100.00
    $40.00
    $375.00
    $196.00
    $140.00
    $60.00
    $410.00
    $59.90
    $33.50
    $240.00
    $37.50
    $200.00
    $454.70
    $227.35
    $227.35
    $100.00
    $796.00
    $476.00
    $160.00
    $341.35
    $260.00
    $115.90
    $250.00
    $700.00
    $1,020.00
    $4,400.00
    $125.58
    $380.10
    $150.00
    $320.00
    $460.00
    $2,400.00
    $300.00
    $800.00
    $400.00
    $100.00
    $500.00
    $155.95
    $46.00
    $160.00
    $82.00
    $300.00
    $160.00
    $56.00
    $80.00
    $15.00
    $65.00

    D113
    D113
    D113
    M230
    M230
    P509
    S162
    P014
    L97
    O065
    O065
    O065
    O065
    D173
    D173
    D173
    D173
    D173
    D173
    D173
    S240
    L081
    P349
    S103
    L046
    M660
    P059
    M814
    P167
    M814
    M814
    P167
    M197
    M197
    M197
    M197
    P479
    M197
    M197
    P019
    M299
    M299
    P394
    S197
    S197
    S197
    H023
    P399
    S197
    P399
    S367
    S253
    L149

    $40.00
    $560.00
    $3,500.00
    $300.00
    $400.00
    $328.60
    $480.00
    $127.50
    $200.00
    $150.00
    $800.00
    $1,920.00
    $150.00
    $140.00
    $30.00
    $130.00
    $2,750.00
    $900.00
    $300.00
    $100.00
    $200.00
    $800.00
    $53.00
    $700.00
    $650.00
    $200.00
    $180.00
    $100.00
    $16.45
    $100.00
    $720.00
    $1,413.00
    $200.00
    $335.00
    $440.00
    $100.00
    $405.00
    $100.00
    $60.00
    $477.00
    $120.00
    $80.00
    $613.00
    $300.00
    $200.00
    $4,700.00
    $1,800.00
    $129.50
    $200.00
    $129.50
    $260.00
    $300.00
    $800.00

    M211
    P286
    P014
    D219
    P246
    P115
    H025
    H025
    M183
    M183
    O076
    O076
    O076
    M331
    M331
    P139
    P094
    L065
    M331
    M331
    P139
    S077
    S077
    P458
    D374
    D374
    D374
    P458
    P014
    M087
    M087
    M087
    P303
    S120
    P286
    P491
    D300
    D300
    D300
    D300
    S323
    S301
    S281
    S281
    S285
    L079
    L079
    P458
    H034
    H034
    H034
    H034
    H034

    $200.00
    $38.50
    $72.55
    $400.00
    $52.60
    $61.95
    $300.00
    $260.00
    $150.00
    $690.00
    $90.00
    $1,975.50
    $1,080.00
    $420.00
    $600.00
    $128.00
    $591.00
    $366.00
    $420.00
    $600.00
    $221.00
    $300.00
    $140.00
    $246.95
    $125.00
    $100.00
    $400.00
    $51.25
    $41.55
    $180.00
    $160.00
    $20.00
    $175.85
    $240.00
    $114.25
    $173.00
    $350.00
    $66.50
    $333.50
    $400.00
    $600.00
    $200.00
    $400.00
    $400.00
    $450.00
    $15.00
    $400.00
    $150.15
    $300.00
    $712.70
    $300.00
    $300.00
    $400.00

    H034
    H034
    M386
    M386
    P435
    P428
    P428
    H034
    M171
    M441
    M441
    P115
    M189
    P115
    M327
    M327
    P115
    S347
    P115
    M189
    P115
    P115
    M189
    P115
    M189
    P115
    D396
    D396
    D396
    D396
    S384
    S384
    M793
    M793
    M793
    M793
    H034
    P115
    P037
    P077
    H011
    H011
    H011
    O076
    O076
    O076
    S118
    M200
    S118
    P499
    M001
    L97
    L97

    $350.00
    $650.00
    $460.00
    $25.00
    $107.85
    $131.20
    $51.60
    $960.00
    $100.00
    $200.00
    $300.00
    $176.10
    $120.00
    $112.00
    $300.00
    $230.00
    $158.40
    $300.00
    $145.00
    $280.00
    $49.00
    $20.70
    $280.00
    $35.80
    $140.00
    $58.35
    $200.00
    $35.00
    $90.00
    $375.00
    $400.00
    $400.00
    $400.00
    $300.00
    $350.00
    $625.00
    $550.00
    $237.00
    $90.35
    $180.00
    $850.00
    $266.00
    $15.00
    $80.00
    $361.92
    $628.83
    $200.00
    $60.00
    $3,000.00
    $66.00
    $200.00
    $350.00
    $550.00

    M441
    H006
    S231
    P014
    M317
    M317
    P014
    M189
    L136
    P059
    O001
    O001
    O001
    S175
    S175
    M842
    M842
    P011
    H023
    D102
    D102
    D102
    D102
    D102
    S220
    S220
    D102
    D102
    D102
    P235
    M049
    P235
    L020
    M666
    M666
    H006
    M666
    M666
    M666
    L025
    M310
    M310
    M310
    S454
    L044
    S454
    L128
    O001
    O001
    O001
    S213
    L124
    D217

    $400.00
    $3,330.00
    $300.00
    $105.30
    $240.00
    $65.00
    $129.10
    $140.00
    $600.00
    $123.50
    $110.00
    $870.00
    $1,340.00
    $300.00
    $50.00
    $300.00
    $150.00
    $100.00
    $1,300.00
    $250.00
    $1,050.00
    $300.00
    $300.00
    $100.00
    $260.00
    $150.00
    $200.00
    $200.00
    $200.00
    $381.90
    $120.00
    $37.00
    $600.00
    $160.00
    $200.00
    $700.00
    $160.00
    $120.00
    $20.00
    $750.00
    $150.00
    $500.00
    $230.00
    $1,300.00
    $3,050.00
    $500.00
    $700.00
    $110.00
    $760.75
    $1,028.50
    $600.00
    $200.00
    $30.00

    D217
    D217
    D217
    M100
    M100
    M100
    P014
    M100
    P014
    M100
    P104
    M213
    S295
    P472
    H048
    P125
    L97
    P169
    S279
    P169
    H048
    M678
    P125
    P125
    P450
    S383
    O004
    O004
    O004
    M514
    P071
    M317
    M317
    P014
    L126
    L126
    H003
    H003
    H003
    H003
    S400
    P073
    P435
    L154
    L97
    P491
    P491
    O001
    O001
    L139
    P454
    P148
    M850

    $60.00
    $180.00
    $640.00
    $160.00
    $160.00
    $85.00
    $114.90
    $80.00
    $183.35
    $150.00
    $597.00
    $100.00
    $400.00
    $220.20
    $169.00
    $97.00
    $500.00
    $46.00
    $400.00
    $650.00
    $232.00
    $500.00
    $231.00
    $668.00
    $1,826.00
    $360.00
    $180.00
    $100.00
    $2,056.00
    $200.00
    $97.85
    $240.00
    $40.00
    $68.50
    $120.00
    $1,040.00
    $1,400.00
    $6,100.35
    $600.00
    $1,500.00
    $600.00
    $949.35
    $53.80
    $160.00
    $250.00
    $85.00
    $18.90
    $110.00
    $1,547.00
    $800.00
    $175.70
    $258.25
    $100.00

    P399
    O006
    O006
    O006
    M020
    M020
    S295
    L174
    P039
    M164
    P491
    O076
    O076
    O076
    S391
    S391
    M331
    M331
    P167
    S333
    S450
    S450
    M246
    H006
    P167
    S220
    O156
    D59
    D59
    D59
    D59
    H011
    H011
    H011
    S312
    S237
    S340
    H034
    P179
    P476
    M441
    P115
    O001
    O001
    O001
    P353
    O136
    O136
    O136
    S136
    S440
    P014
    M312

    $78.50
    $75.00
    $900.00
    $1,000.00
    $320.00
    $90.00
    $400.00
    $160.00
    $106.00
    $100.00
    $120.00
    $90.00
    $1,255.50
    $1,830.50
    $280.00
    $106.20
    $420.00
    $600.00
    $120.45
    $600.00
    $300.00
    $3,000.00
    $1,000.00
    $1,500.00
    $209.10
    $280.00
    $150.00
    $120.00
    $480.00
    $30.00
    $160.00
    $1,400.00
    $8,499.00
    $2,000.00
    $12,000.00
    $2,500.00
    $500.00
    $160.00
    $40.00
    $176.25
    $200.00
    $250.40
    $110.00
    $1,695.00
    $1,520.00
    $313.50
    $60.00
    $1,150.17
    $760.83
    $250.00
    $280.00
    $51.20
    $200.00

    H003
    UN01
    M230
    M230
    P167
    D107
    D107
    L014
    O004
    D435
    D435
    D435
    D435
    P049
    D435
    M139
    M139
    M299
    M299
    P316
    M007
    M007
    M007
    M786
    M786
    M786
    M786
    M100
    M100
    P247
    P247
    M067
    M067
    M067
    S120
    P394
    L97
    L97
    S068
    M792
    M792
    M792
    P140
    L091
    L091
    P071
    P435
    P014
    M331
    M331
    L176
    O008
    O008

    $600.00
    $3,000.00
    $600.00
    $200.00
    $175.95
    $200.00
    $300.00
    $285.00
    $100.00
    $400.00
    $66.50
    $233.50
    $500.00
    $38.20
    $500.00
    $100.00
    $700.00
    $120.00
    $240.00
    $221.75
    $100.00
    $20.00
    $80.00
    $80.00
    $40.00
    $80.00
    $40.00
    $160.00
    $30.00
    $31.20
    $67.50
    $160.00
    $40.00
    $40.00
    $240.00
    $200.00
    $400.00
    $250.00
    $300.00
    $100.00
    $50.00
    $200.00
    $262.00
    $300.00
    $45.50
    $42.85
    $106.88
    $167.30
    $280.00
    $200.00
    $650.00
    $80.00
    $900.00

    O008
    M029
    M029
    M029
    M704
    M704
    M704
    P154
    M494
    M494
    M494
    D45
    D45
    M371
    O167
    O167
    O167
    D252
    D252
    D252
    D252
    S162
    P115
    S346
    M103
    P478
    D86
    D86
    D86
    D86
    S309
    L074
    H006
    D86
    D86
    O007
    O007
    O001
    O001
    O001
    O156
    O054
    O054
    O054
    M001
    P094
    P094
    H006
    H006
    S089
    M246
    S089
    O004

    $1,300.00
    $100.00
    $30.00
    $30.00
    $100.00
    $110.00
    $30.00
    $93.95
    $1,000.00
    $410.00
    $490.00
    $2,000.00
    $2,000.00
    $140.00
    $100.00
    $841.75
    $660.00
    $125.00
    $25.00
    $1,450.00
    $1,250.00
    $300.00
    $227.80
    $200.00
    $60.00
    $38.00
    $50.00
    $350.00
    $35.00
    $15.00
    $600.00
    $1,645.00
    $700.00
    $50.00
    $250.00
    $100.00
    $1,200.00
    $110.00
    $925.00
    $620.00
    $360.00
    $80.00
    $400.00
    $400.00
    $160.00
    $460.80
    $115.20
    $900.00
    $2,600.00
    $8,950.00
    $2,000.00
    $80.00
    $100.00

    D312
    D312
    D312
    D312
    D276
    D276
    D276
    D411
    D411
    D411
    D411
    D411
    D411
    S217
    S217
    S217
    S217
    S217
    T051
    M164
    M473
    L001
    P094
    S400
    L081
    P094
    S356
    H005
    H025
    M374
    S428
    S428
    L154
    M225
    M225
    M452
    P435
    S445
    S445
    P435
    S084
    H006
    M304
    M304
    M304
    P343
    P435
    P435
    M437
    H005
    H005
    H005
    S278

    $210.00
    $100.00
    $90.00
    $150.00
    $60.00
    $910.00
    $2,090.00
    $200.00
    $50.00
    $50.00
    $200.00
    $50.00
    $100.00
    $400.00
    $400.00
    $150.00
    $400.00
    $400.00
    $2,420.00
    $60.00
    $270.00
    $935.00
    $268.70
    $300.00
    $800.00
    $149.25
    $300.00
    $200.00
    $60.00
    $200.00
    $350.00
    $240.00
    $400.00
    $230.00
    $190.00
    $450.00
    $482.23
    $350.00
    $75.00
    $186.47
    $300.00
    $350.00
    $185.00
    $515.00
    $100.00
    $44.99
    $228.64
    $104.72
    $250.00
    $300.00
    $1,100.00
    $7,227.73
    $2,500.00

    H005
    P435
    M817
    M817
    M817
    P435
    S151
    S151
    D299
    L034
    S401
    S401
    L046
    L046
    D41
    D41
    D41
    D41
    S302
    S302
    L97
    D41
    D41
    M580
    M580
    M580
    M580
    M580
    P195
    H008
    H008
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113

    $520.00
    $130.71
    ($250.00)
    $250.00
    $250.00
    $314.49
    $400.00
    $250.00
    $500.00
    $300.00
    $300.00
    $150.00
    $300.00
    $300.00
    $100.00
    $500.00
    $35.00
    $65.00
    $360.00
    $300.00
    $400.00
    $100.00
    $500.00
    $100.00
    $25.00
    $375.00
    $100.00
    $400.00
    $1,421.50
    $440.00
    $523.00
    $80.00
    $300.00
    $100.00
    $160.00
    $80.00
    $250.00
    $100.00
    $160.00
    $80.00
    $300.00
    $100.00
    $160.00
    $80.00
    $350.00
    $70.00
    $30.00
    $240.00
    $80.00
    $350.00
    $70.00
    $30.00
    $160.00

    S242
    L041
    L041
    S242
    P195
    S405
    D228
    D228
    D228
    D228
    D228
    D228
    D228
    D228
    D228
    D259
    D259
    D259
    D259
    D259
    D259
    D259
    D259
    D259
    D66
    D66
    D66
    D66
    M255
    M255
    M255
    D275
    M265
    M265
    L041
    L041
    D164
    D164
    D164
    M238
    M238
    P166
    S172
    M580
    M580
    M580
    M580
    D89
    D89
    D89
    D89
    D89
    D333

    $500.00
    $350.00
    $370.00
    $2,500.00
    $150.00
    $300.00
    $300.00
    $70.00
    $80.00
    $1,050.00
    $200.00
    $700.00
    $300.00
    $300.00
    $150.00
    $50.00
    $300.00
    $70.00
    $80.00
    $50.00
    $300.00
    $150.00
    $133.00
    $217.00
    $120.00
    $450.00
    $100.00
    $610.00
    $100.00
    $20.00
    $20.00
    $350.00
    $80.00
    $120.00
    $600.00
    $545.00
    $70.00
    $2,000.00
    $30.00
    $100.00
    $305.00
    $145.25
    $200.00
    $100.00
    $400.00
    $300.00
    $100.00
    $50.00
    $150.00
    $70.00
    $55.00
    $225.00
    $85.00

    D333
    D333
    D333
    D333
    M704
    S011
    P014
    S011
    P014
    L041
    M647
    M647
    P504
    M647
    M647
    M647
    O076
    O076
    O076
    M871
    P340
    D02
    D02
    D02
    D02
    M686
    P188
    P188
    M686
    M686
    M686
    M686
    P294
    D35
    D198
    M726
    P450
    P450
    S160
    S160
    S160
    S223
    P154
    T077
    T077
    D41
    D41
    D41
    D41
    M018
    P303
    P303
    M018

    $215.00
    $350.00
    $70.00
    $80.00
    $100.00
    $300.00
    $1,491.40
    $300.00
    $948.00
    $450.00
    $80.00
    $60.00
    $150.00
    $80.00
    $25.00
    $135.00
    $90.00
    $895.50
    $1,323.00
    $140.00
    $100.10
    $250.00
    $70.00
    $90.00
    $750.00
    $80.00
    $120.00
    $45.00
    $25.00
    $95.00
    $80.00
    $120.00
    $30.00
    $120.00
    $400.00
    $100.00
    $141.00
    $4.50
    $200.00
    $120.00
    $180.00
    $300.00
    $94.55
    $1,950.00
    $750.00
    $100.00
    $40.00
    $60.00
    $500.00
    $200.00
    $125.95
    $61.15
    $200.00

    M018
    M018
    M018
    P303
    D41
    D255
    D255
    M747
    M747
    M747
    M747
    P469
    P469
    M747
    D51
    D51
    M449
    M449
    M449
    M449
    M570
    M570
    M449
    M449
    M449
    M449
    S323
    D411
    D411
    D411
    D411
    D411
    D411
    S019
    S019
    S179
    S179
    S160
    H027
    P416
    D380
    D380
    D380
    D380
    D380
    D380
    O001
    O076
    O076
    O076
    M678
    P435
    D78

    $25.00
    $35.00
    $200.00
    $110.15
    $500.00
    $520.00
    $80.00
    $120.00
    $20.00
    $120.00
    $223.00
    $213.48
    $9.12
    $41.00
    $1,400.00
    $2,200.00
    $100.00
    $25.00
    $95.00
    $55.00
    $160.00
    $100.00
    $100.00
    $25.00
    $35.00
    $45.00
    $6,000.00
    $200.00
    $50.00
    $50.00
    $200.00
    $100.00
    $50.00
    $260.00
    $1,240.00
    $520.00
    $5,000.00
    $600.00
    $5,245.00
    $121.75
    $160.00
    $100.00
    $60.00
    $500.00
    $60.00
    $440.00
    $110.00
    $90.00
    $2,708.25
    $653.25
    $185.00
    $157.24
    $400.00

    M304
    M304
    O004
    M304
    O001
    O001
    O001
    S302
    S302
    S302
    L070
    S384
    S384
    M327
    M327
    M327
    M327
    P014
    P014
    S416
    S415
    S415
    P468
    P433
    O076
    O076
    O076
    S199
    P416
    O076
    O076
    S160
    P416
    P416
    M232
    M232
    M232
    M653
    M653
    M653
    D310
    D278
    D278
    D278
    D278
    D89
    D89
    D89
    D89
    D64
    M104
    M104
    L070

    $200.00
    $140.00
    $1,516.00
    $180.00
    $110.00
    $1,525.75
    $1,147.50
    $460.00
    $400.00
    $140.00
    $820.00
    $400.00
    $400.00
    $140.00
    $25.00
    $35.00
    $140.00
    $127.00
    $12.75
    $450.00
    $100.00
    $100.00
    $72.50
    $222.90
    $90.00
    $1,356.00
    $1,255.50
    $350.00
    $123.90
    $180.00
    $405.00
    $200.00
    $30.95
    $84.95
    $100.00
    $60.00
    $20.00
    $100.00
    $60.00
    $20.00
    $450.00
    $100.00
    $140.00
    $340.00
    $60.00
    $600.00
    $900.00
    $125.00
    $50.00
    $300.00
    $180.00
    $40.00
    $140.00

    S302
    S302
    P106
    D89
    D89
    D89
    D89
    D208
    D208
    D208
    D208
    D208
    P154
    S155
    P427
    P154
    P154
    P154
    P154
    S155
    L070
    P154
    S149
    H027
    H027
    H027
    S149
    H027
    H027
    H027
    D321
    D321
    H011
    H011
    H011
    S312
    M549
    O001
    O001
    O001
    M153
    M153
    S160
    H027
    H027
    S393
    M602
    M602
    D64
    D64
    D348
    D348
    D348

    $400.00
    $1,600.00
    $126.40
    $50.00
    $150.00
    $225.00
    $125.00
    $80.00
    $340.00
    $300.00
    $1,500.00
    $201.86
    $494.95
    $220.00
    $83.20
    $505.05
    $437.95
    $437.95
    $437.95
    $240.00
    $530.00
    $437.95
    $3,500.00
    $600.00
    $3,460.00
    $230.00
    $1,500.00
    $200.00
    $565.00
    $230.00
    $120.00
    $400.00
    $1,400.00
    $5,360.00
    $350.00
    $12,000.00
    $1,500.00
    $110.00
    $875.00
    $940.00
    $200.00
    $200.00
    $200.00
    $400.00
    $2,030.00
    $2,200.00
    $800.00
    $50.00
    $300.00
    $120.00
    $50.00
    $10.00
    $1,600.00

    D348
    H023
    H023
    H023
    H023
    H023
    H023
    L081
    H44
    H44
    L081
    D102
    D102
    D102
    M505
    P049
    P049
    H025
    M067
    S103
    L070
    O001
    O001
    O001
    D90
    D90
    D90
    L075
    S427
    S427
    P066
    D148
    D148
    D148
    D380
    D380
    D380
    D380
    D380
    D380
    D380
    D380
    D380
    D426
    D426
    D426
    D426
    S103
    L070
    H023
    P005
    L113
    S103

    $500.00
    $375.00
    $241.00
    $48.40
    $75.00
    $1,847.00
    $380.00
    $24,000.00
    $60,490.00
    $59,000.00
    $6,400.00
    $200.00
    $140.00
    $60.00
    $140.00
    $12.50
    $28.50
    $240.00
    $160.00
    $400.00
    $525.00
    $110.00
    $675.00
    $660.00
    $85.00
    $415.00
    $104.00
    $3,800.00
    $350.00
    $350.00
    $783.55
    $50.00
    $70.00
    $1,800.00
    $120.00
    $100.00
    $500.00
    $120.00
    $400.00
    $150.00
    $120.00
    $400.00
    $100.00
    $70.00
    $140.00
    $2,000.00
    $470.00
    $800.00
    $115.00
    $236.60
    $418.61
    $2,000.00
    $25,000.00

    P104
    S103
    S213
    P066
    S286
    S286
    H023
    L070
    H023
    L145
    P005
    P066
    S458
    S103
    M411
    M411
    P360
    P066
    M001
    P066
    O076
    O076
    O076
    M001
    P068
    P066
    S217
    S217
    S217
    S217
    H023
    O001
    O001
    O001
    S323
    S311
    S323
    O001
    O001
    S220
    S220
    T051
    M374
    P343
    T051
    T051
    T051
    T051
    T051
    M056
    M056
    T051
    T051

    $290.50
    $400.00
    $300.00
    $163.00
    $300.00
    $150.00
    $171.00
    $437.00
    $114.50
    $4,000.00
    $199.04
    $163.00
    $500.00
    $800.00
    $130.00
    $10.00
    $40.00
    $326.00
    $200.00
    $185.15
    $90.00
    $845.75
    $756.00
    $200.00
    $20.60
    $326.00
    $1,700.00
    $100.00
    $112.50
    $338.00
    $1,200.00
    $270.00
    $1,695.00
    $995.00
    $1,880.00
    $800.00
    $2,555.00
    $270.00
    $369.15
    $220.00
    $120.00
    $350.00
    $200.00
    $351.94
    $700.00
    $1,050.00
    $525.00
    $350.00
    $875.00
    $150.00
    $55.00
    $350.00
    $700.00

    M248
    P428
    D283
    D283
    D324
    D324
    D324
    D324
    D283
    D283
    P011
    M001
    M001
    M001
    S112
    P106
    S302
    P106
    S302
    S302
    S302
    P106
    M266
    P506
    D103
    D103
    D103
    D103
    D103
    M001
    P458
    L117
    P458
    M076
    P203
    M001
    M001
    P139
    P458
    M001
    P458
    S400
    H005
    P022
    P011
    S400
    S384
    S384
    S384
    S007
    P093
    S383
    P435

    $100.00
    $49.20
    $85.00
    $285.00
    $80.00
    $35.00
    $150.00
    $55.00
    $580.00
    $5,420.00
    $170.50
    $150.00
    $100.00
    $30.00
    $300.00
    $125.90
    $400.00
    $350.00
    $360.00
    $300.00
    $140.00
    $295.90
    $200.00
    $257.35
    $140.00
    $320.00
    $200.00
    $180.00
    $3,400.00
    $160.00
    $266.75
    $3,800.00
    $710.60
    $250.00
    $160.26
    $400.00
    $355.00
    $158.00
    $229.80
    $200.00
    $326.50
    $300.00
    $100.00
    $164.85
    $67.50
    $200.00
    $400.00
    $400.00
    $200.00
    $440.00
    $115.00
    $260.00
    $151.07

    M326
    P435
    D218
    D218
    CD01
    CD01
    CD01
    CD01
    P104
    M375
    P104
    M375
    M375
    H006
    H006
    L065
    M067
    M067
    L065
    L121
    D115
    D115
    D115
    D115
    D184
    D184
    D184
    D184
    D115
    D115
    M375
    S220
    L065
    P104
    M089
    P049
    L065
    M215
    M215
    M215
    D86
    D86
    D86
    D86
    D86
    D86
    D86
    D86
    M015
    P435
    M015
    L149
    D86

    $200.00
    $73.79
    $100.00
    $525.00
    $625.90
    $1,126.62
    $751.08
    $625.90
    $127.90
    $120.00
    $242.90
    $160.00
    $160.00
    $400.00
    $145.00
    $730.00
    $160.00
    $160.00
    $200.00
    $700.00
    $90.00
    $400.00
    $100.00
    $160.00
    $130.00
    $170.00
    $140.00
    $360.00
    $100.00
    $350.00
    $160.00
    $360.00
    $300.00
    $106.45
    $180.00
    $280.00
    $200.00
    $500.00
    $100.00
    $450.00
    $375.00
    $900.00
    $325.00
    $100.00
    $44.00
    $556.00
    $510.00
    $2,990.00
    $200.00
    $781.41
    $200.00
    $150.00
    $85.00

    D86
    D86
    D86
    M015
    P104
    D04
    D04
    O001
    O001
    O001
    D143
    D143
    D143
    H005
    H005
    H005
    H005
    D143
    D299
    D299
    D90
    D90
    D90
    D90
    D90
    D90
    S152
    S152
    M842
    P081
    M842
    P081
    M842
    P081
    P081
    M842
    P081
    D78
    D78
    D78
    P066
    D143
    D143
    P066
    M386
    M386
    M067
    L020
    P059
    D79
    D79
    D79
    D129

    $265.00
    $510.00
    $2,990.00
    $200.00
    $418.65
    $312.00
    $78.00
    $110.00
    $786.25
    $629.00
    $2,000.00
    $6,000.00
    $600.00
    $2,250.00
    $2,653.04
    $700.00
    $2,100.00
    $1,200.00
    $500.00
    $500.00
    $15.00
    $85.00
    $65.00
    $435.00
    $85.00
    $515.00
    $300.00
    $300.00
    $100.00
    $280.65
    $300.00
    $105.00
    $200.00
    $195.65
    $275.20
    $200.00
    $178.00
    $200.00
    $2,201.00
    $99.00
    $835.50
    $50.00
    $150.00
    $914.64
    $200.00
    $160.00
    $160.00
    $60.00
    $515.99
    $50.00
    $20.00
    $140.00
    $70.00

    D129
    D129
    D129
    D129
    M766
    M766
    M766
    H005
    S383
    P399
    S383
    S383
    P399
    S383
    L046
    D125
    D125
    D125
    L133
    L133
    L133
    H023
    S217
    S217
    P457
    D60
    D60
    D60
    D51
    D51
    D51
    D51
    T034
    T034
    P435
    P435
    S309
    P435
    P093
    L065
    L065
    S076
    O004
    O004
    O004
    D148
    D148
    D148
    O004
    O004
    O004
    D60
    D60

    $85.00
    $275.00
    $100.00
    $370.00
    $200.00
    $40.00
    $253.00
    $650.00
    $360.00
    $361.50
    $3,408.00
    $2,852.00
    $129.50
    $260.00
    $550.00
    $80.00
    $85.00
    $215.00
    $695.00
    $400.00
    $350.00
    $700.00
    $500.00
    $338.00
    $161.00
    ($300.00)
    $300.00
    $300.00
    $160.00
    $100.00
    $120.00
    $2,200.00
    $725.00
    $225.00
    $731.48
    $91.20
    $600.00
    $102.98
    $171.57
    $630.00
    $672.58
    $250.00
    $100.00
    $396.00
    $716.00
    $300.00
    $1,000.00
    $1,500.00
    $100.00
    $2,396.00
    $1,016.00
    $50.00
    $250.00

    D60
    D60
    D60
    S165
    S301
    S301
    S301
    S401
    M328
    M707
    H023
    H023
    P435
    S275
    S275
    D323
    D323
    P435
    M668
    P014
    D148
    D148
    D148
    D148
    O004
    O004
    O004
    S151
    S151
    S151
    M185
    P122
    M060
    S244
    S244
    S244
    S244
    S244
    D229
    S400
    L065
    H005
    S275
    S400
    S400
    M089
    M089
    L065
    M089
    P437
    O035
    O035
    O035

    $150.00
    $30.00
    $400.00
    $300.00
    $200.00
    $200.00
    $200.00
    $8,000.00
    $4,000.00
    $2,100.00
    $3,100.00
    $9,266.38
    $161.38
    $900.00
    $300.00
    $650.00
    $2,050.00
    $346.81
    $220.00
    $384.50
    $50.00
    $70.00
    $3,800.00
    $700.00
    $100.00
    $1,516.00
    $776.00
    $350.00
    $300.00
    $170.00
    $360.00
    $247.50
    $200.00
    $300.00
    $300.00
    $600.00
    $300.00
    $300.00
    $300.00
    $7,450.00
    $135.00
    $170.00
    $1,500.00
    $200.00
    $300.00
    $100.00
    $240.00
    $845.00
    $180.00
    $262.30
    $180.00
    $1,340.00
    $1,062.50

    P435
    P435
    P435
    P435
    P435
    S219
    S219
    S219
    S278
    S278
    S278
    S278
    H005
    S219
    M171
    L136
    P115
    P115
    O004
    L001
    O076
    O076
    O076
    L006
    D412
    D412
    D412
    D412
    M711
    P057
    M001
    P014
    P066
    P005
    D205
    O174
    O174
    M387
    P324
    M387
    P324
    M060
    H005
    P081
    M068
    P203
    P203
    M068
    M068
    P085
    P085
    S091
    S091

    $762.91
    $1,283.45
    $762.91
    $762.91
    $4,842.92
    $96.00
    $100.00
    $540.00
    $160.00
    $340.00
    $1,200.00
    $800.00
    $89.95
    $400.00
    $240.00
    $640.00
    $52.60
    $146.30
    $100.00
    $180.00
    $180.00
    $1,478.55
    $1,600.20
    $360.00
    $300.00
    $100.00
    $50.00
    $350.00
    $160.00
    $260.00
    $200.00
    $1,194.00
    $1,956.00
    $1,534.55
    $350.00
    $50.00
    $927.00
    $200.00
    $124.99
    $200.00
    $96.76
    $200.00
    $260.00
    $70.90
    $250.00
    $86.33
    $228.71
    $60.00
    $140.00
    $209.24
    $67.31
    $230.00
    $290.00

    S091
    S091
    D181
    D181
    D181
    D181
    S091
    P003
    M304
    O026
    O026
    S315
    S315
    S315
    P349
    D38
    D38
    D38
    M230
    P014
    M666
    M666
    P131
    D90
    D90
    D90
    D90
    D90
    D90
    D90
    D90
    D90
    S069
    S069
    P306
    O004
    O004
    O004
    O007
    O007
    O007
    O007
    S281
    S281
    S384
    S323
    S323
    O001
    O001
    O001
    D131
    D131
    D131

    $160.00
    $280.00
    $100.00
    $450.00
    $100.00
    $250.00
    $160.00
    $501.20
    $200.00
    $100.00
    $100.00
    $120.00
    $1,000.00
    $120.00
    $128.10
    $130.00
    $20.00
    $400.00
    $300.00
    $486.00
    $240.00
    $120.00
    $93.00
    $171.00
    $129.00
    $1,500.00
    $159.00
    $500.00
    $1,200.00
    $20.00
    $50.00
    $450.00
    $300.00
    $100.00
    $212.00
    $350.00
    $432.00
    $432.00
    $800.00
    $210.00
    $1,075.50
    $1,260.00
    $400.00
    $400.00
    $500.00
    $350.00
    $160.00
    $250.00
    $1,657.50
    $960.50
    $120.00
    $400.00
    $150.00

    D131
    M019
    D432
    D432
    D432
    D432
    S384
    S384
    M766
    M766
    P427
    O001
    O001
    O001
    M029
    P066
    H008
    H008
    D180
    O001
    D208
    D208
    D208
    D208
    D82
    D04
    D04
    M134
    H022
    H022
    M545
    M545
    M867
    S244
    S244
    S244
    P435
    D01
    D01
    D221
    M067
    M067
    L020
    P049
    D260
    D260
    S302
    S302
    P094
    M045
    P094
    H005
    H005

    $370.00
    $276.90
    $150.00
    $150.00
    $250.00
    $2,500.00
    $400.00
    $400.00
    $200.00
    $25.00
    $175.40
    $270.00
    $1,895.00
    $1,130.00
    $100.00
    $684.20
    $679.00
    $385.00
    $350.00
    $110.00
    $160.00
    $100.00
    $60.00
    $600.00
    $80.00
    $300.00
    $400.00
    $150.00
    $80.00
    $200.00
    $150.00
    $240.00
    $150.00
    $600.00
    $600.00
    $300.00
    $98.29
    $171.00
    $179.00
    $1,900.00
    $160.00
    $60.00
    $210.00
    $81.00
    $125.00
    $175.00
    $360.00
    $140.00
    $168.00
    $150.00
    $40.50
    $300.00
    $1,200.00

    M171
    P435
    D324
    D324
    D324
    S091
    D324
    D324
    D324
    D324
    D324
    D324
    D324
    D324
    D324
    S279
    S279
    M473
    L006
    P373
    M229
    P373
    P373
    M229
    M473
    P373
    M473
    P342
    M607
    M607
    P373
    H003
    H003
    H003
    H003
    P373
    P139
    M678
    D181
    D181
    D181
    D181
    M789
    M789
    P014
    O001
    O001
    O001
    D39
    D39
    D39
    D39
    S327

    $100.00
    $151.64
    $80.00
    $260.00
    $440.00
    $160.00
    $840.00
    $1,160.00
    $80.00
    $120.00
    $120.00
    $400.00
    $500.00
    $1,000.00
    $450.00
    $900.00
    $232.00
    $180.00
    $400.00
    $162.50
    $160.00
    $153.55
    $28.35
    $160.00
    $150.00
    $447.95
    $120.00
    $470.40
    $450.00
    $375.00
    $791.20
    $120.00
    $115.00
    $96.50
    $180.00
    $98.00
    $172.00
    $200.00
    $1,000.00
    $4,000.00
    $7,380.00
    $1,000.00
    $90.00
    $110.00
    $76.50
    $110.00
    $1,395.00
    $1,880.00
    $100.00
    $300.00
    $100.00
    $300.00
    $600.00

    H008
    M326
    M326
    M326
    M326
    P427
    H023
    L046
    P427
    P022
    P427
    P005
    P005
    M326
    P427
    O004
    O004
    M368
    M368
    P394
    M033
    M008
    M008
    S281
    S281
    P014
    P332
    M463
    L070
    M368
    M368
    P394
    P435
    P457
    D244
    D244
    D244
    D244
    M212
    M212
    O004
    O004
    O004
    M430
    M430
    M430
    S184
    S184
    L006
    P399
    P399
    L065
    P399

    $3,080.00
    $200.00
    $50.00
    $400.00
    $450.00
    $2,194.50
    $3,800.00
    $2,375.00
    $1,216.90
    $174.65
    $1,346.15
    $10,549.05
    $9,966.72
    $250.00
    $58.10
    $100.00
    $845.75
    $400.00
    $450.00
    $2,325.00
    $200.00
    $200.00
    $55.00
    $400.00
    $400.00
    $25.95
    $150.00
    $200.00
    $190.00
    $200.00
    $250.00
    $1,980.00
    $715.97
    $1,350.50
    $60.00
    $35.00
    $45.00
    $600.00
    $1,050.00
    $380.00
    $100.00
    $476.00
    $1,116.00
    $100.00
    $100.00
    $200.00
    $200.00
    $100.00
    $400.00
    $266.20
    $30.00
    $490.00
    $28.50

    M430
    P399
    M212
    M212
    O169
    O169
    M186
    P353
    P353
    S159
    L075
    P353
    M186
    P399
    L149
    MM06
    S159
    P353
    T068
    S159
    P435
    T068
    M577
    M577
    S126
    S126
    S126
    O001
    O001
    O001
    O076
    O076
    D257
    D257
    D257
    D58
    D58
    M215
    H023
    L070
    M215
    S374
    O001
    O001
    O001
    D345
    D345
    M028
    M254
    M254
    M254
    M189
    P115

    $100.00
    $327.50
    $1,050.00
    $100.00
    $585.00
    $1,075.00
    $220.00
    $46.80
    $68.00
    $800.00
    $3,800.00
    $277.20
    $405.00
    $96.50
    $230.00
    $321.40
    $400.00
    $995.00
    $1,080.00
    $800.00
    $850.35
    $1,080.00
    $200.00
    $40.00
    $300.00
    $1,200.00
    $500.00
    $110.00
    $1,525.75
    $1,496.00
    $2,335.50
    $876.00
    $35.00
    $65.00
    $400.00
    $140.00
    $610.00
    $250.00
    $505.00
    $1,080.00
    $250.00
    $350.00
    $110.00
    $795.00
    $1,641.00
    $700.00
    $1,800.00
    $100.00
    $200.00
    $200.00
    $200.00
    $140.00
    $11.50

    M033
    P318
    M833
    P106
    S312
    S312
    S312
    D257
    D257
    D257
    S237
    P014
    L061
    M229
    L001
    M327
    M327
    D79
    D79
    S240
    L074
    M701
    P432
    P432
    M701
    O076
    M014
    P088
    L143
    M020
    L034
    M213
    M213
    M138
    M138
    M138
    O076
    O076
    O076
    D301
    D301
    D301
    D301
    D301
    O076
    O076
    O076
    O076
    O076
    O076
    O076
    M463
    M463

    $100.00
    $57.60
    $160.00
    $49.00
    $250.00
    $350.00
    $150.00
    $35.00
    $65.00
    $1,250.00
    $500.00
    $541.65
    $70.00
    $40.00
    $320.00
    $140.00
    $80.00
    $85.00
    $55.00
    $200.00
    $545.00
    $600.00
    $24.80
    $400.00
    $200.00
    $80.00
    $140.00
    $60.75
    $1,500.00
    $160.00
    $400.00
    $100.00
    $400.00
    $120.00
    $25.00
    $75.00
    $90.00
    $1,276.00
    $792.00
    $50.00
    $70.00
    $50.00
    $400.00
    $300.00
    $90.00
    $535.50
    $340.50
    $90.00
    $945.75
    $723.19
    $677.06
    $200.00
    $100.00

    P337
    P337
    S187
    P014
    P014
    M463
    M463
    M463
    P337
    M463
    O076
    M299
    M299
    M299
    O004
    O161
    O161
    O004
    O161
    O161
    M304
    P014
    M230
    P014
    H006
    P005
    H006
    H006
    S128
    S128
    P091
    P091
    S069
    S069
    P267
    P267
    S069
    P267
    D397
    D397
    S271
    P039
    O004
    O004
    P427
    P005
    S304
    P427
    P005
    P465
    O004
    O004
    O004

    $180.00
    $70.00
    $200.00
    $59.00
    $133.50
    $100.00
    $300.00
    $80.00
    $60.00
    $80.00
    $90.00
    $150.00
    $25.00
    $205.00
    $200.00
    $1,200.00
    $600.00
    $200.00
    $1,400.00
    $1,100.00
    $140.00
    $239.45
    $300.00
    $331.05
    $365.00
    $2,028.80
    $24.00
    $306.00
    $400.00
    $480.00
    $52.40
    $13.10
    $250.00
    $200.00
    $70.00
    $195.00
    $250.00
    $130.00
    $100.00
    $300.00
    $380.00
    $105.00
    $100.00
    $476.00
    $25.00
    $524.24
    $200.00
    $1,176.00
    $655.30
    $46.00
    $100.00
    $1,036.00
    $1,036.00

    O004
    O004
    O004
    S184
    S184
    P337
    O004
    S384
    S384
    M299
    L070
    M299
    M299
    L070
    M107
    P476
    O136
    O136
    M164
    M248
    P016
    P016
    D319
    D319
    M346
    M346
    M346
    P435
    M346
    M346
    P306
    M299
    M299
    M299
    P316
    M299
    M299
    M299
    M299
    D176
    D176
    D176
    D381
    D381
    D381
    M618
    L034
    P472
    M618
    P039
    M694
    M694
    M694

    $100.00
    $476.00
    $396.00
    $200.00
    $100.00
    $234.00
    $100.00
    $300.00
    $400.00
    $150.00
    $300.00
    $25.00
    $215.00
    $740.00
    $250.00
    $140.00
    $60.00
    $1,327.10
    $120.00
    $180.00
    $52.80
    $5.25
    $170.00
    $530.00
    $100.00
    $25.00
    $75.00
    $96.52
    $100.00
    $100.00
    $190.25
    $120.00
    $25.00
    $55.00
    $133.45
    $120.00
    $336.00
    $25.00
    $59.00
    $350.00
    $70.00
    $30.00
    $35.00
    $35.00
    $140.00
    $240.00
    $400.00
    $51.25
    $140.00
    $110.00
    $100.00
    $200.00
    $40.00

    M694
    D38
    D38
    M694
    M694
    M694
    P366
    S247
    L065
    O076
    O076
    O076
    S433
    S433
    H005
    H005
    S433
    S433
    S433
    S433
    S433
    S433
    P031
    P031
    M225
    M225
    L001
    S214
    S214
    H005
    P215
    P066
    P215
    P215
    M374
    P031
    P436
    P487
    M374
    O001
    S220
    S127
    P031
    S220
    S220
    O156
    P005
    P005
    S020
    P031
    P435
    P031
    S220

    $340.00
    $85.00
    $115.00
    $100.00
    $25.00
    $175.00
    $220.00
    $100.00
    $200.00
    $90.00
    $628.00
    $880.00
    $200.00
    $50.00
    $240.00
    $60.00
    $2,300.00
    $9,700.00
    $1,875.00
    $1,125.00
    $1,875.00
    $4,375.00
    $13,221.99
    $494.31
    $480.00
    $120.00
    $232.75
    $350.00
    $3,400.00
    $2,400.00
    $486.60
    $700.00
    $34.15
    $32.50
    $350.00
    $84.98
    $290.90
    $178.63
    $200.00
    $110.00
    $360.00
    $300.00
    $351.00
    $220.00
    $240.00
    $300.00
    $781.76
    $390.88
    $400.00
    $98.99
    $129.00
    $337.50
    $260.00

    D86
    D86
    D86
    P031
    P031
    P031
    P031
    P005
    M304
    P435
    P435
    P031
    P031
    S220
    O156
    M304
    M304
    US01
    US01
    P372
    US01
    US01
    US01
    US01
    O076
    O076
    O076
    M204
    L070
    S302
    S302
    S302
    O001
    O001
    P005
    P435
    M498
    M498
    S277
    P014
    H006
    S367
    M581
    M304
    S367
    M310
    P484
    M020
    M019
    M019
    M019
    P337
    L003

    $50.00
    $170.00
    $280.00
    $337.50
    $164.70
    $98.99
    $337.50
    $132.07
    $200.00
    $790.91
    $764.27
    $337.50
    $59.70
    $200.00
    $150.00
    $200.00
    $40.00
    $988.55
    $2,159.37
    $7,195.20
    $228.74
    $512.00
    $195.72
    $639.88
    $90.00
    $1,435.00
    $1,593.00
    $200.00
    $700.00
    $360.00
    $140.00
    $200.00
    $110.00
    $1,547.00
    $1,034.06
    $147.63
    $700.00
    $500.00
    $300.00
    $297.00
    $1,040.00
    $280.00
    $200.00
    $835.00
    $360.00
    $150.00
    $903.80
    $180.00
    $300.00
    $25.00
    $175.00
    $498.45
    $800.00

    L003
    L003
    M230
    M230
    M230
    M019
    L003
    L003
    L003
    M230
    M230
    M327
    M327
    M327
    L074
    P484
    M019
    L065
    P484
    P472
    M230
    M230
    M230
    M019
    M019
    M019
    M019
    P484
    P484
    S046
    S046
    P435
    S219
    D103
    D103
    D103
    D103
    S296
    S296
    S296
    P435
    S219
    S219
    S219
    H005
    P381
    P435
    S376
    S376
    P435
    P435
    D78
    D78

    $100.00
    $60.00
    $250.00
    $1,250.00
    $250.00
    $300.00
    $800.00
    $25.00
    $25.00
    $250.00
    $1,025.00
    $140.00
    $25.00
    $35.00
    $70.00
    $194.60
    $500.00
    $300.00
    $441.00
    $105.80
    $400.00
    $450.00
    $150.00
    $100.00
    $600.00
    $500.00
    $800.00
    $73.85
    $50.50
    $400.00
    $100.00
    $395.83
    $400.00
    $140.00
    $320.00
    $140.00
    $320.00
    $1,050.00
    $400.00
    $2,400.00
    $1,421.00
    $400.00
    $800.00
    $50.00
    $440.00
    $94.70
    $236.97
    $400.00
    $1,420.00
    $239.64
    $910.44
    $400.00
    $100.00

    D78
    M683
    M683
    M695
    M695
    P435
    P339
    M626
    P396
    P396
    M626
    P339
    M683
    M683
    P093
    H021
    H021
    S237
    M626
    P046
    M695
    M695
    M695
    M695
    M452
    M452
    P421
    P435
    P396
    P396
    D01
    D01
    D01
    M577
    D01
    H006
    H006
    S109
    S109
    S200
    H006
    S046
    S046
    L158
    L158
    D31
    D31
    M473
    P435
    O007
    O007
    O007
    P066

    $800.00
    $250.00
    $310.00
    $350.00
    $150.00
    $273.07
    $150.50
    $200.00
    $1,221.00
    $251.30
    $200.00
    $608.00
    $250.00
    $310.00
    $105.00
    $700.00
    $1,300.00
    $4,000.00
    $200.00
    $273.50
    $350.00
    $1,000.00
    $400.00
    $300.00
    $200.00
    $500.00
    $750.00
    $473.82
    $1,137.00
    $522.90
    $225.00
    $75.00
    $9,700.00
    $200.00
    $1,650.00
    $900.00
    $1,450.00
    $6,650.00
    $200.00
    $210.00
    $1,200.00
    $100.00
    $300.00
    $120.00
    $30.00
    $275.00
    $275.00
    $60.00
    $371.33
    $100.00
    $855.00
    $985.50
    $881.55

    P014
    M448
    M448
    P014
    P014
    P014
    P014
    P066
    P014
    L139
    P014
    P066
    L139
    M297
    M297
    M297
    M297
    L116
    P422
    P066
    M393
    S107
    S107
    P005
    P487
    H023
    H023
    S266
    S279
    L177
    M393
    S383
    P031
    H44
    O033
    O033
    O033
    S173
    P122
    O156
    P122
    P435
    P435
    P435
    M630
    P435
    P435
    P435
    P435
    P435
    P435
    P435
    L070

    $556.00
    $200.00
    $400.00
    $139.50
    $163.00
    $340.15
    $197.25
    $719.72
    $518.00
    $200.00
    $1,035.00
    $1,341.84
    $200.00
    $120.00
    $25.00
    $225.00
    $20.00
    $220.00
    $164.00
    $84.06
    $470.00
    $300.00
    $100.00
    $803.20
    $308.61
    $2,470.68
    $29.32
    $4,000.00
    $500.00
    $3,400.00
    $250.00
    $760.00
    $361.47
    $4,850.00
    $100.00
    $701.25
    $2,065.50
    $260.00
    $225.00
    $240.00
    $225.00
    $982.91
    $407.47
    $317.36
    $200.00
    $39.90
    $496.16
    $407.47
    $173.40
    $129.80
    $290.09
    $383.53
    $1,660.00

    P435
    P435
    L070
    P435
    UN01
    P435
    P435
    P435
    P435
    P435
    P435
    M630
    P031
    H023
    H023
    S300
    P435
    P055
    D103
    P031
    D103
    D103
    H023
    H023
    H023
    H023
    H023
    P435
    S213
    O001
    O001
    O001
    P005
    P486
    P054
    P005
    P005
    P054
    P005
    P005
    P054
    P005
    P343
    H005
    S173
    S173
    S173
    S173
    S173
    S173
    S245
    H011
    O076

    $490.69
    $210.00
    $200.00
    $420.00
    $539.90
    $868.12
    $112.50
    $843.18
    $66.69
    $108.82
    $395.83
    $180.00
    $37.49
    $750.00
    $1,650.00
    $2,500.00
    $105.42
    $193.20
    $380.00
    $13.00
    $140.00
    $320.00
    $375.00
    $127.03
    $2,690.00
    $960.00
    $241.00
    $152.10
    $300.00
    $110.00
    $1,325.00
    $1,310.00
    $317.50
    $39.00
    $40.30
    $158.75
    $158.75
    $41.90
    $158.75
    $158.75
    $40.30
    $158.75
    $40.50
    $650.00
    $2,800.00
    $5,470.00
    $360.00
    $200.00
    $300.00
    $1,200.00
    $700.00
    $1,507.00
    $1,276.00

    O076
    O004
    S325
    P353
    M441
    P115
    M441
    P353
    H006
    P011
    S007
    P093
    L065
    M774
    L139
    L065
    S007
    L065
    D182
    D182
    D182
    D182
    D182
    M124
    P343
    P343
    P031
    L070
    P435
    M464
    P031
    M215
    P031
    S004
    P031
    P031
    M215
    P031
    P031
    L96
    P031
    P031
    D129
    D129
    D129
    D129
    D129
    D103
    D103
    P005
    P005
    P011
    P011

    $2,395.00
    $100.00
    $300.00
    $212.20
    $120.00
    $130.75
    $200.00
    $200.00
    $175.00
    $112.00
    $240.00
    $322.00
    $220.00
    $300.00
    $350.00
    $220.00
    $200.00
    $175.00
    $840.00
    $3,160.00
    $1,500.00
    $54.18
    $400.00
    $500.00
    $49.35
    $587.74
    $473.48
    $1,240.00
    $870.10
    $300.00
    $682.20
    $250.00
    $1,155.68
    $400.00
    $809.40
    $134.70
    $500.00
    $119.80
    $1,155.68
    $1,800.00
    $859.20
    $1,109.10
    $80.00
    $70.00
    $1,100.00
    $600.00
    $60.00
    $2,025.00
    $11,575.00
    $1,926.63
    $85.00
    $625.00
    $267.12

    M607
    M607
    P011
    P011
    S182
    S182
    P011
    D309
    H048
    D309
    D309
    D309
    D309
    P011
    P011
    S244
    S365
    M473
    P343
    M473
    P343
    P435
    P435
    M473
    S300
    L075
    M473
    P122
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    D103
    M473
    P343
    M695

    $250.00
    $120.00
    $203.98
    $97.09
    $90.00
    $210.00
    $317.72
    $400.00
    $120.00
    $150.00
    $50.00
    $100.00
    $375.00
    $1,156.00
    $353.35
    $300.00
    $300.00
    $120.00
    $262.50
    $150.00
    $104.00
    $277.31
    $69.26
    $180.00
    $600.00
    $6,000.00
    $120.00
    $162.50
    $140.00
    $320.00
    $140.00
    $140.00
    $240.00
    $140.00
    $320.00
    $140.00
    $140.00
    $240.00
    $160.00
    $140.00
    $240.00
    $160.00
    $350.00
    $140.00
    $240.00
    $160.00
    $2,100.00
    $480.00
    $330.00
    $660.00
    $120.00
    $338.10
    $350.00

    M695
    S300
    S300
    M205
    M205
    P031
    S383
    P031
    P031
    S383
    P507
    EC01
    S383
    O004
    O004
    D152
    D152
    D152
    P055
    M630
    P055
    P055
    M630
    P055
    P055
    O015
    O015
    M630
    P055
    P055
    O015
    O015
    M630
    P031
    O015
    O015
    O015
    P055
    P055
    M089
    P055
    M089
    D143
    P055
    D59
    D59
    D59
    O001
    T034
    P031
    M124
    M124
    O001

    $150.00
    $300.00
    $100.00
    $240.00
    $650.00
    $1,331.26
    $1,140.00
    $144.98
    $206.46
    $600.00
    $396.00
    $502.26
    $260.00
    $716.00
    $1,576.00
    $300.00
    $70.00
    $130.00
    $322.50
    $360.00
    $361.30
    $57.30
    $180.00
    $18.30
    $20.00
    $130.00
    $530.00
    $180.00
    $185.90
    $302.00
    $540.00
    $605.00
    $180.00
    $254.85
    $130.00
    $130.00
    $415.00
    $169.50
    $339.00
    $180.00
    $189.70
    $180.00
    $600.00
    $169.95
    $340.00
    $170.00
    $280.00
    $110.00
    $16,200.00
    $4,169.54
    $250.00
    $250.00
    $110.00

    O001
    O001
    O001
    O001
    L075
    H005
    O001
    O001
    O001
    H005
    H005
    H005
    H005
    H005
    D181
    S041
    L006
    H005
    H005
    S433
    M124
    P031
    T034
    UN01
    D181
    D181
    M630
    S214
    S214
    H023
    H023
    M630
    M630
    D181
    D181
    O001
    O001
    P031
    H005
    H005
    H005
    H005
    P031
    P031
    M089
    H047
    H005
    H005
    P031
    S219
    S219
    P343
    S107

    $100.00
    $900.00
    $900.00
    $200.00
    $3,800.00
    $631.82
    $100.00
    $895.00
    $1,280.00
    $380.00
    $1,141.30
    $240.00
    $600.00
    $3,800.00
    $100.00
    $700.00
    $1,050.00
    $280.00
    $44.68
    $500.00
    $250.00
    $99.80
    $5,100.00
    $750.00
    $140.00
    $860.00
    $200.00
    $1,900.00
    $25.00
    $400.00
    $1,192.00
    $180.00
    $180.00
    $800.00
    $180.00
    $1,270.75
    $1,615.00
    $1,465.28
    $280.00
    $200.00
    $500.00
    $400.00
    $75.25
    $1,014.23
    $280.00
    $400.00
    $208.00
    $500.00
    $192.48
    $400.00
    $400.00
    $89.99
    $300.00

    S107
    P031
    T034
    S383
    O177
    O177
    O177
    D38
    D38
    M473
    S363
    L070
    O177
    O177
    O177
    M473
    P435
    M473
    S363
    H006
    S151
    S151
    S151
    M452
    P435
    D427
    H023
    H023
    H023
    S407
    S006
    S433
    S433
    P435
    O004
    O004
    O004
    S162
    P068
    O001
    O001
    O001
    M101
    P154
    P154
    M101
    P154
    P154
    M463
    M463
    P154
    P154
    O001

    $100.00
    $174.49
    $18,225.00
    $360.00
    $100.00
    $805.50
    $1,890.00
    $140.00
    $1,260.00
    $100.00
    $300.00
    $130.00
    $100.00
    $355.50
    $360.00
    $200.00
    $295.26
    $130.00
    $400.00
    $350.00
    $350.00
    $300.00
    $170.00
    $250.00
    $217.33
    $400.00
    $1,100.00
    $3,007.00
    $375.00
    $800.00
    $300.00
    $2,000.00
    $2,700.00
    $593.74
    $100.00
    $1,196.00
    $2,056.00
    $240.00
    $310.45
    $110.00
    $854.75
    $520.00
    $150.00
    $235.90
    $111.95
    $160.00
    $49.90
    $36.00
    $200.00
    $120.00
    $280.60
    $54.00
    $110.00

    O001
    O001
    S149
    S149
    S149
    S149
    S149
    S149
    O001
    M233
    M233
    M215
    P031
    P011
    M215
    P011
    O004
    O004
    O004
    M212
    M212
    M246
    S128
    H006
    H006
    S277
    P007
    H006
    P007
    H006
    M577
    L065
    D283
    D283
    D283
    D283
    D78
    H029
    H029
    H029
    H029
    H029
    D379
    D379
    D379
    D379
    O004
    O004
    O004
    S387
    H027
    O001
    O001

    $2,495.00
    $1,550.00
    $200.00
    $300.00
    $200.00
    $200.00
    $25.00
    $275.00
    $110.00
    $100.00
    $30.00
    $500.00
    $108.43
    $336.00
    $250.00
    $112.00
    $100.00
    $1,196.00
    $1,256.00
    $750.00
    $400.00
    $1,925.00
    $14,500.00
    $2,700.00
    $11,509.00
    $4,000.00
    $71.80
    $150.00
    $309.50
    $360.00
    $200.00
    $462.50
    $100.00
    $400.00
    $860.00
    $1,640.00
    $400.00
    $700.00
    $200.00
    $355.00
    $400.00
    $615.00
    $180.00
    $70.00
    $110.00
    $500.00
    $100.00
    $716.00
    $396.00
    $500.00
    $1,470.00
    $250.00
    $635.80

    L041
    P416
    D182
    D182
    D89
    D51
    D51
    D51
    D51
    D51
    D38
    S160
    S160
    S160
    S160
    S160
    S160
    P005
    O001
    P005
    P005
    P005
    P005
    P005
    P435
    M393
    P155
    P155
    P155
    P435
    P435
    P435
    M393
    S400
    P343
    P122
    M374
    L070
    P435
    M695
    M695
    M695
    H011
    S137
    S137
    S137
    S137
    S137
    D432
    D432
    O001
    O001
    H005

    $40.00
    $574.80
    $1,500.00
    $2,000.00
    $425.00
    $144.00
    $70.00
    $74.00
    $450.00
    $54.00
    $150.00
    $200.00
    $25.00
    $635.00
    $200.00
    $25.00
    $375.00
    $409.06
    $110.00
    $409.06
    $409.06
    $818.12
    $409.60
    $409.06
    $731.69
    $220.00
    $43.00
    $51.10
    $79.50
    $731.69
    $731.69
    $664.11
    $250.00
    $300.00
    $376.45
    $371.40
    $200.00
    $250.00
    $103.82
    $350.00
    $150.00
    $150.00
    $500.00
    $450.00
    $25.00
    $375.00
    $450.00
    $400.00
    $150.00
    $350.00
    $2,120.75
    $850.00
    $1,940.00

    H005
    S302
    M328
    M695
    M695
    S076
    P031
    P031
    S137
    S137
    S137
    S137
    S137
    S076
    P435
    S137
    S137
    S076
    P435
    US01
    US01
    US01
    US01
    US01
    US01
    H051
    S446
    S446
    S296
    S296
    H025
    S323
    S323
    M049
    P081
    D63
    O015
    O015
    D411
    D411
    D411
    D04
    D04
    D04
    D04
    D04
    D04
    D04
    D04
    D04
    M443
    P427
    M060

    $11,135.88
    $10,000.00
    $4,000.00
    $350.00
    $350.00
    $350.00
    $67.99
    $124.99
    $450.00
    $400.00
    $450.00
    $25.00
    $375.00
    $250.00
    $101.51
    $450.00
    $450.00
    $500.00
    $127.18
    ($1,782.76)
    $1,782.76
    ($802.44)
    $802.44
    ($2,240.41)
    $2,240.41
    $500.00
    $5,000.00
    $5,867.00
    $2,400.00
    $1,050.00
    $260.00
    $350.00
    $160.00
    $120.00
    $203.30
    $300.00
    $130.00
    $2,860.00
    $200.00
    $25.00
    $25.00
    $100.00
    $200.00
    $100.00
    $200.00
    $100.00
    $140.00
    $100.00
    $140.00
    $100.00
    $450.00
    $996.20
    $180.00

    M060
    S160
    P154
    S199
    S199
    S199
    S124
    P154
    P154
    S115
    P154
    P154
    S199
    P154
    P154
    P154
    L041
    S124
    P154
    L041
    S124
    S124
    S160
    P014
    M304
    P337
    P337
    H005
    O004
    O004
    O004
    D173
    D173
    D173
    S302
    P014
    S127
    S127
    S127
    S127
    M053
    P081
    P081
    H023
    H023
    H023
    H023
    S279
    S279
    P435
    M045
    L001
    S279

    $180.00
    $200.00
    $184.40
    $300.00
    $25.00
    $175.00
    $300.00
    $130.00
    $32.50
    $300.00
    $23.50
    $261.98
    $300.00
    $38.08
    $50.40
    $9.52
    $350.00
    $200.00
    $162.50
    $400.00
    $1,360.00
    $340.00
    $200.00
    $59.50
    $140.00
    $120.00
    $91.75
    $420.00
    $200.00
    $1,516.00
    $1,896.00
    $800.00
    $600.00
    $300.00
    $860.00
    $76.50
    $400.00
    $1,200.00
    $3,000.00
    $2,000.00
    $290.00
    $216.50
    $31.90
    $375.00
    $383.76
    $14.95
    $210.00
    $500.00
    $700.00
    $49.99
    $150.00
    $505.00
    $400.00

    S279
    S279
    O004
    O004
    O004
    D04
    D04
    M060
    M060
    M060
    M060
    M060
    M060
    M060
    M577
    S217
    L177
    P031
    L96
    H023
    H023
    P427
    H023
    S217
    S217
    S217
    S217
    D86
    D86
    H023
    S217
    H023
    P435
    T074
    M060
    L070
    P348
    P435
    H023
    O004
    S151
    H005
    L068
    O076
    O076
    O076
    O065
    O065
    O065
    D38
    D411
    D411
    D411

    $182.00
    $100.00
    $100.00
    $1,356.00
    $1,656.00
    $140.00
    $285.00
    $200.00
    $25.00
    $315.00
    $200.00
    $25.00
    $315.00
    $200.00
    $200.00
    $500.00
    $3,400.00
    $199.15
    $500.00
    $950.00
    $17,759.72
    $48.90
    $171.15
    $100.00
    $12,000.00
    $4,500.00
    $4,000.00
    $50.00
    $300.00
    $4,318.85
    $800.00
    $100.60
    $366.21
    $1,730.00
    $200.00
    $80.00
    $14.78
    $93.03
    $94.50
    $688.00
    $1,050.00
    $600.00
    $1,130.00
    $180.00
    $1,525.50
    $1,170.00
    $150.00
    $810.00
    $180.00
    $900.00
    $200.00
    $25.00
    $25.00

    D382
    D382
    D382
    D382
    S275
    S275
    S275
    US01
    US01
    US01
    US01
    US01
    P372
    P372
    S244
    P011
    S296
    S296
    S296
    M124
    P011
    O001
    O001
    O001
    S296
    S296
    S296
    M124
    M124
    L070
    P077
    M164
    P077
    P077
    P077
    P077
    M164
    P077
    P077
    H026
    M164
    P077
    D34
    D34
    M204
    M204
    M204
    O004
    O004
    O004
    O004
    O004
    S120

    $200.00
    $260.00
    $500.00
    $305.00
    $300.00
    $25.00
    $925.00
    $787.50
    $1,575.00
    $630.00
    $13,860.00
    $17,640.00
    $2,585.00
    $26,200.00
    $300.00
    $476.00
    $1,500.00
    $450.00
    $800.00
    $600.00
    $28.50
    $110.00
    $1,871.25
    $1,365.00
    $1,050.00
    $400.00
    $3,900.00
    $500.00
    $200.00
    $1,110.00
    $310.00
    $100.00
    $98.00
    $310.00
    $310.00
    $310.00
    $100.00
    $5.00
    $20.00
    $83.00
    $120.00
    $310.00
    $100.00
    $250.00
    $200.00
    $200.00
    $60.00
    $200.00
    $776.00
    $200.00
    $1,516.00
    $1,016.00
    $300.00

    P014
    S120
    P093
    H011
    P093
    S184
    S184
    S381
    P090
    S400
    S400
    H005
    L143
    D07
    D07
    D07
    D102
    M178
    S247
    O004
    O004
    O004
    S026
    P382
    D86
    D86
    D86
    M452
    M452
    M452
    Missing
    S144
    S144
    M231
    S417
    H066
    H066
    H066
    H047
    P343
    H005
    M089
    L070
    M216
    M216
    M207
    P167
    M207
    P167
    D92
    D92
    P484
    M207

    $27.95
    $240.00
    $66.74
    $220.00
    $55.10
    $200.00
    $100.00
    $400.00
    $72.60
    $300.00
    $550.00
    $1,280.00
    $500.00
    $475.00
    $80.00
    $20.00
    $200.00
    $200.00
    $100.00
    $100.00
    $1,516.00
    $680.00
    $160.00
    $300.00
    $50.00
    $240.00
    $60.00
    $240.00
    $60.00
    $290.00
    $300.00
    $300.00
    $200.00
    $100.00
    $300.00
    $800.00
    $500.00
    $2,500.00
    $1,300.00
    $123.20
    $200.00
    $380.00
    $295.00
    $100.00
    $100.00
    $200.00
    $1,223.40
    $200.00
    $1,703.90
    $85.00
    $415.00
    $60.00
    $100.00

    P167
    M207
    P167
    O001
    O001
    O001
    M207
    P167
    M207
    P484
    P167
    M207
    P167
    D07
    D07
    D07
    D07
    D07
    D07
    D07
    D07
    D07
    D07
    M346
    M346
    P478
    P478
    M230
    M230
    P167
    M584
    M584
    O004
    M584
    D114
    D114
    D114
    D114
    D114
    S374
    O001
    P014
    S069
    P014
    P014
    M089
    M089
    M089
    M089
    M089
    D22
    D22
    M657

    $675.75
    $200.00
    $562.25
    $110.00
    $1,295.00
    $650.00
    $300.00
    $1,916.00
    $100.00
    $67.50
    $59.75
    $400.00
    $2,518.30
    $150.00
    $350.00
    $35.00
    $1,265.00
    $325.00
    $100.00
    $1,350.00
    $1,350.00
    $875.00
    $100.00
    $100.00
    $100.00
    $7.00
    $46.20
    $300.00
    $300.00
    $205.25
    $150.00
    $52.00
    $1,140.00
    $150.00
    $120.00
    $70.00
    $10.00
    $340.00
    $540.00
    $200.00
    $200.00
    $121.25
    $650.00
    $20.00
    $37.15
    $180.00
    $200.00
    $100.00
    $180.00
    $20.00
    $200.00
    $480.00
    $100.00

    P014
    L006
    L006
    L140
    L140
    P005
    S296
    S296
    S296
    D232
    D129
    D129
    D129
    D129
    D129
    M189
    M019
    P435
    P085
    M304
    M189
    M304
    P435
    P435
    M087
    M087
    M087
    P081
    P081
    D437
    D437
    D437
    P081
    M374
    L006
    P085
    M325
    M325
    S115
    M294
    O076
    O076
    M294
    M775
    M775
    S113
    H027
    M863
    M310
    M310
    L97
    M310
    M310

    $148.40
    $350.00
    $350.00
    $1,728.00
    $216.00
    $312.88
    $800.00
    $450.00
    $1,500.00
    $250.00
    $70.00
    $320.00
    $70.00
    $60.00
    $370.00
    $140.00
    $300.00
    $42.00
    $188.25
    $745.00
    $140.00
    $865.00
    $529.75
    $529.75
    $160.00
    $20.00
    $160.00
    $81.00
    $33.75
    $35.00
    $15.00
    $500.00
    $144.00
    $200.00
    $400.00
    $109.10
    $100.00
    $40.00
    $200.00
    $100.00
    $80.00
    $1,200.00
    $100.00
    $300.00
    $140.00
    $900.00
    $390.00
    $100.00
    $150.00
    $320.00
    $400.00
    $150.00
    $475.00

    M310
    S136
    M633
    P343
    S136
    P007
    S136
    S091
    P014
    P447
    P465
    M298
    P106
    P106
    P011
    P066
    M298
    M298
    S450
    M211
    P093
    M006
    L065
    S159
    S159
    M378
    M378
    H005
    D141
    M378
    H005
    P435
    P005
    M378
    M378
    D141
    H023
    S220
    O156
    P005
    H006
    H006
    S277
    S277
    S220
    S220
    P005
    P001
    M454
    H006
    H006
    H006
    H006

    $125.00
    $250.00
    $100.00
    $204.89
    $200.00
    $49.95
    $200.00
    $160.00
    $45.85
    $107.45
    $399.00
    $240.00
    $96.45
    $119.00
    $555.00
    $93.00
    $40.00
    $920.00
    $6,000.00
    $200.00
    $100.70
    $300.00
    $440.00
    $400.00
    $200.00
    $400.00
    $125.00
    $674.50
    $300.00
    $350.00
    $280.00
    $356.99
    $1,418.70
    $350.00
    $50.00
    $360.00
    $3,819.85
    $220.00
    $150.00
    $451.02
    $900.00
    $5,385.00
    $150.00
    $2,000.00
    $220.00
    $150.00
    $451.02
    $286.60
    $800.00
    $2,200.00
    $350.00
    $300.00
    $3,900.50

    M229
    P055
    P055
    O001
    O001
    H025
    H025
    S383
    P055
    M229
    L001
    M326
    M030
    P031
    P031
    O001
    O001
    O001
    S375
    P066
    S046
    S046
    M186
    P487
    P487
    H026
    H026
    L075
    S216
    S216
    P343
    P005
    S235
    P435
    P005
    M300
    S069
    S069
    P507
    P343
    P507
    S235
    M771
    M771
    T051
    T051
    P435
    P435
    P427
    P427
    P005
    P435
    M657

    $140.00
    $3,553.00
    $2,655.25
    $110.00
    $173.04
    $260.00
    $300.00
    $260.00
    $6,501.65
    $140.00
    $303.80
    $250.00
    $160.00
    $99.60
    $137.99
    $110.00
    $930.75
    $1,207.00
    $200.00
    $278.64
    $350.00
    $50.00
    $85.00
    $133.32
    $10.10
    $379.95
    $80.00
    $1,900.00
    $1,200.00
    $600.00
    $167.30
    $5,363.94
    $300.00
    $494.68
    $818.12
    $320.00
    $300.00
    $1,200.00
    $637.10
    $224.24
    $27.00
    $300.00
    $300.00
    $400.00
    $750.00
    $393.00
    $156.11
    $17.35
    $48.60
    $5.40
    $617.70
    $678.92
    $200.00

    P435
    P435
    P435
    L075
    P435
    P435
    H005
    H005
    H005
    P427
    P427
    S159
    M673
    P435
    P427
    M657
    P005
    L140
    S159
    P427
    P427
    P427
    M657
    P427
    M299
    L034
    M299
    L061
    M299
    M299
    L061
    P337
    L061
    L061
    P337
    M187
    L97
    S007
    P231
    H023
    H023
    H023
    H023
    H023
    M001
    M001
    P476
    P399
    O002
    O002
    M156
    M156
    P145

    $178.12
    $19.79
    $678.92
    $3,400.00
    $92.91
    $10.32
    $800.00
    $1,400.00
    $12,862.72
    $1,047.60
    $116.40
    $20,000.00
    $5,000.00
    $1,883.58
    $153.85
    $200.00
    $312.88
    $1,640.00
    $800.00
    $276.50
    $63.00
    $189.00
    $200.00
    $235.90
    $150.00
    $400.00
    $60.00
    $145.00
    $25.00
    $265.00
    $180.00
    $54.00
    $300.00
    $205.00
    $90.00
    $200.00
    $250.00
    $440.00
    $94.50
    $750.00
    $3,000.00
    $2,190.00
    $25.00
    $25.00
    $160.00
    $50.00
    $33.60
    $138.50
    $70.00
    $495.00
    $100.00
    $200.00
    $275.00

    D31
    L143
    D41
    D41
    S458
    S458
    O163
    O163
    O163
    S136
    S136
    P014
    M858
    P014
    O006
    O006
    O001
    O006
    O006
    M230
    M858
    L054
    M104
    L070
    P466
    S123
    M167
    M167
    M167
    M327
    M327
    M327
    M327
    P426
    S375
    P235
    S375
    P001
    S375
    M053
    M053
    M053
    M053
    M345
    P014
    S184
    P014
    P014
    M345
    M304
    M345
    M188
    O001

    $325.00
    $500.00
    $1,000.00
    $500.00
    $300.00
    $300.00
    $70.00
    $1,245.00
    $1,200.00
    $200.00
    $300.00
    $65.00
    $200.00
    $406.25
    $500.00
    $900.00
    $110.00
    $1,095.00
    $700.00
    $300.00
    $300.00
    $300.00
    $360.00
    $230.00
    $151.50
    $400.00
    $140.00
    $25.00
    $35.00
    $80.00
    $140.00
    $60.00
    $60.00
    $188.00
    $200.00
    $2,457.00
    $200.00
    $100.93
    $200.00
    $75.00
    $65.00
    $20.00
    $140.00
    $200.00
    $421.00
    $300.00
    $83.60
    $10.80
    $200.00
    $585.00
    $200.00
    $100.00
    $250.00

    O001
    O001
    M188
    L082
    L082
    S096
    S096
    P140
    P140
    L013
    L013
    S439
    S367
    O161
    O161
    S367
    H006
    H006
    S306
    H025
    O004
    M184
    M184
    L001
    O004
    O004
    S090
    P034
    M215
    P014
    P014
    P022
    M215
    M053
    P435
    P435
    M053
    P435
    P435
    M053
    P435
    P435
    M053
    P435
    O007
    O007
    O007
    O007
    M053
    P435
    M053
    S046
    P435

    $1,020.00
    $1,440.75
    $100.00
    $240.00
    $625.00
    $300.00
    $300.00
    $1.40
    $119.00
    $4,990.00
    $475.00
    $300.00
    $340.00
    $800.00
    $600.00
    $260.00
    $450.00
    $150.00
    $400.00
    $150.00
    $200.00
    $60.00
    $140.00
    $260.00
    $100.00
    $2,056.00
    $180.00
    $77.00
    $250.00
    $369.00
    $118.50
    $175.00
    $250.00
    $140.00
    $108.41
    $303.55
    $140.00
    $24.12
    $365.98
    $140.00
    $32.37
    $239.97
    $140.00
    $141.05
    $100.00
    $675.00
    $1,440.00
    $100.00
    $140.00
    $646.62
    $140.00
    $400.00
    $255.31

    M053
    P435
    P435
    M053
    P435
    P435
    O004
    O004
    O004
    M630
    M630
    M089
    M089
    M630
    M630
    P435
    P435
    M630
    M630
    L034
    M630
    M630
    P435
    P435
    S281
    S281
    S281
    S281
    S281
    L049
    M630
    S281
    S281
    M630
    P435
    D58
    D58
    D58
    M077
    D219
    M687
    P437
    P437
    M786
    M786
    S086
    S086
    L070
    S086
    S086
    O004
    O004
    O004

    $140.00
    $153.45
    $58.19
    $140.00
    $108.23
    $56.51
    $100.00
    $1,196.00
    $1,280.00
    $75.00
    $105.00
    $180.00
    $180.00
    $75.00
    $105.00
    $126.64
    $31.66
    $75.00
    $105.00
    $500.00
    $75.00
    $105.00
    $105.45
    $26.36
    $150.00
    $250.00
    $364.44
    $91.11
    $410.00
    $600.00
    $180.00
    $400.00
    $200.00
    $180.00
    $98.29
    $35.00
    $25.00
    $450.00
    $600.00
    $200.00
    $250.00
    $55.50
    $420.75
    $120.00
    $120.00
    $300.00
    $450.00
    $400.00
    $1,200.00
    $1,200.00
    $100.00
    $2,396.00
    $680.00

    M388
    M388
    M388
    D309
    D309
    D309
    D309
    D309
    M786
    M786
    H008
    H008
    S032
    P140
    P492
    S032
    M159
    P283
    M159
    S209
    S256
    D260
    D260
    D260
    S256
    P011
    P011
    S256
    M386
    M386
    M386
    D41
    D41
    D41
    D41
    S391
    P014
    S391
    P014
    M304
    M304
    M304
    M304
    M608
    S007
    S281
    S281
    L006
    L070
    O154
    O154
    D413
    D413

    $150.00
    $25.00
    $125.00
    $35.00
    $15.00
    $50.00
    $400.00
    $20.00
    $100.00
    $20.00
    $450.00
    $1,581.80
    $5,300.00
    $125.75
    $115.50
    $1,000.00
    $900.00
    $255.95
    $160.00
    $200.00
    $350.00
    $300.00
    $100.00
    $400.00
    $350.00
    $126.00
    $16.00
    $180.00
    $125.00
    $25.00
    $75.00
    $100.00
    $140.00
    $360.00
    $500.00
    $280.00
    $61.95
    $280.00
    $127.95
    $140.00
    $400.00
    $25.00
    $75.00
    $200.00
    $400.00
    $800.00
    $400.00
    $400.00
    $650.00
    $475.00
    $360.00
    $80.00
    $35.00

    D413
    D413
    D413
    M046
    P049
    P049
    S005
    D129
    D129
    M030
    L001
    O033
    O033
    P115
    M156
    P115
    M156
    M156
    P115
    P115
    S174
    P435
    P435
    S210
    P115
    S210
    P115
    M156
    P115
    M156
    P115
    P115
    M156
    M156
    P115
    H023
    H023
    H44
    D31
    D31
    D31
    P014
    M630
    P435
    D51
    D51
    D51
    D291
    D291
    D291
    O033
    O033
    O033

    $285.00
    $350.00
    $200.00
    $60.00
    $51.00
    $30.50
    $300.00
    $140.00
    $330.00
    $160.00
    $325.00
    $100.00
    $567.00
    $3,285.00
    $100.00
    $2,235.00
    $100.00
    $100.00
    $3,285.00
    $2,235.00
    $300.00
    $471.39
    $18.00
    $100.00
    $2,133.00
    $100.00
    $3,285.00
    $100.00
    $2,202.00
    $100.00
    $3,285.00
    $2,202.00
    $100.00
    $100.00
    $3,285.00
    $2,437.50
    $62.50
    $6,050.00
    $35.00
    $40.00
    $150.00
    $153.30
    $180.00
    $263.55
    $180.00
    $70.00
    $600.00
    $400.00
    $210.00
    $190.00
    $134.00
    $96.00
    $190.00

    S151
    H005
    P022
    P427
    S089
    P435
    P014
    D78
    D78
    S458
    S242
    P430
    P467
    M694
    M694
    M694
    D253
    P106
    H025
    M124
    P001
    L070
    S151
    S151
    S151
    S286
    S286
    L128
    P031
    M124
    P435
    P034
    P034
    H011
    H011
    P286
    H011
    O065
    O065
    M183
    M183
    M186
    P397
    M189
    L065
    M463
    M463
    M463
    P115
    P011
    M015
    P005
    M015

    $3,150.00
    $969.00
    $132.00
    $66.00
    $450.00
    $14.70
    $52.50
    $42.00
    $1,058.00
    $300.00
    $850.00
    $168.20
    $79.00
    $700.00
    $25.00
    $75.00
    $900.00
    $247.50
    $240.00
    $750.00
    $1,076.70
    $1,855.00
    $400.00
    $300.00
    $170.00
    $350.00
    $100.00
    $700.00
    $876.98
    $250.00
    $151.53
    $106.80
    $92.70
    $750.00
    $215.00
    $500.00
    $257.00
    $150.00
    $3,300.00
    $150.00
    $140.00
    $220.00
    $130.00
    $120.00
    $630.00
    $400.00
    $200.00
    $300.00
    $49.00
    $16.00
    $200.00
    $1,734.24
    $200.00

    P115
    P005
    M346
    P499
    L075
    T073
    D60
    D60
    D60
    D60
    D60
    D60
    P014
    P003
    P003
    P014
    S384
    S384
    M341
    M341
    M341
    M341
    S384
    O001
    O001
    O001
    O001
    O001
    O001
    S281
    S281
    P014
    L149
    L147
    M120
    M120
    M120
    S367
    H006
    S374
    S374
    L139
    M814
    M814
    M814
    P337
    M814
    M814
    P195
    P272
    D113
    D113
    D113

    $190.65
    $3,791.97
    $320.00
    $150.00
    $3,610.00
    $900.00
    $50.00
    $300.00
    $50.00
    $70.00
    $300.00
    $300.00
    $273.00
    $199.80
    $299.80
    $210.00
    $100.00
    $300.00
    $100.00
    $40.00
    $80.00
    $20.00
    $400.00
    $110.00
    $675.75
    $561.00
    $110.00
    $400.00
    $1,062.00
    $400.00
    $200.00
    $106.00
    $150.00
    $250.00
    $140.00
    $80.00
    $93.00
    $260.00
    $7,540.00
    $350.00
    $350.00
    $650.00
    $70.00
    $30.00
    $40.00
    $65.00
    $100.00
    $500.00
    $84.00
    $73.58
    $100.00
    $50.00
    $110.00

    D113
    S071
    S071
    P014
    P014
    P014
    M189
    P077
    P115
    P115
    M067
    M067
    M067
    P049
    P435
    M067
    M164
    P077
    P106
    P106
    M851
    P014
    P106
    L025
    O004
    S165
    S165
    P106
    H006
    S165
    P014
    P106
    P106
    S266
    S266
    P055
    P022
    S323
    P055
    H023
    H023
    P435
    H023
    M550
    M452
    P421
    M452
    M452
    M452
    M452
    P421
    M550
    P435

    $850.00
    $84.00
    $566.00
    $184.15
    $44.48
    $9.17
    $140.00
    $140.00
    $51.60
    $74.90
    $160.00
    $25.00
    $55.00
    $87.50
    $221.46
    $760.00
    $120.00
    $46.00
    $597.00
    $285.00
    $500.00
    $40.95
    $1,791.00
    $575.00
    $100.00
    $360.00
    $4,000.00
    $298.50
    $4,500.00
    $300.00
    $119.25
    $60.00
    $597.00
    $400.00
    $200.00
    $651.95
    $60.00
    $450.00
    $228.00
    $241.00
    $4,380.00
    $82.57
    $2,170.00
    $800.00
    $250.00
    $88.20
    $540.00
    $250.00
    $810.00
    $250.00
    $166.60
    $300.00
    $1,507.68

    P055
    P055
    P435
    P435
    S323
    L079
    D60
    D60
    D60
    P469
    S245
    H011
    L121
    M297
    M297
    D60
    D60
    M297
    L116
    L116
    L021
    L174
    H011
    S245
    H011
    S316
    S239
    L97
    S300
    M139
    M139
    M139
    M139
    M139
    M139
    M139
    M139
    M139
    M851
    H034
    H034
    H005
    M851
    M851
    P014
    S111
    S111
    H011
    D414
    D414
    O001
    O001
    O001

    $420.60
    $270.00
    $27.24
    $59.28
    $1,060.00
    $630.00
    $85.00
    $65.00
    $60.00
    $102.50
    $400.00
    $360.00
    $700.00
    $120.00
    $20.00
    $60.00
    $200.00
    $610.00
    $119.50
    $52.00
    $1,445.00
    $800.00
    $400.00
    $300.00
    $580.00
    $400.00
    $200.00
    $800.00
    $300.00
    $100.00
    $700.00
    $200.00
    $40.00
    $100.00
    $1,000.00
    $100.00
    $25.00
    $675.00
    $500.00
    $610.00
    $1,180.00
    $2,500.00
    $200.00
    $300.00
    $158.85
    $300.00
    $200.00
    $300.00
    $60.00
    $440.00
    $110.00
    $745.00
    $1,730.00

    P034
    P034
    S214
    S214
    H005
    H005
    L065
    D143
    D143
    H023
    H023
    D141
    D141
    O004
    S084
    H006
    H006
    M189
    P059
    M002
    M002
    M002
    M002
    M189
    P059
    M189
    P059
    P059
    L025
    P011
    M393
    P343
    M393
    P343
    P005
    P005
    M393
    P005
    P005
    L081
    L081
    M393
    M393
    P005
    P005
    S091
    P049
    S091
    D205
    D205
    D205
    D205
    D60

    $254.80
    $277.50
    $350.00
    $1,500.00
    $400.00
    $1,592.00
    $1,225.00
    $3,700.00
    $400.00
    $375.00
    $50.00
    $300.00
    $300.00
    $100.00
    $300.00
    $3,000.00
    $440.00
    $140.00
    $720.00
    $130.00
    $50.00
    $130.00
    $135.00
    $140.00
    $720.00
    $140.00
    $95.00
    $20.00
    $190.00
    $45.50
    $220.00
    $175.15
    $220.00
    $268.00
    $412.04
    $518.58
    $60.00
    $518.58
    $412.04
    $400.00
    $345.72
    $370.00
    $950.00
    $691.44
    $412.00
    $160.00
    $90.10
    $160.00
    $4,000.00
    $450.00
    $300.00
    $135.00
    $50.00

    D60
    D60
    D60
    D60
    D60
    M254
    M254
    M254
    M152
    M152
    M152
    L067
    M152
    L067
    O002
    O002
    O002
    M152
    M152
    M152
    L121
    L074
    S138
    S138
    S138
    M345
    M345
    M345
    L147
    P484
    M345
    L147
    M345
    M345
    S386
    S004
    P005
    H006
    D48
    D48
    D48
    D48
    D48
    S346
    H003
    H003
    S346
    S346
    H003
    H003
    P247
    P005
    S346

    $105.00
    $75.00
    $300.00
    $300.00
    $200.00
    $200.00
    $250.00
    $300.00
    $150.00
    $25.00
    $95.00
    $80.00
    $150.00
    $120.00
    $50.00
    $707.50
    $862.50
    $150.00
    $25.00
    $95.00
    $250.00
    $70.00
    $250.00
    $25.00
    $25.00
    $200.00
    $25.00
    $175.00
    $100.00
    $71.50
    $200.00
    $450.00
    $25.00
    $275.00
    $500.00
    $600.00
    $698.48
    $3,330.00
    $50.00
    $100.00
    $14.00
    $25.00
    $25.00
    $300.00
    $1,750.00
    $11,369.30
    $5,200.00
    $10,200.00
    $7,000.00
    $687.95
    $42.75
    $367.82
    $400.00

    H023
    S346
    P247
    P005
    P104
    M304
    M304
    P247
    P247
    P247
    P247
    S346
    D148
    D148
    D148
    D148
    D148
    D148
    D148
    D148
    S228
    O178
    P140
    D420
    D420
    D420
    H011
    H011
    H011
    H011
    O002
    O002
    S250
    S446
    S160
    M189
    M189
    P059
    P059
    P059
    P059
    M265
    M265
    S069
    P167
    M020
    P039
    S069
    M136
    P039
    O001
    O001
    O001

    $1,600.00
    $200.00
    $135.00
    $349.24
    $185.00
    $100.00
    $100.00
    $507.64
    $126.91
    $92.56
    $23.14
    $200.00
    $600.00
    $100.00
    $400.00
    $100.00
    $156.00
    $3,344.00
    $120.00
    $300.00
    $300.00
    $1,500.00
    $140.00
    $250.00
    $250.00
    $80.00
    $350.00
    $250.00
    $5.60
    $1.40
    $50.00
    $950.00
    $300.00
    $300.00
    $200.00
    $120.00
    $140.00
    $120.00
    $25.00
    $252.00
    $152.00
    $80.00
    $120.00
    $450.00
    $244.00
    $160.00
    $330.00
    $450.00
    $160.00
    $199.00
    $110.00
    $925.00
    $1,010.00

    M851
    L126
    M138
    M138
    M138
    D173
    D173
    D173
    D173
    D173
    D173
    D38
    D38
    S242
    P497
    P497
    O001
    O001
    D113
    D113
    D113
    D113
    D113
    P483
    P483
    P483
    D412
    D426
    D426
    D426
    O065
    O065
    O065
    M067
    P077
    D397
    D397
    D397
    P034
    P034
    P034
    P034
    D114
    D114
    D114
    D114
    H005
    H005
    H005
    P122
    S001
    S001
    S001

    $500.00
    $550.00
    $100.00
    $25.00
    $75.00
    $140.00
    $70.00
    $90.00
    $450.00
    $450.00
    $400.00
    $85.00
    $215.00
    $250.00
    $83.00
    $23.00
    $110.00
    $1,674.00
    $80.00
    $450.00
    $140.00
    $310.00
    $80.00
    $115.00
    $45.80
    $134.65
    $300.00
    $350.00
    $1,600.00
    $470.00
    $150.00
    $1,080.00
    $540.00
    $320.00
    $1,386.00
    $400.00
    $170.00
    $330.00
    $5.00
    $176.25
    $106.15
    $269.80
    $120.00
    $340.00
    $70.00
    $10.00
    $455.00
    $254.84
    $200.00
    $123.80
    $400.00
    $100.00
    $750.00

    H005
    H023
    H023
    H023
    S450
    H006
    H006
    S450
    M246
    M657
    P090
    P090
    O001
    O001
    O001
    O001
    O001
    O001
    S266
    H021
    P353
    S314
    P073
    O004
    O004
    S019
    S019
    S019
    S019
    S019
    S019
    S019
    M666
    M666
    M666
    O076
    O076
    O076
    L025
    M068
    M068
    L081
    M068
    M068
    P203
    M215
    L96
    L070
    L96
    M215
    M215
    P014
    L091

    $455.00
    $375.00
    $532.00
    $178.80
    $300.00
    $300.00
    $1,000.00
    $3,700.00
    $1,000.00
    $200.00
    $1,232.00
    $2,420.80
    $50.00
    $220.00
    $750.00
    $645.00
    $450.00
    $1,320.00
    $400.00
    $613.80
    $2,208.00
    $300.00
    $454.70
    $100.00
    $180.00
    $780.00
    $360.00
    $240.00
    $780.00
    $25.00
    $135.00
    $260.00
    $160.00
    $50.00
    $30.00
    $90.00
    $1,885.50
    $1,695.00
    $200.00
    $300.00
    $125.00
    $375.00
    $300.00
    $390.00
    $143.81
    $250.00
    $500.00
    $980.00
    $700.00
    $250.00
    $250.00
    $118.50
    $350.00

    M026
    L001
    L001
    O002
    O002
    L075
    O177
    O177
    O177
    O177
    D276
    D276
    D276
    D276
    D276
    H047
    H047
    O007
    O007
    O007
    O007
    M814
    P457
    P457
    O004
    O004
    O004
    S277
    H006
    D129
    S277
    H006
    D103
    D103
    D103
    D103
    D103
    M225
    M225
    P055
    M225
    M225
    P055
    P055
    M225
    M225
    M225
    P055
    P011
    L001
    D103
    D103
    M613

    $440.00
    $210.00
    $185.00
    $1,657.50
    $2,120.75
    $3,800.00
    $100.00
    $1,890.00
    $1,935.00
    $150.00
    $60.00
    $128.00
    $32.00
    $140.00
    $160.00
    $75.00
    $325.00
    $100.00
    $700.00
    $627.50
    $810.00
    $100.00
    $32.00
    $8.00
    $200.00
    $1,356.00
    $1,656.00
    $300.00
    $506.00
    $300.00
    $300.00
    $625.00
    $320.00
    $120.00
    $35.00
    $140.00
    $320.00
    $220.00
    $280.00
    $70.00
    $220.00
    $50.00
    $15.25
    $189.70
    $220.00
    $130.00
    $100.00
    $79.75
    $101.00
    $1,990.00
    $1,720.00
    $5,080.00
    $2,400.00

    D103
    D103
    D103
    D103
    D103
    D103
    M225
    M225
    M225
    M225
    M225
    M188
    M188
    M188
    S194
    L013
    P167
    O168
    O168
    O168
    O168
    O168
    O168
    H011
    H011
    H011
    H011
    S226
    P435
    P435
    P231
    P011
    P372
    S226
    P173
    P073
    H023
    P011
    S295
    P467
    P467
    O151
    O151
    S295
    S295
    S295
    US01
    P467
    P487
    O065
    O065
    P169
    M067

    $140.00
    $320.00
    $140.00
    $140.00
    $320.00
    $140.00
    $440.00
    $170.00
    $170.00
    $40.00
    $70.00
    $140.00
    $25.00
    $75.00
    $300.00
    $127.00
    $156.45
    $90.00
    $1,195.00
    $1,520.00
    $90.00
    $1,345.00
    $1,520.00
    $550.00
    $365.00
    $485.00
    $250.00
    $1,600.00
    $2,960.02
    $174.42
    $1,822.50
    $204.00
    $805.20
    $1,600.00
    $1,704.75
    $2,862.50
    $1,656.20
    $405.00
    $300.00
    $201.60
    $7.00
    $895.00
    $400.00
    $300.00
    $400.00
    $300.00
    $2,890.80
    $35.00
    $696.86
    $250.00
    $340.00
    $240.50
    $600.00

    M067
    P011
    P011
    H011
    H011
    H011
    H011
    S386
    P498
    S237
    S250
    M183
    H011
    H011
    S250
    S237
    M167
    M167
    M167
    H005
    H005
    H005
    H005
    H005
    S114
    S114
    S114
    S114
    P427
    S137
    S137
    S137
    S137
    S137
    S137
    S137
    S137
    S137
    L025
    P435
    O076
    O076
    O076
    M791
    M791
    M791
    M791
    M791
    P353
    P353
    P353
    P353
    P353

    $160.00
    $176.00
    $185.00
    $510.00
    $30.00
    $160.00
    $395.00
    $300.00
    $42.00
    $500.00
    $300.00
    $700.00
    $700.00
    $2,960.00
    $10,000.00
    $900.00
    $140.00
    $25.00
    $35.00
    $274.32
    $180.68
    $35.64
    $23.47
    $297.81
    $2,000.00
    $25.00
    $25.00
    $200.00
    $252.70
    $800.00
    $450.00
    $25.00
    $1,200.00
    $800.00
    $450.00
    $25.00
    $1,200.00
    $450.00
    $220.00
    $181.53
    $90.00
    $1,440.75
    $1,395.00
    $200.00
    $200.00
    $300.00
    $200.00
    $110.00
    $195.00
    $59.60
    $1,306.00
    $130.00
    $268.00

    S144
    P430
    P140
    S030
    D171
    D171
    D171
    D171
    D171
    D152
    D152
    D152
    P090
    S118
    P090
    P090
    P090
    H005
    S266
    P090
    S314
    P090
    P005
    L140
    L140
    L140
    L070
    L070
    M505
    P049
    L081
    L152
    L112
    M505
    M505
    M505
    L152
    M505
    P049
    P049
    S165
    P246
    L018
    S076
    P422
    P422
    M076
    M076
    M076
    M076
    M076
    P388
    P422

    $600.00
    $206.50
    $1,685.95
    $240.00
    $100.00
    $350.00
    $100.00
    $60.00
    $240.00
    $200.00
    $300.00
    $500.00
    $269.90
    $700.00
    $45.80
    $15.50
    $214.65
    $200.00
    $400.00
    $307.50
    $300.00
    $93.35
    $219.95
    $180.00
    $400.00
    $60.00
    $216.00
    $689.00
    $180.00
    $4,221.00
    $900.00
    $810.00
    $8,847.60
    $180.00
    $25.00
    $175.00
    $385.00
    $180.00
    $74.00
    $92.25
    $360.00
    $128.90
    $300.00
    $350.00
    $206.15
    $241.80
    $225.00
    $225.00
    $240.00
    $50.00
    $10.00
    $75.00
    $80.60

    O001
    O001
    S076
    P422
    S165
    S165
    M076
    M076
    S044
    S044
    P246
    P076
    P076
    S286
    S286
    S286
    L065
    M076
    M076
    P487
    P487
    S044
    S044
    P014
    P014
    P014
    S220
    D143
    D04
    D04
    O011
    O011
    O011
    M215
    P286
    P286
    P068
    L97
    M692
    L065
    S159
    L075
    S159
    O004
    O004
    S044
    S375
    P011
    S083
    S083
    P031
    O015
    O015

    $110.00
    $1,819.00
    $250.00
    $214.90
    $75.00
    $225.00
    $75.00
    $175.00
    $300.00
    $300.00
    $76.00
    $84.96
    $21.24
    $150.00
    $150.00
    $150.00
    $153.00
    $225.00
    $525.00
    $36.07
    $9.02
    $175.00
    $125.00
    $101.32
    $7.83
    $17.50
    $240.00
    $1,200.00
    $80.00
    $120.00
    $80.00
    $780.00
    $2,000.00
    $500.00
    $750.00
    $165.00
    $63.90
    $800.00
    $500.00
    $610.00
    $400.00
    $3,610.00
    $400.00
    $200.00
    $180.00
    $400.00
    $300.00
    $146.00
    $400.00
    $200.00
    $62.00
    $450.00
    $2,090.00

    O015
    US01
    D141
    S244
    S244
    D141
    M225
    M225
    P022
    P022
    P487
    P094
    O156
    O001
    O001
    P011
    S111
    P286
    M562
    M562
    M562
    O065
    O065
    M304
    P104
    M411
    P465
    P465
    M411
    P465
    M700
    M249
    P014
    D78
    D78
    P022
    L033
    O004
    O004
    P380
    P380
    D238
    S426
    L065
    L065
    S419
    S419
    P005
    M657
    P215
    S055
    P155
    S055

    $3,390.00
    $7,745.32
    $300.00
    $300.00
    $200.00
    $260.00
    $660.00
    $390.00
    $354.05
    $112.35
    $195.48
    $83.15
    $300.00
    $1,695.00
    $1,760.00
    $292.50
    $300.00
    $159.79
    $150.00
    $100.00
    $140.00
    $150.00
    $68.00
    $185.00
    $150.60
    $130.00
    $15.00
    $101.80
    $130.00
    $65.00
    $100.00
    $120.00
    $228.20
    $300.00
    $400.00
    $39.50
    $605.00
    $2,716.00
    $1,656.00
    $622.50
    $90.00
    $1,100.00
    $600.00
    $900.00
    $880.00
    $250.00
    $25.00
    $617.10
    $200.00
    $313.60
    $200.00
    $90.00
    $1,700.00

    H023
    H023
    O001
    O001
    O001
    D380
    D380
    D380
    S329
    S329
    M138
    M138
    M138
    T034
    T034
    D78
    P435
    S083
    H023
    S083
    M707
    S361
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    D180
    S231
    T060
    UN01
    UN01
    S141
    O076
    O076
    T064
    S217
    T064
    T064
    M353
    M353
    P049
    D04
    D04
    D04

    $2,000.00
    $1,800.00
    $110.00
    $1,125.00
    $970.00
    $160.00
    $160.00
    $500.00
    $60.00
    $240.00
    $100.00
    $25.00
    $55.00
    $2,475.00
    $800.00
    $400.00
    $30.21
    $2,100.00
    $4,353.56
    $7,762.50
    $1,200.00
    $250.00
    $100.00
    $35.00
    $165.00
    $350.00
    $100.00
    $70.00
    $130.00
    $400.00
    $2,280.00
    $460.00
    $100.00
    $70.00
    $130.00
    $400.00
    $200.00
    $1,040.00
    $300.00
    $580.00
    $4,165.00
    $180.00
    $472.50
    $1,040.00
    $400.00
    $1,370.00
    $2,590.00
    $300.00
    $70.00
    $182.85
    $85.00
    $115.00
    $100.00

    D04
    D04
    D04
    D04
    S083
    S083
    D421
    D421
    D421
    L025
    M421
    M851
    L065
    P427
    P427
    S290
    M463
    M463
    O001
    O001
    O001
    L97
    O001
    O001
    O001
    M230
    P475
    P475
    M144
    P467
    M598
    M598
    M144
    L041
    P369
    S223
    S223
    M602
    L041
    D114
    D114
    D114
    D114
    D114
    US01
    US01
    US01
    US01
    M814
    O076
    O076
    O076
    P076

    $200.00
    $200.00
    $80.00
    $100.00
    $700.00
    $200.00
    $400.00
    $100.00
    $400.00
    $285.00
    $450.00
    $300.00
    $700.00
    $35.25
    $188.40
    $2,540.00
    $250.00
    $150.00
    $110.00
    $895.00
    $1,720.00
    $200.00
    $110.00
    $895.00
    $1,350.00
    $300.00
    $40.00
    $235.00
    $200.00
    $313.85
    $200.00
    $110.00
    $200.00
    $390.00
    $146.15
    $600.00
    $2,500.00
    $600.00
    $2,000.00
    $120.00
    $70.00
    $10.00
    $340.00
    $1,080.00
    $1,615.44
    $1,097.10
    $3,185.72
    $1,025.02
    $100.00
    $90.00
    $930.75
    $1,080.00
    $98.25

    P076
    L147
    M230
    M230
    M230
    P435
    P435
    P435
    UN01
    M451
    L049
    D78
    D78
    Missing
    S300
    D64
    D64
    D64
    M229
    L001
    S041
    L006
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01
    EC01

    $36.25
    $210.00
    $300.00
    $25.00
    $175.00
    $141.71
    ($141.71)
    $141.71
    $600.00
    $300.00
    $180.00
    $100.00
    $800.00
    $300.00
    $300.00
    $35.00
    $15.00
    $350.00
    $160.00
    $510.00
    $800.00
    $520.00
    $288.00
    $264.00
    $120.00
    $360.00
    $868.80
    $552.00
    $120.00
    $345.60
    $299.52
    $168.00
    $180.00
    $168.00
    $293.76
    $144.00
    $240.00
    $86.40
    $24.00
    $167.04
    $120.00
    $117.50
    $2,548.80
    $168.00
    $360.00
    $96.00
    $360.00
    $1,392.00
    $240.00
    $903.60
    $68.40
    $288.00
    $288.00

    EC01
    EC01
    S192
    P106
    P248
    L061
    D04
    D04
    S312
    P011
    D04
    D04
    S453
    O147
    O004
    O004
    D283
    D283
    O163
    O163
    O163
    H011
    H011
    H011
    S446
    S237
    H011
    M304
    P337
    S111
    S111
    O001
    O001
    O001
    D22
    D22
    D22
    D22
    D22
    D22
    D22
    S103
    L070
    D391
    P469
    P071
    D391
    D391
    D438
    D438
    D438
    P465
    D391

    $192.00
    $2,606.40
    $800.00
    $439.80
    $378.00
    $540.00
    $100.00
    $185.00
    $250.00
    $125.00
    $100.00
    $200.00
    $250.00
    $800.00
    $100.00
    $2,056.00
    $150.00
    $350.00
    $70.00
    $1,000.00
    $800.00
    $400.00
    $1,000.00
    $5,890.00
    $10,000.00
    $1,500.00
    $55.00
    $140.00
    $120.00
    $40.00
    $60.00
    $100.00
    $1,130.00
    $895.00
    $300.00
    $650.00
    $350.00
    $680.00
    $80.00
    $320.00
    $380.00
    $400.00
    $200.00
    $100.00
    $125.00
    $117.50
    $800.00
    $120.00
    $200.00
    $380.00
    $2,500.00
    $243.40
    $1,140.00

    D391
    D129
    D129
    D129
    D129
    D129
    D129
    P055
    P372
    D283
    D283
    D283
    M008
    M008
    M008
    M008
    S403
    S403
    D327
    D327
    D327
    D327
    L034
    L034
    L061
    L061
    P005
    P014
    H006
    H006
    M463
    S426
    L065
    H006
    H006
    S426
    D182
    D182
    D182
    D182
    P011
    P011
    P005
    D283
    D283
    D283
    D283
    D283
    D283
    D283
    M310
    M310
    M310

    $260.00
    $80.00
    $50.00
    $80.00
    $320.00
    $80.00
    $280.00
    $537.90
    $566.10
    $75.00
    $525.00
    $600.00
    $220.00
    $10.00
    $30.00
    $20.00
    $300.00
    $600.00
    $150.00
    $95.00
    $305.00
    $300.00
    $360.00
    $800.00
    $1,180.00
    $388.50
    $40.27
    $142.50
    $540.00
    $45.00
    $200.00
    $600.00
    $440.00
    $315.00
    $675.00
    $900.00
    $600.00
    $3,400.00
    $3,000.00
    $1,500.00
    $170.50
    $2,200.00
    $1,231.66
    $272.00
    $100.00
    $128.00
    $100.00
    $80.00
    $304.00
    $96.00
    $150.00
    $275.00
    $290.00

    D283
    D283
    D283
    D283
    L065
    P011
    P066
    P005
    S426
    P458
    P458
    D104
    D104
    D23
    D23
    D23
    M505
    L152
    M505
    M505
    P478
    M505
    M505
    L152
    P478
    P478
    P478
    S109
    O134
    O134
    M505
    M505
    M505
    P478
    L97
    S300
    D393
    D393
    M647
    M647
    M647
    M647
    M647
    P504
    L070
    L070
    L070
    P478
    O007
    O007
    O007
    P465
    P465

    $1,280.00
    $620.00
    $320.00
    $180.00
    $395.00
    $340.00
    $393.00
    $1,269.38
    $300.00
    $1,270.10
    $10.00
    $200.00
    $600.00
    $50.00
    $100.00
    $290.00
    $360.00
    $655.00
    $25.00
    $75.00
    $315.00
    $360.00
    $200.00
    $660.00
    $305.20
    $120.00
    $225.00
    $200.00
    $900.00
    $660.00
    $180.00
    $25.00
    $75.00
    $147.00
    $200.00
    $300.00
    $60.00
    $120.00
    $80.00
    $25.00
    $235.00
    $240.00
    $220.00
    $1,326.40
    $390.00
    $200.00
    $200.00
    $27.80
    $100.00
    $1,160.00
    $290.00
    $304.80
    $50.75

    L97
    S214
    S214
    P148
    S004
    M225
    M225
    M225
    L001
    M225
    M225
    M030
    P507
    P507
    P031
    P055
    M225
    P031
    L006
    M225
    S136
    P435
    S136
    P435
    S296
    S296
    S296
    S296
    S120
    P014
    H006
    H006
    H006
    S191
    S191
    M246
    M246
    H006
    P353
    P353
    H006
    H006
    P167
    P349
    P167
    M751
    M751
    P014
    P472
    P215
    M751
    P472
    O076

    $300.00
    $300.00
    $2,000.00
    $202.25
    $400.00
    $220.00
    $180.00
    $80.00
    $958.50
    $220.00
    $80.00
    $160.00
    $520.80
    $45.64
    $50.27
    $179.30
    $50.00
    $107.10
    $200.00
    $220.00
    $400.00
    $227.27
    $600.00
    $15.00
    $300.00
    $400.00
    $800.00
    $1,500.00
    $300.00
    $36.40
    $450.00
    $315.00
    $3,600.00
    $3,600.00
    $1,900.00
    $900.00
    $600.00
    $121.50
    $174.40
    $43.60
    $1,400.00
    $915.00
    $393.05
    $643.30
    $393.05
    $240.00
    $495.00
    $160.00
    $274.60
    $1,163.35
    $120.00
    $462.00
    $90.00

    O076
    O076
    H006
    H006
    H006
    P005
    P404
    O076
    O076
    O076
    M140
    M140
    P360
    P360
    M140
    P360
    P360
    M001
    P068
    P068
    S551
    L021
    P476
    D253
    D253
    D253
    D253
    H011
    H011
    S250
    P091
    S120
    P093
    D41
    D41
    D41
    P353
    D41
    D41
    O001
    M067
    M067
    P303
    P303
    D192
    D192
    D192
    D192
    D192
    D192
    D303
    D303
    D303

    $985.00
    $1,080.00
    $125.00
    $60.00
    $120.00
    $2,126.07
    $330.00
    $90.00
    $925.50
    $1,030.50
    $150.00
    $150.00
    $152.25
    $42.00
    $150.00
    $367.00
    $35.00
    $200.00
    $162.00
    $118.05
    $500.00
    $450.00
    $339.00
    $100.00
    $25.00
    $25.00
    $800.00
    $500.00
    $1,000.00
    $2,000.00
    $92.00
    $240.00
    $43.70
    $100.00
    $300.00
    $200.00
    $84.00
    $500.00
    $200.00
    $110.00
    $160.00
    $80.00
    $72.00
    $23.95
    $620.00
    $50.00
    $50.00
    $300.00
    $120.00
    $680.00
    $250.00
    $500.00
    $150.00

    D303
    D303
    D303
    D303
    D303
    D303
    D303
    P154
    P154
    P443
    P154
    P154
    P154
    P154
    O076
    O076
    L97
    P154
    D297
    D297
    D297
    D297
    D297
    D297
    D63
    D63
    D63
    D07
    D07
    D07
    P131
    S323
    S323
    M139
    M139
    M139
    M139
    S445
    H006
    S445
    P353
    P353
    O004
    M353
    M353
    P034
    P435
    P435
    S162
    P068
    P435
    L018
    L018

    $300.00
    $150.00
    $120.00
    $880.00
    $100.00
    $500.00
    $300.00
    $310.65
    $30.00
    $69.50
    $106.45
    $15.95
    $16.10
    $12.40
    $180.00
    $405.00
    $300.00
    $54.00
    $70.00
    $75.00
    $125.00
    $400.00
    $180.00
    $180.00
    $170.00
    $230.00
    $200.00
    $325.00
    $70.00
    $150.00
    $360.00
    $350.00
    $300.00
    $100.00
    $30.00
    $190.00
    $80.00
    $2,520.00
    $225.00
    $880.00
    $125.00
    $555.00
    $1,056.00
    $150.00
    $150.00
    $19.95
    $97.20
    $193.54
    $300.00
    $192.45
    $109.50
    $120.00
    $180.00

    O033
    O033
    L97
    L97
    L97
    S300
    O058
    O058
    O058
    D51
    D51
    D51
    P353
    S197
    D102
    D102
    M297
    L116
    P179
    M114
    P419
    M020
    P014
    D188
    D188
    D188
    M020
    P484
    P484
    P167
    M020
    M020
    M020
    L034
    P191
    P191
    S355
    L041
    P445
    M461
    M461
    M461
    M014
    M014
    M014
    M014
    M317
    O001
    O001
    O001
    L091
    L091
    L091

    $230.00
    $150.00
    ($250.00)
    $250.00
    $250.00
    $300.00
    $80.00
    $1,700.00
    $650.00
    $300.00
    $200.00
    $400.00
    $235.00
    $300.00
    $1,000.00
    $3,000.00
    $250.00
    $200.00
    $185.00
    $40.00
    $121.80
    $160.00
    $239.85
    $360.00
    $50.00
    $50.00
    $160.00
    $54.00
    $16.00
    $46.90
    $350.00
    $25.00
    $95.00
    $800.00
    $164.99
    $136.50
    $300.00
    $260.00
    $152.90
    $150.00
    $25.00
    $265.00
    $140.00
    $25.00
    $40.00
    $70.00
    $120.00
    $110.00
    $575.00
    $1,010.00
    $400.00
    $149.50
    $22.50

    L091
    L091
    L091
    L091
    L091
    M317
    P498
    M317
    M317
    S385
    L065
    P005
    M127
    L091
    M799
    M310
    M310
    M310
    O011
    O011
    O011
    O011
    O011
    O011
    M346
    M346
    M346
    M346
    M346
    M346
    S198
    P031
    S198
    P073
    S103
    S103
    P031
    P031
    P031
    P073
    P005
    M310
    M310
    S080
    S080
    L075
    M310
    H023
    H023
    H023
    M402
    M402
    M402

    $900.00
    $700.00
    $500.00
    $145.00
    $375.00
    $240.00
    $231.30
    $240.00
    $130.00
    $400.00
    $175.00
    $1,488.44
    $300.00
    $1,075.00
    $300.00
    $150.00
    $225.00
    $420.00
    $80.00
    $690.00
    $700.00
    $80.00
    $780.00
    $1,500.00
    $100.00
    $25.00
    $75.00
    $100.00
    $25.00
    $75.00
    $400.00
    $1,545.09
    $800.00
    $2,698.20
    $800.00
    $3,500.00
    $434.70
    $89.10
    $1,500.00
    $1,798.80
    $899.40
    $80.00
    $170.00
    $80.00
    $220.00
    $3,800.00
    $100.00
    $440.00
    $310.00
    $7,629.00
    $100.00
    $25.00
    $75.00

    P430
    M647
    M647
    P504
    M647
    M647
    M647
    M647
    P504
    M580
    M580
    M580
    L041
    M647
    M647
    M647
    S191
    S191
    H006
    H006
    P435
    M045
    L001
    D81
    D81
    D81
    D81
    D81
    D81
    D81
    D81
    D81
    S083
    S083
    M224
    P022
    P022
    M167
    M167
    M167
    M167
    M167
    M167
    M167
    M586
    M586
    P306
    P437
    O065
    O065
    O065
    O065
    H023

    $260.40
    $80.00
    $60.00
    $220.00
    $80.00
    $25.00
    $35.00
    $210.00
    $60.00
    $100.00
    $500.00
    $400.00
    $300.00
    $160.00
    $50.00
    $270.00
    $600.00
    $400.00
    $180.00
    $500.00
    $753.41
    $150.00
    $355.00
    $120.00
    $35.00
    $45.00
    $180.00
    $1,620.00
    $320.00
    $480.00
    $720.00
    $560.00
    $400.00
    $150.00
    $300.00
    $161.85
    $31.75
    $60.00
    $80.00
    $120.00
    $60.00
    $80.00
    $96.00
    $24.00
    $60.00
    $140.00
    $69.80
    $62.40
    $50.00
    $300.00
    $800.00
    $150.00
    $375.00

    H023
    H023
    H023
    H023
    P031
    M630
    P031
    M089
    P435
    S112
    P014
    O004
    O004
    O004
    O004
    S195
    S195
    M662
    M662
    M662
    H005
    P122
    P122
    M229
    L001
    M105
    L124
    M028
    O076
    O076
    M028
    M028
    O076
    O076
    O004
    O004
    O004
    O004
    L133
    O108
    O108
    O108
    O015
    O015
    D263
    D263
    D263
    D263
    M758
    M248
    P458
    O076
    O076

    $127.28
    $200.00
    $730.00
    $180.00
    $213.29
    $200.00
    $335.98
    $180.00
    $303.48
    $300.00
    $35.50
    $100.00
    $476.00
    $556.00
    $180.00
    $500.00
    $1,800.00
    $100.00
    $45.00
    $55.00
    $630.00
    $84.15
    $9.35
    $200.00
    $505.00
    $170.00
    $440.00
    $235.00
    $1,325.75
    $1,925.75
    $100.00
    $15.00
    $840.00
    $846.75
    $425.00
    $771.00
    $200.00
    $916.00
    $3,900.00
    $90.00
    $1,390.00
    $1,970.00
    $130.00
    $2,690.00
    $150.00
    $350.00
    $70.00
    $230.00
    $220.00
    $100.00
    $87.50
    $90.00
    $930.75

    O076
    O076
    O076
    O076
    M019
    M019
    P154
    S302
    S302
    S019
    S019
    S019
    S019
    S019
    S019
    S114
    D411
    D411
    D411
    S019
    S019
    S019
    S428
    H006
    S314
    D421
    D421
    D421
    D421
    D421
    H025
    H025
    M456
    M456
    M456
    H008
    M456
    M456
    P055
    S418
    P005
    P005
    M215
    P256
    L070
    L96
    D141
    D141
    D141
    D141
    D141
    D141
    S296

    $825.00
    $90.00
    $642.24
    $1,293.63
    $200.00
    $260.00
    $284.50
    $360.00
    $140.00
    $260.00
    $25.00
    $335.00
    $260.00
    $25.00
    $255.00
    $400.00
    $200.00
    $100.00
    $50.00
    $260.00
    $25.00
    $335.00
    $1,050.00
    $165.00
    $300.00
    $50.00
    $400.00
    $70.00
    $30.00
    $100.00
    $240.00
    $60.00
    $140.00
    $25.00
    $35.00
    $182.00
    $140.00
    $160.00
    $151.35
    $400.00
    $578.85
    $578.85
    $250.00
    $165.30
    $2,250.00
    $1,800.00
    $400.00
    $140.00
    $360.00
    $400.00
    $140.00
    $360.00
    $2,400.00

    S296
    S296
    M577
    P435
    M124
    M124
    P435
    M152
    P008
    P034
    P008
    D60
    D60
    D60
    S112
    M735
    M735
    O033
    O033
    O033
    D113
    M580
    M580
    M580
    M580
    M580
    S089
    M029
    M029
    M029
    D137
    M019
    P318
    P318
    P073
    P005
    P005
    P245
    M456
    P057
    P057
    M456
    M456
    M456
    S122
    P245
    D436
    D436
    D436
    D436
    D436
    O004
    O004

    $1,250.00
    $400.00
    $200.00
    $490.69
    $250.00
    $50.00
    $85.07
    $300.00
    $46.15
    $189.00
    $357.00
    $50.00
    $200.00
    $200.00
    $300.00
    $250.00
    $350.00
    $100.00
    $845.75
    $348.50
    $950.00
    $100.00
    $200.00
    $400.00
    $200.00
    $200.00
    $850.00
    $100.00
    $20.00
    $20.00
    $850.00
    $300.00
    $162.85
    $179.40
    $654.03
    $312.88
    $312.88
    $378.35
    $140.00
    $100.00
    $54.00
    $120.00
    $200.00
    $1,400.00
    $600.00
    $359.10
    $70.00
    $375.00
    $70.00
    $55.00
    $180.00
    $100.00
    $1,196.00

    O004
    S384
    S384
    M304
    S011
    S198
    L046
    L001
    O004
    O004
    M156
    M156
    M156
    P145
    M255
    M255
    M255
    M469
    M469
    M469
    O151
    O151
    O151
    M390
    M390
    M390
    M390
    M390
    M390
    M390
    M390
    M390
    M390
    M390
    O156
    O156
    O156
    O156
    M353
    H026
    L021
    M835
    M835
    M835
    M835
    M835
    M835
    M835
    M866
    M866
    M866
    D371
    D371

    $1,016.00
    $400.00
    $400.00
    $125.00
    $300.00
    $700.00
    $140.00
    $215.00
    $100.00
    $1,576.00
    $100.00
    $25.00
    $125.00
    $345.00
    $100.00
    $40.00
    $60.00
    $80.00
    $80.00
    $60.00
    $75.00
    $895.00
    $1,295.00
    $150.00
    $150.00
    $95.00
    $150.00
    $150.00
    $360.00
    $150.00
    $400.00
    $100.00
    $120.00
    $105.00
    $100.00
    $100.00
    $1,124.25
    $993.75
    $300.00
    $97.00
    $500.00
    $300.00
    $202.50
    $197.50
    $125.00
    $200.00
    $1,345.00
    $300.00
    $125.00
    $200.00
    $400.00
    $280.00
    $370.00

    M331
    M331
    P076
    M464
    M464
    P076
    D134
    D134
    D134
    P066
    M297
    M297
    P075
    P075
    M297
    M297
    L116
    P014
    P014
    P076
    P076
    O011
    O011
    O011
    M390
    M390
    M103
    M103
    M103
    M103
    M103
    L021
    M103
    P014
    L021
    M103
    M331
    M331
    M331
    M667
    P168
    O011
    O011
    O011
    M006
    H034
    P076
    O175
    O175
    O175
    D143
    D143
    S001

    $280.00
    $400.00
    $298.70
    $400.00
    $600.00
    $127.95
    $400.00
    $70.00
    $30.00
    $430.74
    $610.00
    $250.00
    $275.90
    $56.00
    $60.00
    $200.00
    $180.00
    $39.20
    $62.79
    $31.95
    $41.30
    $80.00
    $290.00
    $600.00
    $200.00
    $510.00
    $140.00
    $20.00
    $140.00
    $140.00
    $20.00
    $320.00
    $140.00
    $54.60
    $400.00
    $20.00
    $280.00
    $50.00
    $350.00
    $200.00
    $57.30
    $80.00
    $1,610.00
    $1,900.00
    $160.00
    $510.00
    $86.10
    $50.00
    $1,350.00
    $1,800.00
    $85.00
    $715.00
    $400.00

    S001
    S001
    L021
    D143
    M393
    P155
    P155
    S384
    S384
    S384
    P011
    P435
    S281
    S281
    L049
    M317
    M317
    M317
    M317
    M317
    M317
    M317
    S343
    L170
    M341
    M341
    S029
    D171
    H034
    H034
    O131
    O131
    O131
    O065
    O065
    O065
    D59
    D59
    D59
    D59
    D345
    M152
    M152
    M152
    L021
    M087
    P353
    P353
    M087
    M087
    M514
    L021
    S130

    $200.00
    $200.00
    $160.00
    $1,600.00
    $250.00
    $257.90
    $122.00
    $400.00
    $800.00
    $800.00
    $240.00
    $578.66
    $400.00
    $200.00
    $600.00
    $120.00
    $70.00
    $5.00
    $120.00
    $70.00
    $120.00
    $70.00
    $300.00
    $180.00
    $140.00
    $60.00
    $160.00
    $280.00
    $100.00
    $1,710.00
    $70.00
    $1,300.00
    $800.00
    $150.00
    $675.00
    $1,242.00
    $70.00
    $430.00
    $35.00
    $45.00
    $700.00
    $300.00
    $25.00
    $95.00
    $250.00
    $180.00
    $179.10
    $19.90
    $300.00
    $140.00
    $200.00
    $460.00
    $100.00

    L169
    P179
    P179
    S130
    S130
    M390
    M390
    M390
    M390
    M390
    M799
    M799
    M230
    M230
    L032
    P337
    M230
    M230
    P014
    P014
    M077
    M077
    M230
    M230
    P014
    P337
    P337
    P337
    D113
    O162
    O162
    O162
    M300
    P094
    D190
    D190
    D190
    D190
    S120
    S136
    S136
    S136
    S136
    S136
    S120
    S120
    P104
    P104
    O001
    O001
    O001
    M067
    L020

    $150.00
    $115.00
    $36.00
    $100.00
    $40.00
    $175.00
    $35.00
    $285.00
    $150.00
    $340.00
    $300.00
    $200.00
    $300.00
    $300.00
    $250.00
    $160.00
    $300.00
    $300.00
    $34.10
    $216.75
    $480.00
    $300.00
    $900.00
    $400.00
    $105.00
    $649.50
    $396.00
    $242.00
    $4,400.00
    $75.00
    $1,475.00
    $895.00
    $160.00
    $103.60
    $50.00
    $35.00
    $5.00
    $2,000.00
    $300.00
    $200.00
    $25.00
    $35.00
    $200.00
    $160.00
    $540.00
    $300.00
    $122.95
    $29.89
    $110.00
    $1,300.00
    $1,520.00
    $420.00
    $360.00

    L065
    L149
    M189
    O063
    O065
    L025
    M189
    L025
    L126
    S347
    M189
    P059
    H011
    H011
    H011
    M189
    P059
    S250
    S245
    P286
    S245
    P115
    S245
    L065
    L065
    M189
    L149
    M189
    M575
    M138
    M138
    M138
    L121
    D41
    D41
    M103
    M103
    L021
    H011
    D41
    P093
    D41
    D41
    S383
    S086
    S086
    S086
    S086
    S086
    S086
    D228
    D228
    D228

    $290.00
    $150.00
    $120.00
    $150.00
    $1,150.00
    $160.00
    $280.00
    $235.00
    $300.00
    $300.00
    $140.00
    $96.00
    $550.00
    $250.00
    $184.00
    $140.00
    $25.00
    $300.00
    $400.00
    $690.00
    $300.00
    $96.95
    $300.00
    $250.00
    $375.00
    $140.00
    $150.00
    $120.00
    $100.00
    $100.00
    $25.00
    $55.00
    $650.00
    $712.50
    $287.50
    $50.00
    $90.00
    $200.00
    $21.00
    $400.00
    $91.00
    $170.00
    $330.00
    $260.00
    $350.00
    $1,200.00
    $1,200.00
    $1,800.00
    $1,200.00
    $1,600.00
    $350.00
    $70.00
    $80.00

    D228
    P443
    M104
    L070
    O001
    O001
    S432
    P453
    P453
    M386
    M386
    M386
    M386
    M647
    M647
    M647
    S103
    L013
    O004
    O004
    O004
    M647
    M647
    M647
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    D189
    S071
    S071
    P450
    P450
    DT04
    DT04
    M786
    M683
    M683
    D38
    D38
    D278
    D278
    M733
    M733
    M733
    M733
    M733

    $450.00
    $157.50
    $160.00
    $680.00
    $110.00
    $1,462.00
    $260.00
    $346.75
    $407.50
    $365.00
    $31.00
    $26.00
    $30.00
    $160.00
    $50.00
    $270.00
    $700.00
    $699.00
    $100.00
    $1,276.00
    $1,516.00
    $80.00
    $25.00
    $235.00
    $50.00
    $300.00
    $70.00
    $80.00
    $350.00
    $50.00
    $300.00
    $70.00
    $50.00
    $350.00
    $800.00
    $496.00
    $124.00
    $257.56
    $64.39
    $700.00
    $2,300.00
    $100.00
    $300.00
    $260.00
    $1,400.00
    $200.00
    $300.00
    $240.00
    $60.00
    $120.00
    $60.00
    $370.00
    $130.00

    M019
    P416
    P416
    L046
    M124
    P372
    P005
    M124
    M437
    M437
    S286
    L070
    P435
    P005
    P005
    P372
    M185
    P005
    L001
    P055
    L133
    L133
    H026
    P005
    P005
    P005
    M374
    H003
    M026
    P031
    P031
    P031
    M026
    P085
    P031
    M317
    M317
    M317
    M297
    M297
    L116
    M202
    P408
    D102
    D102
    D102
    D102
    D102
    D102
    M026
    P094
    P094
    P073

    $300.00
    $205.50
    $222.80
    $500.00
    $250.00
    $1,000.00
    $937.76
    $50.00
    $250.00
    $250.00
    $300.00
    $1,053.00
    $49.95
    $884.40
    $937.76
    $1,000.00
    $300.00
    $405.76
    $313.50
    $154.00
    $400.00
    $1,265.00
    $1,275.00
    $405.76
    $405.76
    $840.17
    $200.00
    $100.00
    $220.00
    $406.26
    $61.26
    $262.29
    $440.00
    $280.00
    $33.75
    $120.00
    $80.00
    $5.00
    $120.00
    $120.00
    $760.00
    $200.00
    $1,305.00
    $860.00
    $3,140.00
    $400.00
    $200.00
    $400.00
    $500.00
    $220.00
    $315.00
    $288.75
    $635.00

    P066
    P094
    M026
    P094
    L001
    P073
    H003
    H003
    H003
    H003
    H003
    H003
    H003
    H003
    H003
    P085
    S006
    H005
    M099
    M344
    P437
    M344
    P437
    M344
    S133
    L041
    H066
    P437
    S370
    O004
    O004
    M344
    P032
    S375
    D102
    D102
    D102
    O025
    O025
    M229
    L001
    P066
    P031
    S302
    S302
    S302
    P031
    S162
    S162
    P011
    P031
    P031
    M509

    $672.00
    $94.50
    $440.00
    $1,251.80
    $38.00
    $635.00
    $100.00
    $185.85
    $445.00
    $60.00
    $140.00
    $75.00
    $125.00
    $300.00
    $650.00
    $108.95
    $200.00
    $700.00
    $120.00
    $150.00
    $35.95
    $150.00
    $290.00
    $150.00
    $300.00
    $750.00
    $700.00
    $598.75
    $300.00
    $1,916.00
    $476.00
    $150.00
    $47.60
    $200.00
    $500.00
    $500.00
    $100.00
    $1,275.00
    $950.00
    $360.00
    $288.00
    $372.00
    $273.00
    $100.00
    $260.00
    $440.00
    $123.99
    $400.00
    $200.00
    $149.00
    $182.97
    $4.06
    $100.00

    M509
    S162
    P031
    M509
    P031
    M229
    P011
    O004
    O004
    O004
    M509
    M509
    P011
    P031
    P031
    M509
    M509
    P031
    P031
    P031
    O004
    O004
    O004
    M229
    P106
    L001
    P106
    L001
    M300
    D22
    D224
    D224
    S049
    O061
    S049
    S049
    S049
    O019
    O019
    O019
    S049
    O061
    S049
    O061
    S324
    S324
    M608
    M608
    M608
    M608
    D171
    D171
    D171

    $80.00
    $240.00
    $88.49
    $150.00
    $277.50
    $200.00
    $86.45
    $100.00
    $1,356.00
    $1,516.00
    $100.00
    $80.00
    $44.65
    $239.00
    $77.99
    $100.00
    $90.00
    $415.58
    $63.82
    $28.99
    $100.00
    $1,196.00
    $2,056.00
    $200.00
    $1,620.00
    $610.00
    $459.90
    $190.00
    $160.00
    $1,400.00
    $140.00
    $250.00
    $400.00
    $110.00
    $2,750.00
    $500.00
    $5,510.00
    $120.00
    $1,160.50
    $1,711.50
    $400.00
    $110.00
    $400.00
    $110.00
    $250.00
    $150.00
    $200.00
    $50.00
    $190.00
    $40.00
    $100.00
    $175.00
    $75.00

    D171
    D171
    M100
    S220
    S220
    S200
    M375
    L081
    L065
    O054
    O054
    O004
    O004
    O004
    H006
    H006
    S424
    M788
    S402
    S084
    P316
    S257
    O004
    O004
    O004
    O004
    O001
    S383
    P215
    O001
    P215
    P215
    P215
    P215
    S383
    P215
    M229
    P014
    L046
    L001
    H005
    M229
    P085
    O108
    O108
    O108
    O108
    M124
    M616
    S107
    S107
    P115
    P435

    $300.00
    $750.00
    $880.00
    $280.00
    $200.00
    $250.00
    $160.00
    $400.00
    $310.00
    $80.00
    $1,095.00
    $100.00
    $796.00
    $800.00
    $4,500.00
    $25,418.70
    $5,000.00
    $2,400.00
    $500.00
    $800.00
    $128.50
    $200.00
    $100.00
    $800.00
    $100.00
    $740.00
    $200.00
    $260.00
    $300.00
    $110.00
    $300.00
    $300.00
    $300.00
    $300.00
    $260.00
    $365.40
    $200.00
    $145.30
    $200.00
    $675.00
    $2,500.00
    $200.00
    $45.75
    $90.00
    $90.00
    $1,195.00
    $920.00
    $250.00
    $120.00
    $600.00
    $150.00
    $414.00
    $352.50

    S004
    L075
    H034
    L165
    M354
    M354
    P148
    L165
    S130
    S130
    L169
    P071
    P071
    P071
    P182
    M666
    M666
    M666
    M666
    P131
    M666
    M666
    M666
    M666
    P490
    M666
    M666
    M666
    P490
    M666
    M666
    M666
    M666
    M480
    M073
    S441
    S441
    M325
    M325
    P150
    P150
    P150
    L046
    D97
    D97
    D97
    D97
    D97
    D97
    D97
    M251
    M251
    M251

    $600.00
    $3,800.00
    $180.00
    $590.00
    $120.00
    $160.00
    $89.95
    $560.00
    $300.00
    $60.00
    $775.00
    $4.00
    $305.00
    $5.22
    $130.00
    $80.00
    $50.00
    $50.00
    $40.00
    $266.75
    $60.00
    $160.00
    $50.00
    $20.00
    $190.18
    $70.00
    $160.00
    $60.00
    $297.36
    $80.00
    $50.00
    $100.00
    $50.00
    $250.00
    $200.00
    $400.00
    $1,500.00
    $75.00
    $65.00
    $193.60
    $48.40
    $3.20
    $540.00
    $300.00
    $1,100.00
    $440.00
    $150.00
    $660.00
    $660.00
    $660.00
    $300.00
    $50.00
    $150.00

    M251
    D77
    M190
    M190
    M190
    M213
    M213
    D102
    D77
    D77
    D19
    D82
    M087
    M087
    P332
    H034
    M176
    P014
    M189
    P435
    O001
    O001
    O001
    D232
    S309
    H006
    O004
    O004
    O004
    S091
    P306
    O019
    L079
    P436
    O004
    O004
    O004
    M821
    H005
    H005
    H005
    P435
    L041
    S091
    S091
    P427
    D41
    D41
    D368
    D368
    D308
    D300
    D300

    $160.00
    $250.00
    $100.00
    $25.00
    $55.00
    $200.00
    $40.00
    $200.00
    $170.00
    $230.00
    $1,000.00
    $400.00
    $260.00
    $140.00
    $324.00
    $200.00
    $160.00
    $76.65
    $140.00
    $51.41
    $110.00
    $760.75
    $1,504.50
    $250.00
    $300.00
    $700.00
    $100.00
    $1,916.00
    $776.00
    $160.00
    $165.00
    $120.00
    $200.00
    $219.47
    $250.00
    $686.40
    $1,200.00
    $380.00
    $208.00
    $25.00
    $235.63
    $266.53
    $350.00
    $160.00
    $160.00
    $27.30
    $70.00
    $30.00
    $100.00
    $150.00
    $250.00
    $100.00
    $400.00

    S077
    P427
    S146
    S146
    H005
    O001
    O001
    O001
    S219
    M026
    M026
    P343
    P343
    P343
    P343
    P343
    D299
    D299
    D299
    D299
    D299
    D299
    D299
    D299
    O001
    O001
    D299
    D299
    D299
    D299
    O001
    O001
    M026
    M026
    P343
    P343
    M026
    P215
    P005
    L070
    L070
    D299
    D299
    D299
    D64
    D64
    D64
    S107
    S107
    D07
    D07
    H047
    H047

    $300.00
    $66.70
    $300.00
    $300.00
    $200.00
    $110.00
    $1,126.25
    $858.50
    $400.00
    $80.00
    $140.00
    $201.50
    $75.70
    $97.35
    $33.99
    $144.50
    $85.00
    $15.00
    $300.00
    $500.00
    $85.00
    $15.00
    $300.00
    $500.00
    $110.00
    $1,600.00
    $800.00
    $700.00
    $800.00
    $700.00
    $38.00
    $72.00
    $80.00
    $140.00
    $831.60
    $10.05
    $220.00
    $217.60
    $1,854.18
    $290.00
    $180.00
    $1,500.00
    $2,100.00
    $800.00
    $170.00
    $230.00
    $400.00
    $400.00
    $150.00
    $1,400.00
    $3,600.00
    $400.00
    $1,550.00

    P056
    P056
    H005
    H005
    M166
    M166
    M166
    P056
    S144
    D144
    L013
    O004
    O004
    O004
    O007
    O007
    O007
    D205
    D205
    H051
    S174
    D216
    D216
    D216
    D216
    M332
    P049
    P049
    M332
    P049
    S069
    M316
    P451
    D60
    D60
    D60
    D60
    M501
    P073
    O001
    O001
    O001
    M215
    P094
    M215
    L070
    S302
    P215
    S302
    O065
    O065
    M267
    M267

    $2,746.20
    $469.00
    $380.00
    $4,601.21
    $140.00
    $60.00
    $80.00
    $153.30
    $300.00
    $200.00
    $352.00
    $100.00
    $1,916.00
    $1,516.00
    $130.00
    $900.00
    $1,285.00
    $170.00
    $280.00
    $10,500.00
    $300.00
    $100.00
    $35.00
    $45.00
    $1,200.00
    $100.00
    $500.50
    $105.00
    $100.00
    $2,065.50
    $360.00
    $100.00
    $50.40
    $50.00
    $170.00
    $130.00
    $2,500.00
    $400.00
    $820.00
    $110.00
    $1,196.00
    $1,520.00
    $250.00
    $238.50
    $250.00
    $1,440.00
    $400.00
    $73.70
    $140.00
    $250.00
    $600.00
    $200.00
    $120.00

    O156
    O156
    P085
    O001
    M185
    P122
    S174
    S174
    L041
    L041
    L041
    L041
    O011
    O011
    O011
    D281
    D257
    D257
    M152
    M152
    M152
    M164
    S127
    S127
    D150
    D150
    P011
    P011
    P005
    M229
    P343
    O033
    O033
    O033
    O033
    O033
    O033
    P343
    P005
    P155
    P005
    H003
    H003
    M774
    P353
    P353
    L075
    S107
    S107
    P085
    P085
    M205
    P343

    $760.00
    $800.00
    $275.00
    $50.00
    $180.00
    $353.00
    $150.00
    $150.00
    $575.00
    $8.40
    $75.00
    $120.00
    $80.00
    $1,200.00
    $780.00
    $200.00
    $140.00
    $310.00
    $300.00
    $25.00
    $95.00
    $140.00
    $200.00
    $400.00
    $150.00
    $200.00
    $477.00
    $370.00
    $126.44
    $160.00
    $102.70
    $100.00
    $1,035.00
    $427.50
    $100.00
    $895.50
    $427.50
    $79.80
    $126.44
    $160.00
    $316.10
    $300.00
    $300.00
    $200.00
    $180.00
    $45.00
    $3,420.00
    $300.00
    $200.00
    $103.60
    $25.90
    $240.00
    $219.10

    P343
    D205
    D205
    D143
    O004
    O004
    O004
    O004
    S128
    S128
    M089
    L006
    D66
    M647
    M647
    M647
    P504
    H016
    P166
    M647
    M647
    M647
    M647
    M647
    M647
    L041
    S124
    P158
    S124
    D194
    S242
    P158
    D413
    D413
    M801
    M801
    P208
    P208
    D313
    S353
    H066
    P045
    S327
    S327
    H066
    P467
    S327
    L134
    H066
    H066
    S327
    M357
    P467

    $25.00
    $600.00
    $480.00
    $250.00
    $1,000.50
    $1,395.50
    $499.50
    $696.50
    $800.00
    $800.00
    $360.00
    $500.00
    $750.00
    $80.00
    $25.00
    $95.00
    $190.00
    $60.00
    $60.00
    $80.00
    $25.00
    $95.00
    $80.00
    $25.00
    $95.00
    $70.00
    $200.00
    $150.00
    $2,200.00
    $210.00
    $250.00
    $75.00
    $70.00
    $200.00
    $500.00
    $100.00
    $407.00
    $183.90
    $320.00
    $200.00
    $360.00
    $230.00
    $250.00
    $200.00
    $550.00
    $126.00
    $200.00
    $715.00
    $800.00
    $2,960.00
    $1,500.00
    $1,200.00
    $175.00

    O076
    O076
    O076
    S353
    S327
    L070
    H066
    D200
    D200
    D200
    D200
    S296
    S296
    S296
    S385
    P467
    S237
    P467
    L013
    L013
    M580
    M580
    M580
    M580
    M694
    M694
    M694
    M694
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    M732
    D313
    D313
    D313
    D313
    D313
    D313
    D313
    D313
    D313
    S115

    $90.00
    $1,276.00
    $1,080.00
    $200.00
    $200.00
    $110.00
    $2,500.00
    $100.00
    $35.00
    $25.00
    $800.00
    $450.00
    $2,400.00
    $1,000.00
    $600.00
    $225.00
    $500.00
    $21.00
    $6,300.00
    $87.00
    $100.00
    $500.00
    $100.00
    $100.00
    $100.00
    $500.00
    $400.00
    $100.00
    $200.00
    $50.00
    $250.00
    $200.00
    $20.00
    $200.00
    $200.00
    $20.00
    $100.00
    $200.00
    $2,430.00
    $100.00
    $25.00
    $75.00
    $20.00
    $70.00
    $130.00
    $300.00
    $150.00
    $70.00
    $80.00
    $100.00
    $70.00
    $80.00
    $300.00

    P309
    P309
    M732
    P309
    P427
    P427
    M732
    M732
    P427
    P427
    S179
    S179
    P279
    P279
    P279
    O004
    O004
    O004
    O004
    O004
    D260
    D260
    S427
    L070
    P005
    P005
    D260
    D260
    P005
    M123
    M123
    M123
    M123
    O151
    O151
    O151
    D228
    D228
    D228
    D228
    D228
    S353
    S103
    H008
    S277
    H006
    H006
    S359
    H006
    H006
    S359
    H023
    H023

    $481.88
    $120.47
    $100.00
    $31.99
    $161.75
    $35.95
    $100.00
    $170.00
    $107.16
    $26.79
    $36.00
    $204.00
    $58.50
    $6.50
    $115.00
    $100.00
    $1,756.00
    $439.00
    $164.00
    $1,412.00
    $860.00
    $2,140.00
    $350.00
    $400.00
    $261.00
    $1,094.90
    $300.00
    $580.00
    $4,620.10
    $150.00
    $80.00
    $60.00
    $150.00
    $75.00
    $1,195.00
    $1,650.00
    $50.00
    $300.00
    $70.00
    $80.00
    $2,250.00
    $400.00
    $300.00
    $330.00
    $600.00
    $825.00
    $1,200.00
    $700.00
    $300.00
    $750.00
    $2,000.00
    $1,900.00
    $40,600.00

    S353
    S353
    S456
    H066
    L069
    S417
    S322
    L143
    L069
    UN01
    M029
    M274
    P154
    H029
    H029
    S113
    S086
    S086
    S086
    S086
    L061
    S086
    M449
    M449
    M449
    M449
    M449
    M449
    M449
    M795
    M795
    M795
    M759
    M759
    P457
    M759
    M759
    D148
    D148
    D148
    D148
    P015
    P430
    P349
    O001
    O001
    O001
    O027
    O027
    O027
    O174
    O174
    O174

    $7,500.00
    $25,000.00
    $650.00
    $400.00
    $830.00
    $600.00
    $300.00
    $10,000.00
    $380.00
    $200.00
    $100.00
    $120.00
    $235.00
    $1,200.00
    $3,494.00
    $850.00
    $1,800.00
    $600.00
    $1,200.00
    $400.00
    $290.00
    $450.00
    $100.00
    $25.00
    $75.00
    $100.00
    $100.00
    $40.00
    $65.00
    $150.00
    $60.00
    $120.00
    $100.00
    $100.00
    $163.00
    $100.00
    $100.00
    $100.00
    $700.00
    $170.00
    $730.00
    $297.00
    $857.00
    $103.60
    $110.00
    $1,014.00
    $1,520.00
    $40.00
    $750.00
    $1,450.00
    $50.00
    $400.00
    $877.00

    O174
    O174
    O174
    M204
    H066
    H066
    P318
    M204
    P318
    H008
    M237
    M237
    M237
    P453
    M167
    M167
    M167
    S391
    O076
    O076
    S160
    P154
    M598
    M598
    M598
    M598
    D27
    O008
    O008
    O008
    D408
    D408
    D408
    M461
    M461
    M694
    M694
    M461
    M461
    M813
    P495
    P495
    O076
    O076
    M325
    P150
    P150
    D305
    D305
    D305
    D305
    D255
    D255

    $50.00
    $1,228.00
    $1,250.00
    $400.00
    $700.00
    $350.00
    $74.10
    $200.00
    $75.30
    $360.00
    $170.00
    $50.00
    $110.00
    $94.50
    $280.00
    $25.00
    $25.00
    $280.00
    $1,525.50
    $2,225.50
    $200.00
    $70.95
    $200.00
    $90.00
    $40.00
    $480.00
    $1,010.00
    $80.00
    $700.00
    $1,400.00
    $35.00
    $55.00
    $260.00
    $150.00
    $600.00
    $160.00
    $500.00
    $150.00
    $520.00
    $100.00
    $66.70
    $202.30
    $1,095.00
    $1,100.00
    $140.00
    $135.20
    $56.70
    $50.00
    $140.00
    $60.00
    $900.00
    $105.00
    $135.00

    D255
    D255
    M159
    M159
    P479
    S318
    S318
    L041
    L041
    L041
    S423
    H027
    L041
    S382
    L041
    L041
    L041
    M352
    M352
    L074
    M352
    M352
    M352
    M352
    P435
    P435
    M377
    S083
    S083
    S083
    M377
    P435
    L074
    S419
    P366
    P366
    S419
    P366
    D389
    D389
    D389
    D389
    O076
    O076
    O076
    O108
    O108
    O108
    M575
    M575
    D114
    D114
    D114

    $300.00
    $2,500.00
    $140.00
    $40.00
    $34.00
    $300.00
    $250.00
    $600.00
    $600.00
    $250.00
    $200.00
    $250.00
    $350.00
    $2,400.00
    $370.00
    $300.00
    $30.00
    $250.00
    $175.00
    $240.00
    $150.00
    $50.00
    $100.00
    $60.00
    $57.38
    $6.38
    $80.00
    $400.00
    $200.00
    $1,800.00
    $120.00
    $415.38
    $290.00
    $300.00
    $31.00
    $219.75
    $200.00
    $153.50
    $50.00
    $20.00
    $70.00
    $14.00
    $90.00
    $2,480.37
    $880.37
    $90.00
    $895.00
    $390.00
    $110.00
    $300.00
    $120.00
    $340.00
    $140.00

    D114
    H066
    D188
    D188
    D188
    D188
    D188
    D219
    D219
    D219
    D219
    D219
    O171
    O171
    M633
    P081
    P081
    M053
    M053
    M053
    P081
    P081
    M053
    M053
    P081
    S200
    O076
    S432
    O076
    O145
    H006
    H006
    H006
    H006
    M304
    M304
    P031
    M304
    P031
    P031
    M089
    S008
    P094
    L128
    P427
    M692
    L065
    H023
    H023
    H023
    M868
    M868
    P427

    $320.00
    $700.00
    $80.00
    $35.00
    $45.00
    $800.00
    $900.00
    $70.00
    $300.00
    $280.00
    $520.00
    $230.00
    $675.00
    $800.00
    $300.00
    $15.00
    $572.30
    $280.00
    $240.00
    $140.00
    $53.20
    $45.00
    $280.00
    $300.00
    $70.20
    $470.00
    $400.00
    $570.00
    $500.00
    $500.00
    $450.00
    $25.00
    $140.00
    $145.00
    $400.00
    $915.00
    $17.50
    $450.00
    $114.90
    $23.25
    $180.00
    $200.00
    $399.95
    $250.00
    $1,147.90
    $1,200.00
    $70.00
    $1,100.00
    $2,617.48
    $2,472.50
    $2,500.00
    $800.00
    $1,147.90

    S286
    S286
    H023
    M225
    M225
    M225
    L064
    S063
    S063
    D224
    D224
    M111
    M111
    M111
    M111
    D39
    D39
    M541
    P155
    S231
    S231
    T034
    T034
    M045
    M045
    P022
    P022
    M304
    M304
    M045
    M045
    M304
    P014
    S279
    S279
    S279
    D83
    M067
    M657
    L032
    H023
    M019
    M067
    S076
    O004
    O004
    M706
    P451
    P451
    P451
    S216
    S216
    O001

    $250.00
    $700.00
    $1,900.00
    $400.00
    $200.00
    $500.00
    $400.00
    $300.00
    $350.00
    $495.00
    $5.00
    $400.00
    $30.00
    $80.00
    $120.00
    $170.00
    $830.00
    $200.00
    $180.00
    $80.00
    $220.00
    $480.00
    $1,720.00
    $80.00
    $70.00
    $9.75
    $23.70
    $80.00
    $70.00
    $80.00
    $70.00
    $160.00
    $132.65
    $150.00
    $350.00
    $132.00
    $200.00
    $400.00
    $150.00
    $216.00
    $1,900.00
    $300.00
    $200.00
    $600.00
    $100.00
    $1,416.00
    $100.00
    $452.00
    $102.00
    $36.00
    $100.00
    $300.00
    $110.00

    O001
    O001
    H003
    O004
    O004
    O004
    H003
    S006
    M053
    M053
    M053
    D346
    D346
    S300
    S300
    M030
    P256
    P256
    M225
    M225
    P507
    P507
    P215
    S103
    L070
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    D198
    P390
    P390
    P360
    P360
    D77
    D77
    D232
    M089
    O076
    O076
    O076
    M156
    M156
    P145
    P145
    D39

    $1,211.25
    $1,211.24
    $200.00
    $100.00
    $1,196.00
    $876.00
    $200.00
    $200.00
    $140.00
    $20.00
    $140.00
    $100.00
    $300.00
    $50.00
    $250.00
    $160.00
    $261.80
    $66.35
    $440.00
    $260.00
    $2.50
    $31.70
    $165.50
    $400.00
    $200.00
    $200.00
    $420.00
    $180.00
    $700.00
    $2,400.00
    $100.00
    $400.00
    $420.00
    $180.00
    $3,000.00
    $50.00
    $2,400.00
    $142.50
    $199.50
    $199.00
    $199.00
    $910.00
    $690.00
    $280.00
    $200.00
    $90.00
    $1,214.49
    $1,475.51
    $100.00
    $200.00
    $60.00
    $175.00
    $400.00

    D39
    S292
    P430
    S427
    S427
    S427
    P005
    US01
    US01
    M229
    M229
    O161
    O161
    L113
    H003
    S383
    H006
    H027
    S374
    S374
    S374
    M215
    L070
    O004
    O004
    H003
    H003
    H006
    H006
    S296
    S296
    L113
    S296
    H006
    H006
    H006
    H006
    H006
    H023
    H023
    H44
    S266
    S266
    H006
    M577
    P011
    P011
    M577
    M577
    L070
    M449
    M449
    M449

    $400.00
    $400.00
    $170.50
    $50.00
    $25.00
    $675.00
    $631.96
    $96.00
    $95.10
    $160.00
    $280.00
    $500.00
    $700.00
    $3,000.00
    $400.00
    $1,000.00
    $1,200.00
    $4,500.00
    $4,700.00
    $200.00
    $1,000.00
    $250.00
    $1,270.00
    $1,145.60
    $286.40
    $350.00
    $525.00
    $400.00
    $275.00
    $1,500.00
    $400.00
    $2,000.00
    $800.00
    $250.00
    $2,028.00
    $705.00
    $355.00
    $600.00
    $950.00
    $5,854.82
    $4,850.00
    $4,000.00
    $800.00
    $400.00
    $200.00
    $150.00
    $22.50
    $200.00
    $40.00
    $510.00
    $100.00
    $60.00
    $25.00

    M449
    M449
    M549
    L128
    D79
    S126
    L97
    P014
    S126
    H023
    H011
    L070
    S375
    O065
    O065
    O065
    M189
    P059
    P059
    D78
    D78
    D78
    D78
    D78
    P091
    P091
    D180
    H022
    S290
    S136
    P007
    P007
    S122
    S122
    M156
    S427
    L061
    P430
    P462
    S427
    P430
    P462
    P462
    P430
    P430
    P462
    M580
    M580
    M580
    M580
    M580
    P462
    P430

    $135.00
    $90.00
    $100.00
    $150.00
    $200.00
    $600.00
    $180.00
    $19.25
    $300.00
    $2,000.00
    $100.00
    $115.00
    $300.00
    $150.00
    $1,395.00
    $1,399.50
    $120.00
    $91.20
    $102.80
    $525.00
    $85.00
    $140.00
    $245.00
    $155.00
    $110.25
    $47.25
    $350.00
    $360.00
    $1,200.00
    $200.00
    $84.19
    $9.99
    $1,000.00
    $2,000.00
    $300.00
    $350.00
    $170.00
    $768.00
    $1,387.50
    $200.00
    $768.00
    $1,387.50
    $1,387.50
    $768.00
    $768.00
    $1,387.50
    $200.00
    $900.00
    $200.00
    $200.00
    $500.00
    $1,387.50
    $768.00

    P430
    P462
    D77
    O004
    O004
    O004
    M584
    S004
    S004
    S159
    S357
    L065
    H005
    L075
    M386
    M041
    M041
    P167
    P167
    M002
    M002
    M002
    H006
    H006
    D371
    D371
    D371
    D371
    D371
    D371
    O006
    O006
    D371
    D371
    S309
    L020
    M374
    M374
    L006
    L006
    L070
    L070
    D66
    D66
    P139
    P014
    D397
    D397
    S121
    M187
    M187
    M187
    P014

    $768.00
    $1,387.50
    $533.00
    $100.00
    $2,796.00
    $1,816.00
    $120.00
    $200.00
    $400.00
    $800.00
    $300.00
    $400.00
    $2,220.00
    $3,420.00
    $1,920.00
    $200.00
    $50.00
    $2.10
    $111.95
    $150.00
    $210.00
    $20.00
    $700.00
    $695.00
    $50.00
    $200.00
    $85.00
    $65.00
    $120.00
    $200.00
    $75.00
    $650.00
    $150.00
    $400.00
    $300.00
    $890.00
    $350.00
    $50.00
    $100.00
    $20.00
    $890.00
    $120.00
    $70.00
    $130.00
    $180.00
    $108.15
    $135.00
    $65.00
    $300.00
    $200.00
    $50.00
    $30.00
    $93.90

    P349
    M067
    P049
    M067
    P049
    M067
    P049
    P049
    D151
    D151
    O001
    O001
    O001
    M019
    M019
    M019
    M019
    P492
    P492
    M194
    M194
    M194
    M194
    P154
    M194
    P154
    D196
    D196
    D196
    D259
    D259
    D259
    D259
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255

    $83.90
    $160.00
    $733.50
    $160.00
    $580.55
    $160.00
    $1,290.00
    $247.95
    $85.00
    $165.00
    $110.00
    $760.75
    $2,082.00
    $400.00
    $400.00
    $200.00
    $500.00
    $170.50
    $70.95
    $100.00
    $25.00
    $115.00
    $60.00
    $191.50
    $80.00
    $59.70
    $85.00
    $115.00
    $660.00
    $50.00
    $300.00
    $70.00
    $80.00
    $100.00
    $20.00
    $20.00
    $100.00
    $20.00
    $40.00
    $100.00
    $25.00
    $15.00
    $20.00
    $100.00
    $20.00
    $20.00
    $20.00
    $100.00
    $20.00
    $20.00
    $100.00
    $25.00
    $15.00

    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    M255
    S346
    P240
    L013
    O065
    M304
    P215
    M873
    M873
    M395
    L020
    M395
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M580
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M123
    M769

    $20.00
    $100.00
    $20.00
    $40.00
    $100.00
    $20.00
    $20.00
    $100.00
    $20.00
    $60.00
    $200.00
    $466.00
    $3,400.00
    $150.00
    $185.00
    $135.00
    $200.00
    $10.00
    $200.00
    $240.00
    $20.00
    $100.00
    $400.00
    $100.00
    $200.00
    $200.00
    $700.00
    $200.00
    $500.00
    $200.00
    $900.00
    $300.00
    $300.00
    $200.00
    $100.00
    $200.00
    $100.00
    $180.00
    $80.00
    $60.00
    $150.00
    $450.00
    $420.00
    $160.00
    $1,730.00
    $150.00
    $80.00
    $210.00
    $150.00
    $80.00
    $60.00
    $150.00
    $150.00

    M769
    O170
    O170
    O170
    O001
    O001
    O001
    L140
    P049
    M657
    P049
    O001
    S375
    O156
    S375
    P472
    S375
    P487
    P472
    O156
    S375
    S319
    L034
    L074
    P332
    P332
    H011
    H011
    M151
    S319
    S199
    O004
    M463
    M463
    M463
    M327
    L034
    P014
    P014
    P475
    D310
    M312
    H003
    H003
    P360
    H003
    S375
    P360
    M140
    P360
    L126
    L126
    P360

    $70.00
    $90.00
    $557.87
    $1,752.88
    $110.00
    $1,284.00
    $1,320.00
    $1,640.00
    $4,638.50
    $300.00
    $6,024.45
    $110.00
    $500.00
    $500.00
    $5,000.00
    $97.85
    $200.00
    $216.94
    $201.00
    $500.00
    $5,000.00
    $620.00
    $400.00
    $70.00
    $90.00
    $60.00
    $1,800.00
    $7,560.00
    $1,500.00
    $8,000.00
    $300.00
    $100.00
    $200.00
    $600.00
    $800.00
    $280.00
    $400.00
    $76.95
    $2.25
    $75.00
    $450.00
    $100.00
    $159.08
    $120.00
    $105.65
    $200.00
    $200.00
    $442.25
    $150.00
    $198.00
    $300.00
    $310.00
    $236.35

    M857
    H003
    S375
    P104
    S433
    M211
    M211
    L149
    P014
    M297
    M297
    L116
    P404
    L116
    P404
    M657
    P005
    M215
    M215
    H023
    P031
    M215
    M215
    M215
    H023
    H023
    H023
    P031
    D426
    D426
    S103
    L013
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    D113
    P014
    S091
    S091
    S091
    S091
    S122
    S122
    S122
    S122
    H011
    H011
    H011
    H011

    $100.00
    $175.00
    $200.00
    $443.25
    $300.00
    $200.00
    $300.00
    $150.00
    $79.00
    $240.00
    $580.00
    $1,020.00
    $465.40
    $300.00
    $70.00
    $200.00
    $709.35
    $500.00
    $50.00
    $600.00
    $81.06
    $250.00
    $25.00
    $75.00
    $375.00
    $75.00
    $52.28
    $6.30
    $70.00
    $140.00
    $800.00
    $550.00
    $80.00
    $105.00
    $135.00
    $500.00
    $400.00
    $1,050.00
    $600.00
    $1,365.00
    $38.85
    $160.00
    $230.00
    $160.00
    $370.00
    $80.00
    $220.00
    $160.00
    $40.00
    $560.00
    $1,840.00
    $2,180.00
    $480.00

    H011
    H011
    H011
    H011
    H011
    H011
    H011
    H011
    S091
    S091
    S091
    S091
    S091
    O004
    O004
    S091
    S091
    P066
    P066
    M068
    M068
    P436
    H005
    M248
    P005
    M304
    P066
    P005
    P005
    P005
    P001
    P487
    P001
    P094
    O004
    O004
    O004
    M248
    O030
    O030
    O030
    S375
    S375
    M183
    M183
    M183
    M183
    M183
    M183
    M706
    M706
    L174
    O168

    $842.72
    $210.68
    $1,432.28
    $279.32
    $7,225.00
    $2,775.00
    $2,000.00
    $500.00
    $160.00
    $25.00
    $205.00
    $160.00
    $370.00
    $100.00
    $776.00
    $160.00
    $230.00
    $849.15
    $849.15
    $600.00
    $250.00
    $361.99
    $350.00
    $140.00
    $413.37
    $490.00
    $312.00
    $811.52
    $811.52
    $347.31
    $903.80
    $36.00
    $1,342.14
    $150.00
    $100.00
    $1,356.00
    $1,356.00
    $140.00
    $100.00
    $2,605.50
    $1,552.50
    $5,000.00
    $200.00
    $200.00
    $25.00
    $25.00
    $300.00
    $70.00
    $400.00
    $100.00
    $100.00
    $160.00
    $1,040.00

    O168
    M456
    P178
    P057
    M456
    P178
    M780
    P019
    M123
    M123
    M123
    M123
    M123
    L070
    M456
    M456
    P057
    P057
    M456
    P178
    P178
    P178
    S086
    S086
    M456
    P178
    P178
    M456
    P178
    M456
    P005
    P178
    P178
    D25
    D25
    M123
    M123
    P178
    M123
    M123
    P178
    D388
    D86
    D86
    D86
    O136
    O136
    O136
    D319
    D319
    D319
    D319
    D319

    $1,050.00
    $140.00
    $1,020.35
    $35.00
    $280.00
    $1,265.39
    $300.00
    $760.70
    $300.00
    $50.00
    $110.00
    $300.00
    $120.00
    $160.00
    $140.00
    $60.00
    $113.75
    $162.50
    $140.00
    $55.00
    $283.40
    $99.60
    $750.00
    $300.00
    $280.00
    $552.07
    $363.85
    $140.00
    $560.36
    $140.00
    $312.88
    $66.50
    $141.70
    $860.00
    $5,540.00
    $450.00
    $180.00
    $871.00
    $240.00
    $450.00
    $55.00
    $200.00
    $85.00
    $365.00
    $450.00
    $60.00
    $1,777.50
    $1,057.50
    $60.00
    $300.00
    $70.00
    $30.00
    $1,600.00

    D319
    O076
    O076
    M779
    M779
    M779
    M779
    P394
    D60
    D60
    D60
    D60
    D60
    D60
    D275
    D275
    D275
    D275
    P489
    O076
    O076
    O169
    M353
    O007
    O007
    O026
    O037
    O037
    S245
    H026
    P014
    P014
    M773
    P011
    O004
    M045
    P342
    D60
    D60
    D60
    D60
    D60
    D60
    D60
    D60
    D60
    H026
    H025
    H025
    H025
    D60
    D60
    M378

    $120.00
    $805.50
    $425.50
    $140.00
    $25.00
    $275.00
    $60.00
    $177.50
    $50.00
    $70.00
    $50.00
    $800.00
    $300.00
    $2,700.00
    $50.00
    $35.00
    $15.00
    $300.00
    $148.90
    $75.00
    $1,200.00
    $1,095.00
    $150.00
    $100.00
    $1,350.00
    $200.00
    $400.00
    $440.00
    $300.00
    $585.00
    $174.00
    $180.00
    $300.00
    $28.50
    $100.00
    $150.00
    $30.00
    $50.00
    $360.00
    $200.00
    $400.00
    $800.00
    $100.00
    $175.00
    $175.00
    $2,500.00
    $250.00
    $60.00
    $240.00
    $260.00
    $200.00
    $330.00
    $350.00

    S356
    S356
    S323
    D119
    D119
    D119
    D119
    D38
    D119
    L96
    S298
    S298
    P505
    T068
    M375
    M375
    M375
    M375
    L97
    M262
    M262
    M262
    M262
    M262
    M262
    D137
    D137
    D137
    M262
    S277
    H006
    S277
    H006
    S220
    O156
    O156
    O156
    O156
    O156
    O156
    M076
    M076
    P011
    S286
    M076
    M076
    M076
    M076
    Missing
    M230
    M230
    M230
    P475

    $300.00
    $2,400.00
    $100.00
    $140.00
    $360.00
    $400.00
    $120.00
    $900.00
    $500.00
    $700.00
    $260.00
    $360.00
    $81.90
    $1,080.00
    $200.00
    $460.00
    $160.00
    $500.00
    $400.00
    $200.00
    $25.00
    $75.00
    $200.00
    $25.00
    $75.00
    $380.00
    $300.00
    $780.00
    $200.00
    $400.00
    $120.00
    $400.00
    $1,170.00
    $220.00
    $500.00
    $100.00
    $200.00
    $1,075.50
    $389.60
    $483.40
    $250.00
    $75.00
    $75.00
    $300.00
    $250.00
    $750.00
    $200.00
    $50.00
    $350.00
    $240.00
    $60.00
    $300.00
    $65.00

    P475
    D90
    D90
    D90
    M230
    M230
    M230
    M230
    M230
    P475
    P475
    M230
    M230
    M230
    P475
    P475
    P475
    S356
    D90
    D90
    D90
    H005
    M230
    M230
    P337
    M326
    M326
    P011
    M657
    M164
    P169
    P169
    D228
    D228
    D103
    D103
    D103
    D103
    M754
    P167
    P167
    D208
    D208
    D208
    D297
    D297
    S060
    S060
    P045
    P045
    M317
    M317
    H034

    $125.00
    $300.00
    $70.00
    $130.00
    $240.00
    $60.00
    $160.00
    $25.00
    $15.00
    $11.00
    $94.00
    $240.00
    $60.00
    $300.00
    $30.00
    $156.00
    $39.00
    $300.00
    $350.00
    $350.00
    $1,200.00
    $2,400.00
    $300.00
    $300.00
    $720.80
    $200.00
    $50.00
    $84.00
    $100.00
    $100.00
    $25.00
    $30.00
    $500.00
    $350.00
    $140.00
    $250.00
    $140.00
    $320.00
    $200.00
    $1,400.00
    $150.00
    $35.00
    $25.00
    $550.00
    $70.00
    $250.00
    $260.00
    $20.00
    $45.00
    $260.00
    $120.00
    $100.00
    $400.00

    P168
    O006
    O006
    O006
    S301
    S114
    M304
    L97
    M211
    M211
    S274
    M700
    L035
    S274
    M700
    O001
    P104
    D228
    D228
    D228
    P057
    M412
    P237
    M078
    L006
    O004
    O004
    M375
    L079
    S371
    S371
    M729
    H010
    D160
    D160
    D160
    M626
    M626
    M829
    M067
    P049
    MM06
    M067
    M067
    M067
    P049
    L020
    M067
    M067
    P049
    M067
    M183
    O004

    $199.50
    $75.00
    $1,075.00
    $350.00
    $200.00
    $400.00
    $185.00
    $600.00
    $300.00
    $400.00
    $140.00
    $140.00
    $195.00
    $420.00
    $300.00
    $110.00
    $71.60
    $250.00
    $70.00
    $80.00
    $65.00
    $200.00
    $42.99
    $100.00
    $400.00
    $100.00
    $1,116.00
    $160.00
    $400.00
    $300.00
    $3,000.00
    $600.00
    $1,800.00
    $170.00
    $230.00
    $100.00
    $300.00
    $20.00
    $350.00
    $160.00
    $869.40
    $285.00
    $460.00
    $40.00
    $300.00
    $571.40
    $740.00
    $240.00
    $40.00
    $124.95
    $240.00
    $400.00
    $250.00

    O004
    O004
    O076
    O076
    O076
    M152
    M152
    M152
    S242
    P008
    M138
    M138
    M138
    M371
    M371
    M371
    M371
    M371
    M371
    O004
    O004
    O004
    M346
    M346
    L126
    H006
    H006
    S239
    L149
    P049
    S239
    P115
    P115
    S245
    P014
    P014
    O001
    O001
    O001
    M229
    P022
    M411
    M411
    P115
    M353
    P115
    P155
    D59
    D59
    D59
    D59
    D111
    D111

    $1,516.00
    $2,056.00
    $90.00
    $1,165.50
    $2,265.50
    $150.00
    $25.00
    $105.00
    $250.00
    $204.60
    $100.00
    $25.00
    $55.00
    $100.00
    $25.00
    $75.00
    $100.00
    $25.00
    $15.00
    $100.00
    $556.00
    $260.00
    $200.00
    $240.00
    $150.00
    $1,200.00
    $50.00
    $400.00
    $150.00
    $119.00
    $5,000.00
    $35.00
    $64.50
    $400.00
    $212.00
    $109.20
    $110.00
    $870.75
    $1,134.25
    $160.00
    $220.50
    $130.00
    $30.00
    $43.50
    $150.00
    $48.75
    $77.00
    $60.00
    $80.00
    $590.00
    $150.00
    $180.00
    $395.00

    D111
    D111
    D111
    D111
    D111
    D111
    D111
    D111
    P215
    O015
    O015
    O015
    O015
    O015
    D218
    S280
    D103
    D103
    O033
    P215
    D103
    P215
    D218
    D218
    M437
    M437
    L070
    P215
    D218
    D218
    D218
    P215
    S313
    S313
    S313
    S313
    P215
    S256
    S256
    M189
    P115
    M095
    P231
    L001
    S052
    M766
    M766
    D119
    D119
    D119
    D119
    M060
    P011

    $100.00
    $960.00
    $360.00
    $1,040.00
    $700.00
    $180.00
    $60.00
    $649.00
    $225.00
    $150.00
    $1,216.00
    $604.00
    $1,184.00
    $1,516.00
    $360.00
    $195.00
    $140.00
    $320.00
    $230.00
    $360.00
    $400.00
    $306.00
    $120.00
    $120.00
    $200.00
    $50.00
    $108.00
    $215.20
    $200.00
    $120.00
    $100.00
    $306.00
    $300.00
    $25.00
    $375.00
    $350.00
    $111.60
    $350.00
    $180.00
    $140.00
    $49.00
    $160.00
    $70.00
    $420.00
    $300.00
    $200.00
    $200.00
    $50.00
    $70.00
    $50.00
    $400.00
    $200.00
    $67.00

    D64
    D64
    D64
    D64
    P456
    P456
    P014
    S319
    S319
    L034
    O076
    O076
    O076
    M115
    M155
    M115
    L046
    M774
    L070
    P005
    O002
    O002
    M316
    P014
    P014
    M103
    P076
    P408
    S165
    P351
    M662
    M662
    M662
    O169
    O169
    D59
    D257
    D257
    D257
    D59
    D59
    O004
    O004
    O004
    M099
    L070
    H034
    P456
    M014
    M014
    M014
    M014
    L065

    $50.00
    $180.00
    $140.00
    $30.00
    $300.00
    $300.00
    $170.05
    $970.00
    $260.00
    $400.00
    $90.00
    $1,276.00
    $1,395.00
    $100.00
    $30.00
    $70.00
    $300.00
    $300.00
    $607.00
    $1,217.28
    $1,295.00
    $500.00
    $100.00
    $19.45
    $63.30
    $140.00
    $111.95
    $6.00
    $300.00
    $663.70
    $100.00
    $25.00
    $35.00
    $675.00
    $1,975.00
    $133.00
    $147.00
    $400.00
    $500.00
    $200.00
    $780.00
    $100.00
    $1,516.00
    $2,056.00
    $120.00
    $250.00
    $300.00
    $78.99
    $140.00
    $25.00
    $95.00
    $120.00
    $180.00

    M014
    M014
    M014
    M014
    M014
    L034
    P332
    M014
    M014
    M014
    M014
    M014
    M014
    S114
    S114
    S114
    L117
    S187
    M325
    P477
    P457
    S187
    P477
    S187
    S187
    O001
    M194
    M194
    M194
    S079
    L013
    P479
    P136
    M580
    M580
    M580
    M581
    L124
    D27
    M115
    M115
    M115
    M115
    L172
    M115
    S367
    S367
    M657
    L034
    P014
    P014
    M213
    M213

    $140.00
    $25.00
    $55.00
    $120.00
    $140.00
    $400.00
    $57.50
    $140.00
    $25.00
    $55.00
    $140.00
    $25.00
    $95.00
    $1,600.00
    $50.00
    $50.00
    $3,800.00
    $200.00
    $140.00
    $32.95
    $114.00
    $250.00
    $48.50
    $200.00
    $1,600.00
    $110.00
    $200.00
    $300.00
    $150.00
    $300.00
    $175.00
    $127.80
    $29.40
    $100.00
    $100.00
    $500.00
    $150.00
    $740.00
    $680.00
    $200.00
    $30.00
    $50.00
    $40.00
    $520.00
    $20.00
    $920.00
    $500.00
    $200.00
    $650.00
    $139.65
    $31.50
    $100.00
    $20.00

    M213
    M213
    M213
    M213
    M213
    M213
    D248
    D248
    D248
    S232
    S232
    O004
    O004
    O004
    S232
    M304
    M304
    D35
    D35
    D35
    D35
    D125
    D125
    D125
    D125
    D125
    H047
    H006
    H006
    S311
    S311
    M841
    S244
    S244
    M056
    M056
    D342
    D342
    D342
    S112
    S244
    S244
    M473
    P031
    S019
    S019
    P055
    S019
    M056
    M056
    H005
    H005
    H005

    $100.00
    $20.00
    $200.00
    $20.00
    $200.00
    $20.00
    $70.00
    $90.00
    $300.00
    $5,400.00
    $2,600.00
    $100.00
    $1,196.00
    $396.00
    $300.00
    $200.00
    $525.00
    $120.00
    $450.00
    $120.00
    $450.00
    $80.00
    $70.00
    $140.00
    $400.00
    $280.00
    $700.00
    $450.00
    $400.00
    $800.00
    $600.00
    $1,500.00
    $300.00
    $400.00
    $150.00
    $50.00
    $300.00
    $1,000.00
    $3,500.00
    $300.00
    $300.00
    $300.00
    $140.00
    $27.45
    $260.00
    $520.00
    $83.10
    $260.00
    $150.00
    $20.00
    $455.00
    $170.40
    $200.00

    P122
    D102
    D102
    D102
    O076
    O076
    O076
    M759
    S247
    P031
    P005
    D150
    S302
    S302
    P031
    L070
    S247
    P005
    P343
    P005
    M817
    M437
    L96
    P005
    P005
    M026
    S042
    L006
    P031
    H011
    H011
    H011
    P003
    M706
    M706
    L091
    H011
    H011
    H011
    P049
    S194
    S194
    H008
    P315
    L013
    L070
    P005
    S194
    L070
    L070
    M035
    P315
    S194

    $87.99
    $100.00
    $150.00
    $50.00
    $90.00
    $625.50
    $2,155.50
    $100.00
    $200.00
    $34.86
    $976.49
    $350.00
    $400.00
    $200.00
    $246.48
    $540.00
    $200.00
    $1,952.98
    $128.20
    $476.25
    $250.00
    $500.00
    $700.00
    $317.50
    $635.00
    $220.00
    $1,600.00
    $300.00
    $424.30
    $550.00
    $258.00
    $15.00
    $83.00
    $100.00
    $305.00
    $510.00
    $550.00
    $24.00
    $725.00
    $132.55
    $300.00
    $300.00
    $150.00
    $326.00
    $3,600.00
    $650.00
    $2,681.97
    $1,000.00
    $200.00
    $180.00
    $200.00
    $75.00
    $300.00

    P309
    M035
    M166
    M166
    M166
    M166
    M166
    M166
    D257
    D257
    M035
    M035
    L070
    D120
    D120
    S242
    S242
    S242
    L041
    M580
    M580
    M580
    S160
    M035
    M035
    S279
    S279
    P435
    S001
    S001
    O156
    O156
    D75
    D75
    D75
    D01
    S019
    M087
    P373
    M304
    M304
    H005
    D303
    M254
    M254
    M254
    EC01
    EC01
    EC01
    D79
    D217
    D217
    D217

    $239.40
    $200.00
    $140.00
    $180.00
    $60.00
    $140.00
    $100.00
    $80.00
    $130.00
    $270.00
    $200.00
    $200.00
    $780.00
    $70.00
    $300.00
    $250.00
    $350.00
    $150.00
    $350.00
    $100.00
    $400.00
    $100.00
    $200.00
    $90.00
    $110.00
    $500.00
    $3,000.00
    $89.59
    $700.00
    $200.00
    $200.00
    $1,200.00
    $395.00
    $700.00
    $2,250.00
    $300.00
    $260.00
    $160.00
    $231.00
    $200.00
    $40.00
    $560.00
    $300.00
    $1,000.00
    $400.00
    $400.00
    $2,484.00
    $782.40
    $144.00
    $300.00
    $50.00
    $45.00
    $260.00

    D217
    P179
    D217
    O001
    O001
    D192
    M347
    P081
    D192
    M534
    M534
    M534
    M534
    L075
    H023
    S385
    H005
    O001
    O001
    O001
    M034
    L006
    L003
    D397
    M851
    L172
    P167
    H006
    H006
    H006
    D07
    D07
    M454
    M454
    P049
    D07
    D286
    D286
    D286
    P090
    M443
    P073
    L070
    D119
    D119
    D119
    M375
    M375
    L065
    L123
    S184
    M375
    M375

    $390.00
    $69.00
    $560.00
    $110.00
    $1,504.50
    $600.00
    $600.00
    $1,422.00
    $500.00
    $200.00
    $2,035.00
    $500.00
    $1,855.00
    $6,000.00
    $3,380.00
    $400.00
    $200.00
    $110.00
    $1,395.00
    $1,740.00
    $50.00
    $155.00
    $800.00
    $500.00
    $500.00
    $1,020.00
    $438.00
    $250.00
    $185.00
    $385.00
    $575.00
    $100.00
    $280.00
    $684.25
    $156.00
    $7,500.00
    $100.00
    $25.00
    $375.00
    $148.50
    $200.00
    $1,308.06
    $460.00
    $50.00
    $120.00
    $250.00
    $280.00
    $122.55
    $435.00
    $420.00
    $300.00
    $160.00
    $60.00

    L117
    M375
    T032
    T032
    M375
    M833
    D60
    D60
    D60
    P435
    D150
    D150
    D150
    D150
    S107
    S367
    S107
    S367
    D305
    D305
    D255
    D255
    D255
    D255
    M343
    M343
    L065
    L065
    D255
    D255
    M325
    P477
    P014
    O076
    D427
    D427
    D427
    O001
    O001
    O001
    D192
    D192
    D192
    D192
    D192
    M473
    P343
    L070
    L046
    P343
    M473
    O004
    O004

    $3,800.00
    $120.00
    $1,100.00
    $1,360.00
    $160.00
    $240.00
    $50.00
    $10.00
    $300.00
    $66.33
    $150.00
    $350.00
    $200.00
    $400.00
    $400.00
    $360.00
    $200.00
    $360.00
    $400.00
    $100.00
    $50.00
    $50.00
    $40.00
    $260.00
    $300.00
    $40.00
    $240.00
    $345.00
    $900.00
    $950.00
    $280.00
    $184.90
    $644.55
    $90.00
    $400.00
    $600.00
    $500.00
    $250.00
    $2,056.00
    $476.00
    $100.00
    $50.00
    $250.00
    $600.00
    $600.00
    $240.00
    $85.75
    $795.00
    $690.00
    $104.00
    $150.00
    $100.00
    $1,756.00

    O004
    D276
    D276
    D276
    S149
    S149
    S149
    S149
    S149
    S393
    S393
    M602
    H027
    H027
    S550
    S550
    O076
    O076
    M166
    M166
    M166
    M166
    M166
    M166
    M233
    M233
    M233
    M233
    S144
    L013
    L070
    S115
    P309
    D244
    D244
    D244
    D244
    M233
    M233
    S109
    S109
    S109
    O001
    O001
    M233
    L013
    L013
    M233
    D253
    D253
    D173
    D173
    D173

    $1,016.00
    $1,550.00
    $80.00
    $200.00
    $200.00
    $300.00
    $200.00
    $100.00
    $200.00
    $200.00
    $1,000.00
    $800.00
    $400.00
    $2,300.00
    $200.00
    $200.00
    $180.00
    $1,200.00
    $140.00
    $170.00
    $160.00
    $140.00
    $100.00
    $600.00
    $100.00
    $100.00
    $100.00
    $100.00
    $500.00
    $550.00
    $1,550.00
    $300.00
    $346.50
    $750.00
    $200.00
    $120.00
    $550.00
    $100.00
    $120.00
    $300.00
    $3,400.00
    $270.00
    $1,041.25
    $1,819.00
    $150.00
    $165.00
    $375.00
    $100.00
    $50.00
    $500.00
    $260.00
    $140.00
    $450.00

    D173
    D173
    S361
    D90
    D90
    M275
    M275
    M626
    M829
    D411
    O033
    O033
    O033
    H006
    UN01
    UN01
    UN01
    D06
    D06
    M026
    S266
    S049
    O156

    $350.00
    $450.00
    $250.00
    $650.00
    $350.00
    $300.00
    $200.00
    $200.00
    $300.00
    $200.00
    $100.00
    $1,192.50
    $688.50
    $3,000.00
    $150.00
    $345.00
    $470.00
    $140.00
    $80.00
    $220.00
    $400.00
    $900.00
    $500.00

    n a high to low spending order


    0% of the total claims
    t by the 10% of the High spenders
    rmacy and in Hospital
    t spend more money

    Potrebbero piacerti anche