S0073 Home Health Care Infertility Services Medical Care Outpatient Visits Prescription Drugs Radiation Therapy and Chemotherapy INJECTION, AZTREONAM, 500 MG INJECTION, AZTREONAM, 500 MG
S0077 Home Health Care Infertility Services Medical Care Outpatient Visits Prescription Drugs Radiation Therapy and Chemotherapy INJECTION, CLINDAMYCIN PHOSP INJECTION, CLINDAMYCIN PHOSP
S0122 Home Health Care Infertility Services Medical Care Outpatient Visits Radiation Therapy and Chemotherapy INJ MENOTROPINS 75 IU INJ MENOTROPINS 75 IU
S0201 Emergency Medical Outpatient Services Labs, X-Rays and Other Tests Preventive Dental Care for Children Maternity Services Medical Care Outpatient Visits Mental Health and Substance Use Treatment - Biologically Based Mental Conditions Mental Health and Substance Use Treatment - Non-Biologically Based Mental Conditions Mental Health and Substance Use Treatment - Alcoholism Treatment Routine Vision Care Short-Term Rehabilitation Therapy TMJ Disorder Treatment PARTIAL HOSPITALIZATION SERV PARTIAL HOSPITALIZATION SERV
S0250 Inpatient Medical and Surgical Care in a General Hospital Medical Care Outpatient Visits COMP GERIATR ASSMT TEAM COMP GERIATR ASSMT TEAM
S0302 Emergency Medical Outpatient Services Labs, X-Rays and Other Tests Preventive Dental Care for Children Maternity Services Medical Care Outpatient Visits Mental Health and Substance Use Treatment - Biologically Based Mental Conditions Mental Health and Substance Use Treatment - Non-Biologically Based Mental Conditions Mental Health and Substance Use Treatment - Alcoholism Treatment Routine Vision Care Short-Term Rehabilitation Therapy TMJ Disorder Treatment COMPLETED EPSDT COMPLETED EPSDT
S0311 Emergency Medical Outpatient Services Inpatient Care in a Chronic Disease Hospital Maternity Services Medical Care Outpatient Visits Mental Health and Substance Use Treatment - Biologically Based Mental Conditions Mental Health and Substance Use Treatment - Non-Biologically Based Mental Conditions Mental Health and Substance Use Treatment - Alcoholism Treatment COMP MGMT CARE COORD ADV ILL COMP MGMT CARE COORD ADV ILL
S0315 Emergency Medical Outpatient Services Inpatient Care in a Chronic Disease Hospital Maternity Services Medical Care Outpatient Visits Mental Health and Substance Use Treatment - Biologically Based Mental Conditions Mental Health and Substance Use Treatment - Non-Biologically Based Mental Conditions Mental Health and Substance Use Treatment - Alcoholism Treatment DISEASE MANAGEMENT PROGRAM DISEASE MANAGEMENT PROGRAM