XEROX 99D-Appendix3
DA7 NonFormul Non Formulary Drug NON-FORMULARY. DA8 Diapers Diapers DIAPERS. DA9 Dental Dental DENTAL. DB0 ProcNotPay Procedure Not Payable at Loc DENY-RSN-DB0. DB1 Inpatient Inpatient-Only INPATIENT-ONLY. DB2 Supls-Nt-c Supplies Not Covered SUPPLIES-NOT-CVRD. DB3 Ptnt-Nt-pl Patient Not on Policy PATIENT-NO-PLCY. DB5 Non covrd Non Covered NON ... ................
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