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G3002

Chronic pain management services (initial 30 minutes)
Chronic pain management services (initial 30 minutes)

J0136

Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg
Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg

J0173

Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg
Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg

J0689

Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg

J1643

Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units
Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units

J3371

Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg
Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg

13474

Member for

7 years 10 months
Submitted by Site Factory admin on
Empastes de resina compuesta de una sola superficie en dientes posteriores para premolares y molares (según la tabla de tolerancia dental del grupo). Un empaste para cada superficie dental cada 12 meses.

13474

Member for

7 years 10 months
Submitted by Site Factory admin on
Single surface composite resin fillings on back teeth for bicuspids and molars (based on the group's dental table of allowance). One filling for each tooth surface each 12 months.

13473

Member for

7 years 10 months
Submitted by Site Factory admin on
Los servicios del grupo 2 son servicios dentales prestados por un dentista, en general para recuperar o extraer piezas dentales naturales enfermas o fracturadas, reemplazar reparaciones dañadas o defectuosas, tratar enfermedades de la boca, reparar, rebasar o realinear dentaduras postizas o reparar coronas y puentes y recementar coronas, onlay y puentes fijos. Dichos servicios dentales cubiertos son:

13473

Member for

7 years 10 months
Submitted by Site Factory admin on
Group 2 Services are dental services furnished by a Dentist generally to restore or remove diseased or fractured natural teeth, replace damaged or defective restorations, treat oral disease, repair, rebase or reline dentures or repair crowns and bridges and recement crowns, onlays and fixed bridgework. These covered dental services include: