| S0012 | Butorphanol tartrate, nasal |
| S0014 | Tacrine hydrochloride, 10 mg |
| S0017 | Injection, aminocaproic acid |
| S0020 | Injection, bupivicaine hydro |
| S0021 | Injection, cefoperazone sod |
| S0023 | Injection, cimetidine hydroc |
| S0028 | Injection, famotidine, 20 mg |
| S0030 | Injection, metronidazole |
| S0032 | Injection, nafcillin sodium |
| S0034 | Injection, ofloxacin, 400 mg |
| S0039 | Injection, sulfamethoxazole |
| S0040 | Injection, ticarcillin disod |
| S0073 | Injection, aztreonam, 500 mg |
| S0074 | Injection, cefotetan disodiu |
| S0077 | Injection, clindamycin phosp |
| S0078 | Injection, fosphenytoin sodi |
| S0080 | Injection, pentamidine iseth |
| S0081 | Injection, piperacillin sodi |
| S0088 | Imatinib 100 mg |
| S0090 | Sildenafil citrate, 25 mg |
| S0091 | Granisetron 1mg |
| S0092 | Hydromorphone 250 mg |
| S0093 | Morphine 500 mg |
| S0104 | Zidovudine, oral, 100 mg |
| S0106 | Bupropion hcl sr 60 tablets |
| S0108 | Mercaptopurine 50 mg |
| S0109 | Methadone oral 5mg |
| S0117 | Tretinoin topical 5 g |
| S0119 | Ondansetron 4 mg |
| S0122 | Inj menotropins 75 iu |
| S0126 | Inj follitropin alfa 75 iu |
| S0128 | Inj follitropin beta 75 iu |
| S0132 | Inj ganirelix acetat 250 mcg |
| S0136 | Clozapine, 25 mg |
| S0137 | Didanosine, 25 mg |
| S0138 | Finasteride, 5 mg |
| S0139 | Minoxidil, 10 mg |
| S0140 | Saquinavir, 200 mg |
| S0142 | Colistimethate inh sol mg |
| S0145 | Peg interferon alfa-2a/180 |
| S0146 | Peg interferon alfa-2b/10 |
| S0148 | Peg interferon alfa-2b/10 |
| S0155 | Epoprostenol dilutant |
| S0156 | Exemestane, 25 mg |
| S0157 | Becaplermin gel 1%, 0.5 gm |
| S0160 | Dextroamphetamine |
| S0161 | Calcitrol |
| S0164 | Injection pantroprazole |
| S0166 | Inj olanzapine 2.5mg |
| S0169 | Calcitrol |
| S0170 | Anastrozole 1 mg |
| S0171 | Bumetanide 0.5 mg |
| S0172 | Chlorambucil 2 mg |
| S0174 | Dolasetron 50 mg |
| S0175 | Flutamide 125 mg |
| S0176 | Hydroxyurea 500 mg |
| S0177 | Levamisole 50 mg |
| S0178 | Lomustine 10 mg |
| S0179 | Megestrol 20 mg |
| S0181 | Ondansetron 4 mg |
| S0182 | Procarbazine, oral |
| S0183 | Prochlorperazine 5 mg |
| S0187 | Tamoxifen 10 mg |
| S0189 | Testosterone pellet 75 mg |
| S0190 | Mifepristone, oral, 200 mg |
| S0191 | Misoprostol, oral, 200 mcg |
| S0194 | Vitamin suppl 100 caps |
| S0195 | Pneumo vaccine 5-9 yrs |
| S0196 | Poly-l-lactic acid 1ml face |
| S0197 | Prenatal vitamins 30 day |
| S0199 | Med abortion inc all ex drug |
| S0201 | Partial hospitalization serv |
| S0207 | Paramedicintercep nonhospals |
| S0208 | Paramed intrcept nonvol |
| S0209 | Wc van mileage per mi |
| S0215 | Nonemerg transp mileage |
| S0220 | Medical conference by physic |
| S0221 | Medical conference, 60 min |
| S0250 | Comp geriatr assmt team |
| S0255 | Hospice refer visit nonmd |
| S0257 | End of life counseling |
| S0260 | H&p for surgery |
| S0265 | Genetic counsel 15 mins |
| S0270 | Home std case rate 30 days |
| S0271 | Home hospice case 30 days |
| S0272 | Home episodic case 30 days |
| S0273 | Md home visit outside cap |
| S0274 | Nurse practr visit outs cap |
| S0280 | Medical home, initial plan |
| S0281 | Medical home, maintenance |
| S0302 | Completed epsdt |
| S0310 | Hospitalist visit |
| S0315 | Disease management program |
| S0316 | Follow-up/reassessment |
| S0317 | Disease mgmt per diem |
| S0320 | Rn telephone calls to dmp |
| S0340 | Lifestyle mod 1st stage |
| S0341 | Lifestyle mod 2 or 3 stage |
| S0342 | Lifestyle mod 4th stage |
| S0353 | Cancer treatmentplan initial |
| S0354 | Cancer treatment plan change |
| S0390 | Rout foot care per visit |
| S0395 | Impression casting ft |
| S0400 | Global eswl kidney |
| S0500 | Dispos cont lens |
| S0504 | Singl prscrp lens |
| S0506 | Bifoc prscp lens |
| S0508 | Trifoc prscrp lens |
| S0510 | Non-prscrp lens |
| S0512 | Daily cont lens |
| S0514 | Color cont lens |
| S0515 | Scleral lens liquid bandage |
| S0516 | Safety frames |
| S0518 | Sunglass frames |
| S0580 | Polycarb lens |
| S0581 | Nonstnd lens |
| S0590 | Misc integral lens serv |
| S0592 | Comp cont lens eval |
| S0595 | New lenses in pts old frame |
| S0596 | Phakic iol refractive error |
| S0601 | Screening proctoscopy |
| S0610 | Annual gynecological examina |
| S0612 | Annual gynecological examina |
| S0613 | Ann breast exam |
| S0618 | Audiometry for hearing aid |
| S0620 | Routine ophthalmological exa |
| S0621 | Routine ophthalmological exa |
| S0622 | Phys exam for college |
| S0625 | Digital screening retina |
| S0630 | Removal of sutures |
| S0800 | Laser in situ keratomileusis |
| S0810 | Photorefractive keratectomy |
| S0812 | Phototherap keratect |
