| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9088 |
Services provided in urgent |
630 |
585 |
$0.00 |
| 99213 |
|
28,945 |
25,006 |
$0.00 |
| 96372 |
|
224 |
184 |
$0.00 |
| 99291 |
|
402 |
171 |
$0.00 |
| 86592 |
|
893 |
858 |
$0.00 |
| 80048 |
|
583 |
540 |
$0.00 |
| E0562 |
Humidifier heated used w pap |
553 |
529 |
$0.00 |
| 97014 |
|
2,389 |
765 |
$0.00 |
| 90686 |
|
342 |
342 |
$0.00 |
| 80053 |
|
3,969 |
3,624 |
$0.00 |
| 99202 |
|
936 |
910 |
$0.00 |
| 87591 |
|
2,161 |
2,032 |
$0.00 |
| 96151 |
|
480 |
381 |
$0.00 |
| 99214 |
|
13,766 |
12,586 |
$0.00 |
| 93000 |
|
293 |
291 |
$0.00 |
| 20610 |
|
31 |
29 |
$0.00 |
| 99283 |
|
3,776 |
3,426 |
$0.00 |
| A7030 |
Cpap full face mask |
26 |
26 |
$0.00 |
| 99239 |
|
411 |
378 |
$0.00 |
| 86706 |
|
266 |
262 |
$0.00 |
| 84436 |
|
404 |
383 |
$0.00 |
| 3074F |
|
125 |
110 |
$0.00 |
| 80349 |
|
622 |
443 |
$0.00 |
| 95115 |
|
336 |
109 |
$0.00 |
| 87389 |
|
958 |
923 |
$0.00 |
| 85018 |
|
1,309 |
1,249 |
$0.00 |
| 83036 |
|
4,028 |
3,889 |
$0.00 |
| G0447 |
Behavior counsel obesity 15m |
460 |
459 |
$0.00 |
| 84153 |
|
473 |
457 |
$0.00 |
| 87077 |
|
180 |
170 |
$0.00 |
| 87086 |
|
950 |
884 |
$0.00 |
| 99000 |
|
1,132 |
1,060 |
$0.00 |
| 88342 |
|
88 |
79 |
$0.00 |
| 84402 |
|
47 |
43 |
$0.00 |
| 87070 |
|
259 |
249 |
$0.00 |
| 83880 |
|
56 |
55 |
$0.00 |
| 84075 |
|
38 |
37 |
$0.00 |
| 36415 |
|
10,486 |
9,627 |
$0.00 |
| 82306 |
|
2,063 |
1,988 |
$0.00 |
| 97140 |
|
3,265 |
1,038 |
$0.00 |
| 87147 |
|
90 |
89 |
$0.00 |
| G0481 |
Drug test def 8-14 classes |
65 |
61 |
$0.00 |
| 85027 |
|
1,109 |
1,060 |
$0.00 |
| 83021 |
|
228 |
222 |
$0.00 |
| 81000 |
|
204 |
188 |
$0.00 |
| 86140 |
|
430 |
391 |
$0.00 |
| 83690 |
|
155 |
146 |
$0.00 |
| 85730 |
|
248 |
230 |
$0.00 |
| 83986 |
|
109 |
100 |
$0.00 |
| 87522 |
Neg quan hep c or qual rna |
114 |
112 |
$0.00 |
| 86704 |
|
232 |
231 |
$0.00 |
| J3490 |
Drugs unclassified injection |
490 |
409 |
$0.00 |
| 90698 |
|
26 |
26 |
$0.00 |
| 86800 |
|
82 |
78 |
$0.00 |
| 88141 |
|
106 |
102 |
$0.00 |
| 82746 |
|
447 |
433 |
$0.00 |
| 80178 |
|
44 |
32 |
$0.00 |
| 71260 |
|
82 |
79 |
$0.00 |
| 82378 |
|
116 |
109 |
$0.00 |
| 90716 |
|
17 |
16 |
$0.00 |
| 84480 |
|
229 |
221 |
$0.00 |
| 82043 |
|
951 |
910 |
$0.00 |
| 76801 |
|
34 |
30 |
$0.00 |
| 82040 |
|
65 |
61 |
$0.00 |
| A4556 |
Electrodes, pair |
71 |
71 |
$0.00 |
| 88304 |
|
112 |
104 |
$0.00 |
| 86803 |
|
688 |
678 |
$0.00 |
| 84270 |
|
30 |
24 |
$0.00 |
| 82728 |
|
890 |
842 |
$0.00 |
| 80371 |
|
39 |
39 |
$0.00 |
| 83002 |
|
145 |
142 |
$0.00 |
| 86160 |
|
12 |
12 |
$0.00 |
| 83001 |
|
193 |
188 |
$0.00 |
| 88305 |
|
879 |
814 |
$0.00 |
| 92551 |
|
410 |
406 |
$0.00 |
| 73560 |
|
91 |
67 |
$0.00 |
| K0738 |
Portable gas oxygen system |
143 |
139 |
$0.00 |
| E0570 |
Nebulizer with compression |
264 |
255 |
$0.00 |
| 80358 |
|
124 |
114 |
$0.00 |
| 80324 |
|
278 |
185 |
$0.00 |
| A7037 |
Pos airway pressure tubing |
78 |
76 |
$0.00 |
| 99285 |
|
1,350 |
1,211 |
$0.00 |
| 93306 |
|
221 |
206 |
$0.00 |
| 72040 |
|
85 |
81 |
$0.00 |
| 99232 |
|
1,194 |
339 |
$0.00 |
| 86580 |
|
146 |
146 |
$0.00 |
| 85025 |
|
3,645 |
3,287 |
$0.00 |
| T4535 |
Disposable liner/shield/pad |
97 |
86 |
$0.00 |
| 98941 |
|
461 |
311 |
$0.00 |
| 71045 |
|
961 |
655 |
$0.00 |
| 90471 |
|
705 |
674 |
$0.00 |
| 96110 |
|
270 |
269 |
$0.00 |
| 97162 |
|
157 |
148 |
$0.00 |
| 73564 |
|
111 |
85 |
$0.00 |
| 88142 |
|
315 |
313 |
$0.00 |
| 87624 |
|
699 |
678 |
$0.00 |
| 86762 |
|
66 |
61 |
$0.00 |
| 76815 |
|
138 |
127 |
$0.00 |
| 97112 |
|
269 |
109 |
$0.00 |
| 88307 |
|
50 |
48 |
$0.00 |
| 83789 |
|
149 |
145 |
$0.00 |
| G0442 |
Annual alcohol screen 15 min |
12 |
12 |
$0.00 |
| 76700 |
|
238 |
235 |
$0.00 |
| 82150 |
|
106 |
100 |
$0.00 |
| 95117 |
|
21 |
13 |
$0.00 |
| 86695 |
|
193 |
187 |
$0.00 |
| 87661 |
|
659 |
617 |
$0.00 |
| 82670 |
|
48 |
41 |
$0.00 |
| 87088 |
|
636 |
599 |
$0.00 |
| 93971 |
|
31 |
31 |
$0.00 |
| 76536 |
|
68 |
64 |
$0.00 |
| 82607 |
|
905 |
869 |
$0.00 |
| 80353 |
|
161 |
145 |
$0.00 |
| 86317 |
|
117 |
95 |
$0.00 |
| 81001 |
|
1,973 |
1,870 |
$0.00 |
| 85652 |
|
591 |
545 |
$0.00 |
| 80357 |
|
30 |
30 |
$0.00 |
| 97802 |
|
286 |
285 |
$0.00 |
| 86901 |
|
119 |
111 |
$0.00 |
| 83735 |
|
322 |
264 |
$0.00 |
| 99205 |
Prolong outpt/office vis |
98 |
98 |
$0.00 |
| 87081 |
|
319 |
313 |
$0.00 |
| 97035 |
|
198 |
70 |
$0.00 |
| 83550 |
|
761 |
724 |
$0.00 |
| 86225 |
|
41 |
38 |
$0.00 |
| 82105 |
|
39 |
38 |
$0.00 |
| 82784 |
|
93 |
89 |
$0.00 |
| 78452 |
|
67 |
63 |
$0.00 |
| 1036F |
|
14 |
13 |
$0.00 |
| K0001 |
Standard wheelchair |
113 |
109 |
$0.00 |
| 83014 |
|
71 |
69 |
$0.00 |
| D0120 |
|
245 |
244 |
$0.00 |
| E0431 |
Portable gaseous 02 |
408 |
388 |
$0.00 |
| 80081 |
|
251 |
248 |
$0.00 |
| 82550 |
|
165 |
137 |
$0.00 |
| 80352 |
|
39 |
39 |
$0.00 |
| 84479 |
|
295 |
275 |
$0.00 |
| 96150 |
|
41 |
41 |
$0.00 |
| H0049 |
Alcohol/drug screening |
12 |
12 |
$0.00 |
| 73502 |
|
82 |
76 |
$0.00 |
| 80069 |
|
285 |
259 |
$0.00 |
| 87801 |
|
394 |
388 |
$0.00 |
| 70486 |
|
13 |
12 |
$0.00 |
| H2000 |
Comp multidisipln evaluation |
83 |
82 |
$0.00 |
| 76830 |
|
309 |
295 |
$0.00 |
| G0480 |
Drug test def 1-7 classes |
30 |
27 |
$0.00 |
| 80359 |
|
43 |
43 |
$0.00 |
| 51798 |
|
42 |
40 |
$0.00 |
| 82950 |
|
201 |
197 |
$0.00 |
| 86376 |
|
142 |
137 |
$0.00 |
| 84443 |
|
2,220 |
2,097 |
$0.00 |
| 87340 |
|
409 |
402 |
$0.00 |
| 76817 |
|
91 |
79 |
$0.00 |
| 80050 |
|
2,855 |
2,782 |
$0.00 |
| E0470 |
Rad w/o backup non-inv intfc |
88 |
85 |
$0.00 |
| 80345 |
|
15 |
15 |
$0.00 |
| 99282 |
|
191 |
176 |
$0.00 |
| 99050 |
|
48 |
47 |
$0.00 |
| G0467 |
Fqhc visit, estab pt |
35 |
30 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| 92226 |
|
24 |
12 |
$0.00 |
| 82951 |
|
31 |
29 |
$0.00 |
| 3008F |
|
52 |
45 |
$0.00 |
| 90744 |
|
14 |
14 |
$0.00 |
| 84315 |
|
15 |
15 |
$0.00 |
| 77063 |
|
278 |
191 |
$0.00 |
| 3079F |
|
37 |
37 |
$0.00 |
| 84703 |
|
29 |
26 |
$0.00 |
| 80184 |
|
34 |
34 |
$0.00 |
| 87046 |
|
13 |
13 |
$0.00 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
12 |
12 |
$0.00 |
| 99243 |
|
25 |
25 |
$0.00 |
| 76870 |
|
14 |
14 |
$0.00 |
| Q0111 |
Wet mounts/ w preparations |
13 |
13 |
$0.00 |
| 71275 |
|
13 |
12 |
$0.00 |
| 94760 |
|
36 |
34 |
$0.00 |
| 83615 |
|
50 |
43 |
$0.00 |
| 94640 |
|
16 |
14 |
$0.00 |
| 90680 |
|
14 |
14 |
$0.00 |
| 73090 |
|
15 |
12 |
$0.00 |
| 95024 |
|
16 |
12 |
$0.00 |
| 80363 |
|
33 |
33 |
$0.00 |
| 84144 |
|
30 |
29 |
$0.00 |
| 72148 |
|
99 |
75 |
$0.00 |
| 95886 |
|
13 |
13 |
$0.00 |
| 84132 |
|
14 |
12 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
868 |
808 |
$0.00 |
| 99203 |
|
2,066 |
2,031 |
$0.00 |
| 92014 |
|
128 |
128 |
$0.00 |
| 86696 |
|
194 |
190 |
$0.00 |
| 82274 |
|
440 |
426 |
$0.00 |
| 99173 |
|
950 |
943 |
$0.00 |
| 72125 |
|
95 |
88 |
$0.00 |
| 84702 |
|
189 |
150 |
$0.00 |
| 97110 |
|
3,605 |
1,162 |
$0.00 |
| 95811 |
|
119 |
72 |
$0.00 |
| 80307 |
|
2,548 |
1,737 |
$0.00 |
| 82247 |
|
66 |
62 |
$0.00 |
| 90670 |
|
262 |
249 |
$0.00 |
| 99394 |
|
233 |
232 |
$0.00 |
| 80074 |
|
453 |
433 |
$0.00 |
| 92552 |
|
631 |
628 |
$0.00 |
| 99392 |
|
576 |
555 |
$0.00 |
| 99212 |
|
2,415 |
2,218 |
$0.00 |
| 83540 |
|
832 |
786 |
$0.00 |
| 99223 |
Prolong inpt eval add15 m |
423 |
357 |
$0.00 |
| E0601 |
Cont airway pressure device |
792 |
763 |
$0.00 |
| 80346 |
|
575 |
406 |
$0.00 |
| 93229 |
|
24 |
24 |
$0.00 |
| 99284 |
|
2,150 |
1,956 |
$0.00 |
| 73562 |
|
154 |
127 |
$0.00 |
| 84403 |
|
285 |
254 |
$0.00 |
| 70450 |
|
392 |
355 |
$0.00 |
| A4267 |
Male condom |
190 |
181 |
$0.00 |
| 51741 |
|
42 |
40 |
$0.00 |
| A9575 |
Inj gadoterate meglumi 0.1ml |
17 |
14 |
$0.00 |
| 81002 |
|
902 |
695 |
$0.00 |
| 59425 |
|
2,043 |
1,456 |
$0.00 |
| 72100 |
|
186 |
175 |
$0.00 |
| 87338 |
|
44 |
43 |
$0.00 |
| 71046 |
|
1,218 |
1,148 |
$0.00 |
| 80061 |
|
5,050 |
4,845 |
$0.00 |
| 81025 |
|
771 |
732 |
$0.00 |
| 73030 |
|
183 |
165 |
$0.00 |
| 99001 |
|
104 |
89 |
$0.00 |
| 80348 |
|
706 |
317 |
$0.00 |
| G0482 |
Drug test def 15-21 classes |
209 |
200 |
$0.00 |
| 99222 |
|
110 |
95 |
$0.00 |
| 82542 |
|
174 |
169 |
$0.00 |
| 11100 |
|
128 |
127 |
$0.00 |
| 99204 |
|
586 |
569 |
$0.00 |
| A7038 |
Pos airway pressure filter |
318 |
310 |
$0.00 |
| 80361 |
|
605 |
479 |
$0.00 |
| 17110 |
|
115 |
104 |
$0.00 |
| 99401 |
|
1,101 |
959 |
$0.00 |
| 93010 |
|
1,660 |
1,385 |
$0.00 |
| 81220 |
|
149 |
135 |
$0.00 |
| J3301 |
Triamcinolone acet inj nos |
110 |
106 |
$0.00 |
| 86735 |
|
21 |
21 |
$0.00 |
| 76770 |
|
96 |
91 |
$0.00 |
| 99354 |
|
106 |
100 |
$0.00 |
| 97803 |
|
759 |
690 |
$0.00 |
| 84550 |
|
369 |
351 |
$0.00 |
| 99201 |
|
82 |
76 |
$0.00 |
| 99233 |
Prolong inpt eval add15 m |
1,063 |
342 |
$0.00 |
| 72110 |
|
62 |
62 |
$0.00 |
| 80372 |
|
149 |
140 |
$0.00 |
| 95004 |
|
29 |
27 |
$0.00 |
| 84460 |
|
182 |
180 |
$0.00 |
| 90833 |
|
278 |
251 |
$0.00 |
| 73130 |
|
197 |
154 |
$0.00 |
| 90832 |
|
104 |
79 |
$0.00 |
| 82785 |
|
143 |
135 |
$0.00 |
| 74177 |
|
293 |
270 |
$0.00 |
| 82947 |
|
151 |
136 |
$0.00 |
| 98940 |
|
498 |
326 |
$0.00 |
| 99245 |
|
108 |
107 |
$0.00 |
| 88175 |
|
882 |
853 |
$0.00 |
| 86038 |
|
327 |
315 |
$0.00 |
| 97164 |
|
152 |
140 |
$0.00 |
| 82565 |
|
121 |
118 |
$0.00 |
| 84450 |
|
164 |
162 |
$0.00 |
| 76705 |
|
177 |
162 |
$0.00 |
| A9279 |
Monitoring feature/devicenoc |
63 |
63 |
$0.00 |
| 76642 |
|
121 |
86 |
$0.00 |
| E0114 |
Crutch underarm pair no wood |
77 |
70 |
$0.00 |
| 99051 |
|
204 |
193 |
$0.00 |
| 99391 |
|
173 |
166 |
$0.00 |
| 92550 |
|
120 |
119 |
$0.00 |
| 84481 |
|
571 |
548 |
$0.00 |
| 84146 |
|
181 |
179 |
$0.00 |
| E1390 |
Oxygen concentrator |
812 |
766 |
$0.00 |
| 1159F |
|
45 |
39 |
$0.00 |
| 76856 |
|
363 |
347 |
$0.00 |
| 80369 |
|
76 |
71 |
$0.00 |
| 99211 |
|
381 |
362 |
$0.00 |
| T1015 |
Clinic service |
555 |
434 |
$0.00 |
| 73610 |
|
195 |
159 |
$0.00 |
| H1003 |
Prenatal at risk education |
1,427 |
914 |
$0.00 |
| 83992 |
|
42 |
42 |
$0.00 |
| 99497 |
|
185 |
185 |
$0.00 |
| 90734 |
|
41 |
41 |
$0.00 |
| 85610 |
|
490 |
401 |
$0.00 |
| 80356 |
|
171 |
155 |
$0.00 |
| 74018 |
|
152 |
118 |
$0.00 |
| 77067 |
|
569 |
562 |
$0.00 |
| 99221 |
|
30 |
25 |
$0.00 |
| G8427 |
Docrev cur meds by elig clin |
83 |
75 |
$0.00 |
| 86003 |
|
203 |
195 |
$0.00 |
| 86708 |
|
195 |
191 |
$0.00 |
| 87491 |
|
2,164 |
2,036 |
$0.00 |
| 87186 |
|
243 |
227 |
$0.00 |
| 86787 |
|
33 |
33 |
$0.00 |
| 87880 |
|
121 |
114 |
$0.00 |
| 90649 |
|
19 |
14 |
$0.00 |
| 95887 |
|
13 |
13 |
$0.00 |
| A9502 |
Tc99m tetrofosmin |
12 |
12 |
$0.00 |
| 95144 |
|
341 |
107 |
$0.00 |
| A7034 |
Nasal application device |
46 |
45 |
$0.00 |
| 80321 |
|
288 |
231 |
$0.00 |
| 3078F |
|
106 |
91 |
$0.00 |
| 93325 |
|
17 |
12 |
$0.00 |
| A7035 |
Pos airway press headgear |
172 |
169 |
$0.00 |
| 88312 |
|
60 |
59 |
$0.00 |
| 83970 |
|
74 |
68 |
$0.00 |
| 99238 |
|
105 |
104 |
$0.00 |
| 81003 |
|
657 |
615 |
$0.00 |
| 73140 |
|
39 |
38 |
$0.00 |
| 84439 |
|
1,664 |
1,592 |
$0.00 |
| 82652 |
|
246 |
243 |
$0.00 |
| 71250 |
|
49 |
44 |
$0.00 |
| 82570 |
|
1,184 |
1,097 |
$0.00 |
| 73630 |
|
298 |
251 |
$0.00 |
| 99393 |
|
384 |
375 |
$0.00 |
| 45385 |
|
60 |
60 |
$0.00 |
| 99199 |
|
72 |
65 |
$0.00 |
| A7039 |
Filter, non disposable w pap |
43 |
42 |
$0.00 |
| 76805 |
|
86 |
82 |
$0.00 |
| 87798 |
|
80 |
32 |
$0.00 |
| 74176 |
|
137 |
128 |
$0.00 |
| 87177 |
|
68 |
68 |
$0.00 |
| 90685 |
|
14 |
14 |
$0.00 |
| 80365 |
|
604 |
477 |
$0.00 |
| 87799 |
|
1,047 |
344 |
$0.00 |
| 84156 |
|
70 |
52 |
$0.00 |
| 90472 |
|
231 |
166 |
$0.00 |
| 80323 |
|
55 |
55 |
$0.00 |
| 82248 |
|
211 |
196 |
$0.00 |
| A4604 |
Tubing with heating element |
79 |
77 |
$0.00 |
| 73721 |
|
66 |
59 |
$0.00 |
| 87209 |
|
68 |
68 |
$0.00 |
| 83655 |
|
383 |
368 |
$0.00 |
| 83525 |
|
51 |
51 |
$0.00 |
| 80076 |
|
225 |
213 |
$0.00 |
| 99244 |
|
54 |
54 |
$0.00 |
| 73110 |
|
157 |
125 |
$0.00 |
| 72070 |
|
12 |
12 |
$0.00 |
| 80373 |
|
118 |
109 |
$0.00 |
| 86480 |
|
176 |
170 |
$0.00 |
| 80355 |
|
70 |
67 |
$0.00 |
| 86431 |
|
273 |
266 |
$0.00 |
| 80325 |
|
13 |
12 |
$0.00 |
| 87806 |
|
98 |
96 |
$0.00 |
| 90648 |
|
13 |
13 |
$0.00 |
| 90715 |
|
49 |
45 |
$0.00 |
| 87512 |
|
342 |
335 |
$0.00 |
| Q0144 |
Azithromycin dihydrate, oral |
44 |
40 |
$0.00 |
| S0199 |
Med abortion inc all ex drug |
39 |
39 |
$0.00 |
| 93015 |
|
25 |
25 |
$0.00 |
| 93975 |
|
102 |
99 |
$0.00 |
| 80360 |
|
92 |
88 |
$0.00 |
| 80366 |
|
68 |
65 |
$0.00 |
| 83516 |
|
59 |
52 |
$0.00 |
| T4541 |
Large disposable underpad |
137 |
131 |
$0.00 |
| A7036 |
Pos airway press chinstrap |
13 |
13 |
$0.00 |
| 80354 |
|
121 |
112 |
$0.00 |
| 92134 |
|
27 |
26 |
$0.00 |
| 87481 |
|
179 |
65 |
$0.00 |
| S0191 |
Misoprostol, oral, 200 mcg |
40 |
38 |
$0.00 |
| 86200 |
|
118 |
115 |
$0.00 |
| T4526 |
Adult size pull-on med |
39 |
37 |
$0.00 |
| 90700 |
|
82 |
80 |
$0.00 |
| S0190 |
Mifepristone, oral, 200 mg |
25 |
25 |
$0.00 |
| J0135 |
Adalimumab injection |
57 |
47 |
$0.00 |
| 77066 |
Tomosynthesis, mammo |
54 |
52 |
$0.00 |
| 72141 |
|
27 |
25 |
$0.00 |
| 70553 |
|
71 |
64 |
$0.00 |
| 83013 |
|
107 |
107 |
$0.00 |
| 86235 |
|
50 |
46 |
$0.00 |
| 01967 |
|
27 |
27 |
$0.00 |
| 90633 |
|
45 |
44 |
$0.00 |
| S4993 |
Contraceptive pills for bc |
85 |
85 |
$0.00 |
| 3077F |
|
12 |
12 |
$0.00 |
| 80305 |
|
12 |
12 |
$0.00 |
| 99231 |
|
46 |
31 |
$0.00 |
| A7046 |
Repl water chamber, pap dev |
31 |
31 |
$0.00 |
| 90791 |
|
13 |
13 |
$0.00 |
| 99152 |
|
46 |
42 |
$0.00 |
| 95810 |
|
19 |
13 |
$0.00 |
| 84100 |
|
39 |
26 |
$0.00 |
| 80299 |
|
38 |
38 |
$0.00 |
| 90707 |
|
15 |
14 |
$0.00 |
| 93970 |
|
20 |
18 |
$0.00 |
| 73080 |
|
20 |
18 |
$0.00 |
| 29125 |
|
18 |
17 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
36 |
33 |
$0.00 |
| G0483 |
Drug test def 22+ classes |
17 |
16 |
$0.00 |
| 86765 |
|
21 |
21 |
$0.00 |
| 87427 |
|
13 |
13 |
$0.00 |
| 82310 |
|
16 |
16 |
$0.00 |
| 70551 |
|
32 |
26 |
$0.00 |
| 86900 |
|
51 |
48 |
$0.00 |
| 0403T |
|
21 |
15 |
$0.00 |
| 87045 |
|
14 |
14 |
$0.00 |
| 73590 |
|
14 |
14 |
$0.00 |
| 86039 |
|
16 |
14 |
$0.00 |
| 92012 |
|
14 |
13 |
$0.00 |