Table 5 Enhanced Benefits Report Sample Clauses

Table 5 Enhanced Benefits Report. Plan ID Recipient ID: Character, 9 bytes Date of Birth: CCYY-MM-DD SSN: XXX-XX-XXXX Procedure Code Character 5 Date of Paid Claim CCYY-MM-DD NDC: Character 11 Date of Service: CCYY-MM-DD 45330 CR 45378 CR 76090 MAMMO 76091 MAMMO 76092 MAMMO 88141 PAP 88142 PAP 88143 PAP 88150 PAP 88155 PAP 88164 PAP 88174 PAP 88175 PAP 92002 EYE 92004 EYE 92012 EYE 92014 EYE 92015 EYE 92018 EYE 92020 EYE 99201 OV 99202 OV 99203 OV 99204 OV 99205 OV 99211 OV 99212 OV 99213 OV 99214 OV 99215 OV 99381 PREV 99382 PREV 99383 PREV 99384 PREV 99385 PREV 99386 PREV 99387 PREV 99391 PREV 99392 PREV 99393 PREV 99394 PREV 99395 PREV 99396 PREV 99397 PREV 99403 PM Counsel 99431 PREV 99432 PREV 99435 PREV