|
|
| # |
CodeValue |
Description |
| 1 |
03 |
MMR |
| 2 |
06 |
rubella |
| 3 |
07 |
mumps |
| 4 |
08 |
Hep B, adolescent or pediatric |
| 5 |
09 |
Td (adult), adsorbed |
| 6 |
10 |
IPV |
| 7 |
101 |
typhoid, ViCPs |
| 8 |
104 |
Hep A-Hep B |
| 9 |
106 |
DTaP, 5 pertussis antigens |
| 10 |
110 |
DTaP-Hep B-IPV |
| 11 |
113 |
Td (adult) preservative free |
| 12 |
114 |
meningococcal MCV4P |
| 13 |
115 |
Tdap |
| 14 |
116 |
rotavirus, pentavalent |
| 15 |
118 |
HPV, bivalent |
| 16 |
119 |
rotavirus, monovalent |
| 17 |
12 |
diphtheria antitoxin |
| 18 |
120 |
DTaP-Hib-IPV |
| 19 |
121 |
zoster |
| 20 |
13 |
TIG |
| 21 |
130 |
DTaP-IPV |
| 22 |
133 |
Pneumococcal conjugate PCV 13 |
| 23 |
134 |
Japanese Encephalitis IM |
| 24 |
135 |
Influenza, high dose seasonal |
| 25 |
136 |
Meningococcal MCV4O |
| 26 |
138 |
Td (adult) |
| 27 |
140 |
Influenza, seasonal, injectable, preservative free |
| 28 |
141 |
Influenza, seasonal, injectable |
| 29 |
142 |
tetanus toxoid, not adsorbed |
| 30 |
143 |
Adenovirus types 4 and 7 |
| 31 |
144 |
influenza, seasonal, intradermal, preservative free |
| 32 |
145 |
RSV-MAb (new) |
| 33 |
146 |
DTaP,IPV,Hib,HepB |
| 34 |
147 |
meningococcal MCV4, unspecified formulation |
| 35 |
148 |
Meningococcal C/Y-HIB PRP |
| 36 |
149 |
influenza, live, intranasal, quadrivalent |
| 37 |
150 |
influenza, injectable, quadrivalent, preservative free |
| 38 |
153 |
Influenza, injectable, MDCK, preservative free |
| 39 |
154 |
Hep A, IG |
| 40 |
155 |
influenza, recombinant, injectable, preservative free |
| 41 |
156 |
Rho(D)-IG |
| 42 |
157 |
Rho(D) -IG IM |
| 43 |
158 |
influenza, injectable, quadrivalent |
| 44 |
160 |
Influenza A monovalent (H5N1), ADJUVANTED-2013 |
| 45 |
161 |
Influenza, injectable,quadrivalent, preservative free, pediatric |
| 46 |
162 |
meningococcal B, recombinant |
| 47 |
163 |
meningococcal B, OMV |
| 48 |
165 |
HPV9 |
| 49 |
166 |
influenza, intradermal, quadrivalent, preservative free |
| 50 |
168 |
FLUAD |
| 51 |
17 |
Hib, unspecified formulation |
| 52 |
171 |
FLUCELVAX QUADRIVALENT |
| 53 |
174 |
Vaxchora |
| 54 |
175 |
IMOVAX RABIES |
| 55 |
176 |
RabAvert |
| 56 |
18 |
rabies, intramuscular injection |
| 57 |
183 |
STAMARIL |
| 58 |
185 |
Flublok Quadrivalent |
| 59 |
186 |
FLUCELVAX QUADRIVALENT (MULTI-DOSE VIAL) |
| 60 |
187 |
Shingrix |
| 61 |
189 |
HEPLISAV-B |
| 62 |
19 |
BCG |
| 63 |
197 |
FLUZONE High-Dose Quadrivalent Northern Hemisphere |
| 64 |
20 |
DTaP |
| 65 |
200 |
FLUZONE QUADRIVALENT SOUTHERN HEMISPHERE |
| 66 |
201 |
FLUZONE QUADRIVALENT SOUTHERN HEMISPHERE |
| 67 |
202 |
FLUZONE QUADRIVALENT SOUTHERN HEMISPHERE |
| 68 |
203 |
MenQuadfi |
| 69 |
204 |
ERVEBO |
| 70 |
205 |
FLUAD QUADRIVALENT |
| 71 |
206 |
JYNNEOS |
| 72 |
207 |
Moderna COVID-19 Vaccine |
| 73 |
208 |
Pfizer-BioNTech Covid-19 Vaccine |
| 74 |
21 |
varicella |
| 75 |
211 |
NOVAVAX COVID-19 Vaccine, Adjuvanted |
| 76 |
212 |
Janssen COVID-19 Vaccine |
| 77 |
215 |
VAXNEUVANCE |
| 78 |
216 |
Prevnar 20 |
| 79 |
217 |
Comirnaty |
| 80 |
218 |
Pfizer-BioNTech Covid-19 Vaccine |
| 81 |
219 |
Pfizer-BioNTech Covid-19 Vaccine |
| 82 |
220 |
PREHEVBRIO |
| 83 |
221 |
Moderna COVID-19 Vaccine |
| 84 |
223 |
TicoVac |
| 85 |
224 |
TicoVac |
| 86 |
225 |
ANTIGEN COMPONENT |
| 87 |
227 |
Moderna COVID-19 Vaccine |
| 88 |
228 |
Moderna COVID-19 Vaccine |
| 89 |
229 |
Moderna COVID-19 Vaccine, Bivalent |
| 90 |
23 |
plague |
| 91 |
230 |
Moderna COVID-19 Vaccine, Bivalent |
| 92 |
231 |
FLUZONE High-Dose Quadrivalent Southern Hemisphere |
| 93 |
24 |
anthrax |
| 94 |
25 |
typhoid, oral |
| 95 |
27 |
botulinum antitoxin |
| 96 |
28 |
DT (pediatric) |
| 97 |
29 |
CMVIG |
| 98 |
30 |
HBIG |
| 99 |
300 |
Pfizer-BioNTech Covid-19 Vaccine, Bivalent |
| 100 |
301 |
Pfizer-BioNTech Covid-19 Vaccine, Bivalent |
| 101 |
302 |
Pfizer-BioNTech Covid-19 Vaccine, Bivalent |
| 102 |
32 |
meningococcal MPSV4 |
| 103 |
33 |
pneumococcal polysaccharide PPV23 |
| 104 |
34 |
RIG |
| 105 |
35 |
tetanus toxoid, adsorbed |
| 106 |
36 |
VZIG |
| 107 |
37 |
yellow fever |
| 108 |
39 |
Japanese encephalitis SC |
| 109 |
40 |
rabies, intradermal injection |
| 110 |
41 |
typhoid, parenteral |
| 111 |
43 |
Hep B, adult |
| 112 |
44 |
Hep B, dialysis |
| 113 |
48 |
Hib (PRP-T) |
| 114 |
49 |
Hib (PRP-OMP) |
| 115 |
50 |
DTaP-Hib |
| 116 |
51 |
Hib-Hep B |
| 117 |
52 |
Hep A, adult |
| 118 |
53 |
typhoid, parenteral, AKD (U.S. military) |
| 119 |
56 |
dengue fever |
| 120 |
57 |
hantavirus |
| 121 |
58 |
Hep C |
| 122 |
59 |
Hep E |
| 123 |
60 |
herpes simplex 2 |
| 124 |
61 |
HIV |
| 125 |
62 |
HPV, quadrivalent |
| 126 |
63 |
Junin virus |
| 127 |
64 |
leishmaniasis |
| 128 |
65 |
leprosy |
| 129 |
67 |
malaria |
| 130 |
68 |
melanoma |
| 131 |
70 |
Q fever |
| 132 |
71 |
RSV-IGIV |
| 133 |
72 |
rheumatic fever |
| 134 |
73 |
Rift Valley fever |
| 135 |
75 |
vaccinia (smallpox) |
| 136 |
79 |
vaccinia immune globulin |
| 137 |
801 |
AS03 Adjuvant |
| 138 |
83 |
Hep A, ped/adol, 2 dose |
| 139 |
86 |
IG |
| 140 |
87 |
IGIV |
| 141 |
88 |
influenza, unspecified formulation |
| 142 |
89 |
polio, unspecified formulation |
| 143 |
93 |
RSV-MAb |
| 144 |
94 |
MMRV |
| 145 |
998 |
no vaccine administered |