| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
|
127,689 |
104,828 |
$3.70M |
| 99284 |
|
13,644 |
12,157 |
$2.40M |
| 76816 |
|
12,710 |
11,492 |
$1.35M |
| 99214 |
|
27,204 |
23,461 |
$1.17M |
| 99212 |
|
35,764 |
29,609 |
$1.10M |
| 99285 |
|
5,591 |
5,127 |
$1.10M |
| 74177 |
|
4,063 |
3,922 |
$903K |
| 93005 |
|
20,543 |
14,107 |
$729K |
| 87631 |
|
4,947 |
4,638 |
$613K |
| 76811 |
|
3,742 |
3,412 |
$553K |
| 76815 |
|
7,155 |
5,106 |
$489K |
| 93306 |
|
2,325 |
2,266 |
$395K |
| 76805 |
|
3,354 |
3,070 |
$357K |
| U0003 |
Cov-19 amp prb hgh thruput |
5,346 |
5,035 |
$352K |
| 93975 |
|
1,495 |
1,381 |
$335K |
| 99215 |
Prolong outpt/office vis |
3,508 |
3,272 |
$333K |
| 76801 |
|
3,147 |
2,786 |
$323K |
| 99283 |
|
7,178 |
6,304 |
$292K |
| 76819 |
|
3,476 |
2,016 |
$282K |
| 85025 |
|
56,794 |
45,364 |
$276K |
| 59025 |
|
7,630 |
4,744 |
$271K |
| 80307 |
|
6,755 |
5,946 |
$270K |
| 96413 |
|
3,706 |
2,547 |
$262K |
| 70450 |
|
3,123 |
2,965 |
$258K |
| 87491 |
|
9,620 |
9,081 |
$237K |
| 87591 |
|
9,618 |
9,079 |
$236K |
| 87536 |
|
4,483 |
3,918 |
$228K |
| 87635 |
|
5,231 |
4,929 |
$223K |
| G0463 |
Hospital outpt clinic visit |
32,642 |
25,663 |
$211K |
| 76817 |
|
2,417 |
2,072 |
$209K |
| 80053 |
|
27,019 |
22,107 |
$207K |
| 76818 |
|
1,735 |
1,093 |
$205K |
| 71260 |
|
1,815 |
1,792 |
$200K |
| 71275 |
|
1,114 |
1,079 |
$192K |
| 99291 |
|
344 |
326 |
$179K |
| 80048 |
|
31,804 |
23,991 |
$169K |
| 96374 |
|
4,316 |
3,748 |
$166K |
| 80061 |
|
20,628 |
19,542 |
$163K |
| 94640 |
|
3,447 |
945 |
$163K |
| 86703 |
|
15,901 |
15,169 |
$162K |
| 71046 |
|
6,321 |
5,920 |
$155K |
| 99211 |
|
5,086 |
4,171 |
$149K |
| 83036 |
|
22,491 |
21,394 |
$130K |
| 86780 |
|
13,301 |
12,481 |
$128K |
| 84443 |
|
12,313 |
11,684 |
$116K |
| 96365 |
|
2,402 |
2,090 |
$112K |
| 90677 |
|
1,437 |
1,412 |
$108K |
| G0257 |
Unsched dialysis esrd pt hos |
1,744 |
984 |
$100K |
| 92014 |
|
3,567 |
3,160 |
$100K |
| 76705 |
|
1,291 |
1,245 |
$100K |
| 86360 |
|
3,661 |
3,224 |
$99K |
| 88305 |
|
3,631 |
1,983 |
$96K |
| 86850 |
|
9,049 |
8,247 |
$92K |
| P9016 |
Rbc leukocytes reduced |
2,105 |
644 |
$92K |
| 76830 |
|
954 |
924 |
$92K |
| 71045 |
|
5,179 |
4,489 |
$87K |
| 82306 |
|
5,750 |
5,558 |
$82K |
| J9271 |
Inj pembrolizumab |
27 |
25 |
$81K |
| 97110 |
|
3,168 |
1,606 |
$80K |
| 76770 |
|
899 |
878 |
$78K |
| 87880 |
|
4,603 |
4,238 |
$77K |
| 70553 |
|
346 |
341 |
$74K |
| 99281 |
|
2,181 |
1,879 |
$73K |
| 49083 |
|
224 |
148 |
$68K |
| 84484 |
|
11,815 |
6,701 |
$68K |
| 96361 |
|
2,385 |
1,863 |
$67K |
| 76700 |
|
773 |
766 |
$66K |
| 87086 |
|
11,734 |
10,859 |
$66K |
| 93017 |
|
332 |
313 |
$65K |
| 83880 |
|
3,139 |
2,912 |
$65K |
| 92012 |
|
2,268 |
1,969 |
$64K |
| 87088 |
|
11,719 |
10,845 |
$63K |
| 74176 |
|
404 |
398 |
$61K |
| 96360 |
|
1,228 |
1,151 |
$58K |
| 80076 |
|
11,690 |
10,703 |
$58K |
| 72125 |
|
758 |
734 |
$55K |
| 85027 |
|
13,066 |
10,729 |
$54K |
| 96375 |
|
3,756 |
2,955 |
$50K |
| 86592 |
|
16,825 |
14,028 |
$49K |
| 87624 |
|
2,117 |
2,051 |
$48K |
| 93308 |
|
657 |
627 |
$48K |
| 97161 |
|
1,111 |
1,078 |
$47K |
| 93971 |
|
515 |
478 |
$47K |
| 80074 |
|
3,292 |
3,194 |
$47K |
| 78452 |
|
172 |
168 |
$46K |
| J1050 |
Medroxyprogesterone acetate |
1,771 |
1,721 |
$46K |
| 82947 |
|
30,108 |
11,677 |
$43K |
| 90471 |
|
11,533 |
10,630 |
$43K |
| 77067 |
|
2,032 |
2,005 |
$43K |
| 94618 |
|
217 |
176 |
$42K |
| 86923 |
|
1,624 |
851 |
$42K |
| 90715 |
|
3,408 |
3,315 |
$42K |
| 88720 |
|
9,115 |
8,132 |
$41K |
| 76857 |
|
932 |
903 |
$40K |
| 90833 |
|
1,386 |
1,146 |
$40K |
| J1453 |
Fosaprepitant injection |
768 |
542 |
$38K |
| 93970 |
|
274 |
268 |
$38K |
| 99282 |
|
1,071 |
989 |
$38K |
| 97162 |
|
856 |
816 |
$37K |
| 90750 |
|
1,153 |
1,141 |
$37K |
| 73630 |
|
1,393 |
1,160 |
$35K |
| 90832 |
|
1,033 |
846 |
$34K |
| 83735 |
|
9,190 |
5,880 |
$33K |
| 96372 |
|
6,671 |
5,355 |
$33K |
| 86762 |
|
3,809 |
3,643 |
$33K |
| 82803 |
|
2,678 |
2,019 |
$32K |
| 83655 |
|
3,125 |
2,900 |
$32K |
| 78815 |
|
37 |
37 |
$32K |
| 73562 |
|
1,054 |
920 |
$31K |
| 0002A |
|
3,116 |
3,072 |
$31K |
| 96417 |
|
1,298 |
862 |
$31K |
| 97530 |
|
1,506 |
747 |
$30K |
| 84702 |
|
3,184 |
2,664 |
$30K |
| 81001 |
|
14,878 |
13,458 |
$29K |
| 87340 |
|
5,780 |
5,490 |
$28K |
| 73030 |
|
1,146 |
1,014 |
$27K |
| G0378 |
Hospital observation per hr |
328 |
139 |
$27K |
| 73130 |
|
978 |
793 |
$27K |
| 83020 |
|
2,719 |
2,541 |
$27K |
| 73610 |
|
931 |
788 |
$26K |
| 0012A |
|
2,748 |
2,679 |
$26K |
| 71250 |
|
392 |
387 |
$26K |
| 90834 |
|
598 |
470 |
$26K |
| 70496 |
|
159 |
157 |
$26K |
| 96415 |
|
1,561 |
973 |
$25K |
| 84439 |
|
4,682 |
4,488 |
$25K |
| 72100 |
|
884 |
860 |
$25K |
| 96366 |
|
1,097 |
841 |
$24K |
| 20610 |
|
560 |
490 |
$24K |
| 82607 |
|
3,217 |
3,127 |
$23K |
| 96367 |
|
1,403 |
998 |
$23K |
| 82728 |
|
3,207 |
3,090 |
$23K |
| 83690 |
|
5,646 |
5,182 |
$22K |
| 0001A |
|
2,896 |
2,852 |
$22K |
| 70498 |
|
140 |
136 |
$22K |
| 88175 |
|
1,163 |
1,121 |
$21K |
| 90686 |
|
2,986 |
2,827 |
$21K |
| 86803 |
|
2,832 |
2,718 |
$21K |
| 83970 |
|
1,055 |
1,019 |
$20K |
| 87522 |
Neg quan hep c or qual rna |
763 |
732 |
$20K |
| 88142 |
|
1,395 |
1,342 |
$20K |
| 85610 |
|
7,938 |
6,209 |
$20K |
| 83605 |
|
3,082 |
2,266 |
$19K |
| A0428 |
Bls |
544 |
452 |
$19K |
| 88342 |
|
688 |
499 |
$18K |
| 94760 |
|
759 |
447 |
$18K |
| 76820 |
|
368 |
214 |
$18K |
| 76642 |
|
316 |
273 |
$17K |
| 86900 |
|
9,208 |
8,352 |
$17K |
| 86901 |
|
9,202 |
8,350 |
$17K |
| 87040 |
|
2,556 |
1,276 |
$17K |
| 81002 |
|
6,184 |
4,940 |
$17K |
| 87081 |
|
3,126 |
2,995 |
$17K |
| 0011A |
|
2,444 |
2,394 |
$16K |
| 87077 |
|
3,678 |
2,596 |
$16K |
| 70551 |
|
101 |
100 |
$16K |
| G0328 |
Fecal blood scrn immunoassay |
2,000 |
1,988 |
$16K |
| 80047 |
|
3,451 |
3,042 |
$16K |
| 73110 |
|
485 |
364 |
$15K |
| 73590 |
|
630 |
561 |
$15K |
| 82570 |
|
5,529 |
5,050 |
$15K |
| 84153 |
|
1,507 |
1,399 |
$14K |
| 87210 |
|
3,336 |
3,188 |
$14K |
| 85730 |
|
4,462 |
3,705 |
$14K |
| 81025 |
|
2,294 |
2,194 |
$14K |
| 85007 |
|
6,323 |
4,769 |
$14K |
| 82950 |
|
3,554 |
3,437 |
$14K |
| 82565 |
|
6,265 |
5,738 |
$13K |
| 86480 |
|
403 |
389 |
$13K |
| A0425 |
Ground mileage |
1,506 |
1,327 |
$13K |
| 82746 |
|
1,746 |
1,701 |
$13K |
| J3475 |
Inj magnesium sulfate |
2,162 |
1,437 |
$12K |
| 87186 |
|
2,600 |
1,949 |
$12K |
| 84460 |
|
3,922 |
3,716 |
$12K |
| 84450 |
|
3,914 |
3,704 |
$12K |
| 76821 |
|
118 |
68 |
$12K |
| 85018 |
|
4,799 |
4,506 |
$12K |
| A9502 |
Tc99m tetrofosmin |
540 |
293 |
$11K |
| J2426 |
Inj, invega sustenna, 1 mg |
15 |
12 |
$11K |
| 73502 |
|
342 |
317 |
$11K |
| J1650 |
Inj enoxaparin sodium |
3,883 |
1,823 |
$11K |
| 73565 |
|
412 |
408 |
$11K |
| 67028 |
|
246 |
225 |
$11K |
| 94010 |
|
246 |
208 |
$10K |
| 87070 |
|
1,577 |
1,402 |
$10K |
| 94726 |
|
175 |
135 |
$10K |
| 83540 |
|
3,093 |
2,988 |
$10K |
| 83550 |
|
2,215 |
2,133 |
$10K |
| 97597 |
|
462 |
212 |
$10K |
| 90756 |
|
1,319 |
1,311 |
$9K |
| 96416 |
|
214 |
124 |
$9K |
| 82378 |
|
799 |
711 |
$9K |
| J3490 |
Drugs unclassified injection |
3,739 |
1,794 |
$9K |
| 82247 |
|
3,131 |
2,469 |
$9K |
| J2785 |
Regadenoson injection |
233 |
227 |
$9K |
| 82043 |
|
3,052 |
2,993 |
$9K |
| 77066 |
Tomosynthesis, mammo |
162 |
162 |
$8K |
| 81003 |
|
5,882 |
5,610 |
$8K |
| 99001 |
|
703 |
660 |
$8K |
| 97165 |
|
193 |
192 |
$8K |
| 45385 |
|
31 |
30 |
$8K |
| 87661 |
|
362 |
345 |
$8K |
| J7030 |
Normal saline solution infus |
12,607 |
5,243 |
$7K |
| 96376 |
|
477 |
420 |
$7K |
| 94729 |
|
144 |
118 |
$7K |
| 85014 |
|
2,890 |
2,683 |
$7K |
| 84100 |
|
5,432 |
3,842 |
$7K |
| 97112 |
|
162 |
71 |
$7K |
| J3370 |
Vancomycin hcl injection |
954 |
514 |
$7K |
| 76536 |
|
81 |
80 |
$7K |
| 91320 |
|
318 |
311 |
$6K |
| 43239 |
|
12 |
12 |
$6K |
| 86706 |
|
1,200 |
1,141 |
$6K |
| 86140 |
|
2,209 |
2,075 |
$6K |
| 97163 |
|
123 |
107 |
$6K |
| 80050 |
|
308 |
302 |
$6K |
| 92250 |
|
1,077 |
1,066 |
$6K |
| J1644 |
Inj heparin sodium per 1000u |
3,396 |
1,017 |
$6K |
| 87811 |
|
155 |
135 |
$6K |
| 78306 |
|
24 |
24 |
$6K |
| 85651 |
|
2,118 |
2,021 |
$5K |
| 70486 |
|
66 |
64 |
$5K |
| 90656 |
|
723 |
710 |
$5K |
| 86704 |
|
799 |
759 |
$5K |
| 90732 |
|
322 |
321 |
$5K |
| J0692 |
Cefepime hcl for injection |
1,450 |
502 |
$5K |
| 36430 |
|
1,048 |
836 |
$5K |
| 84403 |
|
533 |
480 |
$5K |
| 77080 |
|
321 |
319 |
$5K |
| 0004A |
|
558 |
558 |
$5K |
| J0696 |
Ceftriaxone sodium injection |
2,200 |
1,656 |
$5K |
| 0064A |
|
441 |
437 |
$5K |
| 82550 |
|
1,270 |
1,066 |
$5K |
| 84156 |
|
2,072 |
1,946 |
$4K |
| 86255 |
|
665 |
642 |
$4K |
| 80051 |
|
1,449 |
1,356 |
$4K |
| 82533 |
|
495 |
405 |
$4K |
| 82105 |
|
564 |
529 |
$4K |
| 73552 |
|
159 |
143 |
$4K |
| J1940 |
Furosemide injection |
2,279 |
1,127 |
$4K |
| 83615 |
|
1,114 |
963 |
$4K |
| J9190 |
Fluorouracil injection |
402 |
193 |
$4K |
| 84520 |
|
2,341 |
2,243 |
$4K |
| 85378 |
|
610 |
587 |
$4K |
| 74018 |
|
162 |
147 |
$4K |
| 73090 |
|
153 |
133 |
$4K |
| 84703 |
|
758 |
730 |
$3K |
| P9046 |
Albumin (human), 25%, 20 ml |
116 |
52 |
$3K |
| 86160 |
|
529 |
256 |
$3K |
| J1885 |
Ketorolac tromethamine inj |
2,265 |
1,873 |
$3K |
| J2270 |
Morphine sulfate injection |
3,567 |
2,162 |
$3K |
| 82248 |
|
1,819 |
1,567 |
$3K |
| J7040 |
Normal saline solution infus |
7,022 |
2,733 |
$3K |
| 84165 |
|
524 |
495 |
$3K |
| 77065 |
Tomosynthesis, mammo |
120 |
117 |
$3K |
| 87205 |
|
1,110 |
920 |
$3K |
| 80320 |
|
307 |
296 |
$3K |
| J0690 |
Cefazolin sodium injection |
462 |
333 |
$3K |
| 90472 |
|
932 |
818 |
$3K |
| 82951 |
|
272 |
266 |
$3K |
| J3301 |
Triamcinolone acet inj nos |
966 |
796 |
$3K |
| 97116 |
|
132 |
86 |
$3K |
| 0124A |
|
215 |
214 |
$3K |
| 0054A |
|
168 |
164 |
$3K |
| 93296 |
|
126 |
121 |
$3K |
| 72141 |
|
14 |
14 |
$2K |
| 90480 |
|
320 |
313 |
$2K |
| 76886 |
|
27 |
27 |
$2K |
| 82274 |
|
121 |
121 |
$2K |
| 92550 |
|
54 |
52 |
$2K |
| J2405 |
Ondansetron hcl injection |
5,550 |
3,953 |
$2K |
| J7050 |
Normal saline solution infus |
2,184 |
1,100 |
$2K |
| 82140 |
|
208 |
178 |
$2K |
| 86225 |
|
240 |
234 |
$2K |
| J0561 |
Penicillin g benzathine inj |
42 |
24 |
$2K |
| 84075 |
|
1,005 |
893 |
$2K |
| 88341 |
|
376 |
82 |
$2K |
| 90670 |
|
37 |
37 |
$2K |
| J3420 |
Vitamin b12 injection |
717 |
561 |
$2K |
| 87338 |
|
236 |
230 |
$2K |
| 97535 |
|
300 |
202 |
$2K |
| 0134A |
|
121 |
121 |
$2K |
| 80069 |
|
986 |
849 |
$1K |
| A0426 |
Als 1 |
12 |
12 |
$1K |
| 94660 |
|
20 |
12 |
$1K |
| 70491 |
|
12 |
12 |
$1K |
| J9045 |
Carboplatin injection |
107 |
65 |
$1K |
| J1170 |
Hydromorphone injection |
2,403 |
810 |
$1K |
| J7060 |
5% dextrose/water |
3,755 |
1,744 |
$1K |
| 84550 |
|
579 |
540 |
$1K |
| 82330 |
|
537 |
381 |
$1K |
| Q3014 |
Telehealth facility fee |
799 |
684 |
$1K |
| J1100 |
Dexamethasone sodium phos |
1,372 |
1,041 |
$1K |
| 72148 |
|
12 |
12 |
$1K |
| 90662 |
|
867 |
859 |
$1K |
| J3010 |
Fentanyl citrate injection |
2,585 |
1,911 |
$1K |
| 92557 |
|
28 |
26 |
$1K |
| C1769 |
Guide wire |
490 |
290 |
$984.51 |
| 96368 |
|
76 |
54 |
$942.42 |
| 88307 |
|
23 |
14 |
$912.42 |
| 94762 |
|
15 |
12 |
$881.54 |
| J1750 |
Inj iron dextran |
23 |
12 |
$873.26 |
| 82553 |
|
129 |
104 |
$836.77 |
| 72040 |
|
25 |
25 |
$833.98 |
| J3489 |
Zoledronic acid 1mg |
12 |
12 |
$789.73 |
| 85045 |
|
281 |
246 |
$714.95 |
| 85384 |
|
89 |
75 |
$711.59 |
| 82310 |
|
456 |
431 |
$663.18 |
| 86790 |
|
71 |
67 |
$649.06 |
| J1200 |
Diphenhydramine hcl injectio |
1,245 |
918 |
$611.17 |
| 70355 |
|
27 |
27 |
$610.62 |
| J2250 |
Inj midazolam hydrochloride |
2,052 |
1,527 |
$557.91 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
1,803 |
1,699 |
$549.34 |
| 86431 |
|
182 |
177 |
$526.10 |
| 80164 |
|
93 |
78 |
$506.94 |
| 31575 |
|
13 |
12 |
$462.05 |
| 82784 |
|
79 |
39 |
$444.24 |
| 84295 |
|
343 |
326 |
$436.94 |
| 73521 |
|
13 |
13 |
$410.22 |
| 82374 |
|
320 |
306 |
$403.27 |
| 82435 |
|
328 |
314 |
$394.20 |
| 89051 |
|
91 |
82 |
$384.89 |
| 96402 |
|
15 |
12 |
$382.55 |
| 90688 |
|
38 |
37 |
$326.82 |
| J2765 |
Metoclopramide hcl injection |
559 |
424 |
$296.45 |
| C9257 |
Bevacizumab injection |
68 |
51 |
$252.40 |
| Q0162 |
Ondansetron oral |
468 |
327 |
$231.27 |
| 90674 |
|
32 |
32 |
$208.48 |
| 87147 |
|
54 |
54 |
$206.29 |
| 83930 |
|
48 |
39 |
$204.36 |
| J0131 |
Inj, acetaminophen (nos) |
53 |
41 |
$201.65 |
| 90682 |
|
13 |
13 |
$186.40 |
| 0013A |
|
15 |
15 |
$174.21 |
| 92083 |
|
24 |
24 |
$170.13 |
| J2001 |
Lidocaine injection |
3,697 |
3,205 |
$153.98 |
| 77063 |
|
335 |
331 |
$153.15 |
| J0330 |
Succinycholine chloride inj |
65 |
54 |
$147.51 |
| J2710 |
Neostigmine methylslfte inj |
27 |
26 |
$130.96 |
| Q0163 |
Diphenhydramine hcl 50mg |
2,487 |
1,877 |
$117.79 |
| 90694 |
|
173 |
152 |
$116.84 |
| 90746 |
|
12 |
12 |
$111.28 |
| 85597 |
|
14 |
12 |
$109.31 |
| 0003A |
|
19 |
19 |
$108.42 |
| J1642 |
Inj heparin sodium per 10 u |
1,596 |
1,041 |
$95.66 |
| H0049 |
Alcohol/drug screening |
25 |
25 |
$89.76 |
| 87181 |
|
79 |
27 |
$83.62 |
| J2060 |
Lorazepam injection |
61 |
41 |
$82.73 |
| 90654 |
|
19 |
18 |
$78.64 |
| 83935 |
|
18 |
13 |
$74.49 |
| 97164 |
|
13 |
12 |
$70.16 |
| 92134 |
|
270 |
263 |
$69.74 |
| J1836 |
Inj, metronidazole, 10 mg |
25 |
12 |
$69.25 |
| G0279 |
Tomosynthesis, mammo |
68 |
68 |
$61.16 |
| 85613 |
|
12 |
12 |
$58.29 |
| J0461 |
Atropine sulfate injection |
18 |
12 |
$57.04 |
| J1817 |
Insulin for insulin pump use |
820 |
210 |
$56.19 |
| J2930 |
Methylprednisolone injection |
14 |
12 |
$43.37 |
| J2704 |
Inj, propofol, 10 mg |
1,736 |
1,464 |
$41.07 |
| J1815 |
Insulin injection |
186 |
37 |
$37.69 |
| 11721 |
|
17 |
17 |
$35.78 |
| J0780 |
Prochlorperazine injection |
14 |
13 |
$35.40 |
| A9503 |
Tc99m medronate |
24 |
24 |
$27.16 |
| C9803 |
Hopd covid-19 spec collect |
30 |
28 |
$24.17 |
| J2370 |
Phenylephrine hcl injection |
120 |
101 |
$7.68 |
| J1630 |
Haloperidol injection |
19 |
14 |
$1.37 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
78 |
70 |
$0.27 |
| 91301 |
|
1,670 |
1,532 |
$0.09 |
| 91300 |
|
2,217 |
2,066 |
$0.05 |
| 91313 |
|
132 |
131 |
$0.00 |
| J7070 |
D5w infusion |
35 |
25 |
$0.00 |
| G1004 |
Cdsm ndsc |
665 |
466 |
$0.00 |
| 91312 |
|
208 |
208 |
$0.00 |
| A9552 |
F18 fdg |
51 |
51 |
$0.00 |
| J2004 |
Inj, lidocaine w epinephrine |
13 |
13 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
868 |
864 |
$0.00 |
| G0008 |
Admin influenza virus vac |
1,808 |
1,783 |
$0.00 |
| 59430 |
|
167 |
153 |
$0.00 |
| 91306 |
|
34 |
34 |
$0.00 |
| J7512 |
Prednisone ir or dr oral 1mg |
296 |
151 |
$0.00 |
| G0103 |
Psa screening |
13 |
13 |
$0.00 |
| J2371 |
Inj phenylephrine hcl 20 mcg |
31 |
25 |
$0.00 |
| G0480 |
Drug test def 1-7 classes |
26 |
24 |
$0.00 |
| 91305 |
|
209 |
204 |
$0.00 |