| Name | Value |
|---|---|
| CODE | 168 |
| STATUS EFFECTIVE DATE |
|
| DESCRIPTION EFFECTIVE DATE |
|
| SUSPENSION DESCRIPTION | Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan |
| REMITTANCE REMARK |
|
| CORE SCENARIO | Billed Service Not Covered |
| ADJUSTMENT GROUP |
|