A minor tray service benefit may be claimed for the following procedures only when they are performed in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services.
| 07.53C | 07.56A | 07.57B | 10.16A | 11.23A | 12.01 |
| 12.21 | 13.53B | 13.59E | 13.59F | 13.59H | 13.59J |
| 13.59K | 13.59L | 13.59N | 13.99BB 16.89B | 16.89C | |
| 16.89D | 17.71A | 17.71B | 18.29E | 18.29EA 19.81 |
| 21.31A | 21.41 | 21.32D | 21.69C | 23.99D | 24.91 |
| 30.19A | 32.96A | 32.96B | 33.01A | 33.03A | 33.21A |
| 33.22A | 33.61A | 35.0 A | 37.81 | 37.91A | 38.0 A |
| 39.91B |
| 43.0 B | 50.98A | 51.92A | 53.81B |
| 61.01A | 67.93 | 70.5 B | 71.95 | 73.91 | 78.7 A |
| 79.22 |
| 80.83B | 81.8 | 93.91A | 93.91B | 94.01B | 94.04 |
| 95.03 | 95.93 | 95.94A | 95.94B | 95.96A | 97.81 |
| 97.89A | 98.01A | 98.03A | 98.03B | 98.03C | 98.03E |
| 98.04B | 98.04C | 98.12K | 98.12S |
