| Code | Description | Claims | Beneficiaries | Total Paid |
| 0450 |
|
129,465 |
116,671 |
$5.40M |
| 74176 |
|
10,405 |
10,079 |
$875K |
| 70450 |
|
10,319 |
10,006 |
$775K |
| Z7502 |
|
18,184 |
18,034 |
$683K |
| 99199 |
|
27,497 |
23,816 |
$641K |
| 96372 |
|
36,196 |
33,204 |
$617K |
| 93005 |
|
33,483 |
30,245 |
$603K |
| 87633 |
|
2,646 |
2,597 |
$600K |
| 74177 |
|
3,783 |
3,649 |
$548K |
| 96374 |
|
11,451 |
10,651 |
$470K |
| 99283 |
|
7,190 |
6,622 |
$468K |
| 80053 |
|
69,503 |
63,753 |
$387K |
| 0762 |
|
7,847 |
6,008 |
$387K |
| Z7500 |
|
10,394 |
9,084 |
$354K |
| 99281 |
|
29,305 |
24,350 |
$345K |
| 80307 |
|
7,220 |
6,335 |
$335K |
| 99285 |
|
1,816 |
1,700 |
$315K |
| 85025 |
|
81,789 |
74,272 |
$315K |
| 76700 |
|
6,839 |
6,556 |
$314K |
| 71045 |
|
30,466 |
28,807 |
$298K |
| 96365 |
|
5,684 |
5,151 |
$282K |
| J1100 |
Dexamethasone sodium phos |
16,439 |
13,904 |
$260K |
| 99231 |
|
26,142 |
22,379 |
$249K |
| 0510 |
|
29,180 |
25,525 |
$236K |
| 76815 |
|
6,846 |
5,619 |
$231K |
| U0002 |
Covid-19 lab test non-cdc |
6,440 |
6,086 |
$229K |
| J3490 |
Drugs unclassified injection |
48,927 |
29,014 |
$220K |
| 71275 |
|
1,496 |
1,460 |
$207K |
| 76817 |
|
4,516 |
3,994 |
$180K |
| 87635 |
|
5,120 |
4,984 |
$179K |
| 70551 |
|
1,249 |
1,220 |
$171K |
| 72125 |
|
1,680 |
1,648 |
$166K |
| 96375 |
|
8,419 |
7,498 |
$161K |
| 76801 |
|
3,909 |
3,411 |
$161K |
| 97139 |
|
11,254 |
1,787 |
$159K |
| 76856 |
|
4,098 |
3,931 |
$144K |
| 96360 |
|
3,323 |
3,196 |
$134K |
| 93971 |
|
1,835 |
1,778 |
$130K |
| 0360 |
|
3,269 |
2,276 |
$129K |
| J1885 |
Ketorolac tromethamine inj |
23,704 |
17,719 |
$129K |
| 99284 |
|
1,344 |
1,289 |
$120K |
| 84484 |
|
19,506 |
17,730 |
$119K |
| G0480 |
Drug test def 1-7 classes |
1,663 |
1,526 |
$108K |
| 76830 |
|
3,070 |
2,943 |
$105K |
| 96361 |
|
7,835 |
7,100 |
$105K |
| 0250 |
|
37,197 |
23,221 |
$103K |
| 0760 |
|
10,706 |
8,955 |
$97K |
| G0463 |
Hospital outpt clinic visit |
2,262 |
2,034 |
$97K |
| 83690 |
|
20,880 |
19,436 |
$93K |
| G0108 |
Diab manage trn per indiv |
2,897 |
1,939 |
$92K |
| 0270 |
|
23,007 |
14,513 |
$85K |
| J7030 |
Normal saline solution infus |
14,041 |
11,565 |
$81K |
| J0696 |
Ceftriaxone sodium injection |
7,692 |
7,104 |
$79K |
| 97110 |
|
8,333 |
1,991 |
$77K |
| 0160 |
|
2,047 |
1,522 |
$77K |
| G0500 |
Mod sedat endo service >5yrs |
2,654 |
2,563 |
$74K |
| 90715 |
|
3,425 |
3,324 |
$74K |
| 94640 |
|
4,480 |
4,032 |
$73K |
| J2405 |
Ondansetron hcl injection |
9,202 |
7,788 |
$70K |
| 81025 |
|
19,349 |
17,666 |
$70K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
8,550 |
6,551 |
$67K |
| 83880 |
|
3,741 |
3,521 |
$66K |
| 87086 |
|
17,272 |
16,337 |
$64K |
| J2270 |
Morphine sulfate injection |
10,265 |
7,870 |
$64K |
| 93970 |
|
519 |
512 |
$60K |
| 43239 |
|
1,382 |
1,289 |
$60K |
| 45380 |
|
963 |
922 |
$60K |
| 81001 |
|
31,019 |
28,843 |
$55K |
| 84443 |
|
15,178 |
14,411 |
$54K |
| 82803 |
|
5,692 |
5,206 |
$54K |
| 88305 |
|
3,527 |
3,359 |
$50K |
| 99282 |
|
1,215 |
1,124 |
$49K |
| Z9725 |
|
1,108 |
1,102 |
$48K |
| 73610 |
|
3,146 |
3,024 |
$48K |
| 70486 |
|
595 |
582 |
$47K |
| 73630 |
|
3,434 |
3,272 |
$46K |
| 0301 |
|
1,338 |
1,191 |
$45K |
| 73564 |
|
2,299 |
2,235 |
$44K |
| 76705 |
|
1,368 |
1,252 |
$44K |
| 87040 |
|
5,398 |
3,718 |
$43K |
| 59025 |
|
4,207 |
3,165 |
$42K |
| 0637 |
|
12,391 |
8,460 |
$41K |
| 73030 |
|
2,715 |
2,582 |
$39K |
| 84702 |
|
5,330 |
4,520 |
$39K |
| 84999 |
|
267 |
261 |
$39K |
| 20610 |
|
750 |
698 |
$38K |
| 87491 |
|
4,990 |
4,801 |
$37K |
| 76805 |
|
923 |
884 |
$36K |
| J2250 |
Inj midazolam hydrochloride |
6,498 |
5,392 |
$35K |
| 72131 |
|
455 |
453 |
$35K |
| 73130 |
|
2,066 |
1,985 |
$34K |
| G0109 |
Diab manage trn ind/group |
1,057 |
887 |
$34K |
| Z7610 |
|
4,691 |
3,073 |
$31K |
| 96366 |
|
1,302 |
1,042 |
$31K |
| 97803 |
|
1,443 |
1,347 |
$31K |
| 71046 |
|
3,556 |
3,390 |
$28K |
| S3620 |
Newborn metabolic screening |
287 |
287 |
$27K |
| 73110 |
|
1,689 |
1,616 |
$27K |
| 80048 |
|
6,154 |
5,781 |
$26K |
| 81003 |
|
21,587 |
20,562 |
$26K |
| 73502 |
|
1,223 |
1,192 |
$26K |
| J7120 |
Ringers lactate infusion |
5,149 |
3,328 |
$25K |
| 83605 |
|
3,488 |
3,106 |
$25K |
| 81220 |
|
57 |
57 |
$24K |
| 72100 |
|
1,428 |
1,394 |
$24K |
| 0420 |
|
1,370 |
321 |
$24K |
| 0761 |
|
1,528 |
1,124 |
$24K |
| 0942 |
|
354 |
229 |
$23K |
| 82731 |
|
737 |
688 |
$22K |
| 97802 |
|
497 |
477 |
$21K |
| 73562 |
|
1,401 |
1,362 |
$21K |
| 97750 |
|
960 |
921 |
$21K |
| J1815 |
Insulin injection |
833 |
602 |
$21K |
| 96110 |
|
2,031 |
2,018 |
$21K |
| 0710 |
|
2,410 |
2,257 |
$21K |
| 76816 |
|
723 |
674 |
$20K |
| 90697 |
|
3,539 |
3,529 |
$20K |
| 36415 |
|
46,364 |
41,006 |
$20K |
| J2175 |
Meperidine hydrochl /100 mg |
2,585 |
2,282 |
$20K |
| 83735 |
|
5,378 |
5,075 |
$20K |
| 74018 |
|
1,926 |
1,803 |
$20K |
| 73590 |
|
1,381 |
1,353 |
$19K |
| 85730 |
|
6,312 |
6,003 |
$19K |
| 97140 |
|
2,130 |
615 |
$19K |
| J2704 |
Inj, propofol, 10 mg |
2,120 |
1,923 |
$19K |
| 85379 |
|
2,808 |
2,726 |
$18K |
| J1200 |
Diphenhydramine hcl injectio |
4,706 |
4,160 |
$18K |
| 90677 |
|
1,503 |
1,496 |
$17K |
| 72148 |
|
257 |
251 |
$17K |
| 85610 |
|
8,294 |
7,791 |
$17K |
| 45378 |
|
370 |
366 |
$17K |
| 90460 |
|
10,372 |
10,175 |
$17K |
| J2765 |
Metoclopramide hcl injection |
4,098 |
3,750 |
$17K |
| 82550 |
|
4,532 |
4,341 |
$16K |
| 87186 |
|
3,599 |
3,445 |
$16K |
| 76870 |
|
582 |
564 |
$16K |
| 90461 |
|
7,318 |
7,119 |
$16K |
| 73080 |
|
988 |
962 |
$16K |
| 88313 |
|
1,318 |
1,249 |
$16K |
| 71250 |
|
274 |
261 |
$15K |
| 90471 |
|
5,051 |
4,899 |
$14K |
| 70496 |
|
90 |
89 |
$14K |
| 86900 |
|
7,663 |
7,183 |
$13K |
| 0278 |
|
497 |
479 |
$13K |
| 87276 |
|
3,060 |
2,840 |
$13K |
| 73090 |
|
988 |
937 |
$13K |
| 45385 |
|
151 |
150 |
$12K |
| J3010 |
Fentanyl citrate injection |
3,658 |
3,222 |
$12K |
| 96376 |
|
1,062 |
869 |
$12K |
| 70498 |
|
95 |
94 |
$12K |
| 76770 |
|
385 |
376 |
$12K |
| J0131 |
Inj, acetaminophen (nos) |
485 |
448 |
$12K |
| 80051 |
|
2,813 |
2,696 |
$12K |
| J2060 |
Lorazepam injection |
2,127 |
1,713 |
$11K |
| 90681 |
|
2,284 |
2,228 |
$11K |
| J0690 |
Cefazolin sodium injection |
2,226 |
1,642 |
$11K |
| 90670 |
|
3,167 |
3,036 |
$11K |
| J7050 |
Normal saline solution infus |
4,626 |
3,680 |
$11K |
| J7060 |
5% dextrose/water |
4,521 |
3,765 |
$11K |
| 90651 |
|
978 |
951 |
$11K |
| 87275 |
|
3,066 |
2,850 |
$11K |
| 71101 |
|
477 |
472 |
$10K |
| 87591 |
|
1,542 |
1,466 |
$10K |
| 97804 |
|
713 |
694 |
$10K |
| 86850 |
|
4,190 |
3,990 |
$10K |
| 84703 |
|
2,753 |
2,573 |
$9K |
| 84439 |
|
4,875 |
4,644 |
$9K |
| 88312 |
|
1,266 |
1,210 |
$9K |
| 93306 |
|
68 |
68 |
$8K |
| 92551 |
|
3,210 |
2,911 |
$8K |
| 99153 |
Mod sedat endo service >5yrs |
1,057 |
1,024 |
$7K |
| 82962 |
|
3,634 |
2,805 |
$7K |
| 90633 |
|
2,431 |
2,388 |
$6K |
| J1170 |
Hydromorphone injection |
743 |
515 |
$6K |
| 87804 |
|
1,144 |
1,136 |
$6K |
| 72040 |
|
402 |
391 |
$6K |
| 87430 |
|
967 |
922 |
$6K |
| 80061 |
|
12,451 |
11,795 |
$6K |
| 0121 |
|
123 |
119 |
$6K |
| 12001 |
|
461 |
449 |
$5K |
| 90686 |
|
2,217 |
2,144 |
$5K |
| 72128 |
|
63 |
63 |
$5K |
| 87084 |
|
804 |
772 |
$5K |
| 87880 |
|
940 |
933 |
$5K |
| 70491 |
|
46 |
46 |
$5K |
| 90707 |
|
1,222 |
1,201 |
$4K |
| 96367 |
|
202 |
179 |
$4K |
| 73060 |
|
299 |
296 |
$4K |
| 90716 |
|
1,219 |
1,204 |
$4K |
| 0272 |
|
2,979 |
2,706 |
$4K |
| 82553 |
|
580 |
552 |
$4K |
| 72110 |
|
242 |
236 |
$4K |
| J1953 |
Levetiracetam injection |
82 |
68 |
$4K |
| 99070 |
|
2,356 |
1,443 |
$4K |
| 73140 |
|
370 |
355 |
$4K |
| 76819 |
|
108 |
99 |
$4K |
| 86140 |
|
2,321 |
2,237 |
$4K |
| 85018 |
|
2,901 |
2,779 |
$3K |
| 0370 |
|
1,029 |
1,006 |
$3K |
| 90472 |
|
795 |
784 |
$3K |
| 74019 |
|
213 |
209 |
$3K |
| 82306 |
|
4,877 |
4,637 |
$3K |
| S0020 |
Injection, bupivicaine hydro |
463 |
426 |
$3K |
| 83036 |
|
9,433 |
9,001 |
$3K |
| 90700 |
|
1,109 |
1,094 |
$3K |
| 90648 |
|
1,376 |
1,331 |
$3K |
| 12011 |
|
161 |
158 |
$3K |
| 87339 |
|
763 |
716 |
$3K |
| 99499 |
|
41 |
38 |
$3K |
| 0214 |
|
94 |
86 |
$3K |
| J2930 |
Methylprednisolone injection |
349 |
316 |
$3K |
| 73552 |
|
175 |
168 |
$3K |
| 90674 |
|
316 |
313 |
$3K |
| 87420 |
|
894 |
832 |
$3K |
| 90671 |
|
921 |
920 |
$2K |
| J7040 |
Normal saline solution infus |
559 |
522 |
$2K |
| J0171 |
Adrenalin epinephrine inject |
149 |
91 |
$2K |
| 73560 |
|
294 |
286 |
$2K |
| 90620 |
|
265 |
263 |
$2K |
| G0009 |
Admin pneumococcal vaccine |
2,202 |
2,193 |
$2K |
| 99173 |
|
4,049 |
3,711 |
$2K |
| 90710 |
|
920 |
890 |
$2K |
| 71260 |
|
25 |
25 |
$2K |
| J1030 |
Methylprednisolone 40 mg inj |
245 |
235 |
$2K |
| 97530 |
|
1,472 |
476 |
$2K |
| 80076 |
|
701 |
671 |
$2K |
| 81000 |
|
998 |
965 |
$2K |
| 70553 |
|
13 |
12 |
$2K |
| 90696 |
|
860 |
840 |
$2K |
| 87070 |
|
705 |
673 |
$2K |
| J3301 |
Triamcinolone acet inj nos |
110 |
104 |
$2K |
| 86901 |
|
855 |
802 |
$2K |
| 85652 |
|
2,627 |
2,527 |
$2K |
| 10060 |
|
92 |
89 |
$2K |
| G9920 |
Scrning perf and negative |
1,018 |
998 |
$2K |
| 82140 |
|
200 |
191 |
$2K |
| 73620 |
|
181 |
174 |
$1K |
| 92652 |
|
14 |
14 |
$1K |
| 84112 |
|
314 |
284 |
$1K |
| 87340 |
|
1,286 |
1,250 |
$1K |
| 71010 |
|
90 |
51 |
$1K |
| J2710 |
Neostigmine methylslfte inj |
140 |
137 |
$1K |
| J1171 |
Inj, hydromorphone, 0.1 mg |
94 |
42 |
$1K |
| 86592 |
|
3,940 |
3,781 |
$1K |
| 97799 |
|
142 |
31 |
$1K |
| 86803 |
|
1,246 |
1,234 |
$1K |
| 80074 |
|
653 |
636 |
$1K |
| 94150 |
|
696 |
695 |
$1K |
| 82010 |
|
239 |
228 |
$1K |
| 90734 |
|
729 |
714 |
$1K |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
84 |
80 |
$1K |
| 71100 |
|
65 |
63 |
$1K |
| A9270 |
Non-covered item or service |
1,417 |
1,249 |
$1K |
| 73120 |
|
164 |
162 |
$1K |
| A9577 |
Inj multihance |
140 |
111 |
$1K |
| J2001 |
Lidocaine injection |
91 |
90 |
$1K |
| G0378 |
Hospital observation per hr |
29 |
26 |
$1K |
| 92650 |
|
41 |
41 |
$1K |
| 72141 |
|
14 |
14 |
$1K |
| 96127 |
|
1,229 |
1,220 |
$998.18 |
| 84100 |
|
544 |
511 |
$955.97 |
| 82728 |
|
1,443 |
1,360 |
$953.42 |
| 90746 |
|
44 |
43 |
$915.74 |
| 0324 |
|
318 |
295 |
$890.71 |
| 0171 |
Inj, epinephrine (belcher) |
71 |
71 |
$870.70 |
| 82607 |
|
1,628 |
1,568 |
$847.95 |
| 29125 |
|
175 |
172 |
$834.47 |
| 86703 |
|
2,306 |
2,170 |
$815.89 |
| H1001 |
Antepartum management |
146 |
106 |
$794.68 |
| 88720 |
|
161 |
152 |
$678.14 |
| 87081 |
|
363 |
351 |
$666.31 |
| Q0091 |
Obtaining screen pap smear |
525 |
521 |
$632.59 |
| 0636 |
|
766 |
628 |
$589.43 |
| 73721 |
|
13 |
12 |
$565.45 |
| 87205 |
|
344 |
331 |
$564.17 |
| 88304 |
|
116 |
114 |
$563.50 |
| 86480 |
|
724 |
720 |
$562.45 |
| 0002A |
|
47 |
47 |
$560.00 |
| 86920 |
|
28 |
27 |
$549.72 |
| J1630 |
Haloperidol injection |
124 |
108 |
$541.35 |
| 76642 |
|
40 |
40 |
$541.25 |
| A0429 |
Bls-emergency |
13 |
12 |
$522.61 |
| S0164 |
Injection pantroprazole |
52 |
41 |
$491.60 |
| 83540 |
|
1,425 |
1,364 |
$484.50 |
| 73000 |
|
39 |
37 |
$473.99 |
| 83550 |
|
1,382 |
1,323 |
$464.02 |
| A4649 |
Surgical supplies |
11,220 |
5,910 |
$461.35 |
| 86701 |
|
1,009 |
1,003 |
$459.19 |
| Q0144 |
Azithromycin dihydrate, oral |
40 |
39 |
$459.01 |
| 84550 |
|
1,359 |
1,307 |
$455.58 |
| 82746 |
|
809 |
787 |
$451.41 |
| 29515 |
|
79 |
76 |
$440.29 |
| J1644 |
Inj heparin sodium per 1000u |
29 |
13 |
$434.13 |
| 90723 |
|
516 |
417 |
$396.01 |
| 72072 |
|
25 |
25 |
$361.00 |
| 72070 |
|
26 |
25 |
$339.26 |
| 97116 |
|
1,252 |
363 |
$338.23 |
| 83655 |
|
1,570 |
1,477 |
$293.75 |
| 97162 |
|
28 |
26 |
$289.92 |
| 99152 |
|
12 |
12 |
$270.57 |
| G0283 |
Elec stim other than wound |
103 |
26 |
$256.60 |
| 87806 |
|
32 |
31 |
$220.16 |
| 88342 |
|
28 |
27 |
$214.63 |
| J2919 |
Inj, methylpred sod succ 5mg |
16 |
13 |
$202.60 |
| 73521 |
|
12 |
12 |
$197.96 |
| H1000 |
Prenatal care atrisk assessm |
14 |
14 |
$192.68 |
| 82043 |
|
1,936 |
1,842 |
$190.68 |
| 87210 |
|
67 |
66 |
$184.41 |
| 90474 |
|
53 |
53 |
$180.00 |
| 87045 |
|
82 |
81 |
$177.86 |
| 94664 |
|
46 |
46 |
$177.15 |
| 92552 |
|
142 |
87 |
$175.98 |
| G9919 |
Scrn nd pos nd prov of rec |
147 |
142 |
$174.00 |
| 84153 |
|
932 |
885 |
$162.76 |
| 76536 |
|
38 |
38 |
$160.88 |
| 87522 |
Neg quan hep c or qual rna |
51 |
51 |
$149.24 |
| 96160 |
|
1,717 |
1,681 |
$147.10 |
| 90698 |
|
201 |
201 |
$144.01 |
| J3105 |
Terbutaline sulfate inj |
16 |
13 |
$134.50 |
| J3370 |
Vancomycin hcl injection |
15 |
14 |
$131.97 |
| 73100 |
|
12 |
12 |
$125.58 |
| 99221 |
|
1,135 |
913 |
$115.28 |
| 12002 |
|
12 |
12 |
$113.40 |
| 86038 |
|
526 |
514 |
$101.36 |
| 86235 |
|
12 |
12 |
$98.04 |
| 77067 |
|
301 |
285 |
$89.50 |
| 84436 |
|
157 |
154 |
$86.98 |
| 90656 |
|
213 |
213 |
$72.00 |
| 86225 |
|
371 |
355 |
$69.85 |
| J0604 |
Cinacalcet, esrd on dialysis |
35 |
24 |
$67.18 |
| 82570 |
|
93 |
87 |
$63.34 |
| 86762 |
|
155 |
154 |
$61.47 |
| 84156 |
|
85 |
83 |
$57.14 |
| G1004 |
Cdsm ndsc |
172 |
142 |
$50.00 |
| 90473 |
|
138 |
122 |
$43.85 |
| 86308 |
|
19 |
19 |
$38.77 |
| 84480 |
|
189 |
179 |
$34.00 |
| G0008 |
Admin influenza virus vac |
748 |
650 |
$33.38 |
| 87807 |
|
12 |
12 |
$33.17 |
| 82784 |
|
14 |
12 |
$30.62 |
| 82247 |
|
15 |
12 |
$30.23 |
| 85027 |
|
847 |
815 |
$25.05 |
| 90661 |
|
29 |
29 |
$25.00 |
| 83615 |
|
46 |
46 |
$24.23 |
| 77063 |
|
301 |
285 |
$22.95 |
| 29130 |
|
13 |
12 |
$20.40 |
| 82378 |
|
55 |
52 |
$19.63 |
| 86706 |
|
88 |
85 |
$18.90 |
| 84403 |
|
123 |
116 |
$18.24 |
| 82951 |
|
554 |
532 |
$15.21 |
| 86317 |
|
99 |
99 |
$9.80 |
| 86003 |
|
1,037 |
432 |
$9.45 |
| 90744 |
|
80 |
80 |
$9.01 |
| 90381 |
|
12 |
12 |
$9.00 |
| 82270 |
|
601 |
557 |
$7.27 |
| 0305 |
|
582 |
537 |
$0.00 |
| 0112 |
|
103 |
102 |
$0.00 |
| 0307 |
|
328 |
313 |
$0.00 |
| 0306 |
|
531 |
492 |
$0.00 |
| 83001 |
|
153 |
146 |
$0.00 |
| 87337 |
|
44 |
44 |
$0.00 |
| 90647 |
|
178 |
127 |
$0.00 |
| 0310 |
|
12 |
12 |
$0.00 |
| 0352 |
|
58 |
52 |
$0.00 |
| 0001A |
|
38 |
37 |
$0.00 |
| 83002 |
|
31 |
29 |
$0.00 |
| 90688 |
|
21 |
20 |
$0.00 |
| 0258 |
|
134 |
126 |
$0.00 |
| S2900 |
Robotic surgical system |
13 |
13 |
$0.00 |
| 99441 |
|
17 |
13 |
$0.00 |
| Q4051 |
Splint supplies misc |
31 |
16 |
$0.00 |
| 96380 |
|
13 |
13 |
$0.00 |
| 86431 |
|
102 |
101 |
$0.00 |
| 81329 |
|
272 |
271 |
$0.00 |
| 0460 |
|
183 |
175 |
$0.00 |
| 0302 |
|
274 |
205 |
$0.00 |
| 82785 |
|
414 |
406 |
$0.00 |
| 91300 |
|
100 |
96 |
$0.00 |
| 0320 |
|
13 |
12 |
$0.00 |
| 0402 |
|
103 |
98 |
$0.00 |
| 82274 |
|
107 |
103 |
$0.00 |
| 0300 |
|
729 |
586 |
$0.00 |
| 0390 |
|
303 |
200 |
$0.00 |
| 0730 |
|
161 |
148 |
$0.00 |
| S3005 |
Eval self-assess depression |
375 |
296 |
$0.00 |
| 90655 |
|
30 |
30 |
$0.00 |
| 84146 |
|
39 |
39 |
$0.00 |
| 87481 |
|
65 |
56 |
$0.00 |
| 82977 |
|
15 |
15 |
$0.00 |
| 0312 |
|
28 |
28 |
$0.00 |
| 99218 |
|
39 |
30 |
$0.00 |
| 86787 |
|
12 |
12 |
$0.00 |
| 86200 |
|
13 |
13 |
$0.00 |