| Code | Description | Claims | Beneficiaries | Total Paid |
| 99214 |
|
274,083 |
260,775 |
$27.13M |
| 99213 |
|
282,590 |
266,078 |
$19.53M |
| U0003 |
Cov-19 amp prb hgh thruput |
24,484 |
22,749 |
$2.04M |
| 99392 |
|
21,128 |
20,967 |
$1.94M |
| 99204 |
|
12,366 |
12,309 |
$1.81M |
| 99391 |
|
20,007 |
19,190 |
$1.67M |
| 87637 |
|
11,862 |
11,535 |
$1.67M |
| 99393 |
|
16,404 |
16,345 |
$1.54M |
| 99203 |
|
13,474 |
13,424 |
$1.30M |
| 0202U |
|
3,805 |
3,728 |
$1.24M |
| 88305 |
|
16,057 |
15,686 |
$1.11M |
| 74177 |
|
13,232 |
13,084 |
$1.09M |
| 99394 |
|
8,491 |
8,462 |
$882K |
| 99211 |
|
29,371 |
25,119 |
$656K |
| 90471 |
|
53,554 |
53,144 |
$630K |
| 84443 |
|
35,525 |
34,929 |
$615K |
| 99215 |
Prolong outpt/office vis |
4,333 |
4,048 |
$612K |
| 77067 |
|
10,368 |
10,344 |
$602K |
| 80053 |
|
54,835 |
53,070 |
$585K |
| 82306 |
|
16,852 |
16,687 |
$529K |
| 80061 |
|
29,656 |
29,335 |
$398K |
| 90472 |
|
21,227 |
21,178 |
$365K |
| 93306 |
|
4,485 |
4,446 |
$365K |
| U0005 |
Infec agen detec ampli probe |
15,900 |
14,802 |
$346K |
| 87491 |
|
9,818 |
9,687 |
$324K |
| 87591 |
|
9,806 |
9,674 |
$324K |
| 99212 |
|
6,888 |
6,690 |
$313K |
| 77063 |
|
8,825 |
8,799 |
$287K |
| 85025 |
|
38,644 |
36,745 |
$283K |
| 71046 |
|
20,182 |
19,969 |
$273K |
| 90847 |
|
2,990 |
2,727 |
$266K |
| 70450 |
|
6,489 |
6,370 |
$247K |
| 87880 |
|
18,578 |
18,254 |
$237K |
| 83036 |
|
25,786 |
25,496 |
$232K |
| 93010 |
|
29,644 |
26,383 |
$225K |
| 96127 |
|
45,909 |
45,747 |
$222K |
| 97110 |
|
6,205 |
2,464 |
$217K |
| 43239 |
|
1,644 |
1,633 |
$188K |
| V2100 |
Lens spher single plano 4.00 |
9,162 |
4,347 |
$185K |
| 67028 |
|
1,686 |
1,491 |
$181K |
| 87631 |
|
1,395 |
1,374 |
$180K |
| 99233 |
Prolong inpt eval add15 m |
1,683 |
786 |
$169K |
| 0352U |
|
1,691 |
1,658 |
$168K |
| 82607 |
|
11,361 |
11,268 |
$163K |
| 80050 |
|
2,595 |
2,458 |
$162K |
| 90460 |
|
7,154 |
7,062 |
$158K |
| 87651 |
|
4,954 |
4,875 |
$149K |
| 71045 |
|
18,687 |
16,350 |
$148K |
| 92004 |
|
3,183 |
3,169 |
$147K |
| 99223 |
Prolong inpt eval add15 m |
1,018 |
989 |
$144K |
| 76830 |
|
2,654 |
2,640 |
$142K |
| 92014 |
|
3,040 |
2,963 |
$141K |
| 92551 |
|
13,242 |
13,104 |
$141K |
| 20610 |
|
2,995 |
2,734 |
$138K |
| 87086 |
|
16,555 |
15,914 |
$136K |
| 76816 |
|
2,624 |
2,588 |
$133K |
| 87660 |
|
6,199 |
6,037 |
$131K |
| 84439 |
|
14,953 |
14,636 |
$131K |
| 82746 |
|
9,394 |
9,313 |
$130K |
| 87081 |
|
19,590 |
19,192 |
$129K |
| 93000 |
|
8,324 |
8,124 |
$129K |
| V2020 |
Vision svcs frames purchases |
10,846 |
10,452 |
$128K |
| 90686 |
|
19,372 |
19,277 |
$128K |
| 85027 |
|
18,857 |
18,581 |
$126K |
| 73721 |
|
1,508 |
1,474 |
$126K |
| 87480 |
|
5,789 |
5,639 |
$124K |
| 73564 |
|
4,034 |
3,984 |
$123K |
| 80307 |
|
1,851 |
1,822 |
$118K |
| 92134 |
|
3,331 |
3,167 |
$116K |
| 76705 |
|
3,179 |
3,153 |
$116K |
| 83970 |
|
2,602 |
2,557 |
$107K |
| 74176 |
|
1,369 |
1,351 |
$106K |
| 82728 |
|
7,361 |
7,231 |
$96K |
| 71275 |
|
1,077 |
1,064 |
$94K |
| 87510 |
|
4,909 |
4,817 |
$93K |
| 95886 |
|
1,005 |
946 |
$90K |
| 87507 |
|
236 |
234 |
$87K |
| 76805 |
|
1,436 |
1,428 |
$86K |
| 99232 |
|
1,754 |
774 |
$81K |
| 73610 |
|
4,243 |
4,128 |
$81K |
| 73630 |
|
4,355 |
4,274 |
$81K |
| 99205 |
Prolong outpt/office vis |
431 |
425 |
$78K |
| 76642 |
|
1,960 |
1,948 |
$75K |
| 87635 |
|
1,528 |
1,488 |
$75K |
| 80048 |
|
8,394 |
8,077 |
$74K |
| 76536 |
|
1,309 |
1,302 |
$67K |
| G0108 |
Diab manage trn per indiv |
1,109 |
1,032 |
$66K |
| 93971 |
|
882 |
863 |
$65K |
| 73110 |
|
2,946 |
2,824 |
$64K |
| 92567 |
|
4,670 |
4,626 |
$64K |
| 92557 |
|
1,995 |
1,972 |
$63K |
| 73030 |
|
2,967 |
2,916 |
$62K |
| 86803 |
|
3,837 |
3,812 |
$61K |
| 0001A |
|
1,457 |
1,453 |
$58K |
| 0002A |
|
1,361 |
1,358 |
$58K |
| 73221 |
|
650 |
638 |
$58K |
| 45380 |
|
347 |
343 |
$54K |
| 72110 |
|
1,663 |
1,649 |
$52K |
| 92012 |
|
1,315 |
1,262 |
$49K |
| 92002 |
|
1,242 |
1,237 |
$49K |
| 83721 |
|
4,717 |
4,700 |
$48K |
| 73130 |
|
2,373 |
2,305 |
$48K |
| 83540 |
|
6,934 |
6,812 |
$47K |
| 83550 |
|
5,860 |
5,735 |
$46K |
| 99239 |
|
537 |
530 |
$44K |
| 87389 |
|
1,763 |
1,754 |
$44K |
| 86762 |
|
2,728 |
2,699 |
$43K |
| 87186 |
|
4,926 |
4,758 |
$43K |
| 45385 |
|
181 |
179 |
$43K |
| 88307 |
|
541 |
531 |
$42K |
| 90474 |
|
3,651 |
3,648 |
$42K |
| 83880 |
|
1,087 |
1,055 |
$41K |
| 82043 |
|
6,271 |
6,196 |
$41K |
| 71260 |
|
776 |
770 |
$40K |
| 82570 |
|
6,832 |
6,695 |
$40K |
| 76801 |
|
540 |
526 |
$40K |
| 90715 |
|
3,001 |
2,982 |
$40K |
| 76856 |
|
918 |
909 |
$39K |
| 95004 |
|
392 |
388 |
$38K |
| 76817 |
|
746 |
715 |
$38K |
| 94060 |
|
1,275 |
1,271 |
$36K |
| 93975 |
|
435 |
431 |
$35K |
| 84481 |
|
1,843 |
1,825 |
$35K |
| 76819 |
|
775 |
580 |
$35K |
| 99395 |
|
368 |
365 |
$34K |
| 99222 |
|
299 |
295 |
$34K |
| 93923 |
|
377 |
372 |
$33K |
| J1050 |
Medroxyprogesterone acetate |
1,772 |
1,738 |
$33K |
| 84480 |
|
2,497 |
2,461 |
$32K |
| M0243 |
Casirivi and imdevi inj |
71 |
71 |
$32K |
| 97597 |
|
913 |
473 |
$32K |
| 73502 |
|
1,253 |
1,228 |
$31K |
| 87798 |
|
869 |
817 |
$30K |
| 94729 |
|
919 |
918 |
$29K |
| 71271 |
|
493 |
493 |
$29K |
| V2200 |
Lens spher bifoc plano 4.00d |
990 |
492 |
$29K |
| 99460 |
|
485 |
472 |
$28K |
| 83001 |
|
1,513 |
1,498 |
$28K |
| 87340 |
|
2,386 |
2,365 |
$27K |
| G0399 |
Home sleep test/type 3 porta |
703 |
696 |
$26K |
| 81003 |
|
10,728 |
10,462 |
$26K |
| G0103 |
Psa screening |
1,521 |
1,519 |
$25K |
| 88304 |
|
1,618 |
1,609 |
$25K |
| 0012A |
|
635 |
635 |
$25K |
| 84146 |
|
1,167 |
1,142 |
$25K |
| 86140 |
|
5,226 |
4,940 |
$25K |
| 88342 |
|
600 |
595 |
$24K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,183 |
587 |
$24K |
| 86703 |
|
1,770 |
1,766 |
$24K |
| 85651 |
|
6,085 |
5,825 |
$24K |
| 83525 |
|
2,085 |
2,063 |
$24K |
| 83735 |
|
3,266 |
3,047 |
$22K |
| 90670 |
|
11,124 |
11,066 |
$22K |
| 64615 |
|
167 |
166 |
$22K |
| 99238 |
|
414 |
408 |
$22K |
| 84702 |
|
1,371 |
1,041 |
$22K |
| 96110 |
|
2,655 |
2,320 |
$22K |
| 86850 |
|
2,176 |
2,146 |
$21K |
| 36415 |
|
76,246 |
71,528 |
$21K |
| 76700 |
|
347 |
342 |
$20K |
| 87506 |
|
88 |
88 |
$20K |
| 98940 |
|
1,908 |
1,351 |
$19K |
| 73562 |
|
694 |
682 |
$19K |
| 97140 |
|
877 |
449 |
$19K |
| 96372 |
|
1,133 |
1,049 |
$19K |
| 85610 |
|
4,530 |
3,374 |
$18K |
| 80074 |
|
330 |
329 |
$17K |
| 83655 |
|
1,522 |
1,483 |
$17K |
| 00142 |
|
215 |
181 |
$17K |
| 86618 |
|
966 |
962 |
$17K |
| 0011A |
|
505 |
501 |
$17K |
| 84134 |
|
1,088 |
1,074 |
$17K |
| 83002 |
|
934 |
927 |
$17K |
| 72125 |
|
327 |
325 |
$16K |
| 84153 |
|
816 |
803 |
$16K |
| 84403 |
|
613 |
608 |
$16K |
| 93970 |
|
178 |
178 |
$16K |
| 95117 |
|
1,410 |
688 |
$15K |
| 77065 |
Tomosynthesis, mammo |
343 |
332 |
$15K |
| J3301 |
Triamcinolone acet inj nos |
1,056 |
975 |
$15K |
| 87070 |
|
1,652 |
1,622 |
$14K |
| 70551 |
|
108 |
108 |
$14K |
| 99309 |
|
1,092 |
983 |
$13K |
| 90656 |
|
1,359 |
1,357 |
$13K |
| 74018 |
|
828 |
798 |
$13K |
| 82784 |
|
451 |
435 |
$13K |
| 86431 |
|
2,063 |
2,049 |
$13K |
| 83690 |
|
1,958 |
1,930 |
$13K |
| 90698 |
|
7,579 |
7,556 |
$13K |
| 84703 |
|
1,564 |
1,542 |
$13K |
| 0071A |
|
319 |
319 |
$13K |
| 93296 |
|
782 |
763 |
$13K |
| 94727 |
|
390 |
389 |
$13K |
| 70553 |
|
125 |
125 |
$13K |
| 99152 |
|
801 |
800 |
$12K |
| 85018 |
|
3,852 |
3,824 |
$12K |
| 82670 |
|
481 |
449 |
$12K |
| 96158 |
|
209 |
202 |
$12K |
| 00731 |
|
98 |
96 |
$12K |
| 99308 |
|
1,328 |
1,060 |
$11K |
| 0072A |
|
273 |
273 |
$11K |
| 90680 |
|
7,170 |
7,132 |
$11K |
| 88112 |
|
186 |
173 |
$11K |
| V2784 |
Lens polycarb or equal |
21,923 |
10,571 |
$11K |
| 87502 |
|
121 |
119 |
$10K |
| 0004A |
|
247 |
247 |
$10K |
| 93298 |
|
271 |
266 |
$10K |
| 90651 |
|
1,750 |
1,733 |
$10K |
| 72050 |
|
265 |
265 |
$9K |
| 97161 |
|
117 |
117 |
$9K |
| D7210 |
|
80 |
15 |
$9K |
| 82950 |
|
1,376 |
1,364 |
$9K |
| 80076 |
|
983 |
974 |
$9K |
| 81001 |
|
2,766 |
2,704 |
$9K |
| 90633 |
|
4,835 |
4,807 |
$8K |
| 71250 |
|
162 |
162 |
$8K |
| 69436 |
|
39 |
39 |
$8K |
| 86900 |
|
2,229 |
2,200 |
$8K |
| 86901 |
|
2,209 |
2,181 |
$8K |
| 95816 |
|
245 |
243 |
$8K |
| 87205 |
|
1,680 |
1,640 |
$8K |
| 81025 |
|
1,116 |
1,101 |
$8K |
| 86706 |
|
656 |
652 |
$8K |
| 90744 |
|
3,109 |
3,082 |
$7K |
| 74183 |
|
60 |
59 |
$7K |
| 95165 |
|
25 |
25 |
$7K |
| 90838 |
|
62 |
62 |
$7K |
| 88341 |
|
51 |
50 |
$7K |
| 72148 |
|
64 |
64 |
$7K |
| 77080 |
|
487 |
487 |
$7K |
| 73140 |
|
340 |
328 |
$7K |
| 69210 |
|
215 |
202 |
$7K |
| 90732 |
|
69 |
69 |
$7K |
| 84144 |
|
349 |
317 |
$7K |
| 76770 |
|
127 |
127 |
$6K |
| 95913 |
|
25 |
25 |
$6K |
| 94726 |
|
307 |
307 |
$6K |
| 99202 |
|
93 |
93 |
$6K |
| 84550 |
|
1,141 |
1,108 |
$6K |
| 96156 |
|
75 |
75 |
$6K |
| 82550 |
|
856 |
812 |
$6K |
| 00170 |
|
31 |
31 |
$6K |
| 80069 |
|
628 |
586 |
$6K |
| S0620 |
Routine ophthalmological exa |
142 |
142 |
$6K |
| 73080 |
|
294 |
281 |
$6K |
| 95810 |
|
53 |
53 |
$5K |
| 87077 |
|
648 |
621 |
$5K |
| 90734 |
|
3,034 |
3,023 |
$5K |
| 3074F |
|
9,040 |
8,276 |
$5K |
| 78815 |
|
49 |
49 |
$5K |
| 0031A |
|
112 |
110 |
$5K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
165 |
83 |
$5K |
| 90832 |
|
68 |
57 |
$5K |
| 77066 |
Tomosynthesis, mammo |
85 |
85 |
$5K |
| 82150 |
|
712 |
707 |
$5K |
| J9035 |
Bevacizumab injection |
56 |
52 |
$4K |
| 92015 |
|
1,715 |
1,660 |
$4K |
| 80055 |
|
103 |
103 |
$4K |
| 82248 |
|
703 |
663 |
$4K |
| 31575 |
|
43 |
42 |
$4K |
| 00126 |
|
38 |
38 |
$4K |
| J1040 |
Methylprednisolone 80 mg inj |
633 |
614 |
$4K |
| 86308 |
|
622 |
618 |
$4K |
| 90707 |
|
791 |
788 |
$4K |
| 3078F |
|
7,198 |
6,624 |
$4K |
| 99459 |
|
180 |
180 |
$4K |
| 93294 |
|
254 |
249 |
$4K |
| 59025 |
|
114 |
100 |
$4K |
| 90716 |
|
863 |
856 |
$4K |
| 11102 |
|
53 |
53 |
$4K |
| 81002 |
|
1,168 |
1,155 |
$4K |
| 0064A |
|
81 |
81 |
$3K |
| 90710 |
|
1,292 |
1,281 |
$3K |
| 90677 |
|
242 |
242 |
$3K |
| 87427 |
|
272 |
268 |
$3K |
| 82274 |
|
292 |
292 |
$3K |
| 76981 |
|
140 |
140 |
$3K |
| 90473 |
|
268 |
268 |
$3K |
| 00811 |
|
28 |
27 |
$3K |
| 78264 |
|
83 |
83 |
$3K |
| 99385 |
|
24 |
24 |
$3K |
| 87329 |
|
232 |
231 |
$3K |
| 99244 |
|
15 |
14 |
$3K |
| 87147 |
|
595 |
581 |
$3K |
| 90750 |
|
25 |
24 |
$3K |
| 90696 |
|
1,108 |
1,096 |
$3K |
| 87046 |
|
271 |
267 |
$3K |
| 87045 |
|
271 |
267 |
$3K |
| 51798 |
|
206 |
205 |
$2K |
| 87328 |
|
195 |
194 |
$2K |
| 97803 |
|
282 |
272 |
$2K |
| 73590 |
|
158 |
155 |
$2K |
| 95251 |
|
65 |
65 |
$2K |
| 95910 |
|
25 |
25 |
$2K |
| 45378 |
|
12 |
12 |
$2K |
| 31231 |
|
13 |
13 |
$2K |
| 90688 |
|
164 |
164 |
$2K |
| 93295 |
|
71 |
68 |
$2K |
| 95909 |
|
26 |
26 |
$2K |
| 3079F |
|
2,125 |
2,024 |
$2K |
| 86376 |
|
153 |
152 |
$2K |
| 86160 |
|
147 |
87 |
$2K |
| 99490 |
Ccm add 20min |
384 |
384 |
$2K |
| 90785 |
|
150 |
113 |
$2K |
| 90833 |
|
27 |
25 |
$2K |
| 99462 |
|
67 |
54 |
$2K |
| J1030 |
Methylprednisolone 40 mg inj |
89 |
87 |
$2K |
| 82533 |
|
115 |
111 |
$2K |
| D0150 |
|
70 |
67 |
$2K |
| 0124A |
|
42 |
42 |
$2K |
| 92552 |
|
91 |
91 |
$2K |
| 84156 |
|
430 |
406 |
$2K |
| 73523 |
|
43 |
43 |
$2K |
| 84100 |
|
284 |
255 |
$2K |
| 96160 |
|
484 |
456 |
$2K |
| 83615 |
|
236 |
215 |
$2K |
| 82105 |
|
93 |
91 |
$2K |
| 00813 |
|
13 |
13 |
$2K |
| 90648 |
|
3,560 |
3,549 |
$1K |
| 87075 |
|
136 |
133 |
$1K |
| 76870 |
|
38 |
37 |
$1K |
| 43237 |
|
12 |
12 |
$1K |
| 73560 |
|
73 |
72 |
$1K |
| G0279 |
Tomosynthesis, mammo |
44 |
44 |
$1K |
| 0054A |
|
29 |
29 |
$1K |
| S0621 |
Routine ophthalmological exa |
33 |
33 |
$1K |
| 43235 |
|
12 |
12 |
$1K |
| 96152 |
|
31 |
25 |
$1K |
| 92556 |
|
51 |
51 |
$1K |
| 92136 |
|
39 |
38 |
$1K |
| 93016 |
|
68 |
68 |
$1K |
| 85652 |
|
422 |
405 |
$1K |
| 87493 |
|
24 |
24 |
$1K |
| 97162 |
|
12 |
12 |
$997.34 |
| 93225 |
|
61 |
61 |
$977.10 |
| 70498 |
|
12 |
12 |
$972.87 |
| 92083 |
|
24 |
24 |
$966.92 |
| 93018 |
|
81 |
81 |
$892.57 |
| 86704 |
|
90 |
89 |
$866.70 |
| 76815 |
|
26 |
25 |
$851.68 |
| 86800 |
|
46 |
46 |
$758.22 |
| 58300 |
|
12 |
12 |
$749.97 |
| 70486 |
|
13 |
13 |
$748.75 |
| 85705 |
|
79 |
76 |
$723.69 |
| 98928 |
|
13 |
12 |
$709.05 |
| 81015 |
|
237 |
231 |
$685.63 |
| 90723 |
|
2,248 |
2,239 |
$674.50 |
| 92558 |
|
232 |
229 |
$671.60 |
| 85045 |
|
163 |
147 |
$661.73 |
| 3075F |
|
703 |
673 |
$615.00 |
| 93280 |
|
13 |
13 |
$598.03 |
| J3420 |
Vitamin b12 injection |
681 |
555 |
$552.50 |
| 86592 |
|
166 |
166 |
$545.91 |
| 92250 |
|
12 |
12 |
$538.90 |
| 83718 |
|
75 |
75 |
$536.83 |
| 97802 |
|
14 |
14 |
$531.76 |
| 87804 |
|
32 |
32 |
$510.24 |
| 78227 |
|
12 |
12 |
$506.42 |
| 95800 |
|
13 |
13 |
$492.57 |
| 90671 |
|
36 |
36 |
$491.91 |
| 85014 |
|
178 |
176 |
$490.56 |
| 86769 |
|
12 |
12 |
$455.04 |
| 20550 |
|
13 |
12 |
$454.30 |
| G0444 |
Depression screen annual |
28 |
28 |
$441.00 |
| 99310 |
Prolong nursin fac eval 15m |
51 |
48 |
$431.82 |
| 77062 |
|
13 |
13 |
$424.32 |
| 93226 |
|
12 |
12 |
$399.00 |
| 11721 |
|
12 |
12 |
$343.05 |
| 90697 |
|
26 |
26 |
$340.00 |
| G0296 |
Visit to determ ldct elig |
14 |
14 |
$320.15 |
| 92133 |
|
15 |
15 |
$314.88 |
| 93227 |
|
24 |
24 |
$311.22 |
| J1010 |
Inj, methylpred acetate 1 mg |
106 |
104 |
$309.76 |
| 85378 |
|
28 |
28 |
$291.71 |
| 94010 |
|
39 |
39 |
$288.79 |
| 90620 |
|
28 |
28 |
$247.42 |
| 73000 |
|
13 |
12 |
$243.99 |
| 85730 |
|
38 |
37 |
$235.75 |
| 90700 |
|
264 |
264 |
$218.50 |
| 80164 |
|
13 |
13 |
$214.79 |
| 85007 |
|
57 |
52 |
$213.54 |
| G2211 |
Complex e/m visit add on |
16 |
15 |
$200.22 |
| 73090 |
|
14 |
13 |
$187.70 |
| 88720 |
|
25 |
24 |
$182.09 |
| 90672 |
|
397 |
393 |
$169.66 |
| 82951 |
|
12 |
12 |
$168.25 |
| 99318 |
|
25 |
25 |
$168.08 |
| 82565 |
|
26 |
25 |
$157.07 |
| 94640 |
|
15 |
15 |
$146.94 |
| 88302 |
|
13 |
13 |
$133.15 |
| 88311 |
|
12 |
12 |
$118.92 |
| 94760 |
|
870 |
832 |
$91.95 |
| 90685 |
|
248 |
248 |
$86.63 |
| 93325 |
|
13 |
13 |
$78.84 |
| 84460 |
|
14 |
14 |
$75.36 |
| 3044F |
|
598 |
385 |
$70.00 |
| 82947 |
|
14 |
14 |
$69.34 |
| 84450 |
|
14 |
14 |
$69.14 |
| 99484 |
|
82 |
82 |
$68.19 |
| 82952 |
|
12 |
12 |
$47.47 |
| 96161 |
|
14 |
14 |
$36.92 |
| 91301 |
|
1,102 |
1,074 |
$26.46 |
| 91300 |
|
3,483 |
3,191 |
$0.00 |
| G1004 |
Cdsm ndsc |
320 |
302 |
$0.00 |
| 3051F |
|
28 |
26 |
$0.00 |
| 91322 |
|
13 |
13 |
$0.00 |
| 2022F |
|
16 |
16 |
$0.00 |
| 3046F |
|
21 |
12 |
$0.00 |
| 91307 |
|
682 |
649 |
$0.00 |
| 91306 |
|
70 |
70 |
$0.00 |
| 91303 |
|
108 |
108 |
$0.00 |
| 91305 |
|
150 |
145 |
$0.00 |
| 2023F |
|
12 |
12 |
$0.00 |
| J0178 |
Aflibercept injection |
53 |
50 |
$0.00 |