| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
222,353 |
193,936 |
$11.03M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
83,557 |
79,123 |
$6.57M |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
11,911 |
3,852 |
$5.65M |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
7,236 |
7,100 |
$4.76M |
| 99479 |
Subsequent intensive care, per day, very low birth weight infant |
23,840 |
5,488 |
$3.33M |
| 93303 |
Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study |
15,217 |
14,164 |
$3.20M |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
42,205 |
38,650 |
$3.02M |
| 99469 |
Subsequent inpatient neonatal critical care, per day, 28 days or younger |
7,025 |
1,477 |
$2.70M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
28,377 |
27,718 |
$2.67M |
| 99480 |
Subsequent intensive care, per day, low birth weight infant |
19,874 |
4,642 |
$2.60M |
| 99472 |
Subsequent inpatient pediatric critical care, per day, 2-5 years |
5,846 |
1,164 |
$2.43M |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
20,283 |
19,668 |
$2.39M |
| 99215 |
Prolong outpt/office vis |
14,852 |
14,095 |
$2.11M |
| 76819 |
Fetal biophysical profile; without non-stress testing |
36,422 |
27,161 |
$2.06M |
| 01967 |
Neuraxial labor analgesia/anesthesia for planned vaginal delivery |
5,963 |
5,674 |
$1.99M |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
21,776 |
21,295 |
$1.94M |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
15,947 |
15,387 |
$1.87M |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12,501 |
12,223 |
$1.79M |
| 99233 |
Prolong inpt eval add15 m |
23,542 |
9,062 |
$1.75M |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
45,481 |
40,506 |
$1.71M |
| 99238 |
Hospital discharge day management, 30 minutes or less |
25,415 |
24,904 |
$1.65M |
| 99460 |
|
18,894 |
18,705 |
$1.61M |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
20,754 |
19,732 |
$1.40M |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
11,161 |
10,922 |
$1.31M |
| 01922 |
|
2,204 |
2,167 |
$1.29M |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
24,470 |
10,238 |
$1.19M |
| 93320 |
|
15,866 |
14,205 |
$1.15M |
| 95720 |
|
4,532 |
3,136 |
$1.11M |
| 93325 |
|
23,771 |
20,466 |
$1.03M |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
11,339 |
11,056 |
$1.03M |
| 59514 |
|
1,359 |
1,319 |
$1.03M |
| 71045 |
Radiologic examination, chest; single view |
136,864 |
75,795 |
$875K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
19,913 |
18,368 |
$809K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
7,794 |
7,466 |
$677K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
103,576 |
85,583 |
$620K |
| 01961 |
|
1,153 |
1,126 |
$588K |
| 59025 |
Fetal non-stress test |
25,239 |
22,868 |
$575K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
48,430 |
20,876 |
$527K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
5,377 |
5,283 |
$474K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13,401 |
12,138 |
$455K |
| 70450 |
Computed tomography, head or brain; without contrast material |
17,351 |
15,983 |
$450K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
6,493 |
6,187 |
$378K |
| 74018 |
|
51,887 |
29,641 |
$373K |
| 76820 |
|
9,330 |
6,356 |
$311K |
| 93000 |
|
10,587 |
10,156 |
$305K |
| 90834 |
Psychotherapy, 45 minutes with patient |
5,072 |
4,171 |
$295K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
4,603 |
4,483 |
$274K |
| 54150 |
|
887 |
874 |
$255K |
| 76821 |
|
3,448 |
2,334 |
$221K |
| 76801 |
|
2,668 |
2,560 |
$210K |
| 99462 |
|
4,751 |
4,261 |
$197K |
| 93304 |
|
1,845 |
1,609 |
$191K |
| 92579 |
|
4,754 |
4,629 |
$190K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,014 |
1,981 |
$185K |
| 99223 |
Prolong inpt eval add15 m |
1,292 |
1,234 |
$167K |
| 99222 |
Initial hospital care, per day, moderate complexity |
1,469 |
1,439 |
$164K |
| 92567 |
|
12,163 |
11,856 |
$162K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
582 |
575 |
$160K |
| 99243 |
|
1,098 |
1,069 |
$160K |
| 76506 |
|
5,433 |
4,641 |
$136K |
| 99205 |
Prolong outpt/office vis |
884 |
866 |
$129K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
4,051 |
3,881 |
$127K |
| 76818 |
|
2,592 |
1,670 |
$123K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
1,060 |
1,041 |
$120K |
| 99244 |
Office or other outpatient consultation, moderate to high complexity |
689 |
677 |
$114K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
1,541 |
1,516 |
$107K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
567 |
564 |
$101K |
| 71046 |
Radiologic examination, chest; 2 views |
11,585 |
11,250 |
$99K |
| 90837 |
Psychotherapy, 53 minutes with patient |
1,330 |
1,075 |
$97K |
| 76830 |
Ultrasound, transvaginal |
1,604 |
1,569 |
$97K |
| 76825 |
|
552 |
516 |
$95K |
| 93321 |
|
3,059 |
2,581 |
$93K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
1,471 |
1,443 |
$91K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
3,849 |
3,537 |
$90K |
| 95816 |
|
515 |
499 |
$90K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
1,009 |
971 |
$87K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
881 |
844 |
$78K |
| 76770 |
|
2,393 |
2,347 |
$78K |
| 92588 |
|
2,704 |
2,651 |
$75K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
759 |
735 |
$71K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
476 |
464 |
$70K |
| 99254 |
|
477 |
453 |
$67K |
| 92557 |
|
2,285 |
2,228 |
$67K |
| 99255 |
|
319 |
302 |
$64K |
| 92587 |
|
3,187 |
3,075 |
$60K |
| G2066 |
Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results |
2,453 |
2,368 |
$59K |
| 97803 |
|
1,437 |
1,340 |
$58K |
| 95782 |
|
476 |
468 |
$58K |
| 90791 |
Psychiatric diagnostic evaluation |
664 |
652 |
$58K |
| 90461 |
|
6,972 |
5,770 |
$55K |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,262 |
1,171 |
$53K |
| 96112 |
|
687 |
673 |
$52K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
1,006 |
952 |
$52K |
| 69210 |
|
1,116 |
1,074 |
$50K |
| 99417 |
Prolong home eval add 15m |
1,400 |
1,357 |
$48K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
5,498 |
4,161 |
$47K |
| 99245 |
|
232 |
227 |
$47K |
| 59430 |
|
495 |
469 |
$44K |
| 99350 |
Prolong home eval add 15m |
440 |
416 |
$44K |
| 90715 |
|
1,435 |
1,395 |
$43K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
550 |
531 |
$40K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,394 |
4,210 |
$40K |
| 70498 |
|
730 |
699 |
$40K |
| 97802 |
|
671 |
660 |
$40K |
| 54161 |
|
117 |
117 |
$36K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
1,223 |
1,151 |
$35K |
| 90935 |
Hemodialysis procedure with single evaluation by a physician |
1,241 |
558 |
$35K |
| 93297 |
|
2,385 |
2,287 |
$33K |
| 99464 |
|
352 |
349 |
$33K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,361 |
1,345 |
$32K |
| 99477 |
|
81 |
79 |
$32K |
| 72082 |
|
528 |
516 |
$31K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
397 |
393 |
$31K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
3,529 |
3,432 |
$29K |
| 76827 |
|
526 |
502 |
$28K |
| 92586 |
|
425 |
418 |
$25K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,658 |
1,605 |
$25K |
| 81025 |
|
3,436 |
3,260 |
$25K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
442 |
424 |
$24K |
| 99468 |
|
26 |
25 |
$24K |
| 74230 |
|
995 |
958 |
$23K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
413 |
380 |
$23K |
| 93295 |
|
920 |
906 |
$22K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,445 |
1,392 |
$22K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
638 |
622 |
$21K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
602 |
319 |
$21K |
| 76826 |
|
217 |
191 |
$20K |
| 94621 |
|
99 |
98 |
$20K |
| 64644 |
|
319 |
313 |
$20K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
338 |
337 |
$19K |
| 93296 |
|
1,428 |
1,413 |
$18K |
| 73110 |
|
639 |
512 |
$17K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
42 |
41 |
$16K |
| 99242 |
|
130 |
128 |
$15K |
| 44970 |
|
28 |
27 |
$15K |
| 70496 |
|
257 |
249 |
$15K |
| 90960 |
End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits |
635 |
626 |
$14K |
| 82947 |
|
4,093 |
3,753 |
$14K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,145 |
1,033 |
$13K |
| 71250 |
|
262 |
252 |
$13K |
| 73630 |
|
733 |
548 |
$13K |
| 99442 |
|
500 |
473 |
$12K |
| 99241 |
|
272 |
262 |
$12K |
| 31575 |
|
120 |
119 |
$12K |
| 99471 |
|
13 |
13 |
$11K |
| 99219 |
|
120 |
111 |
$11K |
| 92582 |
|
138 |
137 |
$10K |
| 94375 |
|
321 |
319 |
$10K |
| 31231 |
|
53 |
52 |
$10K |
| 99441 |
|
409 |
398 |
$10K |
| 76942 |
|
642 |
627 |
$9K |
| 74019 |
|
942 |
775 |
$9K |
| 93294 |
|
915 |
896 |
$9K |
| 73562 |
|
1,216 |
932 |
$9K |
| 73130 |
|
752 |
551 |
$8K |
| 93308 |
|
191 |
162 |
$8K |
| 93750 |
|
260 |
158 |
$8K |
| 92555 |
|
394 |
385 |
$8K |
| 64643 |
|
118 |
118 |
$8K |
| 72100 |
|
408 |
396 |
$8K |
| 90651 |
|
179 |
171 |
$7K |
| 90686 |
|
7,022 |
6,925 |
$7K |
| 00731 |
|
54 |
49 |
$7K |
| 99253 |
|
51 |
50 |
$7K |
| 51798 |
|
493 |
466 |
$6K |
| 64642 |
|
73 |
72 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
349 |
333 |
$6K |
| 92551 |
|
982 |
929 |
$5K |
| 99217 |
|
89 |
87 |
$5K |
| 84703 |
|
908 |
856 |
$5K |
| 99429 |
|
177 |
170 |
$5K |
| 73090 |
|
312 |
250 |
$5K |
| 17250 |
|
82 |
80 |
$5K |
| 93531 |
|
17 |
14 |
$5K |
| 29065 |
|
64 |
56 |
$5K |
| 92504 |
|
201 |
193 |
$4K |
| 76642 |
|
186 |
156 |
$4K |
| 74174 |
|
56 |
54 |
$4K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
69 |
69 |
$4K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
236 |
235 |
$4K |
| 73610 |
|
312 |
262 |
$4K |
| 99463 |
|
38 |
38 |
$4K |
| 90682 |
|
86 |
83 |
$4K |
| 76828 |
|
208 |
179 |
$4K |
| 99252 |
|
49 |
39 |
$4K |
| 90480 |
|
115 |
106 |
$4K |
| 99100 |
|
41 |
39 |
$4K |
| 99236 |
Prolong inpt eval add15 m |
17 |
14 |
$4K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
33 |
25 |
$4K |
| 73080 |
|
224 |
191 |
$3K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
345 |
324 |
$3K |
| 93298 |
|
136 |
130 |
$3K |
| 73700 |
|
86 |
67 |
$3K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
51 |
49 |
$3K |
| 99465 |
|
15 |
15 |
$3K |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
540 |
527 |
$3K |
| 72170 |
|
154 |
150 |
$3K |
| 96132 |
|
44 |
25 |
$2K |
| 31579 |
|
14 |
14 |
$2K |
| 92652 |
|
26 |
26 |
$2K |
| 0071A |
|
58 |
56 |
$2K |
| 29075 |
|
27 |
27 |
$2K |
| 72081 |
|
56 |
56 |
$2K |
| 99443 |
|
63 |
60 |
$2K |
| 36011 |
|
30 |
26 |
$2K |
| 99292 |
|
20 |
12 |
$2K |
| 93971 |
|
143 |
136 |
$2K |
| 73560 |
|
77 |
66 |
$2K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
114 |
111 |
$2K |
| 73030 |
|
282 |
241 |
$2K |
| 29450 |
|
31 |
12 |
$2K |
| 73100 |
|
65 |
56 |
$2K |
| 92511 |
|
13 |
13 |
$2K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
25 |
25 |
$2K |
| 81003 |
|
681 |
651 |
$1K |
| 72141 |
|
25 |
24 |
$1K |
| 88720 |
|
295 |
277 |
$1K |
| 0072A |
|
40 |
35 |
$1K |
| 95811 |
|
13 |
12 |
$1K |
| 77073 |
|
51 |
46 |
$1K |
| 83037 |
|
187 |
160 |
$1K |
| 73564 |
|
33 |
27 |
$1K |
| 76377 |
|
51 |
44 |
$1K |
| 74183 |
|
15 |
15 |
$1K |
| 70486 |
|
40 |
36 |
$1K |
| 96381 |
|
79 |
77 |
$1K |
| 94010 |
|
159 |
154 |
$1K |
| 81002 |
|
260 |
242 |
$1K |
| 73590 |
|
195 |
166 |
$1K |
| 93970 |
|
57 |
54 |
$1K |
| 96160 |
|
636 |
618 |
$1K |
| 99385 |
|
12 |
12 |
$939.51 |
| 87807 |
|
84 |
82 |
$936.99 |
| 99381 |
|
14 |
12 |
$935.78 |
| 94729 |
|
117 |
117 |
$912.24 |
| 96116 |
|
12 |
12 |
$903.92 |
| 99218 |
|
13 |
13 |
$842.73 |
| 76937 |
|
46 |
41 |
$832.36 |
| 73552 |
|
127 |
106 |
$815.13 |
| 99349 |
|
14 |
12 |
$749.12 |
| 96121 |
|
12 |
12 |
$738.58 |
| 90380 |
|
107 |
104 |
$718.06 |
| 94618 |
|
39 |
39 |
$714.39 |
| 0001A |
|
17 |
17 |
$708.00 |
| 74181 |
|
12 |
12 |
$698.16 |
| 99225 |
|
15 |
14 |
$694.52 |
| 94726 |
|
78 |
78 |
$632.91 |
| 0002A |
|
13 |
13 |
$616.00 |
| 99221 |
|
14 |
13 |
$548.42 |
| 58300 |
|
12 |
12 |
$542.36 |
| 73521 |
|
12 |
12 |
$478.26 |
| 76885 |
|
14 |
14 |
$447.93 |
| 98960 |
|
39 |
35 |
$443.52 |
| 96113 |
|
13 |
13 |
$432.90 |
| 90674 |
|
25 |
25 |
$409.37 |
| 77080 |
|
57 |
57 |
$365.35 |
| 77066 |
Tomosynthesis, mammo |
13 |
13 |
$355.80 |
| 95874 |
|
19 |
19 |
$341.60 |
| 73060 |
|
54 |
50 |
$339.87 |
| 99000 |
|
29 |
29 |
$325.22 |
| 86580 |
|
43 |
42 |
$306.36 |
| 3044F |
|
986 |
821 |
$300.00 |
| 97165 |
|
29 |
16 |
$296.29 |
| 93227 |
|
31 |
30 |
$291.05 |
| 92550 |
|
15 |
15 |
$288.10 |
| 76536 |
|
12 |
12 |
$269.45 |
| 90621 |
|
34 |
31 |
$214.46 |
| 94727 |
|
25 |
25 |
$204.69 |
| 94760 |
|
76 |
75 |
$197.24 |
| 77072 |
|
17 |
17 |
$149.78 |
| 72040 |
|
15 |
14 |
$141.60 |
| 90474 |
|
13 |
13 |
$123.11 |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
12 |
12 |
$121.57 |
| 73502 |
|
12 |
12 |
$90.98 |
| 3046F |
|
606 |
434 |
$80.00 |
| 80305 |
|
14 |
12 |
$76.73 |
| 95115 |
|
12 |
12 |
$68.46 |
| 97535 |
Self-care/home management training, each 15 minutes |
26 |
12 |
$45.56 |
| 84030 |
|
15 |
15 |
$37.67 |
| 90677 |
|
751 |
749 |
$24.51 |
| 99446 |
|
13 |
12 |
$18.52 |
| 90697 |
|
379 |
376 |
$1.11 |
| 90671 |
|
152 |
151 |
$0.72 |
| 90689 |
|
205 |
200 |
$0.55 |
| 91307 |
|
137 |
127 |
$0.52 |
| 91311 |
|
12 |
12 |
$0.08 |
| 90670 |
|
3,669 |
3,575 |
$0.02 |
| 90680 |
|
1,546 |
1,510 |
$0.01 |
| 90723 |
|
970 |
956 |
$0.01 |
| 91301 |
|
16 |
12 |
$0.01 |
| 90648 |
|
1,328 |
1,304 |
$0.01 |
| 36415 |
Collection of venous blood by venipuncture |
134 |
114 |
$0.00 |
| 3079F |
|
147 |
116 |
$0.00 |
| 90647 |
|
220 |
218 |
$0.00 |
| 3074F |
|
541 |
457 |
$0.00 |
| 96127 |
|
44 |
42 |
$0.00 |
| 90698 |
|
239 |
231 |
$0.00 |
| 96161 |
|
14 |
12 |
$0.00 |
| 36416 |
|
72 |
66 |
$0.00 |
| 82962 |
|
39 |
29 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
122 |
122 |
$0.00 |
| 90716 |
|
41 |
40 |
$0.00 |
| 90744 |
|
33 |
32 |
$0.00 |
| 90688 |
|
28 |
28 |
$0.00 |
| 99335 |
|
14 |
12 |
$0.00 |
| 90656 |
|
42 |
42 |
$0.00 |
| 90696 |
|
14 |
14 |
$0.00 |
| 90633 |
|
716 |
698 |
$0.00 |
| 99173 |
|
1,029 |
985 |
$0.00 |
| 90685 |
|
127 |
122 |
$0.00 |
| 90681 |
|
326 |
324 |
$0.00 |
| 91300 |
|
88 |
82 |
$0.00 |
| 93356 |
|
288 |
285 |
$0.00 |
| 90687 |
|
40 |
35 |
$0.00 |
| 90734 |
|
98 |
92 |
$0.00 |
| 3078F |
|
157 |
127 |
$0.00 |
| 99499 |
|
12 |
12 |
$0.00 |
| 3077F |
|
15 |
12 |
$0.00 |
| 99487 |
Ccm add 20min |
31 |
31 |
$0.00 |
| G1004 |
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program |
94 |
74 |
$0.00 |
| 90658 |
|
132 |
115 |
$0.00 |
| 90707 |
|
38 |
37 |
$0.00 |
| 90649 |
|
31 |
29 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
34 |
33 |
$0.00 |
| 90710 |
|
36 |
32 |
$0.00 |
| 0502F |
|
40 |
33 |
$0.00 |
| 90655 |
|
12 |
12 |
$0.00 |
| Q4040 |
Cast supplies, short leg cast, pediatric (0-10 years), fiberglass |
27 |
13 |
$0.00 |
| 99188 |
|
18 |
15 |
$0.00 |