| Selected Infectious
and Parasitic Diseases |
| 1. Symptomatic HIV |
042.xx; 079.53 |
317 |
101 |
3.14 |
| 2. Asymptomatic HIV |
V08 |
1 |
1 |
1.00 |
| 3. Tuberculosis |
010.xx - 018.xx |
7 |
5 |
1.40 |
| 4. Syphilis and other sexually transmitted
diseases |
090.xx - 099.xx |
35 |
20 |
1.75 |
| Selected Diseases
of the Respiratory System |
| 5. Asthma |
493.xx |
765 |
500 |
1.53 |
| 6. Chronic bronchitis and emphysema |
490.xx - 492.xx |
1,448 |
798 |
1.81 |
| Selected Other Medical
Conditions |
| 7. Abnormal breast findings, female |
174.xx; 198.81; 233.0x;
793.8x |
24 |
19 |
1.26 |
| 8. Abnormal cervical findings |
180.xx; 198.82; 233.1x;
795.0x |
168 |
123 |
1.37 |
| 9. Diabetes mellitus |
250.xx; 775.1x |
3,423 |
1,293 |
2.65 |
| 10. Heart disease (selected) |
391.xx - 392.xx;
410.xx - 429.xx |
1,680 |
494 |
3.40 |
| 11. Hypertension |
401.xx - 405.xx |
3,499 |
1,960 |
1.79 |
| 12. Contact dermatitis and other eczema |
692.xx |
367 |
304 |
1.21 |
| 13. Dehydration |
276.5x |
168 |
70 |
2.40 |
| 14. Exposure to heat or cold |
991.xx - 992.xx |
11 |
5 |
2.20 |
| Selected Childhood
Conditions |
| 15. Otitis media and eustachian tube
disorders |
381.xx - 382.xx |
963 |
748 |
1.29 |
| 16. Selected perinatal medical conditions |
770.xx; 771.xx; 773.xx;
774.xx - 779.xx (excluding 779.3x) |
94 |
49 |
1.92 |
| 17. Lack of expected normal physiological
development (such as delayed milestone;
failure to gain weight; failure to thrive)
-- does not include sexual or mental development;
Nutritional deficiencies |
260.xx - 269.xx;
779.3x; 783.3x - 783.4x |
127 |
64 |
1.98 |
| Selected Mental Health
and Substance Abuse Conditions |
| 18. Alcohol related disorders |
291.xx, 303.xx; 305.0x
357.5x |
333 |
141 |
2.36 |
19. Other substance related disorders
(excluding tobacco use disorders)
|
292.1x - 292.8x,
304.xx,
305.2x - 305.9x, 357.6x,
648.3x |
92 |
73 |
1.26 |
| 20a. Depression and other mood disorders |
296.xx, 300.4
301.13, 311.xx |
4,057 |
1,689 |
2.40 |
| 20b. Anxiety disorders including PTSD |
300.0x, 300.21, 300.22,
300.23, 300.29, 300.3,
308.3, 309.81 |
1,167 |
591 |
1.97 |
| 20c. Attention deficit and disruptive
behavior disorders |
312.8x, 312.9x, 313.81,
314.xx |
505 |
270 |
1.87 |
| 20d. Other mental disorders, excluding
drug or alcohol dependence (includes mental
retardation) |
290.xx
293.xx - 302.xx
(excluding 296.xx, 300.0x, 300.21, 300.22,
300.23, 300.29, 300.3, 300.4, 301.13);
306.xx - 319.xx
(excluding 308.3, 309.81,
311.xx, 312.8x,
312.9x, 313.81, 314.xx) |
1,389 |
550 |
2.53 |
| Selected Diagnostic
Tests/Screening/Preventive Services |
| 21. HIV Test |
CPT-4: 86689; 86701-86703;
87390-87391 |
356 |
344 |
1.03 |
| 22. Mammogram |
CPT-4: 77055-77057
OR
ICD-9: V76.11, V76.12 |
27 |
22 |
1.23 |
| 23. Pap Test |
CPT-4: 88141-88155;
88164-88167 OR
ICD-9: V72.3; V72.31;
V76.2 |
1,791 |
1,663 |
1.08 |
| 24. Selected Immunizations: Hepatitis
A, Hemophilus Influenza B (HiB), Influenza
virus, Pneumococcal, Diptheria, Tetanus,
Pertussis (DTaP) (DTP) (DT), Mumps, Measles,
Rubella, Poliovirus, Varicella, Hepatitis
B Child) |
CPT-4: 90633-90634,
90645 - 90648; 90657 - 90660; 90669;
90700 - 90702; 90704 - 90716; 90718;
90720-90721, 90723, 90743 - 90744; 90748 |
3,112 |
2,301 |
1.35 |
| 25. Contraceptive management |
ICD-9: V25.xx |
677 |
405 |
1.67 |
| 26. Health supervision of infant or
child (ages 0 through 11) |
CPT-4: 99391-99393;99381-99383;
99431-99433
or
ICD-9: V20.xx; V29.xx |
2,750 |
1,365 |
2.01 |
| Selected Dental Services |
| 27. I. Emergency Services |
ADA: D9110 |
9 |
9 |
1.00 |
| 28. II. Oral Exams |
ADA: D0120, D0140,
D0145, D0150, D0160, D0170, D0180 |
1,135 |
895 |
1.27 |
| 29. Prophylaxis - adult or child |
ADA: D1110, D1120 |
996 |
696 |
1.43 |
| 30. Sealants |
ADA: D1351 |
71 |
62 |
1.15 |
31. Fluoride Treatment - adult or child
|
ADA: D1203,
D1204 |
47 |
45 |
1.04 |
| 32. III. Restorative Services |
ADA: D21xx, D23xx,
D27xx |
916 |
418 |
2.19 |
33. IV. Oral Surgery
(extractions and other surgical procedures)
|
ADA: D7111, D7140,
D7210, D7220, D7230, D7240, D7241, D7250,
D7260, D7261, D7270, D7272, D7280 |
364 |
321 |
1.13 |
34. V. Rehabilitative Services (Endo,
Perio, Prostho, Ortho)
|
ADA: D3xxx, D4xxx,
D5xxx, D6xxx, D8xxx |
571 |
272 |
2.10 |
