No	Kolom	Nilai
1	Pulpitis
2	General medical examination
3	Extracorporeal dialysis
4	Chronic kidney disease, stage 5
5	Low back pain
6	Supervision of other high-risk pregnancies
7	Essential (primary) hypertension
8	Hyperlipidaemia, unspecified
9	Stroke, not specified as haemorrhage or infarction
10	Follow-up examination after other treatment for other conditions