Vision exams on and after January 1, 2004 (PPO vision network; any vision provider out-of-network)
Service Benefit Category Id
10236
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Network physician or network nurse practitioner for age-based schedule
Service Benefit Category Id
10237
Additional visits to designated PCP or nurse practitioner
Service Benefit Category Id
10238
Additional visits to other network physicians
Service Benefit Category Id
10239
Network physician or nurse practitioner for 1 exam each calendar year
Service Benefit Category Id
10240
Additional visits to designated PCP or nurse practitioner
Service Benefit Category Id
10241
Additional visits to other network physicians
Service Benefit Category Id
10242
Physical therapy
Service Benefit Category Id
10243
Speech and occupational therapy
Service Benefit Category Id
10244
First accident treatment (fractures, dislocations and burns)
Service Benefit Category Id
10245