| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0450 |
|
169,111 |
149,491 |
$36.40M |
| 0250 |
|
96,333 |
50,257 |
$15.68M |
| J3490 |
Drugs unclassified injection |
93,407 |
49,650 |
$7.70M |
| 80053 |
|
89,063 |
80,648 |
$5.86M |
| 36415 |
|
18,410 |
16,389 |
$4.12M |
| 86850 |
|
11,990 |
11,279 |
$1.99M |
| 71045 |
|
50,827 |
48,361 |
$1.98M |
| 74177 |
|
11,537 |
11,192 |
$1.89M |
| 70450 |
|
12,395 |
12,022 |
$1.89M |
| 99281 |
|
25,207 |
21,101 |
$1.55M |
| 82962 |
|
31,394 |
26,256 |
$1.41M |
| Z7502 |
|
35,510 |
34,965 |
$1.36M |
| 59025 |
|
21,935 |
13,113 |
$1.20M |
| 0301 |
|
8,452 |
7,688 |
$1.16M |
| 99283 |
|
9,941 |
9,382 |
$1.02M |
| 81001 |
|
55,670 |
51,838 |
$892K |
| G0481 |
Drug test def 8-14 classes |
9,587 |
8,829 |
$865K |
| 96374 |
|
32,028 |
30,200 |
$854K |
| 99284 |
|
9,149 |
8,704 |
$840K |
| 76705 |
|
8,272 |
7,964 |
$807K |
| 0360 |
|
9,338 |
9,105 |
$805K |
| 0710 |
|
13,038 |
12,790 |
$729K |
| 93005 |
|
51,118 |
47,739 |
$666K |
| 76815 |
|
7,529 |
3,088 |
$662K |
| 99285 |
|
4,506 |
4,285 |
$654K |
| 76801 |
|
5,088 |
4,452 |
$612K |
| A9150 |
Misc/exper non-prescript dru |
5,651 |
2,907 |
$598K |
| 76830 |
|
5,766 |
5,630 |
$551K |
| 76805 |
|
4,051 |
3,613 |
$538K |
| Z9725 |
|
12,270 |
11,601 |
$528K |
| 72125 |
|
4,369 |
4,248 |
$504K |
| 99282 |
|
3,111 |
2,885 |
$492K |
| U0002 |
Covid-19 lab test non-cdc |
13,412 |
12,814 |
$477K |
| 99199 |
|
7,134 |
5,680 |
$476K |
| 85025 |
|
84,273 |
77,145 |
$436K |
| G0480 |
Drug test def 1-7 classes |
5,955 |
5,622 |
$434K |
| 80048 |
|
9,529 |
8,885 |
$424K |
| 78452 |
|
2,404 |
2,360 |
$417K |
| 93306 |
|
4,044 |
3,965 |
$412K |
| 73564 |
|
5,516 |
5,276 |
$402K |
| 74176 |
|
2,970 |
2,887 |
$399K |
| 0949 |
|
16,675 |
13,842 |
$375K |
| 71275 |
|
2,853 |
2,781 |
$354K |
| 84484 |
|
30,248 |
27,289 |
$351K |
| 73130 |
|
4,689 |
4,496 |
$344K |
| 76817 |
|
6,289 |
5,453 |
$320K |
| 0750 |
|
5,225 |
5,111 |
$314K |
| 76856 |
|
6,813 |
6,645 |
$300K |
| 96372 |
|
13,840 |
12,887 |
$288K |
| 83880 |
|
22,239 |
21,089 |
$275K |
| 99221 |
|
12,177 |
10,594 |
$271K |
| 71046 |
|
4,403 |
4,307 |
$271K |
| 73610 |
|
3,916 |
3,804 |
$271K |
| 93971 |
|
2,311 |
2,239 |
$261K |
| 73030 |
|
4,026 |
3,875 |
$261K |
| 96375 |
|
15,936 |
14,971 |
$256K |
| 81025 |
|
8,925 |
8,591 |
$256K |
| 0720 |
|
6,897 |
5,572 |
$249K |
| 83690 |
|
52,651 |
49,361 |
$242K |
| 86803 |
|
23,598 |
23,357 |
$234K |
| 70486 |
|
2,290 |
2,235 |
$227K |
| 87086 |
|
13,906 |
13,296 |
$225K |
| 73630 |
|
4,552 |
4,408 |
$224K |
| 73110 |
|
2,651 |
2,569 |
$222K |
| 43239 |
|
3,847 |
3,791 |
$219K |
| 0121 |
|
1,070 |
1,034 |
$217K |
| 0241U |
|
2,817 |
2,705 |
$212K |
| 87804 |
|
2,444 |
2,362 |
$211K |
| 77067 |
|
3,229 |
3,217 |
$204K |
| 45378 |
|
3,182 |
3,128 |
$200K |
| 76811 |
|
1,743 |
1,674 |
$187K |
| 76641 |
|
3,993 |
3,933 |
$184K |
| 94640 |
|
6,840 |
5,545 |
$180K |
| 72110 |
|
1,461 |
1,422 |
$175K |
| 0272 |
|
6,511 |
6,251 |
$161K |
| 87040 |
|
5,329 |
4,569 |
$156K |
| 87081 |
|
3,194 |
2,997 |
$150K |
| 87591 |
|
4,934 |
4,718 |
$149K |
| 0214 |
|
1,359 |
1,278 |
$142K |
| A9500 |
Tc99m sestamibi |
1,270 |
1,244 |
$137K |
| 0762 |
|
2,565 |
1,211 |
$136K |
| U0003 |
Cov-19 amp prb hgh thruput |
3,446 |
3,290 |
$128K |
| 87491 |
|
6,560 |
6,323 |
$128K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
15,839 |
14,990 |
$126K |
| 93017 |
|
2,608 |
2,521 |
$124K |
| 76819 |
|
1,259 |
1,112 |
$123K |
| J7030 |
Normal saline solution infus |
38,631 |
33,614 |
$112K |
| 76870 |
|
982 |
949 |
$111K |
| 73140 |
|
1,051 |
1,013 |
$111K |
| J2785 |
Regadenoson injection |
1,645 |
1,520 |
$108K |
| 90715 |
|
5,166 |
5,028 |
$108K |
| 45380 |
|
2,137 |
2,095 |
$107K |
| 73080 |
|
1,715 |
1,674 |
$106K |
| 88305 |
|
9,914 |
8,787 |
$104K |
| 73590 |
|
2,127 |
2,063 |
$103K |
| 77066 |
Tomosynthesis, mammo |
1,422 |
1,404 |
$103K |
| 81003 |
|
12,718 |
12,258 |
$101K |
| 99153 |
Mod sedat endo service >5yrs |
3,526 |
3,364 |
$101K |
| 86592 |
|
2,257 |
2,122 |
$98K |
| 84702 |
|
7,324 |
6,444 |
$97K |
| 86703 |
|
9,991 |
9,766 |
$92K |
| 0270 |
|
25,559 |
14,766 |
$90K |
| G0463 |
Hospital outpt clinic visit |
2,452 |
2,178 |
$87K |
| 77065 |
Tomosynthesis, mammo |
1,681 |
1,613 |
$86K |
| 96365 |
|
2,122 |
2,031 |
$85K |
| 85730 |
|
22,854 |
21,500 |
$79K |
| 87210 |
|
4,545 |
4,289 |
$77K |
| 73090 |
|
1,629 |
1,570 |
$77K |
| 86901 |
|
12,319 |
11,550 |
$75K |
| 85610 |
|
24,420 |
22,907 |
$74K |
| 12011 |
|
444 |
433 |
$74K |
| 87420 |
|
582 |
551 |
$73K |
| 96360 |
|
1,204 |
1,107 |
$72K |
| 73502 |
|
1,304 |
1,253 |
$72K |
| 87077 |
|
3,426 |
3,247 |
$72K |
| 0682 |
|
201 |
196 |
$71K |
| 86900 |
|
12,287 |
11,398 |
$70K |
| 88304 |
|
1,473 |
1,345 |
$69K |
| 72131 |
|
531 |
526 |
$68K |
| 52000 |
|
635 |
586 |
$68K |
| 10060 |
|
735 |
705 |
$64K |
| 0160 |
|
935 |
468 |
$60K |
| 71101 |
|
706 |
696 |
$59K |
| 72100 |
|
497 |
486 |
$59K |
| 87631 |
|
938 |
897 |
$58K |
| 85027 |
|
14,574 |
13,331 |
$58K |
| G0390 |
Trauma respons w/hosp criti |
192 |
190 |
$56K |
| J0561 |
Penicillin g benzathine inj |
461 |
426 |
$55K |
| J1885 |
Ketorolac tromethamine inj |
21,161 |
19,941 |
$54K |
| 70551 |
|
398 |
388 |
$53K |
| J1815 |
Insulin injection |
2,165 |
1,582 |
$53K |
| Z7610 |
|
10,295 |
5,962 |
$53K |
| 12001 |
|
679 |
654 |
$53K |
| 87070 |
|
1,099 |
1,031 |
$52K |
| 93458 |
|
70 |
64 |
$50K |
| J2405 |
Ondansetron hcl injection |
22,399 |
20,177 |
$44K |
| 0761 |
|
1,978 |
1,715 |
$41K |
| G0500 |
Mod sedat endo service >5yrs |
2,336 |
2,265 |
$41K |
| 87186 |
|
2,589 |
2,444 |
$39K |
| 80047 |
|
345 |
333 |
$39K |
| 51741 |
|
2,513 |
2,118 |
$38K |
| 83605 |
|
5,634 |
5,249 |
$36K |
| J0696 |
Ceftriaxone sodium injection |
9,560 |
8,928 |
$36K |
| A9502 |
Tc99m tetrofosmin |
1,053 |
1,042 |
$36K |
| J1100 |
Dexamethasone sodium phos |
10,847 |
10,439 |
$35K |
| 85007 |
|
12,105 |
11,163 |
$33K |
| 12002 |
|
484 |
465 |
$33K |
| 76700 |
|
454 |
448 |
$33K |
| 70496 |
|
295 |
287 |
$33K |
| 87502 |
|
1,162 |
1,136 |
$32K |
| 99291 |
|
160 |
157 |
$32K |
| A9270 |
Non-covered item or service |
7,007 |
3,411 |
$31K |
| 99152 |
|
1,116 |
1,013 |
$29K |
| 0760 |
|
1,275 |
1,163 |
$28K |
| 0370 |
|
6,688 |
6,536 |
$27K |
| J2270 |
Morphine sulfate injection |
11,564 |
9,066 |
$27K |
| 73620 |
|
234 |
225 |
$26K |
| 51729 |
|
753 |
695 |
$26K |
| 73560 |
|
316 |
308 |
$25K |
| 29125 |
|
638 |
607 |
$24K |
| 73120 |
|
255 |
248 |
$24K |
| 72170 |
|
1,264 |
1,235 |
$23K |
| 96361 |
|
1,796 |
1,688 |
$23K |
| 87635 |
|
560 |
554 |
$22K |
| 86759 |
|
1,659 |
1,628 |
$22K |
| J1644 |
Inj heparin sodium per 1000u |
4,353 |
2,097 |
$22K |
| 74018 |
|
172 |
161 |
$20K |
| 70491 |
|
138 |
136 |
$20K |
| 45385 |
|
358 |
353 |
$20K |
| 70498 |
|
311 |
303 |
$20K |
| J3010 |
Fentanyl citrate injection |
11,686 |
10,360 |
$19K |
| J0690 |
Cefazolin sodium injection |
7,242 |
5,859 |
$18K |
| 82803 |
|
1,384 |
1,333 |
$17K |
| 0122 |
|
77 |
75 |
$17K |
| 87522 |
Neg quan hep c or qual rna |
974 |
960 |
$17K |
| 84145 |
|
1,873 |
1,813 |
$17K |
| 84443 |
|
1,946 |
1,881 |
$17K |
| 88312 |
|
4,129 |
3,813 |
$17K |
| 93970 |
|
114 |
111 |
$17K |
| 71250 |
|
122 |
121 |
$17K |
| J2704 |
Inj, propofol, 10 mg |
9,261 |
8,500 |
$16K |
| J2250 |
Inj midazolam hydrochloride |
9,434 |
8,738 |
$16K |
| J0131 |
Inj, acetaminophen (nos) |
2,906 |
2,832 |
$16K |
| 29515 |
|
314 |
296 |
$15K |
| 73660 |
|
93 |
88 |
$15K |
| 84703 |
|
1,820 |
1,745 |
$15K |
| G0378 |
Hospital observation per hr |
290 |
257 |
$14K |
| J2765 |
Metoclopramide hcl injection |
8,225 |
7,749 |
$14K |
| 83735 |
|
4,534 |
3,494 |
$14K |
| 76376 |
|
553 |
535 |
$14K |
| 72040 |
|
141 |
134 |
$13K |
| 77063 |
|
945 |
944 |
$12K |
| E0601 |
Cont airway pressure device |
233 |
233 |
$12K |
| 71260 |
|
27 |
27 |
$12K |
| 77014 |
|
194 |
191 |
$12K |
| 96366 |
|
383 |
357 |
$12K |
| 90471 |
|
5,309 |
5,174 |
$11K |
| 80074 |
|
29 |
27 |
$11K |
| 51797 |
|
693 |
639 |
$11K |
| 82375 |
|
1,308 |
1,257 |
$10K |
| 73552 |
|
326 |
318 |
$9K |
| 83615 |
|
1,008 |
916 |
$9K |
| J7512 |
Prednisone ir or dr oral 1mg |
45 |
42 |
$9K |
| A4649 |
Surgical supplies |
22,983 |
11,601 |
$9K |
| 96376 |
|
2,120 |
1,853 |
$9K |
| 82570 |
|
475 |
397 |
$9K |
| 97750 |
|
610 |
452 |
$9K |
| 80061 |
|
1,277 |
1,224 |
$8K |
| 84133 |
|
449 |
372 |
$8K |
| 85384 |
|
307 |
269 |
$8K |
| 76770 |
|
25 |
25 |
$8K |
| 51784 |
|
443 |
392 |
$8K |
| S0164 |
Injection pantroprazole |
2,732 |
2,233 |
$8K |
| A0429 |
Bls-emergency |
54 |
44 |
$7K |
| 85380 |
|
1,851 |
1,805 |
$7K |
| E1390 |
Oxygen concentrator |
163 |
152 |
$7K |
| 73060 |
|
301 |
287 |
$7K |
| 72072 |
|
52 |
50 |
$7K |
| J1200 |
Diphenhydramine hcl injectio |
3,325 |
3,040 |
$6K |
| U0005 |
Infec agen detec ampli probe |
1,783 |
1,698 |
$6K |
| J3370 |
Vancomycin hcl injection |
936 |
711 |
$6K |
| A9579 |
Gad-base mr contrast nos,1ml |
348 |
324 |
$6K |
| 74230 |
|
171 |
169 |
$5K |
| 77059 |
|
12 |
12 |
$5K |
| 81005 |
|
474 |
453 |
$5K |
| J2060 |
Lorazepam injection |
2,954 |
2,389 |
$5K |
| 83036 |
|
1,278 |
1,215 |
$4K |
| 94060 |
|
73 |
69 |
$4K |
| J7120 |
Ringers lactate infusion |
3,676 |
3,472 |
$4K |
| J3475 |
Inj magnesium sulfate |
1,409 |
1,329 |
$4K |
| 77049 |
|
27 |
26 |
$4K |
| J7040 |
Normal saline solution infus |
1,623 |
1,548 |
$4K |
| 87147 |
|
1,031 |
960 |
$4K |
| J1953 |
Levetiracetam injection |
221 |
197 |
$4K |
| 86140 |
|
1,910 |
1,863 |
$4K |
| 73100 |
|
20 |
17 |
$4K |
| 83050 |
|
1,254 |
1,205 |
$3K |
| 93226 |
|
96 |
96 |
$3K |
| J1170 |
Hydromorphone injection |
3,278 |
2,447 |
$3K |
| 92522 |
|
56 |
56 |
$3K |
| T4541 |
Large disposable underpad |
100 |
99 |
$3K |
| V5008 |
Hearing screening |
191 |
140 |
$3K |
| 47562 |
|
26 |
26 |
$3K |
| K0001 |
Standard wheelchair |
78 |
78 |
$3K |
| 94664 |
|
36 |
35 |
$3K |
| 84100 |
|
1,870 |
1,519 |
$3K |
| 66984 |
|
43 |
43 |
$3K |
| 87637 |
|
74 |
72 |
$3K |
| E0562 |
Humidifier heated used w pap |
215 |
215 |
$3K |
| 87340 |
|
180 |
161 |
$3K |
| A0427 |
Als1-emergency |
19 |
18 |
$3K |
| 88313 |
|
323 |
309 |
$3K |
| 87088 |
|
881 |
849 |
$3K |
| 71010 |
|
210 |
125 |
$3K |
| 87205 |
|
822 |
773 |
$3K |
| 93976 |
|
40 |
40 |
$3K |
| J2930 |
Methylprednisolone injection |
704 |
636 |
$3K |
| 76937 |
|
286 |
260 |
$3K |
| J0330 |
Succinycholine chloride inj |
1,554 |
1,517 |
$3K |
| J2001 |
Lidocaine injection |
3,386 |
3,302 |
$3K |
| 73600 |
|
72 |
71 |
$3K |
| Z7500 |
|
73 |
65 |
$2K |
| 94729 |
|
58 |
55 |
$2K |
| 76536 |
|
72 |
71 |
$2K |
| 82550 |
|
980 |
889 |
$2K |
| E0570 |
Nebulizer with compression |
16 |
16 |
$2K |
| E0443 |
Portable 02 contents, gas |
29 |
29 |
$2K |
| 82009 |
|
449 |
408 |
$2K |
| C1769 |
Guide wire |
291 |
279 |
$2K |
| E0431 |
Portable gaseous 02 |
121 |
117 |
$2K |
| 82731 |
|
15 |
13 |
$2K |
| 80185 |
|
116 |
99 |
$2K |
| J0360 |
Hydralazine hcl injection |
622 |
521 |
$2K |
| 82728 |
|
438 |
424 |
$2K |
| J1630 |
Haloperidol injection |
1,168 |
1,036 |
$2K |
| J1650 |
Inj enoxaparin sodium |
126 |
70 |
$2K |
| J1940 |
Furosemide injection |
912 |
653 |
$2K |
| 82553 |
|
391 |
342 |
$2K |
| 84132 |
|
1,048 |
1,016 |
$2K |
| 87451 |
|
55 |
47 |
$2K |
| 85651 |
|
971 |
945 |
$2K |
| 82248 |
|
16 |
12 |
$2K |
| J2919 |
Inj, methylpred sod succ 5mg |
84 |
67 |
$2K |
| 0258 |
|
707 |
664 |
$1K |
| 84439 |
|
306 |
300 |
$1K |
| C8908 |
Mri w/o fol w/cont, breast, |
33 |
29 |
$1K |
| J2543 |
Piperacillin/tazobactam |
483 |
303 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
12 |
12 |
$1K |
| 88342 |
|
69 |
66 |
$1K |
| 0171 |
Inj, epinephrine (belcher) |
174 |
172 |
$1K |
| 94726 |
|
30 |
27 |
$1K |
| 85018 |
|
1,115 |
1,071 |
$1K |
| J0171 |
Adrenalin epinephrine inject |
644 |
618 |
$1K |
| 77001 |
|
56 |
52 |
$1K |
| 88307 |
|
156 |
148 |
$1K |
| 76942 |
|
25 |
25 |
$1K |
| S0020 |
Injection, bupivicaine hydro |
1,033 |
972 |
$1K |
| S0077 |
Injection, clindamycin phosp |
70 |
62 |
$982.41 |
| P9016 |
Rbc leukocytes reduced |
13 |
12 |
$963.60 |
| G0279 |
Tomosynthesis, mammo |
99 |
98 |
$937.86 |
| 99070 |
|
659 |
378 |
$823.97 |
| 0510 |
|
16 |
16 |
$677.73 |
| 76775 |
|
14 |
13 |
$642.43 |
| 0324 |
|
1,186 |
1,143 |
$626.97 |
| J7050 |
Normal saline solution infus |
433 |
398 |
$553.32 |
| 72128 |
|
12 |
12 |
$549.83 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
102 |
98 |
$488.04 |
| 0001A |
|
26 |
26 |
$440.44 |
| 97755 |
|
77 |
75 |
$436.99 |
| 84550 |
|
51 |
44 |
$431.78 |
| J2470 |
Inj pantoprazole sodium 40mg |
173 |
128 |
$425.98 |
| 92611 |
|
26 |
26 |
$414.84 |
| A4648 |
Implantable tissue marker |
96 |
90 |
$370.80 |
| V2632 |
Post chmbr intraocular lens |
41 |
41 |
$300.60 |
| 0278 |
|
304 |
297 |
$292.10 |
| C1887 |
Catheter, guiding |
39 |
37 |
$284.70 |
| 0402 |
|
636 |
619 |
$254.36 |
| 84112 |
|
28 |
27 |
$244.85 |
| 88329 |
|
17 |
14 |
$232.81 |
| S0028 |
Injection, famotidine, 20 mg |
2,168 |
2,081 |
$227.41 |
| J2370 |
Phenylephrine hcl injection |
188 |
181 |
$224.75 |
| C9399 |
Unclassified drugs or biolog |
418 |
409 |
$222.22 |
| 82330 |
|
26 |
25 |
$219.70 |
| 0420 |
|
1,211 |
961 |
$201.55 |
| 0430 |
|
564 |
464 |
$189.05 |
| 85014 |
|
339 |
328 |
$177.99 |
| 0440 |
|
83 |
83 |
$174.00 |
| 93247 |
|
110 |
109 |
$167.65 |
| 0320 |
|
360 |
348 |
$165.92 |
| 93246 |
|
15 |
15 |
$140.30 |
| J3480 |
Inj potassium chloride |
75 |
61 |
$127.73 |
| J3411 |
Thiamine hcl 100 mg |
33 |
26 |
$102.58 |
| 0254 |
|
73 |
71 |
$98.00 |
| 99406 |
|
12 |
12 |
$95.00 |
| 19083 |
|
14 |
12 |
$84.00 |
| 99211 |
|
17 |
16 |
$78.99 |
| J1920 |
Inj, labetalol hcl, 5mg |
41 |
38 |
$69.44 |
| 86920 |
|
12 |
12 |
$66.31 |
| C1894 |
Intro/sheath, non-laser |
49 |
46 |
$63.75 |
| 99396 |
|
12 |
12 |
$61.38 |
| 99072 |
|
181 |
109 |
$60.22 |
| 99001 |
|
198 |
197 |
$57.61 |
| 87798 |
|
12 |
12 |
$51.90 |
| 0305 |
|
2,976 |
2,762 |
$50.61 |
| 0730 |
|
981 |
938 |
$49.60 |
| J7060 |
5% dextrose/water |
126 |
124 |
$42.42 |
| 97165 |
|
26 |
25 |
$37.10 |
| 76000 |
|
15 |
15 |
$27.96 |
| 88300 |
|
14 |
12 |
$21.30 |
| J2175 |
Meperidine hydrochl /100 mg |
32 |
31 |
$12.52 |
| J3301 |
Triamcinolone acet inj nos |
13 |
12 |
$11.10 |
| 45388 |
|
13 |
12 |
$10.00 |
| 0302 |
|
1,253 |
1,191 |
$9.13 |
| J0689 |
Inj cefazolin sodium, baxter |
15 |
12 |
$6.84 |
| 0306 |
|
2,324 |
2,175 |
$6.60 |
| 0307 |
|
1,132 |
1,091 |
$4.06 |
| J7198 |
Anti-inhibitor |
38 |
37 |
$0.08 |
| 0351 |
|
257 |
249 |
$0.00 |
| 0489 |
|
612 |
602 |
$0.00 |
| 0300 |
|
978 |
881 |
$0.00 |
| C1729 |
Cath, drainage |
141 |
122 |
$0.00 |
| 0412 |
|
172 |
165 |
$0.00 |
| T5999 |
Supply, nos |
74 |
69 |
$0.00 |
| A0425 |
Ground mileage |
288 |
249 |
$0.00 |
| 0361 |
|
204 |
199 |
$0.00 |
| 0340 |
|
40 |
39 |
$0.00 |
| J2710 |
Neostigmine methylslfte inj |
12 |
12 |
$0.00 |
| C1713 |
Anchor/screw bn/bn,tis/bn |
13 |
13 |
$0.00 |
| J1756 |
Iron sucrose injection |
15 |
12 |
$0.00 |
| C1788 |
Port, indwelling, imp |
16 |
15 |
$0.00 |
| 0611 |
|
195 |
192 |
$0.00 |
| 0352 |
|
609 |
594 |
$0.00 |
| 0310 |
|
257 |
253 |
$0.00 |
| 0400 |
|
315 |
308 |
$0.00 |
| S9445 |
Pt education noc individ |
253 |
136 |
$0.00 |
| 0341 |
|
52 |
51 |
$0.00 |
| 97166 |
|
12 |
12 |
$0.00 |
| 0610 |
|
57 |
56 |
$0.00 |
| 36561 |
|
18 |
14 |
$0.00 |
| 0410 |
|
12 |
12 |
$0.00 |