| Code | Display | Definition |
| 1 | Medical Care | Medical Care. |
| 2 | Surgical | Surgical. |
| 3 | Consultation | Consultation. |
| 4 | Diagnostic XRay | Diagnostic XRay. |
| 5 | Diagnostic Lab | Diagnostic Lab. |
| 14 | Renal Supplies | Renal Supplies excluding Dialysis. |
| 23 | Diagnostic Dental | Diagnostic Dental. |
| 24 | Periodontics | Periodontics. |
| 25 | Restorative | Restorative. |
| 26 | Endodontics | Endodontics. |
| 27 | Maxillofacial Prosthetics | Maxillofacial Prosthetics. |
| 28 | Adjunctive Dental Services | Adjunctive Dental Services. |
| 30 | Health Benefit Plan Coverage | Health Benefit Plan Coverage. |
| 35 | Dental Care | Dental Care. |
| 36 | Dental Crowns | Dental Crowns. |
| 37 | Dental Accident | Dental Accident. |
| 49 | Hospital Room and Board | Hospital Room and Board. |
| 55 | Major Medical | Major Medical. |
| 56 | Medically Related Transportation | Medically Related Transportation. |
| 61 | In-vitro Fertilization | In-vitro Fertilization. |
| 62 | MRI Scan | MRI Scan. |
| 63 | Donor Procedures | Donor Procedures such as organ harvest. |
| 69 | Maternity | Maternity. |
| 76 | Renal Dialysis | Renal dialysis. |
| F1 | Medical Coverage | Medical Coverage. |
| F3 | Dental Coverage | Dental Coverage. |
| F4 | Hearing Coverage | Hearing Coverage. |
| F6 | Vision Coverage | Vision Coverage. |